摘要
目的探讨以问题为导向联合线上学习模式相比于非问题为导向的线下学习模式在缺血性脑血管病专业进修中的可行性及有效性。方法采取问卷调查法对2017年1月至2023年1月在首都医科大学宣武医院介入放射中心接受过系统培训的152名进修医师进行回访。根据进修时间以及学习模式的不同,将2017年1月至2020年1月进修方式为非问题为导向的线下学习模式的进修医师纳入非问题为导向组,将2020年2月至2023年1月进修方式为以问题为导向联合线上学习模式的进修医师纳入以问题为导向组。于培训结束时以及结束2个月后进行问卷调查。问卷内容包括:进修医师的性别、年龄,参与培训前已有的工作年限,参加进修培训的目的,培训时长,对培训的感受、建议和意见,培训结束后是否开展新手术(主要包括颅内外动脉支架置入术、颈动脉内膜切除术、杂交手术、动脉旁路移植术、急诊取栓术或其他)和培训结束后开展的新手术数量。结果(1)共发放问卷调查表152份,参与问卷调查并完成反馈者136名,其中4份问卷填写不全或填写错误,排除无效问卷后,剩余有效问卷调查表共132份,回收率和有效应答率分别为89.5%和97.1%。参与培训时,进修医师的年龄为25~44岁,平均(34±4)岁。医师的工作年限分布不等,>10年者占22.7%(30/132),>5~10年者占40.9%(54/132),0~5年者占36.4%(48/132)。不同工作年限者间是否开展新手术的比例差异有统计学意义(χ^(2)=2.501,P=0.012)。(2)参与以问题为导向和非问题为导向两种培训模式的人数分别为70人和62人。以问题为导向组中,希望通过培训学习新技术和提高手术能力的进修医师占88.6%(62/70),而在非问题为导向组中,该比例为87.1%(54/62),两组进修医师的进修培训目的差异无统计学意义(χ^(2)=0.067,P=0.796)。对培训体会进行分析显示,认为现有的培训形式合理和内容较为充实的进修医师占比为96.2%(127/132),以问题为导向组和非问题为导向组中比例分别为97.1%(68/70)和95.2%(59/62),两组差异无统计学意义(χ^(2)=0.354,P=0.552)。(3)经过培训后,以问题为导向组开展新手术的进修医师比例为80.0%(56/70),非问题为导向组的比例为66.1%(41/62),两组差异无统计学意义(χ^(2)=3.247,P=0.072)。在开展新手术的数量方面,以问题为导向组和非问题为导向组中,开展新手术数量≥30例的进修医师比例分别为70.0%(49/70)和46.8%(29/62),两组差异有统计学意义(χ^(2)=7.337,P=0.007)。(4)在非问题为导向组中,开展新手术例数≥30例的进修医师进修时长为3、6、12个月者分别占13.8%(4/29)、82.8%(24/29)、3.4%(1/29);在以问题为导向组中,开展新手术例数≥30例的进修医师进修时长为3、6、12个月者分别占4.1%(2/49)、57.1%(28/49)、38.8%(19/49),两组差异有统计学意义(χ^(2)=3.531,P<0.01)。结论以问题为导向联合线上学习模式有助于中青年神经外科医师的新手术开展以及增加开展的新手术数量,但需结合既往的工作年限和进修时长作为参考。
Objective To explore the feasibility and effectiveness of problem-based online learning model compared with non-problem-based learning model in terms of training methods and training effects in the ischemic stroke discipline.Methods From January 2017 to January 2023,152 physicians who had received systematic training in Interventional Radiology Center of Xuanwu Hospital,Capital Medical University were interviewed by questionnaire.Due to the different training time,the training mode was non-problem-based from January 2017 to January 2020,and the training model of problem-based online learning model was performed from February 2020 to January 2023.Questionnaires were conducted at the end of the training and 2 months after the training.The questionnaire includes:the gender and age of the trainee doctor,the working years before participating in the training,the purpose of participating in the training,the length of the training,the feelings,suggestions and opinions on the training,whether new procedures were performed after the training and the number of procedures performed after the training(mainly including intracranial and extracranial arterial stenting,carotid endarterectomy,hybrid surgery,arterial bypass surgery,mechanical thrombectomy,or others).Results(1)A total of 152 questionnaires were sent out,136 physicians participated in the questionnaire survey and completed the feedback,among which 4 questionnaires were incomplete or incorrectly filled in.After excluding the invalid questionnaires,a total of 132 valid questionnaires remained.The recovery rate and effective response rate of this questionnaire were 89.5%and 97.1%,respectively.When participating in the training,the age of studying physicians ranged from 25 to 44 years old,and the average age was(34±4)years old.The working years of doctors were 22.7%(30/132)for>10 years,40.9%(54/132)for>5-10 years and 36.4%(48/132)for 0-5 years.There was significant difference in the proportion of new operation among different working years(χ^(2)=2.501,P=0.012).(2)The number of participants in problem-based and non-problem-based learning models was 70 and 62,respectively.In problem-based group,88.6%(62/70)hoped to learn new techniques and improve their surgical ability through training;In the non-problem-based group,the proportion was 87.1%(54/62),and there was no significant difference in the purpose of training among the physicians who participated in different training modes(χ^(2)=0.067,P=0.796).The analysis of the training experience showed that 96.2%(127/132)of the practicing physicians believed that the training method was novel and greatly helped to improve their clinical skills,and the proportion of problem-based and non-problem-based models was 97.1%(68/70)and 95.2%(59/62),respectively.There was no significant difference between the two models(χ^(2)=0.354,P=0.552).(3)After training,80.0%(56/70)of new surgeries were performed in problem-based mode compared with 66.1%(41/62)in non-problem-based mode,with no significant difference(χ^(2)=3.247,P=0.072).In terms of the number of operations performed,70.0%(49/70)and 46.8%(29/62)of problem-based and non-problem-based learning models performed≥30 operations,respectively,and the difference was statistically significant(χ^(2)=7.337,P=0.007).(4)For the studying physicians whose new operations number was≥30,in the non-problem-based learning mode,the number was 13.8%(4/29),82.8%(24/29)and 3.4%(1/29)of studying physicians who studied for 3 months,6 months and 12 months respectively;in the problem-based learning model,the number of studying physicians who studied for 3 months,6 months and 12 months accounted for 4.1%(2/49),57.1%(28/49)and 38.8%(19/49),respectively,and the difference was statistically significant(χ^(2)=3.531,P<0.01).Conclusion The problem-based combined online learning model is helpful for young and middle-aged neurosurgeons to carry out new operations and increase the number of new operations,but the previous work years and training time should be taken as reference.
作者
杨斌
马妍
焦力群
Yang Bin;Ma Yan;Jiao Liqun(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2024年第2期102-108,共7页
Chinese Journal of Cerebrovascular Diseases
关键词
缺血性卒中
缺血性脑血管病
以问题为导向
培训模式
Ischemic stroke
Ischemic cerebrovascular disease
Problem-based learning
Study mode
