2024 年第 3 期 第 19 卷

导师制短期高级培训在体外循环高难度专项技术提升中的应用探索

The application exploration of tutorial system short term advanced training in improving high difficulty special techniques of extracorporeal circulation

作者：杨晓芳1付琳1郝星1关明1侯晓彤2黑飞龙1

英文作者：Yang Xiaofang1 Fu Lin1 Hao Xing1 Guan Ming1 Hou Xiaotong2 Hei Feilong1

单位：1首都医科大学附属北京安贞医院体外循环与机械循环辅助科，北京100029；2首都医科大学附属北京安贞医院心脏外科危重症中心，北京100029

英文单位：1Department of Extracorporeal Circulation and Mechanical Circulation Assistants Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Center for Cardiac Surgery Critical Care Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：体外循环；导师制；进修医师；临床教学

英文关键词：Extracorporealcirculation;Tutorialsystem;Refresherdoctors;Clinicalteaching

• 摘要：

• 目的 评估导师制短期高级培训应用于体外循环高难度专项技术教学的效果，探索该培养模式的应用。方法纳入2022年1月至2023年1月于首都医科大学附属北京安贞医院体外循环与机械循环辅助科进修的32名医师作为研究对象，进修时长均为1个月。分不同专业进修方向，包括主动脉内球囊反搏（8名）、微创体外循环（8名）、大血管体外循环（8名）和小儿体外循环（8名），自选导师进行一对一教学。分别于入科前和出科后由科室内不参与导师教学制度的专业医师对学员能力进行评估并打分，出科后3 d内完成对学员的问卷调查，观察学员自评和学员对导师的评价结果。结果经过为期1个月的培训，学员在理论知识、临床操作、危重患者管理、异常情况判定及处理、团队沟通合作意识方面的能力均得到显著提升，各项评分及总分均高于入科前［（4.5±0.5）分比（2.5±0.7）分、（4.4±0.7）分比（2.5±0.5）分、（3.8±0.9）分比（1.8±0.7）分、（4.0±0.7）分比（2.4±0.6）分、（4.4±0.6）分比（2.5±0.6）分、（21.1±1.8）分比（11.8±1.3）分］，差异均有统计学意义（均P<0.001）。经学员自评，其理论知识方面提升的平均值为57.2%，临床操作技术方面提升的平均值为61.9%，危重患者管理方面提升的平均值为60.0%，疑难杂症诊疗方面提升的平均值为64.1%，意外情况处理方面提升的平均值为65.3%。学员对导师在理论知识和临床经验、临床操作熟练程度及教学参与程度、反馈工作及时性方面的评价均较高，平均分值不低于4.00分。结论 导师制短期高级培训在体外循环高难度专项技术提升中发挥了积极作用，对于体外循环专业进修学员有很好的教学效果，可以在有一定专业基础的体外循环进修医师教学中应用。

• Objective To evaluate the application effect of tutorial system short term advanced training in improving high difficulty special techniques for extracorporeal circulation(ECC), and explore the application of this training model. Methods A total of 32 physicians who were trained in the Department of ECC and Mechanical Circulation Assistants, Beijing Anzhen Hospital, Capital Medical University from January 2022 to January 2023 were enrolled as the research subjects, and the duration of training was 1 month. They were divided into different professional training directions, including intra aortic balloon counterpulsation(8 students), minimally invasive ECC(8 students), large vessel ECC(8 students) and pediatric ECC(8 students), and one-to-one teaching was conducted by self-selected tutors. The ability of the trainees was evaluated and scored by professional doctors in the department who did not participate in the tutor teaching system before and after the department. A questionnaire survey was completed within 3 d after the department, and the self-evaluation and the evaluation results of the trainees to the tutor were observed. Results After one month of training, the ability of trainees in theoretical knowledge, clinical operation, management of critical patients, judgment and treatment of abnormal situations, team communication and cooperation awareness were significantly improved, and the scores of each item and the total score were higher than those before admission［(4.5±0.5) vs (2.5±0.7), (4.4±0.7) vs (2.5±0.5), (3.8±0.9) vs (1.8±0.7), (4.0±0.7) vs (2.4±0.6), (4.4±0.6) vs (2.5±0.6), (21.1±1.8) vs (11.8±1.3)］(all P<0.001). After self-evaluation by the students, the mean improvements in theoretical knowledge, clinical operation skills, management of critical patients, diagnosis and treatment of difficult and miscellaneous diseases, and judgment of abnormal accident situations were 57.2%, 61.9%, 60.0%, 64.1%, and 65.3%, respectively. The scores of theoretical knowledge and clinical experience, proficiency of clinical operation and participation in teaching, and timeliness of feedback were all higher, with an average score of not less than 4.00. Conclusion The tutorial system short-term advanced training plays a positive role in the improvement of the difficult special skills of ECC, and has a good teaching effect for the advanced training students of ECC, which can be applied in the teaching of advanced doctors with a certain professional basis of ECC.