Kubva pakaitika denda reCCIDID-19, nyika yatanga kutarisisa zvakanyanya basa rekudzidzisa kwekiriniki rezvipatara zveyunivhesiti.Kusimbisa kubatanidzwa kwemishonga uye dzidzo nekuvandudza kunaka uye kubudirira kwekudzidzisa kwekliniki matambudziko makuru anotarisana nedzidzo yezvokurapa.Kuoma kwekudzidzisa orthopedics kuri mumhando dzakasiyana-siyana dzezvirwere, hunyanzvi hwepamusoro uye hunhu husinganzwisisike, izvo zvinopesvedzera kutanga, kushingaira uye kubudirira kwekudzidzisa kwevadzidzi vezvokurapa.Chidzidzo ichi chakagadzira hurongwa hwekudzidzisa mukirasi hwakachinjika hwakavakirwa paCDIO (Concept-Design-Implement-Operate) uye vakaishandisa mukosi yekudzidzira vana mukoti yemapfupa kuvandudza maitiro ekudzidza uye kubatsira vadzidzisi kuona kushandura ramangwana redzidzo yehukoti uye kunyange. dzidzo yezvokurapa.Kudzidza mukirasi kuchave kunoshanda uye kwakanangana.
Vadzidzi makumi mashanu vezvokurapa vakapedza internship mudhipatimendi remapfupa echipatara chepamusoro muna Chikumi 2017 vakaverengerwa muboka rekutonga, uye vadzidzi makumi mashanu vanoyamwisa vakapedza kudzidza mubazi muna Chikumi 2018 vakaverengerwa muboka rekupindira.Boka rekupindira rakatora pfungwa yeCDIO yemhando yekudzidzisa mukirasi, ukuwo boka rinodzora rakatora chinyakare chekudzidzisa.Mushure mekupedza mabasa anoshanda edhipatimendi, mapoka maviri evadzidzi akaongororwa padzidziso, hunyanzvi hwekushanda, kugona kudzidza kwakazvimirira uye kugona kufunga kwakadzama.Mapoka maviri evadzidzisi akapedza matanho masere ekuongorora kugona kwekiriniki yekudzidzira, kusanganisira nzira ina dzehukoti, kugona kwevanhu mukoti, uye ongororo yemhando yedzidziso yekiriniki.
Mushure mekudzidziswa, kugona kwekiriniki yekudzidzira, kugona kufunga kwakanyanya, kugona kudzidza kwakazvimirira, dzidziso uye mashandiro ekuita, uye kiriniki yekudzidzisa kwemhando yepamusoro yeboka rekupindira yaive yakakwira zvakanyanya kupfuura yeboka rinodzora (ese P <0.05).
Iyo modhi yekudzidzisa yakavakirwa paCDIO inogona kukurudzira kudzidza kwakazvimirira kwevakoti uye kugona kufunga kwakadzama, kukurudzira kusanganiswa kwedzidziso uye tsika, kuvandudza kugona kwavo kushandisa zvizere ruzivo rwedzidziso kuongorora nekugadzirisa matambudziko anoshanda, uye kugadzirisa maitiro ekudzidza.
Dzidzo yekiriniki ndiyo nhanho yakakosha yedzidzo yehukoti uye inosanganisira shanduko kubva muruzivo rwedzidziso kuenda kukudzidzira.Kudzidzira kukiriniki kunoshanda kunogona kubatsira vadzidzi vehukoti kugona hunyanzvi hwehunyanzvi, kusimbisa ruzivo rwehunyanzvi, nekuvandudza kugona kwavo kudzidzira hukoti.Ndiyo zvakare nhanho yekupedzisira yebasa rekuchinja kwevadzidzi vekurapa [1].Mumakore achangopfuura, vatsvakurudzi vakawanda vezvidzidzo zvekiriniki vakaita tsvakiridzo pamusoro penzira dzekudzidzisa dzakadai sekudzidza-kwakavakirwa padambudziko (PBL), kudzidza kwakavakirwa pachiitiko (CBL), kudzidza-kweboka (TBL), uye kudzidza kwemamiriro ezvinhu uye kuenzanisa kwemamiriro ezvinhu mukudzidzisa kwekiriniki. ..Nekudaro, nzira dzakasiyana dzekudzidzisa dzine zvadzakanakira uye nekuipa kwadzo maererano nemhedzisiro yekudzidza yekubatanidza inoshanda, asi haigone kubatanidzwa kwedzidziso uye maitiro [2].
