目的比较急诊住院医师在颈内静脉穿刺中使用传统解剖定位和超声辅助定位的教学效果,探讨颈内静脉穿刺超声辅助定位法在急诊住院医师规范化培训中的应用价值。方法选取某三甲医院2020年9月1日-2022年8月31日参加急诊住院医师规范化培训...目的比较急诊住院医师在颈内静脉穿刺中使用传统解剖定位和超声辅助定位的教学效果,探讨颈内静脉穿刺超声辅助定位法在急诊住院医师规范化培训中的应用价值。方法选取某三甲医院2020年9月1日-2022年8月31日参加急诊住院医师规范化培训的第三年住院医师作为研究对象,2020年9月1日-2021年8月31的20名住院医师作为对照组接受传统解剖定位法培训,2021年9月1日-2022年8月31的21名住院医师作为研究组接受超声辅助定位法培训,分别记录并分析培训考核成绩、教学满意度、操作前自信度、穿刺成功率、穿刺用时、穿刺并发症等指标。结果考核成绩(86.90±4.93 VS 90.62±4.73分)、教学满意度(85.90±5.92VS96.90±5.67分)和操作前自信度(69.40±13.25VS86.90±10.31分),研究组均优于对照组(P<0.05)。此外,研究组的首次穿刺成功率(71.4%)及总穿刺成功率(95.2%)均更高,穿刺用时(24.52±10.38分钟)和穿刺并发症(0%)均更少(P<0.05)。结论颈内静脉穿刺超声辅助定位法穿刺安全、有效,更能提高操作者自信度,在急诊住院医师第一阶段规范化培训中值得推广。展开更多
The application of main methodologies for clinical decision-making by residents in emergency medical practice was assessed,and issues in this area were investigated.The treatments provided to 2611 critical patients by...The application of main methodologies for clinical decision-making by residents in emergency medical practice was assessed,and issues in this area were investigated.The treatments provided to 2611 critical patients by the Emergency Department of Peking Union Medical College Hospital were analyzed by independent investigators who evaluated the main clinical decision-making processes applied by the hospital residents.The application of decision-making strategies by PG1 and PG3 groups,which means the residents in first year and the third year,were compared.The patients were treated according to pattern recognition(43.0%),hypotheticodeductive reasoning(23.4%),event-driven models(19.3%),and rule-using algorithms(5.9%).A significant difference was found between PG1 and PG3 groups(χ^(2)=498.01,P<0.001).Pattern recognition and hypotheticdeductive methods were the most common techniques applied by emergency physicians in evaluating critically ill patients.The decision-making processes applied by junior and senior residents were significantly different,although neither group adequately applied rule-using algorithms.Inclusion of clinical decision-making in medical curricula is needed to improve decision-making in critical care.展开更多
文摘目的比较急诊住院医师在颈内静脉穿刺中使用传统解剖定位和超声辅助定位的教学效果,探讨颈内静脉穿刺超声辅助定位法在急诊住院医师规范化培训中的应用价值。方法选取某三甲医院2020年9月1日-2022年8月31日参加急诊住院医师规范化培训的第三年住院医师作为研究对象,2020年9月1日-2021年8月31的20名住院医师作为对照组接受传统解剖定位法培训,2021年9月1日-2022年8月31的21名住院医师作为研究组接受超声辅助定位法培训,分别记录并分析培训考核成绩、教学满意度、操作前自信度、穿刺成功率、穿刺用时、穿刺并发症等指标。结果考核成绩(86.90±4.93 VS 90.62±4.73分)、教学满意度(85.90±5.92VS96.90±5.67分)和操作前自信度(69.40±13.25VS86.90±10.31分),研究组均优于对照组(P<0.05)。此外,研究组的首次穿刺成功率(71.4%)及总穿刺成功率(95.2%)均更高,穿刺用时(24.52±10.38分钟)和穿刺并发症(0%)均更少(P<0.05)。结论颈内静脉穿刺超声辅助定位法穿刺安全、有效,更能提高操作者自信度,在急诊住院医师第一阶段规范化培训中值得推广。
文摘The application of main methodologies for clinical decision-making by residents in emergency medical practice was assessed,and issues in this area were investigated.The treatments provided to 2611 critical patients by the Emergency Department of Peking Union Medical College Hospital were analyzed by independent investigators who evaluated the main clinical decision-making processes applied by the hospital residents.The application of decision-making strategies by PG1 and PG3 groups,which means the residents in first year and the third year,were compared.The patients were treated according to pattern recognition(43.0%),hypotheticodeductive reasoning(23.4%),event-driven models(19.3%),and rule-using algorithms(5.9%).A significant difference was found between PG1 and PG3 groups(χ^(2)=498.01,P<0.001).Pattern recognition and hypotheticdeductive methods were the most common techniques applied by emergency physicians in evaluating critically ill patients.The decision-making processes applied by junior and senior residents were significantly different,although neither group adequately applied rule-using algorithms.Inclusion of clinical decision-making in medical curricula is needed to improve decision-making in critical care.
