基于临床流行病学与循证医学的内科规培教学改革实践与效果评估

Practice and Effect Evaluation of Internal Medicine Standardized Training Teaching Reform Based on Clinical Epidemiology and Evidence-Based Medicine

摘要: 目的：探索临床流行病学和循证医学对内科规培医师临床思维与实践能力的提升效果。方法：采用前瞻性干预研究，选取2022年6月~2024年7月复旦大学附属闵行医院内科基地80名规培医师，通过随机化分组分为干预组(n = 40)和对照组(n = 40)。对照组行传统规培教学，干预组在常规教学基础上增设临床流行病学与循证医学教学模块，干预前后采用理论测试、临床病例分析、实践技能考核(分循证相关能力与手工技能)及满意度问卷进行多维度评估。结果：干预组理论知识测试得分较干预前提升25.3分，显著高于对照组的5.6分(P < 0.001, Cohen’s d = 2.87)；临床病例分析(诊断准确性、治疗方案合理性等)及临床实践技能中循证相关能力(病史采集、体格检查等)评分均显著优于对照组(P < 0.05)，手工技能评分组间差异较小(P = 0.032, Cohen’s d = 0.41)；干预组教学满意度(90%)高于对照组(60%)。结论：将临床流行病学与循证医学融入内科规培教学效果显著，可提升规培医师理论水平、临床思维及实践能力，规培医师认可度较高，具备进一步多中心验证推广的潜力。

Abstract: Objective: To explore the effect of clinical epidemiology and evidence-based medicine on improving the clinical thinking and practical abilities of standardized training residents in internal medicine. Methods: A prospective intervention study was conducted, selecting 80 standardized training residents from the internal medicine base of Minhang Hospital Affiliated to Fudan University between June 2022 and July 2024. They were randomly divided into an intervention group (n = 40) and a control group (n = 40). The control group received traditional standardized training, while the intervention group added teaching modules of clinical epidemiology and evidence-based medicine on the basis of routine teaching. Multi-dimensional evaluations including theoretical tests, clinical case analysis, practical skill assessments (divided into evidence-based related abilities and manual skills), and satisfaction questionnaires were conducted before and after the intervention. Results: The theoretical knowledge test score of the intervention group increased by 25.3 points compared with that before the intervention, which was significantly higher than the 5.6-point increase in the control group (P < 0.001, Cohen’s d = 2.87); the scores of clinical case analysis (diagnostic accuracy, rationality of treatment plans, etc.) and evidence-based related abilities in clinical practical skills (medical history collection, physical examination, etc.) in the intervention group were significantly better than those in the control group (P < 0.05),while the difference in manual skill scores between the two groups was small (P = 0.032, Cohen’s d = 0.41); the teaching satisfaction rate of the intervention group (90%) was higher than that of the control group (60%). Conclusion: Integrating clinical epidemiology and evidence-based medicine into the standardized training of internal medicine has a significant effect, which can improve the theoretical level, clinical thinking and practical abilities of standardized training residents, with high recognition from residents, and has the potential for further multi-center verification and promotion.