“Kirasi yakachinjika” inoreva modhi itsva yekudzidza umo vadzidzi vanoshandisa chikuva cheruzivo chakananga kuti vadzidze vakazvimiririra zvakasiyana-siyana zvedzidzo vasati vapedza kirasi uye kupedza basa rechikoro rechikoro nenzira ye“kudzidza kwakabatana” mukirasi apo vadzidzisi vachitungamirira vadzidzi.Pindura mibvunzo uye upe rubatsiro rwemunhu[3].IAmerican New Media Alliance yakaona kuti kirasi yakachinjika inogadzirisa nguva mukati nekunze kwekirasi uye inotamisa sarudzo dzekudzidza kwevadzidzi kubva kuvadzidzisi kuenda kuvadzidzi [4].Nguva yakakosha inopedzwa mukirasi mune iyi modhi yekudzidza inobvumira vadzidzi kuti vatarise zvakanyanya pakudzidza kunoshanda, kunoenderana nedambudziko.Deshpande [5] akaita chidzidzo pakirasi yakachinjika mune dzidzo yepasirese uye kudzidzisa uye akagumisa kuti kirasi yakachinjika inogona kuvandudza kufarira kwevadzidzi kudzidza uye kuita mudzidzo uye kuderedza nguva yekirasi.Khe Fung HEW naChung Kwan LO [6] vakaongorora mhedzisiro yekutsvagisa yezvinyorwa zvekuenzanisa pakirasi yakapeperetswa uye akapfupisa mhedzisiro yeyakapeperutswa nzira yekudzidzisa yemukirasi kuburikidza meta-kuongorora, zvichiratidza kuti zvichienzaniswa nenzira dzechinyakare dzekudzidzisa, iyo yakachinjika nzira yekudzidzisa mukirasi. mune dzidzo yehutano yehunyanzvi iri nani zvakanyanya uye inovandudza kudzidza kwevadzidzi.Zhong Jie [7] akaenzanisa mhedzisiro yekirasi yakapeperutswa yekirasi uye yakachinjika yepanyama yekirasi yekudzidza yakasanganiswa pakuwana ruzivo rwevadzidzi, uye akaona kuti mukuita kwekudzidza kwakasanganiswa mukirasi yehistology yakapfava, kuvandudza mhando yedzidziso yepamhepo inogona kuvandudza kugutsikana kwevadzidzi uye. ruzivo.bata.Zvichienderana nemhedzisiro yetsvakiridzo iri pamusoro, mundima yedzidzo yehukoti, nyanzvi zhinji dzinoongorora mashandiro ekirasi yakachinjika pakubudirira kwekudzidzisa mukirasi uye vanotenda kuti kudzidzisa mukirasi kwakachinjika kunogona kuvandudza kuita kwevadzidzi vehukoti, kugona kudzidza vakazvimiririra, uye kugutsikana mukirasi.
Naizvozvo, pane chido chekukurumidzira chekuongorora nekugadzira nzira itsva yekudzidzisa inozobatsira vadzidzi vehukoti kutora nekuita ruzivo rwehunyanzvi hwakarongeka uye kuvandudza kugona kwavo kwekiriniki nemhando yakazara.CDIO (Concept-Design-Implement-Operate) imhando yedzidzo yeinjiniya yakagadzirwa muna 2000 nemayunivhesiti mana, kusanganisira Massachusetts Institute of Technology uye Royal Institute of Technology muSweden.Iyo yemhando yepamusoro yedzidzo yeinjiniya inobvumira vadzidzi vehukoti kuti vadzidze uye vawane hunyanzvi mune inoshanda, maoko-on, uye organic maitiro [8, 9].Panyaya yekudzidza kwakakosha, modhi iyi inosimbisa “kutariswa kwemudzidzi,” ichibvumira vadzidzi kuti vatore chikamu mukubata pamuviri, dhizaini, kuita, nekushanda kwemapurojekiti, uye kushandura ruzivo rwakawanikwa rwedzidziso kuita maturusi ekugadzirisa matambudziko.Zvidzidzo zvakawanda zvakaratidza kuti CDIO yekudzidzisa modhi inobatsira mukuvandudza hunyanzvi hwekuita zvekiriniki uye huwandu hwakazara hwevadzidzi vekurapa, kuvandudza kudyidzana kwevadzidzisi, kuvandudza hunyanzvi hwekudzidzisa, uye inoita basa mukusimudzira shanduko yeruzivo uye kugadzirisa nzira dzekudzidzisa.Inoshandiswa zvakanyanya mukudzidziswa kwetarenda [10].
Nekushandurwa kwemuenzaniso wezvokurapa wepasi rose, zvido zvevanhu zvehutano zviri kuwedzera, izvo zvakakonzerawo kuwedzera kwebasa revashandi vezvokurapa.Kugona uye hutano hwevanamukoti hunoenderana zvakananga nehutano hwehutano hwehutano uye kuchengetedzwa kwevarwere.Mumakore achangopfuura, kusimudzira uye kuongororwa kwehunyanzvi hwekiriniki yevashandi mukoti yave nyaya inopisa mumunda weukoti [11].Naizvozvo, chinangwa, chakazara, chakavimbika, uye chechokwadi nzira yekuongorora yakakosha pakutsvagisa dzidzo yekurapa.Iyo mini-kiriniki evaluation Exercise (mini-CEX) inzira yekuongorora yakakwana yekiriniki kugona kwevadzidzi vekurapa uye inoshandiswa zvakanyanya mundima yemultidisciplinary dzidzo yekurapa kumba nekune dzimwe nyika.Zvakaonekwa zvishoma nezvishoma mumunda wehukoti [12, 13].
Zvidzidzo zvakawanda zvakaitwa pakushandiswa kweiyo CDIO modhi, kirasi yakachinjika, uye mini-CEX mudzidzo yehukoti.Wang Bei [14] akakurukura nezve maitiro eCDIO modhi pakuvandudza kudzidziswa kwakanangana nemukoti kune zvinodiwa neCOVID-19 vanamukoti.Mhedzisiro iyi inoratidza kuti kushandisa iyo CDIO yekudzidzisa modhi kupa yakasarudzika dzidziso yehukoti paCCIDID-19 kuchabatsira vashandi vehukoti zviri nani kuwana hunyanzvi hwekudzidzisa vanamukoti uye ruzivo rwakabatana, uye kunyatsovandudza hunyanzvi hwavo hwehukoti.Nyanzvi dzakaita saLiu Mei [15] dzakakurukura mashandisirwo enzira yekudzidzisa yechikwata yakasanganiswa nekirasi yakapepetwa mukudzidzisa vanamukoti vemapfupa.Mhedzisiro yacho yakaratidza kuti iyi modhi yekudzidzisa inogona kunyatso kuvandudza kugona kwekutanga kwevanamukoti vemapfupa akadai sekunzwisisa.nekushandiswa kweruzivo rwe theoretical, kushandira pamwe, kufunga kwakadzama, uye tsvakiridzo yesainzi.Li Ruyue et al.[16] akadzidza mhedzisiro yekushandisa yakagadziridzwa Nursing Mini-CEX muyakamisikidzwa kudzidziswa kwevanamukoti vatsva vekuvhiya uye vakawana kuti vadzidzisi vaigona kushandisa Nursing Mini-CEX kuongorora iyo yese yekuongorora uye maitiro ekuita mukudzidzisa kwekiriniki kana work.weak links mu her.vanamukoti uye kupa mhinduro chaiyo-nguva.Kuburikidza nemaitiro ekuzviongorora uye kuzviona-chega, iwo mapoinzi ekutanga ekuongorora mashandiro ehukoti anodzidzwa, kosi inogadziriswa, mhando yedzidziso yekiriniki inovandudzwa, kugona kwakazara kwekuvhiya kwekiriniki yekuyamwisa kwevadzidzi kunovandudzwa, uye kuchinjika. musanganiswa wekirasi unoenderana nepfungwa yeCDIO inoedzwa, asi parizvino hapana chirevo chekutsvagisa.Kushandiswa kwemini-CEX yekuongorora modhi kune dzidzo yehukoti yevadzidzi vemapfupa.Munyori akashandisa modhi yeCDIO mukuvandudza makosi ekudzidziswa kwevadzidzi vemapfupa evana mukoti, akavaka kirasi yakachinjika yakavakirwa papfungwa yeCDIO, uye yakasanganiswa nemini-CEX yekuongorora modhi kuti iite matatu-mu-imwe yekudzidza uye mhando yemhando.ruzivo nemano, uye zvakabatsirawo mukuvandudza kunaka kwekudzidzisa.Kuenderera mberi kwekuvandudza kunopa hwaro hwekudzidzira-kwakavakirwa kudzidza muzvipatara zvekudzidzisa.
