Criley Jasminka M, Keiner Jennifer, Boker John R, Criley Stuart R, Warde Carole M
UCLA School of Medicine, Los Angeles, California, USA.
J Hosp Med. 2008 Mar;3(2):124-33. doi: 10.1002/jhm.287.
Proper diagnosis of cardiac disorders is a core competency of internists. Yet numerous studies have documented that the cardiac examination (CE) skills of physicians have declined compared with those of previous generations of physicians, attributed variously to inadequate exposure to cardiac patients and lack of skilled bedside teaching. With growing concerns about ensuring patient safety and quality of care, public and professional organizations are calling for a renewed emphasis on the teaching and evaluation of clinical skills in residency training.
The objective of the study was to determine whether Web training improves CE competency, whether residents retain what they learn, and whether a Web-based curriculum plus clinical training is better than clinical training alone. Journal of Hospital Medicine 2008;3:124-133. (c) 2008 Society of Hospital Medicine.
This was a controlled intervention study.
The intervention group (34 internal and family medicine interns) participated in self-directed use of a Web-based tutorial and three 1-hour teaching sessions taught by a hospitalist. Twenty-five interns from the prior year served as controls.
We assessed overall CE competency and 4 subcategories of CE competency: knowledge, audio skills, visual skills, and audio-visual integration.
The over mean score of the intervention group significantly improved, from 54 to 66 (P = .002). This improvement was retained (63.5, P = .05). When compared with end-of-year controls, the intervention group had significantly higher end-of-year CE scores (57 vs. 63.5, P = .05), knowledge (P = .04), and audio skills (P = .01). At the end of the academic year, all improvements were retained (P <or= .04) except visual skills (P = .75).
A Web-based interactive educational program with minimal hospitalist involvement led to significant improvement in CE competence and was better than clinical training alone.
正确诊断心脏疾病是内科医生的一项核心能力。然而，大量研究表明，与前几代医生相比，医生的心脏检查（CE）技能有所下降，原因包括接触心脏病患者不足以及缺乏经验丰富的床边教学。随着对确保患者安全和医疗质量的关注度不断提高，公共和专业组织呼吁在住院医师培训中重新重视临床技能的教学和评估。
本研究的目的是确定网络培训是否能提高心脏检查能力，住院医师是否能记住所学内容，以及基于网络的课程加临床培训是否比单纯的临床培训更好。《医院医学杂志》2008年；3：124 - 133。（c）2008年医院医学协会。
这是一项对照干预研究。
干预组（34名内科和家庭医学实习生）参与了基于网络教程的自主学习以及由一名住院医师进行的三次1小时教学课程。上一年的25名实习生作为对照组。
我们评估了整体心脏检查能力以及心脏检查能力的4个子类别：知识、听觉技能、视觉技能和视听整合。
干预组的平均总分显著提高，从54分提高到66分（P = 0.002）。这种提高得以保持（63.5分，P = 0.05）。与年末对照组相比，干预组的年末心脏检查得分显著更高（57分对63.5分，P = 0.05）、知识得分（P = 0.04）和听觉技能得分（P = 0.01）。在学年结束时，除视觉技能外（P = 0.75），所有提高均得以保持（P≤0.04）。
一个只需住院医师极少参与的基于网络的交互式教育项目导致心脏检查能力显著提高，且比单纯的临床培训更好。
