【摘要】 目的 探究启元重症大模型嵌入脓毒性休克情境模拟教学对临床推理及决策能力的影响。方法 采用横断面问卷研究设计，对77名参与过启元重症大模型嵌入情境模拟教学的毕业后医学教育学员（住培、专培和专修学员）实施调查，评价在学习增益、评估胜任力、决策胜任力、复盘质量与学习氛围、认知负荷与专注度以及支持作用等方面的提升情况，并比较不同培训层级之间的差异。结果 教学后，全体学员在初始评估与复评把握、复苏与升压决策把握、时间压力下组织优先级与团队沟通把握的得分均明显高于教学前，差异均有统计学意义（t分别=-11.42、-10.63、-11.18,P均<0.05）。亚组分析显示，专修学员在评估胜任力和决策胜任力评分高于住培和专培学员（t分别=5.01、2.42、4.83、2.31,P均<0.05），专修学员在复盘质量与学习氛围评分高于住培学员（t=2.11,P<0.05）。不同培训层级学员间的认知负荷与专注度和支持作用评分比较，差异均无统计学意义（F分别=0.98、1.98,P均>0.05）。开放性反馈显示，55名（71.43%）学员给予正向反馈，20名（25.97%）学员提出改进意见，集中在模型准确性、个体化程度、真实病例和互动安排等方面。另有36名（46.75%）学员提到潜在风险。结论 启元重症大模型嵌入脓毒性休克情境模拟教学在重症医学毕业后教育学员中具有较好的接受度。学员教学后在脓毒性休克评估、复苏决策和团队沟通方面的自我把握提高，提示该模式可为临床推理与处置决策训练提供辅助支持。更多还原

【Abstract】 Objective To evaluate the effect of Qiyuan critical care large language model embedded septic shock simulation teaching on clinical reasoning and decision-making. Methods A cross-sectional questionnaire survey was conducted among 77 postgraduate medical trainees,including residents,specialist trainees and visiting fellows,who had participated in Qiyuan critical care large language model embedded simulation teaching.Learning gains,assessment competence,decision-making competence,debriefing quality and learning atmosphere,cognitive load and attention,and support effect were evaluated.Differences among training levels were also compared. Results After teaching,the scores for initial assessment and reassessment,resuscitation and vasopressor decision-making,and prioritization and team communication under time pressure were significantly higher than before teaching(t=-11.42,-10.63,-11.18,P<0.05).Subgroup analysis showed that visiting fellows scored higher than residents and specialist trainees in assessment and decision-making competence(t=5.01,2.42,4.83,2.31,P<0.05),and higher than residents in debriefing quality and learning atmosphere(t=2.11,P<0.05).No significant differences were found among training levels in cognitive load,attention,or support effect(F=0.98,1.98,P>0.05). Open-ended responses showed that 55 trainees(71.43%) gave positive feedback,20(25.97%)suggested improvements in model accuracy,personalization,real-case integration,and interaction design,and36(46.75%) mentioned potential risks. Conclusion Qiyuan critical care large language model embedded septic shock simulation teaching was well accepted by postgraduate critical care trainees.Trainees reported improved confidence in septic shock assessment,resuscitation decision-making,and team communication after teaching,suggesting that this approach may support training in clinical reasoning and management decision-making.更多还原