目的

探讨目标导向的进阶式教学法在急诊气管插管技能培训过程中的应用效果。

方法

以2023年3月至2024年3月期间在东南大学附属中大医院急诊科轮转的64 例规范化培训住院医师作为研究对象，按照随机数字表法分为对照组（32 例）和进阶组（32 例），分别采用传统临床带教和目标导向的进阶式教学方式进行气管插管培训。培训结束后，以理论测试、临床技能操作两种形式评价两组学员对相关知识的掌握程度，并以问卷调查的形式进行教学反馈。此外，对急诊、重症和麻醉的学员随访6 个月，评估学员在实际工作中的培训效果。

结果

培训后，进阶组[（90.8 ± 3.6）分vs.（76.8 ± 8.7）分，t = 8.371，P < 0.001]和对照组[（87.6 ± 5.3）分vs.（77.1 ±10.9）分，t = 4.891，P= 0.007]学员考核总成绩均较同组培训前有明显提升，且进阶组学员培训后考核总成绩[（90.8±3.6）分vs.（87.6±5.3）分，t = 2.889，P= 0.006]、技能考核[（55.7±2.8）分vs.（53.6±3.7）分，t = 2.559，P = 0.013]及临床思维考核成绩[（17.8 ± 1.6）分vs.（16.1 ± 2.0）分，t = 3.815，P <0.001]均高于对照组。问卷调查结果显示，进阶组学员知识接受度[（9.1±0.8）分vs.（7.7±1.1）分，t = 5.719，P<0.001]、学习主动性[（8.9±0.9）分vs.（7.7±1.4）分，t = 4.221，P<0.001]、临床思维能力[（8.5±1.2）分vs.（7.0±1.2）分，t = 5.172，P<0.001]、应急处置能力[（9.1±1.0）分vs.（7.2±1.3）分，t = 6.309，P<0.001]和培训满意度评分[（9.1±0.9）分vs.（7.7±1.3）分，t = 5.111，P<0.001]均较对照组有显著提升。在工作实践中，进阶组与对照组急诊、重症和麻醉专业学员气管插管首次操作成功率比较，差异无统计学意义（10/11 vs. 6/9，χ²=1.727，P= 0.189）。

结论

目标导向的进阶式教学能提高急诊规范化培训住院医师气管插管教学的培训效果，对不同学习阶段的规培医师设立了明确的阶段性目标，临床教学效果良好。

Objective

To investigate the application effect of the goal-oriented advanced teaching method in emergency endotracheal intubation skills training.

Methods

A total of 64 standardized training residents who trained in the Department of Emergency Medicine, Zhongda Hospital, Southeast University from March 2023 to March 2024 were recruited as the research objects. Participants were randomly assigned to a control group (32 cases) and an advanced group (32 cases) based on the random number table method. Participants in the control group and advanced group received traditional clinical training and goal-oriented advanced training for tracheal intubation, respectively. After the training, all of resident doctors were assessed by theoretical test and clinical skill operations, while feedback on the teaching process was obtained through questionnaires. Besides, the training effect of resident doctors of emergency, critical care and anesthesiology in clinical practice was evaluated after 6-mouth follow-up.

Results

After the training, the total assessment scores of both the advanced group[(90.8±3.6) vs. (76.8±8.7), t=8.371, P<0.001] and the control group [(87.6 ±5.3) vs. (77.1 ±10.9),t = 4.891,P = 0.007] were significantly improved compared to those before the training.Moreover, the total assessment scores [(90.8 ± 3.6) vs. (87.6 ± 5.3),t = 2.889,P = 0.006], skill assessment scores [(55.7 ± 2.8) vs. (53.6 ± 3.7),t = 2.559,P = 0.013], and clinical thinking assessment scores [(17.8±1.6) vs. (16.1±2.0),t=3.815, P<0.001] of the advanced group after the training were all higher than those of the control group. The questionnaire survey showed that the advanced group had significantly improved scores in knowledge acceptance [(9.1 ± 0.8)vs. (7.7±1.1), t=5.719, P < 0.001], learning initiative [(8.9 ± 0.9) vs. (7.7 ± 1.4),t = 4.221, P <0.001], clinical thinking ability [(8.5 ± 1.2) vs. (7.0 ± 1.2) ,t = 5.172, P < 0.001], emergency response ability [(9.1 ± 1.0) vs. (7.2 ± 1.3),t = 6.309, P < 0.001], and training satisfaction [(9.1 ±0.9) vs. (7.7 ± 1.3),t = 5.111, P < 0.001] as compared with the control group. In clinical practice, there was no statistically significant difference in the success rate of the first tracheal intubation of residents of emergency, critical care, and anesthesiology between the advanced group and the control groups (10 / 11 vs. 6 / 9, χ²= 1.727,P = 0.189).

Conclusion

The goaloriented advanced teaching could enhance the efficacy of endotracheal intubation training for emergency resident physicians, by establishing explicit stage-specific objectives.