Oddone E Z, Waugh R A, Samsa G, Corey R, Feussner J R
Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina.
Am J Med. 1993 Oct;95(4):389-96. doi: 10.1016/0002-9343(93)90308-c.
To evaluate the effectiveness of a teaching program designed to improve interns' cardiovascular examination skills.
All 56 interns rotating on a mandatory 4-week inpatient cardiology service during 1 academic year (July 1989-June 1990).
We randomly assigned interns to receive either an eight-session physical diagnosis course ("teaching group") taught on the cardiology-patient simulator ("Harvey") or to receive no supplemental teaching ("control group"). Before and immediately after the teaching or control period, the interns were evaluated on three preprogrammed simulations (mitral regurgitation, MR; mitral stenosis, MS; aortic regurgitation, AR). Immediately after the control or the intervention period, the interns also evaluated patient volunteers.
There were no baseline differences in the interns' ability to correctly identify the disease simulations. Both the intervention and the control interns showed similar, moderate improvement in their diagnostic ability on the simulator. The intervention interns improved on MR from 42% correct to 54% correct; on MS from 8% correct to 23% correct; and on AR from 46% correct to 58% correct. The intervention and the control interns performed similarly on patient volunteers: for MR, 20% correct versus 31%; for AR, 29% correct versus 33%; and for aortic sclerosis, 64% correct versus 33%, respectively.
The interns had difficulty correctly identifying three valvular heart disease simulations before and after an educational intervention employing a cardiovascular-patient simulator. At no time did the proportion of correct responses exceed 64%. Our teaching intervention during internship was either of insufficient intensity or of insufficient duration to produce significant improvement in cardiovascular diagnostic skills.
评估一项旨在提高实习生心血管检查技能的教学计划的有效性。
在1个学年（1989年7月至1990年6月）期间，所有56名在强制性4周住院心脏病学服务岗位轮转的实习生。
我们将实习生随机分为两组，一组接受在心脏病患者模拟器（“哈维”）上进行的为期八节的体格诊断课程（“教学组”），另一组不接受补充教学（“对照组”）。在教学或对照期之前及之后，对实习生进行三项预编程模拟评估（二尖瓣反流，MR；二尖瓣狭窄，MS；主动脉瓣反流，AR）。在对照期或干预期结束后，实习生还对患者志愿者进行了评估。
实习生正确识别疾病模拟的能力在基线时无差异。干预组和对照组实习生在模拟器上的诊断能力均有类似的中等程度提高。干预组实习生在MR诊断上从42%正确提高到54%正确；在MS诊断上从8%正确提高到23%正确；在AR诊断上从46%正确提高到58%正确。干预组和对照组实习生在患者志愿者评估中的表现相似：对于MR，正确诊断率分别为20%和31%；对于AR，正确诊断率分别为29%和33%；对于主动脉硬化，正确诊断率分别为64%和33%。
在采用心血管患者模拟器进行教育干预之前和之后，实习生在正确识别三种瓣膜性心脏病模拟方面存在困难。正确反应的比例从未超过64%。我们在实习期间的教学干预强度或时长不足，无法在心血管诊断技能方面产生显著改善。