Kufambisira kufambiswa kwekosi iyi, nzira yekuenzanisira yakareruka yakashandiswa sezvidzidzo zvekusarudza vadzidzi vanoyamwisa kubva muna 2017 na2018 vaidzidzira mubazi remapfupa epachipatara chepamusoro.Sezvo paine vadzidzi makumi mashanu nevaviri padanho rega rega, saizi yemuenzaniso ichave 104. Vadzidzi vana havana kutora chikamu mune yakazara kliniki tsika.Boka rekutonga raisanganisira vadzidzi makumi mashanu vanoyamwisa vakapedza kudzidza mudhipatimendi remapfupa echipatara chepamusoro muna Chikumi 2017, avo varume ve6 nevakadzi makumi mana nevana vane makore makumi maviri kusvika makumi maviri nemaviri (21.30 ± 0.60) makore, vakapedza kudzidza padhipatimendi rimwe chete. muna June 2018. Boka rekupindira raisanganisira vadzidzi vezvokurapa ve50, kusanganisira varume ve8 nevakadzi ve42 vane makore 21 kusvika ku22 (21.45± 0.37) makore.Zvidzidzo zvese zvakapa mvumo ine ruzivo.Inclusion Criteria: (1) Orthopedic medical internship vadzidzi vane bachelor's degree.(2) Ruzivo rwemvumo uye nekuzvidira kutora chikamu muchidzidzo ichi.Maitiro ekusabvisa: Vanhu vasingakwanise kuita zvizere mukuita kwekiriniki.Hapana mutsauko wakakosha wenhamba muruzivo rwakakwana rwemapoka maviri evadzidzi vezvokurapa (p> 0.05) uye anofananidzwa.
Mapoka ese ari maviri akapedza 4-vhiki yekiriniki internship, nemakosi ese akapedzwa muDhipatimendi reOrthopedics.Munguva yekucherechedza, pakanga pane mapoka e10 evadzidzi vezvokurapa, vadzidzi ve5 muboka rimwe nerimwe.Kudzidziswa kunoitwa zvinoenderana neiyo internship chirongwa chevadzidzi vehukoti, kusanganisira theoretical uye tekinoroji zvikamu.Vadzidzisi vari mumapoka ose vane zvikwanisiro zvakafanana, uye mukoti mudzidzisi ane basa rekutarisa kunaka kwekudzidzisa.
Boka rinodzora rakashandisa mitoo yokudzidzisa yechinyakare.Muvhiki rokutanga rechikoro, makirasi anotanga neMuvhuro.Vadzidzisi vanodzidzisa dzidziso neChipiri neChitatu, uye vanotarisa pakudzidziswa kwekushanda neChina neChishanu.Kubva pasvondo rechipiri kusvika kusvondo rechina, nhengo yega yega yefizikisi ine basa remudzidzi wezvekurapa achipa apo neapo hurukuro mudhipatimendi.Muvhiki yechina, kuongororwa kuchapedzwa mazuva matatu isati yapera kosi.
Sezvambotaurwa, munyori anotora yakachinjika nzira yekudzidzisa mukirasi yakavakirwa pane iyo CDIO pfungwa, sekutsanangurwa pazasi.
Vhiki yekutanga yekudzidziswa yakafanana neyo muboka rekutonga;Vhiki mbiri kusvika ina dzekudzidziswa kwemapfupa perioperative shandisa hurongwa hwekudzidzisa hwekirasi hunoenderana nepfungwa yeCDIO kwemaawa makumi matatu nematanhatu.Iyo yekufunga uye dhizaini chikamu chinopedzwa muvhiki yechipiri uye chikamu chekushandisa chinopedzwa muvhiki rechitatu.Kuvhiya kwakapedzwa muvhiki yechina, uye kuongorora uye kuongorora kwakapedzwa mazuva matatu vasati vasunungurwa.Ona Tafura 1 yenguva dzekirasi dzakagoverwa.
Chikwata chekudzidzisa chinosanganisira 1 mukoti mukuru, 8 orthopedic faculty uye 1 asiri orthopedic CDIO mukoti nyanzvi yakavambwa.Mukoti Mukuru anopa nhengo dzechikwata chevadzidzisi chidzidzo uye kugona kweCDIO curriculum nezviyero, bhuku remusangano reCDIO nedzimwe dzidziso dzine hukama nedzimwe nzira dzekuita (angangoita maawa makumi maviri), uye anobvunza nyanzvi nguva dzese nezvenyaya dzakaoma dzedzidziso. .Faculty inoisa zvinangwa zvekudzidza, gadzirisa kosi, uye gadzirira zvidzidzo nenzira inopindirana nezvinodiwa zvehukoti uye chirongwa chekugara.
