Smith Christopher A, Hart Avery S, Sadowski Laura S, Riddle Janet, Evans Arthur T, Clarke Peter M, Ganschow Pamela S, Mason Ellen, Sequeira Winston, Wang Yue
Department of Medicine, John H. Stroger Jr. Hospital of Cook County (Cook County Hospital)/Rush Medical College, Chicago, Ill 60612, USA.
J Gen Intern Med. 2006 Jan;21(1):7-12. doi: 10.1111/j.1525-1497.2005.00254.x.
To determine if structured teaching of bedside cardiac examination skills improves medical residents' examination technique and their identification of key clinical findings.
Firm-based single-blinded controlled trial.
Inpatient service at a university-affiliated public teaching hospital.
Eighty Internal Medicine residents.
The study assessed 2 intervention groups that received 3-hour bedside teaching sessions during their 4-week rotation using either: (1) a traditional teaching method, "demonstration and practice" (DP) (n=26) or (2) an innovative method, "collaborative discovery" (CD) (n=24). The control group received their usual ward teaching sessions (n=25). The main outcome measures were scores on examination technique and correct identification of key clinical findings on an objective structured clinical examination (OSCE).
All 3 groups had similar scores for both their examination technique and identification of key findings in the preintervention OSCE. After teaching, both intervention groups significantly improved their technical examination skills compared with the control group. The increase was 10% (95% confidence interval [CI] 4% to 17%) for CD versus control and 12% (95% CI 6% to 19%) for DP versus control (both P<.005) equivalent to an additional 3 to 4 examination skills being correctly performed. Improvement in key findings was limited to a 5% (95% CI 2% to 9%) increase for the CD teaching method, CD versus control P=.046, equivalent to the identification of an additional 2 key clinical findings.
Both programs of bedside teaching increase the technical examination skills of residents but improvements in the identification of key clinical findings were modest and only demonstrated with a new method of teaching.
确定床边心脏检查技能的结构化教学是否能提高住院医师的检查技术及其对关键临床发现的识别能力。
基于科室的单盲对照试验。
一所大学附属公立教学医院的住院部。
80名内科住院医师。
该研究评估了2个干预组，这两组住院医师在为期4周的轮转期间接受了3小时的床边教学课程，其中一组采用：（1）传统教学方法“示范与实践”（DP）（n = 26），另一组采用：（2）创新方法“协作发现”（CD）（n = 24）。对照组接受常规病房教学课程（n = 25）。主要结局指标是客观结构化临床考试（OSCE）中的检查技术得分和对关键临床发现的正确识别情况。
在干预前的OSCE中，所有3组在检查技术和关键发现识别方面的得分相似。教学后，与对照组相比，两个干预组的技术检查技能均有显著提高。CD组与对照组相比提高了10%（95%置信区间[CI] 4%至17%），DP组与对照组相比提高了12%（95% CI 6%至19%）（均P <.005），相当于多正确执行了3至4项检查技能。关键发现方面的改善仅限于CD教学方法使识别率提高了5%（95% CI 2%至9%），CD组与对照组相比P = 0.046，相当于多识别出2项关键临床发现。
两种床边教学方案均提高了住院医师的技术检查技能，但在关键临床发现的识别方面改善不大，且仅在一种新的教学方法中得到体现。
