情景模拟与案例教学结合在心内科急性冠脉综合征诊疗教学中的应用实践

Application of Situational Simulation Combined with Case-Based Teaching in the Teaching of Acute Coronary Syndrome in Cardiology Department

摘要: 目的：探讨情景模拟与案例教学结合模式在心内科急性冠脉综合征(ACS)诊疗教学中的应用价值，为临床教学改革提供依据。方法：以2022年1月至2023年12月我院120名临床医学专业实习医师为对象，随机分为情景模拟教学组(60人)与传统教学组(60人)。情景模拟组通过设计标准化病人(SP)案例、模拟急诊抢救场景、开展多维度评价反馈进行教学；传统组采用“理论授课 + 病房带教”模式。通过理论考试、操作技能考核、模拟病例诊疗及团队协作与沟通评分，对比两组在ACS诊疗核心能力指标上的差异。结果：情景模拟组理论成绩(85.2 ± 6.1分vs. 78.3 ± 7.4分，P < 0.001)、操作技能评分(心电图读图、心肺复苏、电除颤均P < 0.001)、临床决策能力评分(诊断准确性、治疗合理性、并发症处理均P < 0.001)及团队协作与沟通评分(病史采集沟通、家属安抚、团队协作效率均P < 0.001)均显著优于传统组。结论：情景模拟与案例教学结合模式可显著提升实习医师的ACS理论知识、操作技能、临床决策能力及团队协作水平，优于传统教学模式，值得在临床教学中推广应用。

Abstract: Purpose: To explore the application value of the combined model of situational simulation and case-based teaching in the diagnosis and treatment teaching of acute coronary syndrome (ACS) in the department of cardiology, and to provide a basis for the reform of clinical teaching. Methods: From January 2022 to December 2023, 120 interns majoring in clinical medicine in our hospital were selected as the research objects and randomly divided into the situational simulation teaching group (60 persons), and the true situational simulation group implemented teaching by designing standardized patient (SP) cases, simulating emergency rescue scenarios, and conducting multi-dimensional evaluation and feedback; the traditional teaching group adopted the “theoretical lectures + ward-based teaching” model. Differences in the core competency indicators of ACS diagnosis and treatment between the two groups were compared through theoretical examinations, operational skill assessments, simulated case diagnosis and treatment evaluations, as well as team collaboration and communication scoring. Additional teaching group (60 persons). Results: The situational simulation group showed significantly better performance than the traditional group in the following aspects: theoretical scores (85.2 ± 6.1 vs. 78.3 ± 7.4, P < 0.001), operational skill scores (electrocardiogram interpretation, cardiopulmonary resuscitation, and defibrillation, all P < 0.001), clinical decision-making ability scores (diagnostic accuracy, rationality of treatment, and management of complications, all P < 0.001), as well as team collaboration and communication scores (history-taking communication, family member reassurance, and team collaboration efficiency, all P < 0.001). Conclusion: The combined model of situational simulation and case-based teaching can significantly improve interns’ theoretical knowledge of ACS, operational skills, clinical decision-making ability, and team collaboration level. It is superior to the traditional teaching model and is worthy of promotion and application in clinical teaching.