Zvinoenderana nechirongwa che internship, maererano neCDIO tarenda yekudzidzisa tarenda uye zviyero [17] uye mukubatana nehunhu hwekudzidzisa hwemukoti wemapfupa, zvinangwa zvekudzidza zvevanamukoti vakaiswa muzvikamu zvitatu, zvinoti: zvinangwa zvezivo (mastering basic. ruzivo), ruzivo rwehunyanzvi uye zvine chekuita nehurongwa maitirwo, nezvimwewo), zvibodzwa zvehunyanzvi (kuvandudza hunyanzvi hwehunyanzvi, hunyanzvi hwekufunga uye kugona kuzvimiririra kudzidza, nezvimwewo) uye zvibodzwa zvemhando yepamusoro (kuvaka hunhu hwakanaka hwehunyanzvi uye mweya wekutarisira kwevanhu uye etc.)..).Zvinangwa zveruzivo zvinoenderana neruzivo rwehunyanzvi uye kufunga kweCDIO kosi, kugona kwemunhu, kugona kwehunyanzvi uye hukama hweCDIO kosi, uye zvibodzwa zvemhando yepamusoro zvinoenderana nehunyanzvi hwakapfava hweCDIO curriculum: kushanda pamwe nekutaurirana.
Mushure memisangano miviri, timu yekudzidzisa yakakurukura hurongwa hwekudzidzisa vanamukoti mukirasi yakachinjika zvichibva pane pfungwa yeCDIO, yakakamura kudzidziswa kuita nhanho ina, uye yakaronga zvinangwa uye dhizaini, sezvakaratidzwa muTebhura 1.
Mushure mekuongorora basa rekuyamwisa pazvirwere zvemapfupa, mudzidzisi akacherechedza zviitiko zvezvirwere zvakajairika uye zvinowanzozivikanwa zvemapfupa.Ngatitorei chirongwa chekurapa kwevarwere vane lumbar disc herniation semuenzaniso: Murwere Zhang Moumou (murume, 73 wemakore, kureba 177 cm, uremu 80 kg) akanyunyuta nezve "kurwadza kwepasi kumashure kunoperekedzwa nechiveve uye kurwadziwa kuruboshwe rwezasi 2 months” uye akaiswa muchipatara mune imwe kiriniki inorapwa kunze.Semurwere mukoti ane mutoro: (1) Ndapota bvunza zvakarongeka nhoroondo yemurwere zvichienderana neruzivo rwawakawana uye ona zviri kuitika kumurwere;(2) Sarudza ongororo yakarongeka uye nzira dzekuongorora dzehunyanzvi zvichienderana nemamiriro ezvinhu uye kurudzira mibvunzo yeongororo inoda kumwe kuongororwa;(3) Ita chirwere cheukoti.Muchiitiko ichi, zvinodikanwa kusanganisa nyaya yekutsvaga database;rekodhi inonangwa yekupindira kwehukoti ine chekuita nemurwere;(4) Kurukurai matambudziko aripo mukuzvibata kwemurwere, pamwe chete nenzira dzemazuva ano uye zvinyorwa zvekutevera murwere pakubuda.Tumira nyaya dzevadzidzi uye rondedzero yebasa mazuva maviri pamberi pekirasi.Rondedzero yebasa renyaya iyi ndeyotevera: (1) Ongorora uye simbisa ruzivo rwedzidziso nezve etiology uye kliniki zviratidzo zve lumbar intervertebral disc herniation;(2) Gadzira chirongwa chakanangwa chekuchengetedza;(3) Gadzira iyi nyaya yakavakirwa pabasa rekiriniki uye shandisa preoperative uye postoperative kuchengetedza ndiwo maviri makuru mamiriro ekudzidzisa purojekiti simulation.Vanamukoti vakazvimiririra vanoongorora kosi zvirimo nemibvunzo yekudzidzira, bvunza mabhuku akakodzera uye dhatabhesi, uye zadzisa mabasa ekuzvidzidza nekupinda muboka reWeChat.
Vadzidzi vanoumba mapoka vakasununguka, uye boka rinosarudza mutungamiri weboka ane basa rekuparadzanisa vashandi uye kuronga chirongwa.Mutungamiriri weboka repamberi ane basa rekuparadzira zvinyorwa zvina: sumo yenyaya, kuita hurongwa hwehukoti, dzidzo yehutano, uye ruzivo rwechirwere kune nhengo yega yega yechikwata.Munguva yekudzidzira, vadzidzi vanoshandisa nguva yavo yemahara kutsvagisa theoretical kumashure kana zvinhu kugadzirisa matambudziko enyaya, kuita nhaurirano dzechikwata, nekuvandudza hurongwa hweprojekiti.Mukuvandudza chirongwa, mudzidzisi anobatsira mutungamiri wechikwata mukugovera nhengo dzechikwata kuronga ruzivo rwakakodzera, kugadzira uye kugadzira mapurojekiti, kuratidza nekugadzirisa magadzirirwo, uye kubatsira vadzidzi vanoyamwisa mukubatanidza ruzivo rune chekuita nebasa mukugadzira nekugadzira.Wana ruzivo rwemodule yega yega.Matambudziko nemapoinzi akakosha eboka iri rekutsvagisa akaongororwa uye akagadziridzwa, uye chirongwa chekushandisa chemuenzaniso weboka iri rekutsvaga chakaitwa.Muchikamu ichi, vadzidzisi vakarongawo zviratidziro zvehukoti.
