摘要目的 探讨病例报告式晨报会在外科住院医师规范化培训中的应用效果.方法 采用实验对照方法.选择2016年10月至2018年1月在浙江省人民医院普通外科胃肠胰组参加住院医师规范化培训的43名学员为研究对象,通过随机抽签方式将其分为两组,参加病例报告式晨报会的22名学员为实验组;仅参加常规晨交班的21名学员为对照组.培训结束后,比较两组学员的出科理论考试成绩和问卷调查结果,以及带教教师对实验组学员病例报告式晨报会的评价.结果 实验组学员和对照组学员出科理论考试成绩分别为(88.1±3.8)分、(82.8±4.4)分,其差异具有统计学意义(t=4.26,P<0.01).对两组学员的问卷调查结果显示,实验组学员认为病例报告式晨报会对提高病例书写、病情评估、辅助结果判读能力、临床思维、医学论文书写、提高团队合作能力等方面有所帮助,其评分分别为9(8.0,9.0)分、7.5(7.0,8.0)分、8(7.0,9.0)分、8(8.0,9.0)分、6(4.0,7.3)分、5(3.0,6.0)分,对照组学员相应评分分别为5(4.0,6.5)分、6(5.5,7.0)分、2(1.0,2.0)分、6(4.0,7.0)分、3(2.0,4.0)分、2(1.5,3.0)分,其差异均具有统计学意义(均P<0.05).实验组学员对病例报告式晨报会的整体满意度[8(7.8,9.0)分]高于对照组学员[7(6.5,8.0)分],其差异具有统计学意义(Z=2.83,P<0.01).带教教师评价结果显示,所有的带教教师认为晨报会有助于培养学员的临床实践能力,有助于更好地了解学员的学习成效.大部分教师对晨报会的评价为满意.结论 病例报告式晨报会应用在胃肠胰外科住院医师规范化培训中,有助于锻炼学员的临床思维能力和实践能力,提高其岗位胜任力.

abstractsObjective To explore the application effect of the case-based morning report in the standardized training of redidents in the department of general surgery. Methods The experimental control method was used in this research. Fourty-three resident in standardized resident training program from October 2016 to January 2018 in the gastroenteropancreatic division of general surgery of Zhejiang Provincial People's Hospital were recruited and were randomly divided into two groups. Twenty-two students participating in the case-based morning report defined as the experiment group, and Twenty-one students participating in the traditional shift group defined as the control group. After the training, the questionnaire survey results and the score of the theoretical test of the two groups were compared. And the teacher evaluation reports were also collected. Results The score of the theoretical test of the experiment group and the control group were (88. 1± 3. 8) and (82. 8±4. 4) respectively, and the difference was statistically significant (t=4. 26,P<0. 01). The students in the experimental group showed that the case-based morning report had more significant effects on improving their ability of the patient record writing, illness evaluation, auxiliary result interpretation, clinical thinking and medical paper writing(all P<0. 05). The scoresof experiment group were 9(8. 0,9. 0), 7. 5 (7. 0,8. 0),8(7. 0,9. 0),8(8. 0,9. 0),6(4. 0,7. 3),5(3. 0,6. 0) respectively. The scores of the control group were 5(4.0, 6.5),6(5.5, 7.0),2(1.0, 2.0),6(4.0, 7.0),3(2.0, 4.0),2(1.5, 3.0) respectively. Scores of satisfaction of experimental group were significantly higher than those in the control group [ 8( 7. 8,9. 0) vs 7( 6. 5,8. 0) ,Z=2. 83,P<0. 01] . The teacher's questionnaire survey showed that all teachers believed that case-based morning report would be helpful to train the students' clinical practice ability, and thought that case-based morning report would be helpful to better understand the students' learning outcome. Most of the teachers were satisfied with the case-based morning report. Conclusions The case-based morning report is helpful to train the clinical reasoning, skill and the competency of resident students. The teaching effect in the standardized training of general surgery are satisfactory and worth popularizing.