评估基于"情境沉浸与案例融入"的急诊临床思维教学体系短期化培训实践效果。

选取参加浙江大学医学院附属第一医院急诊科临床轮转的各教学基地2017级~2019级学员和急诊科低年资医生（172例）为研究对象，按照便利抽样法进行分组。对照组（90例）按照传统急诊教学方法进行培训；实验组（82例）进行急诊临床思维体系培训，在短期化课程中，通过案例融入和情景沉浸的方式逐步将急诊临床思维体系融入到理论课教学、实践技能教学和医患沟通训练。培训后对所有学员进行A2型急诊临床思维试题考核。比较两组学员的一般资料，考核成绩，"动态性原则"、"剃刀原理"、"发散思维"、"模型化原则"、"一元论原则"、"整体性原则"、"扼制理论"和"证据论"急诊临床思维相应试题正确率以及"容易"、"中等"和"困难"试题正确率。

实验组学员经急诊临床思维教学体系短期化培训后的考核成绩较对照组明显提高[（81 ± 11）分vs. （77 ± 10）分，t = 2.412，P = 0.017]。同时，实验组学员"证据论"急诊临床思维相应试题正确率高于对照组[89.43%（220 / 246） vs. 80.74%（218 / 270），χ² = 7.576，P = 0.006]；而两组学员"动态性原则"、"剃刀原理"、"发散思维"、"模型化原则"、"一元论原则"、"整体性原则"和"扼制理论"相应试题正确率比较，差异均无统计学意义（P均> 0.05）。两组学员"困难"试题正确率比较，差异具有统计学意义[75.30% （494 / 656） vs. 70.56%（508 / 720），χ² = 3.911，P = 0.048]；而"容易"和"中等"试题正确率比较，差异均无统计学意义（P均> 0.05）。

基于"情境沉浸与案例融入"的急诊临床思维教学体系可在短期课程训练后有效提高学员的各种急诊临床思维能力，尤其是对困难问题的解决能力，并达到预期设定的教学目标。

To evaluate the practical effect of short-term training of emergency clinical thinking teaching system based on "situation immersion and case integration".

Trainees of each Teaching Base from 2017 to 2019 participating in the clinical rotation and junior doctors (172 cases) of the Department of Emergency Medicine of the First Affiliated Hospital, College of Medicine, Zhejiang University were selected and divided into two groups according to the convenience sampling method. Trainees in the control group (n = 90) were trained by traditional emergency teaching methods, and those in the experimental group (n = 82) were trained for the emergency clinical thinking system. In short-term courses, the emergency clinical thinking system was gradually integrated into theoretical teaching, practical teaching, and doctor-patient communication training through case integration and situation immersion. After training, trainees were assessed with A2 emergency clinical thinking tests. The general data and test results of trainees were compared between the two groups. Their correct rates of corresponding "dynamic principle", "razor principle", "divergent thinking", "modeling principle", "monist principle", "holistic principle", "suppression theory", and "evidence theory" questions were recorded, as well as those of "easy", "medium", and "difficult" questions.

After the short-term training of emergency clinical thinking teaching system, the test result was significantly higher in the experimental group than in the control group [(81 ± 11) scores vs. (77 ± 10) scores, t = 2.412, P = 0.017]. The correct rate of "evidence theory" questions was also significantly higher in the experimental group than in the control group [89.43% (220 / 246) vs. 80.74% (218 / 270), χ² = 7.576, P = 0.006], while the correct rates of "dynamic principle", "razor principle", "divergent thinking", "modeling principle", "monist principle", "holistic principle", and "suppression theory" questions were not significantly different between the two groups (all P > 0.05). Besides, the correct rate of "difficult" questions was significantly different between the two groups [75.30% (494 / 656) vs. 70.56% (508 / 720), χ² = 3.911, P = 0.048], while the correct rates of "easy" and "medium" questions were not significantly different (both P > 0.05).

The emergency clinical thinking teaching system based on "situation immersion and case integration" can effectively improve trainees' various clinical thinking skills and their ability to solve difficult problems after short-term training, and thus the expected teaching goals were reached.