Vadzidzi vanoshanda mumapoka madiki kupa mapurojekiti.Kutevera mushumo uyu, dzimwe nhengo dzeboka nenhengo dzefekisheni dzakakurukura nekutaura nezveboka rekuzivisa kuti vawedzere kuvandudza chirongwa chekuchengeta vanamukoti.Mutungamiriri wechikwata anokurudzira nhengo dzechikwata kutevedzera maitiro ese ekuchengeta, uye mudzidzisi anobatsira vadzidzi kuongorora shanduko ine simba yechirwere kuburikidza nekuita inoedzesera, kudzamisa kunzwisisa kwavo nekuvaka ruzivo rwedzidziso, uye kukudziridza hunyanzvi hwekufunga.Zvese zvirimo zvinofanirwa kupedzwa mukuvandudzwa kwezvirwere zvakasiyana zvinopedzwa pasi pekutungamirwa kwevadzidzisi.Vadzidzisi vanotsinhira uye kutungamira vadzidzi vanoyamwisa kuti vaite kudzidzira padivi pemubhedha kuti vawane musanganiswa weruzivo uye maitiro ekiriniki.
Mushure mekuongorora boka rega rega, mudzidzisi akataura uye akacherechedza simba uye kusasimba kwenhengo yeboka rimwe nerimwe muhurongwa hwezvinyorwa uye maitiro eunyanzvi kuti varambe vachivandudza manzwisisiro evadzidzi mukoti pazviri pakudzidza.Vadzidzisi vanoongorora hunhu hwekudzidzisa uye nekunatsiridza makosi akavakirwa pakuongororwa kwemudzidzi wehukoti uye dzidziso dzekudzidzisa.
Vanamukoti vanotora bvunzo uye bvunzo dzekuita mushure mekudzidziswa kwekuita.Mibvunzo yedzidziso yekupindira inobvunzwa nemudzidzisi.Mapepa ekupindira akakamurwa kuva mapoka maviri (A uye B), uye rimwe boka rinosarudzwa kuti ripindire.Mibvunzo yekupindira yakakamurwa kuita zvikamu zviviri: ruzivo rwehunyanzvi hwedzidziso uye kuongorora nyaya, imwe neimwe yakakosha makumi mashanu mapoinzi ezvibodzwa zvezana.Vadzidzi, pavanenge vachiongorora unyanzvi hwekuyamwisa, vachasarudza chimwe chezvinotevera, kusanganisira axial inversion technique, nzira yakanaka yekuisa nhengo kune varwere vane kukuvara kwemusana, kushandiswa kwepneumatic therapy technique, nzira yekushandisa CPM joint rehabilitation machine, nezvimwewo. zvibodzwa zvibodzwa zana.
Musvondo rechina, Kuzvimiririra Kudzidza Assessment Scale kuchaongororwa mazuva matatu kosi isati yapera.Chiyero chekuzvimiririra chekuongorora chekugona kudzidza chakagadzirwa naZhang Xiyan [18] chakashandiswa, kusanganisira kukurudzira kudzidza (8 zvinhu), kuzvidzora (11 zvinhu), kugona kudyidzana mukudzidza (5 zvinhu), uye ruzivo kuverenga (6 zvinhu) .Chinhu chimwe nechimwe chakayerwa pachiyero che 5-point Likert kubva "hachisi kuenderana" kusvika "kunyatsoenderana," ine zvibodzwa kubva pa1 kusvika ku5. Nhamba yese ndeye 150. Kukwirisa zvibodzwa, ndiko kusimba kwekugona kudzidza wakazvimirira. .Iyo Cronbach's alpha coefficient yechiyero ndeye 0.822.
Muvhiki yechina, chiyero chekufunga chekufunga kwakaongororwa mazuva matatu asati asunungurwa.Shanduro yeChinese yeCritical Thinking Ability Assessment Scale yakashandurwa naMercy Corps [19] yakashandiswa.Iine mativi manomwe: kuwanikwa kwechokwadi, kufunga kwakazaruka, kugona kuongorora uye kugona kuronga, iine zvinhu gumi muchikamu chimwe nechimwe.Chikero che6-point chinoshandiswa kubva pa "kupikisa zvakasimba" kusvika "kubvumirana zvakasimba" kubva pa1 kusvika ku6, zvichiteerana.Mashoko asina kunaka ari reverse anowanikwa, ane nhamba yose kubva ku70 kusvika ku420. Nhamba yose ye ≤210 inoratidza kushanda kusina kunaka, 211-279 inoratidza kusarerekera kwekuita, 280-349 inoratidza kushanda kwakanaka, uye ≥350 inoratidza simba rakasimba rokufunga.Iyo Cronbach's alpha coefficient yechiyero ndeye 0.90.
Muvhiki yechina, kuongororwa kwehutano hwekliniki kuchaitika mazuva matatu vasati vasunungurwa.Iyo mini-CEX chiyero chakashandiswa muchidzidzo ichi chakatorwa kubva kuMedical Classic [20] zvichibva pane mini-CEX, uye kukundikana kwakapihwa kubva pa1 kusvika ku3 mapoinzi.Inosangana nezvinodiwa, 4-6 mapoinzi ekusangana zvinodiwa, 7-9 mapoinzi ezvakanaka.Vadzidzi vezvokurapa vanopedza kudzidziswa kwavo mushure mekupedza hunyanzvi hwekuita internship.Iyo Cronbach's alpha coefficient yechiyero ichi i0.780 uye kupatsanurwa-hafu yekuvimbika coefficient i0.842, ichiratidza kuvimbika kwakanaka.
