【摘要】 目的 评价“1+6”肺部超声培训模式的可行性及效果。方法 以肺部超声评分系统为培训内容,选取2017年12月至2019年3月能在北京大学人民医院重症监护病房(ICU)学习至少3个月的学员作为研究对象,其中本科室医师7名,轮转研究生3名,进修医师5名,1名因个人原因中途退出培训,最终14名完成教学计划纳入本研究。所有学员均进行1次深度理论讲解+6次(实践+阶段性评估)的循环评估培训模式。通过比较老师和学员进行肺部超声检查时病变判别的一致性、操作时间的差异,评估学员对肺部超声检查掌握的准确性和熟练程度,了解肺部超声检查的难点和培训周期等。结果 除去评分为2分的病变因病例数太少最终没有达到Kappa值大于0.6的目标(Kappa值为0),其余病变判读在所有参加培训的学员中,到第6次操作时与教师的判读准确性均达到基本一致(Kappa值分别为0.93、0.62、0.93)。所有学员肺部超声评分总分均在最后1次操作时与老师的评分基本一致,Kappa值为0.8。在培训结束时,所有学员检查用时与老师基本接近;所有学员的培训周期均少于3个月。结论 通过肺部超声评分系统的设计,以及“1次深度理论讲解+6次(实践+阶段性评估)”的循环评估培训后,可较明显地减少超声检查的主观误差,缩短肺部超声检查培训的周期。更多还原

【Abstract】 Objective To evaluate the feasibility and effect of "1+6" pulmonary ultrasound training mode.Methods Taking the lung ultrasound scoring system as the training content,the students who could study in the intensive care unit(ICU) of Peking University People’s Hospital at least 3 months from December 2017 to March 2019 were selected as the research objects,including 7 doctors in this department,3 rotating postgraduates and5 refresher doctors;one withdrew from the training due to personal reasons,and finally 14 were included in this study and completed the teaching plan.All the trainees would have one in-depth theoretical explanation+6 ×(practice+periodic evaluation) training mode of circular evaluation.By comparing the consistency of lesion discrimination and the difference in operation time between teachers and students in pulmonary ultrasound examination,the accuracy and proficiency of students in pulmonary ultrasound examination were evaluated,and the difficulties and training cycle during pulmonary ultrasound examination were understood.Results Except the number of lesions with a score of 2 being too small,finally that did not reach the goal of Kappa value greater than 0.6(Kappa value was 0);the trainees’ interpretation accuracy of other lesions was basically the same as that of the teacher’s at the 6 operation(Kappa value scores were 0.93,0.62 and 0.93).The total score of lung ultrasound examination of all students was basically consistent with the teacher’s score at the last operation,and the Kappa value was 0.8.At the end of the training,the inspection time of all trainees is basically close to that of the teacher;the training period of all trainees is less than 3 months.Conclusion Through the design of pulmonary ultrasound scoring system and after the circular evaluation training of "one-time depth theory explanation+6 X(practice+phased assessment)",the training can significantly reduce the subjective error of ultrasound examination and shorten the training cycle of lung ultrasound examination.更多还原