PDCA循环法在普通外科住院医师规范化培养中的应用

曹锋 赵烨 郑亚民

[摘要] 目的 探讨PDCA循环法在普通外科住院医师规范化培养中的应用价值。 方法 将2014年9月～2017年8月在首都医科大学宣武医院普通外科接受住院医师规范化培训的62名学员按随机数字表法分成实验组及对照组，每组各31名学员，实验组采用PDCA循环法，对照组采用传统教学法。采用客观结构化临床考试（OSCE）及学生满意度调查评价教学效果。 结果 实验组OSCE考试中病史采集和查体、病例分析、基本操作技能及辅助检查结果判读得分均高于对照组（P < 0.01），学员对教学方式的满意度评分中课程设计合理性、教学技能、知识掌握度及分析解决问题能力均高于对照组（P < 0.01）。。 结论 PDCA循环法有助于提高普通外科住院医师规范化培训质量。

[关键词] PDCA循环；住院医师；普通外科；住院医师规范化培训

[中图分类号] R197 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0044-04

[Abstract] Objective To evaluate the application of PDCA cycle in standardized training of general surgery residents. Methods Sixty-two students received standardized training in General Surgery Department of Xuanwu Hospital， Capital Medical University from September 2014 to August 2017 were selected and divided into the experimental group and the control group by random number table method， with 31 students in each group. PDCA cycle method and the traditional teaching method were used in the experimental group and the control group respectively. Objective structured clinical examination （OSCE） and student satisfaction survey were used to evaluate teaching efficacy. Results Scores of the medical history collection and physical examination， case analysis， basic operation skills and auxiliary examination results in the OSCE examination of the experimental group were higher than those of the control group （P < 0.01）. The scores of rationality in the curriculum design， teaching skills， knowledge and analytical problem solving skills of students′ satisfaction to the teaching manner were higher than those of the control group （P < 0.01）. Conclusion PDCA cycle is helpful to improve the quality of standardized training for general surgery residents.

[Key words] PDCA cycle； Resident； General surgery； Standardized residents training

普通外科是整个外科学的基础与主干学科，涉及病种复杂多样，对解剖学、病理生理学、病理学等基础课程要求高，教学难度大。北京市于1988年即开始试行外科住院医师规范化培训，以期通过3年在大型教學医院的强化学习，使住院医师系统掌握外科常见病及多发病的诊疗常规。总结过去30年的普通外科教学实践，可以发现，普通外科住院医师的培训质量始终难以达到让人满意的程度。2014年，普通外科开始尝试在住院医师规范化培训中施行PDCA循环教学法，使培训质量大幅提高，现将结果报道如下：

1 对象与方法

1.1 研究对象

将2014年9月～2017年8月在首都医科大学宣武医院普通外科接受住院医师规范化培训的62名学员纳入研究。按随机数字表法随机分成实验组及对照组，每组各31名学员。实验组男28人，女3人，平均年龄（24.0±1.7）岁，均为大学本科学历；……