Musvondo rechina, zuva risati rabuda mubazi iri, pakaitwa symposium yevadzidzisi nevadzidzi uye ongororo yemhando yekudzidzisa.Fomu rekuongorora unhu hwekudzidzisa rakagadzirwa naZhou Tong [21] uye rinosanganisira zvinhu zvishanu: maitiro ekudzidzisa, kudzidzisa zvirimo, uye kudzidzisa.Nzira, mhedzisiro yekudzidziswa uye maitiro ekudzidziswa.A 5-point Likert scale yakashandiswa.Kuwanda kwezvibodzwa, ndikowo kunaka kwekudzidzisa.Yakapedzwa mushure mekupedza specialized internship.Mibvunzo ine kuvimbika kwakanaka, neCronbach's alpha yechikero ichiva 0.85.
Data yakaongororwa pachishandiswa SPSS 21.0 statistical software.Chiyero che data chinoratidzwa sechinoreva ± chiyero chakatsauka (\(\ rova X \pm S\)) uye boka rekupindira t rinoshandiswa kuenzanisa pakati pemapoka.Nhamba yedata yakaratidzwa sehuwandu hwezviitiko (%) uye zvichienzaniswa nekushandisa chi-square kana kupindira kwaFisher chaiko.A p kukosha <0.05 inoratidza mutsauko wakakosha.
Kuenzanisa kwezvinyorwa zvezvinyorwa uye zvekushanda zvekupindira kwemapoka maviri emukoti interns anoratidzwa muTebhu 2.
Kuenzanisa kwekudzidza kwakazvimirira uye kugona kufunga kwakadzama kwemapoka maviri evanamukoti interns kunoratidzwa muTafura 3.
Kuenzanisa kwekiriniki yekudzidzira kugona kuongorora pakati pemapoka maviri emukoti interns.Kugona kwekiriniki yekuyamwisa kwevadzidzi muboka rekupindira kwaive nani zvikuru kupfuura iyo muboka rekutonga, uye mutsauko waive wakakosha (p <0.05) sezvakaratidzwa muTebhu 4.
Migumisiro yekuongorora hutano hwekudzidzisa kwemapoka maviri yakaratidza kuti huwandu hwekudzidzisa hutano hweboka rekutonga hwakanga huri 90.08 ± 2.34 points, uye huwandu hwehutano hwekudzidzisa hweboka rekupindira raiva 96.34 ± 2.16 points.Musiyano wacho waive wakakosha.(t = – 13.900, p <0.001).
Kubudirira uye kufambira mberi kwemishonga kunoda kuunganidza kwakakwana kwetarenda yezvokurapa.Kunyange zvazvo nzira dzakawanda dzekufananidza uye dzekufananidza dzekudzidzisa dziripo, hadzigone kutsiva tsika yekiriniki, iyo yakanangana nekugona kweramangwana tarenda rekurapa kurapa zvirwere uye kuponesa hupenyu.Kubva pakaitika dambudziko reCCIDID-19, nyika yakawedzera kutarisisa basa rekudzidzisa kwekiriniki yezvipatara zveyunivhesiti [22].Kusimbisa kubatanidzwa kwemishonga uye dzidzo nekuvandudza kunaka uye kubudirira kwekudzidzisa kwekliniki matambudziko makuru anotarisana nedzidzo yezvokurapa.Kuoma kwekudzidzisa orthopedics kuri mumhando dzakasiyana-siyana dzezvirwere, hunyanzvi hwepamusoro uye hunhu husinganzwisisike, izvo zvinokanganisa kutanga, kufarira uye kugona kudzidza kwevadzidzi vekurapa [23].
Iyo yakachinjika nzira yekudzidzisa mukirasi mukati meiyo CDIO yekudzidzisa pfungwa inosanganisa zvekudzidza nemaitiro ekudzidzisa, kudzidza uye kuita.Izvi zvinoshandura chimiro chemakamuri uye zvinoisa vadzidzi vehukoti pamusimboti wekudzidzisa.Munguva yedzidzo, vadzidzisi vanobatsira vadzidzi vanoyamwisa vakazvimiririra kuwana ruzivo rwakakodzera nezvenyaya dzakaoma dzehukoti mune zvakajairika [24].Tsvagiridzo inoratidza kuti CDIO inosanganisira kusimudzira basa uye mabasa ekudzidzisa ekiriniki.Iyo purojekiti inopa yakadzama nhungamiro, inonyatso kusanganisa kubatanidzwa kweruzivo rwehunyanzvi nekuvandudzwa kwehunyanzvi hwekuita basa, uye inoratidza matambudziko panguva yekufananidza, iyo inobatsira vadzidzi vanoyamwisa mukuvandudza kudzidza kwavo kwakazvimirira uye kugona kufunga kwakadzama, pamwe nekutungamira panguva yekuzvimiririra. kudzidza.-kudzidza.Mhedzisiro yechidzidzo ichi inoratidza kuti mushure memavhiki e4 ekudzidziswa, kudzidza kwakazvimiririra uye kugona kufunga kwakadzama huwandu hwevadzidzi vanoyamwisa muboka rekupindira hwakanga hwakanyanya kupfuura avo vari muboka rekutonga (zvose p <0.001).Izvi zvinoenderana nemhedzisiro yeongororo yaFan Xiaoying pamhedzisiro yeCDIO yakasanganiswa neCBL nzira yekudzidzisa mudzidzo yehukoti [25].Iyi nzira yekudzidzisa inogona kuvandudza zvakanyanya kufunga kwakadzama kwevadzidzi uye kugona kudzidza vakazvimiririra.Muchikamu chepfungwa, mudzidzisi anotanga agovera pfungwa dzakaoma nevadzidzi vanoyamwisa mukirasi.Vadzidzi vehukoti vakazodzidza vakazvimiririra ruzivo rwakakodzera kuburikidza nemavhidhiyo-ehurukuro uye vakashinga kutsvaga zvinhu zvakakosha kuti vawedzere kupfumisa manzwisisiro avo ebasa rehukoti.Munguva yekugadzira, vadzidzi vanoyamwisa vakadzidzira kushanda pamwe chete uye hunyanzvi hwekufunga kwakadzama kuburikidza nehurukuro dzeboka, vachitungamirwa nevadzidzisi uye vachishandisa nyaya dzezvidzidzo.Munguva yechikamu chekuita, vadzidzisi vanoona perioperative care yezvirwere-chaiyo-hupenyu semukana uye vanoshandisa nyaya yekufananidza nzira dzekudzidzisa kudzidzisa vadzidzi vanoyamwisa kuti vaite zviitiko zvechiitiko mukubatana kweboka kuti vazvizive uye