混合式教学在急性脑卒中临床培训中的实践研究

doi:10.3969/j.issn.2096-045X.2026.02.011

摘要/Abstract

摘要：

目的　探讨案例导向学习（case-based learning，CBL）联合模拟病例训练（simulation-based case training，SCT）对提升神经内科住院医师急性脑卒中教学质量的效果，重点评估其在影像判读能力、临床决策能力、时间效率及理论掌握方面的综合影响。方法　采用回顾性队列研究设计，纳入2022年1月—2024年12月期间，在郑州大学第一附属医院神经内科接受急性脑卒中培训教学的135名学员。以2023年1月15日该院引入混合教学模式为时间节点，按不同教学模式分为对照组和观察组。对照组（CBL，n=65）接受传统CBL教学；观察组（CBL+SCT，n=70）在CBL教学基础上，额外参与SCT，包括模拟影像判读系统、模拟溶栓/取栓决策系统及绿色通道流程推演。所有学员在教学前均接受相同的急性脑卒中理论课程，比较两组在教学后影像判读正确率、临床决策正确率、影像判读耗时、流程制定耗时及理论考试成绩的变化。所有教学数据由自动化教学管理系统记录。结果　教学前两组在一般资料及各项基础能力指标上差异均无统计学意义（P>0.05）。教学后，观察组在所有核心能力维度上均显著优于对照组。影像判读方面，观察组ASPECTS判读正确率、大血管闭塞识别正确率及“出血 vs 梗死”判别正确率分别为82.9%、84.3%和88.6%，均显著高于对照组（P<0.001）。临床决策方面，观察组溶栓适应证判断、溶栓禁忌证识别及取栓适应证判断正确率显著高于对照组（均P<0.001）。时间效率方面，观察组影像判读耗时缩短至（82.07±4.63） s，流程制定耗时缩短至（48.91±5.34）s，显著优于对照组（P<0.001）。理论成绩方面，观察组教学后平均得分为（90.63±2.15）分，明显优于对照组的（87.62±3.16）分（P<0.001）。结论　CBL+SCT能够显著提升住院医师在急性脑卒中中的影像判读、临床决策与流程处理能力，是优于传统教学的高效教学模式。

Abstract:

Objective　To evaluate the effectiveness of Case-Based Learning (CBL) combined with Simulation-based Case Training (SCT) in enhancing the quality of acute stroke teaching for neurology residents, focusing on its overall impact on image interpretation skills, clinical decision-making abilities, time efficiency, and theoretical knowledge.Methods　A retrospective cohort study design was adopted, including 135 residents who received acute ischemic stroke training at the Department of Neurology, First Affiliated Hospital of Zhengzhou University, from January 2022 to December 2024. Based on the introduction of the hybrid teaching model on January 15, 2023, participants were divided into two groups: the unexposed group (CBL, n=65), who received traditional CBL teaching, and the exposed group (CBL+SCT, n=70), who participated in CBL+SCT teaching, including simulated image interpretation, thrombolysis/thrombectomy decision-making systems, and green channel process simulations. All participants received the same acute ischemic stroke theoretical course before the teaching intervention. Changes in image interpretation accuracy, clinical decision-making accuracy, image interpretation time, process formulation time, and theoretical exam scores were compared between the two groups post-intervention. All teaching data were recorded by an automated teaching management system.Results　There were no significant differences in demographic data and baseline ability indicators between the two groups prior to the intervention (P>0.05). Post-intervention, the exposed group outperformed the unexposed group in all core skill dimensions. In image interpretation, the exposed group showed significantly higher ASPECTS interpretation accuracy (82.9%), large vessel occlusion recognition accuracy (84.3%), and "hemorrhage vs. infarction" differentiation accuracy (88.6%) compared to the unexposed group (P<0.001). In clinical decision-making, the exposed group had significantly higher accuracy in thrombolysis indications, thrombolysis contraindications, and thrombectomy indications (all P<0.001). In terms of time efficiency, the exposed group had significantly reduced image interpretation time (82.07±4.63) s and process formulation time (48.91±5.34) s compared to the unexposed group (P<0.001). In theoretical exam scores, the exposed group scored significantly higher (90.63±2.15) points compared to the unexposed group (87.62±3.16) points (P<0.001).Conclusion　The combination of CBL and SCT can significantly improve residents' ability in imaging interpretation, clinical decision-making, and workflow management in acute stroke, and is an efficient teaching model superior to traditional methods.

中图分类号:

R74
G642

杨楠楠, 桑树山, 梁东晓. 混合式教学在急性脑卒中临床培训中的实践研究[J]. 医学教育管理, doi: 10.3969/j.issn.2096-045X.2026.02.011.

Yang Nannan, Sang Shushan, Liang Dongxiao.

Implementing and evaluating a CBL + SCT blended teaching in clinical training for acute stroke [J]. Medical Education Management, doi: 10.3969/j.issn.2096-045X.2026.02.011.

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