nekuwana matambudziko mubasa reukoti.Panguva imwe cheteyo, nokudzidzisa zviitiko chaizvoizvo, vadzidzi vanoyamwisa vanogona kudzidza mapfundo makuru etariro yepamberi neyokuvhiyiwa kuitira kuti vanzwisise zvakajeka kuti mativi ose okutarisira perioperative zvinhu zvinokosha mukupora pashure pokuvhiyiwa kwomurwere.Padanho rekushanda, vadzidzisi vanobatsira vadzidzi vezvokurapa kugona dzidziso nehunyanzvi mukuita.Mukuita kudaro, vanodzidza kuona kuchinja kwemamiriro ezvinhu mumamiriro ezvinhu chaiwo, kufunga pamusoro pezvinetso zvinogona kuitika, uye kwete kuyeuka maitiro akasiyana-siyana ehukoti kubatsira vadzidzi vezvokurapa.Iyo nzira yekuvaka nekuita organically inosanganisa zviri mukati mekudzidziswa.Muchirongwa ichi chekudyidzana, chekudyidzana uye neruzivo rwekudzidza, kugona kwevadzidzi vehukoti uye chido chekudzidza zvinofambiswa zvakanaka uye unyanzvi hwavo hwekufunga hwakadzama hunovandudzwa.Vatsvaguri vakashandisa Dhizaini Kufunga (DT) -Conceive-Design-Implement-Operate (CDIO)) kuunza dhizaini yekugadzira mainjiniya mune inopihwa web programming makosi ekuvandudza kugona kwevadzidzi muzvidzidzo uye kugona kufunga (CT), uye mhedzisiro inoratidza, Kuita kwevadzidzi muzvidzidzo uye kugona kufunga kwemakomputa kunovandudzwa zvakanyanya [26].
Chidzidzo ichi chinobatsira vadzidzi vehukoti kuti vatore chikamu muhurongwa hwese zvinoenderana neQuestioning-Concept-Design-Implementation-Operation-Debriefing process.Mamiriro ekiriniki akagadzirwa.Chinotariswa ipapo chiri pakubatana kweboka uye kufunga kwakazvimirira, zvichiwedzerwa nemudzidzisi achipindura mibvunzo, vadzidzi vachipa mhinduro kumatambudziko, kuunganidzwa kwedata, maekisesaizi echiitiko, uye pakupedzisira maekisesaizi epamubhedha.Zvigumisiro zvechidzidzo zvakaratidza kuti nhamba dzevadzidzi vezvokurapa muboka rekupindira pamusoro pekuongororwa kweruzivo rwezvinyorwa uye unyanzvi hwekushanda hwakanga huri nani pane hwevadzidzi vari muboka rekutonga, uye mutsauko waive wakakosha (p <0.001).Izvi zvinopindirana nechokwadi chokuti vadzidzi vezvokurapa muboka rekupindira vaiva nemigumisiro iri nani pakuongorora ruzivo rwezvidzidzo uye unyanzvi hwekushanda.Kuenzaniswa neboka rekutonga, mutsauko waive wakakosha (p <0.001).Yakasanganiswa nemhedzisiro yekutsvaga mhinduro [27, 28].Chikonzero chekuongorora ndechekuti CDIO modhi inotanga kusarudza mapoinzi eruzivo rwechirwere ane huwandu hwezviitiko, uye chechipiri, kuomarara kwezvirongwa zvepurojekiti zvinoenderana nekutanga.Mumuenzaniso uyu, mushure mekunge vadzidzi vapedza zvirimo zvinoshanda, vanopedza bhuku rebasa repurojekiti pazvinenge zvichidiwa, vanodzokorora zvirimo, uye vanokurukura mabasa nenhengo dzeboka kuti vadzeye nekuisa mukati zviri mukati mekudzidza nekubatanidza ruzivo rutsva nekudzidza.Zivo yekare nenzira itsva.Kubatanidzwa kwezivo kunovandudza.
Ichi chidzidzo chinoratidza kuti kuburikidza nekushandiswa kweCDIO yekiriniki yekudzidza modhi, vadzidzi vanoyamwisa muboka rekupindira vaive nani pane vanamukoti muboka rekutonga pakuita kubvunzana kwehukoti, kuongororwa kwemuviri, kuona kuongororwa kwevanamukoti, kuita kupindira kwevanamukoti, uye kutarisira mukoti.migumisiro.uye kutarisirwa kwevanhu.Mukuwedzera, pakanga paine misiyano yakakosha mune imwe neimwe parameter pakati pemapoka maviri (p <0.05), yaive yakafanana nemhedzisiro yeHongyun [29].Zhou Tong [21] akadzidza maitiro ekushandisa iyo Concept-Design-Implement-Operate (CDIO) yekudzidzisa modhi mune yekiriniki yekudzidzira yemoyo nemoyo mukoti kudzidzisa, uye akawana kuti vadzidzi vari muboka rekuyedza vakashandisa CDIO kiriniki tsika.Nzira yekudzidzisa muhukoti, vanhu Maparamita masere, akadai sekugona mukoti uye kungwarira, ari nani zvakanyanya pane aya evadzidzi vehukoti vachishandisa nzira dzechinyakare dzekudzidzisa.Izvi zvinogona kunge zviri nekuti mukudzidza, vadzidzi vehukoti havachagamuchire ruzivo, asi vanoshandisa kugona kwavo.kuwana ruzivo nenzira dzakasiyana-siyana.Nhengo dzechikwata dzinoburitsa zvizere mweya wechikwata chavo, kubatanidza zviwanikwa zvekudzidza, uye kudzokorodza kushuma, kudzidzira, kuongorora, uye kukurukura nyaya dzazvino dzehukoti hwekiriniki.Zivo yavo inokura kubva pamusoro kusvika pakadzika, ichinyanya kutarisisa kune chaiyo yemukati yekuongorora chikonzero.matambudziko ehutano, kuumbwa kwezvinangwa zveukoti uye kugona kwekupindira kwevanamukoti.Faculty inopa gwara uye ratidziro panguva yekukurukurirana kugadzira cyclic kukurudzira kwekuona-tsika-mhinduro, kubatsira vana mukoti kupedzisa zvine musoro maitiro ekudzidza, kuvandudza kugona kwevadzidzi vehukoti maitiro ekiriniki, kuwedzera kufarira kudzidza nekubudirira, uye kuramba vachivandudza tsika yekiriniki yevadzidzi - vanamukoti. ..kugona.Kugona kudzidza kubva padzidziso kudzidzira, kupedzisa kutorwa kwezivo.
Kuitwa kweCDIO-yakavakirwa zvirongwa zvekiriniki dzidzo inovandudza mhando yedzidzo yekiriniki.Mhedzisiro yetsvakiridzo yeDing Jinxia [30] nevamwe inoratidza kuti pane kuwirirana pakati pezvinhu zvakasiyana-siyana sekusimudzira kudzidza, kugona kudzidza kwakazvimirira, uye maitiro ekudzidzisa anoshanda evadzidzisi vekiriniki.Muchidzidzo ichi, nekuvandudzwa kweCDIO dzidziso yekiriniki, vadzidzisi vekiriniki vakagamuchira kudzidziswa kwehunyanzvi, mazano akagadziridzwa ekudzidzisa, uye kugona kudzidzisa kwakavandudzwa.Chechipiri, inopfumisa mienzaniso yedzidziso yekiriniki uye zvemukati zvedzidzo yehukoti, inoratidza kurongeka uye kuita kwemuenzaniso wekudzidzisa kubva pamaonero makuru, uye inosimudzira kunzwisisa kwevadzidzi uye kuchengetedza zvemukati zvekosi.Mhinduro mushure mehurukuro yega yega inogona kukurudzira kuzviziva kwevadzidzisi vekiriniki, kukurudzira vadzidzisi vekiriniki kuti vafunge nezvehunyanzvi hwavo, nhanho yehunyanzvi uye hunhu hwevanhu, kuona zvechokwadi kudzidza kwevezera, uye kuvandudza kunaka kwedzidziso yekiriniki.Zvigumisiro zvakaratidza kuti hutano hwekudzidzisa hwevadzidzisi vekiriniki muboka rekupindira hwakanga huri nani pane huri muboka rekutonga, iro rakanga rakafanana nemigumisiro yekudzidza na Xiong Haiyang [31].
Kunyange zvazvo migumisiro yechidzidzo ichi yakakosha pakudzidzisa kwekiriniki, chidzidzo chedu chichiri nemiganhu yakawanda.Kutanga, kushandiswa kwekureruka sampling kunogona kudzikisira kuwanda kwezviwanikwa izvi, uye sampuli yedu yakaganhurirwa kune chimwe chipatara chepamusoro chepamusoro.Kechipiri, nguva yekudzidziswa imavhiki mana chete, uye mukoti interns vanoda nguva yakawanda yekuvandudza hunyanzvi hwekufunga.Chechitatu, muchidzidzo ichi, varwere vakashandiswa muMini-CEX vaive varwere chaivo vasina kudzidziswa, uye kunaka kwekosi yekudzidzira vanamukoti kunogona kusiyana kubva kumurwere kune murwere.Idzi ndidzo nyaya huru dzinoganhura zvakabuda muongororo iyi.Tsvagiridzo yeramangwana inofanira kuwedzera saizi yemuenzaniso, kuwedzera kudzidziswa kwevadzidzisi vekiriniki, uye kubatanidza zviyero zvekugadzira zvidzidzo zvenyaya.Chidzidzo chenguva refu chinodiwawo kuongorora kana kirasi yakaputsika yakavakirwa papfungwa yeCDIO inogona kukudziridza kugona kwakadzama kwevadzidzi vekurapa munguva refu.
Chidzidzo ichi chakagadzira modhi yeCDIO mukugadzira kosi yevadzidzi vemapfupa evanamukoti, yakavaka kirasi yakachinjika zvichibva pane pfungwa yeCDIO, ndokuisanganisa nemini-CEX yekuongorora modhi.Mhedzisiro yacho inoratidza kuti kirasi yakachinjika yakavakirwa pane yeCDIO pfungwa haingogadzirise mhando yedzidziso yekiriniki, asi zvakare inovandudza kugona kwevadzidzi vakazvimiririra pakudzidza, kufunga kwakadzama, uye kugona kwekiriniki.Iyi nzira yekudzidzisa yakavimbika uye inoshanda pane zvechinyakare hurukuro.Zvinogona kugumiswa kuti mhedzisiro yacho inogona kuve nezvainoreva kune dzidzo yezvokurapa.Imba yekirasi yakachinjika, yakavakirwa papfungwa yeCDIO, inotarisa pakudzidzisa, kudzidza uye zviitiko zvinoshanda uye inosanganisa kubatanidzwa kweruzivo rwehunyanzvi nekuvandudzwa kwehunyanzvi hunoshanda kugadzirira vadzidzi basa rekiriniki.Tichifunga kukosha kwekupa vadzidzi mukana wekutora chikamu nesimba mukudzidza nekuita, uye tichifunga nezvese zvinhu, zvinokurudzirwa kuti modhi yekudzidza yekiriniki yakavakirwa paCDIO ishandiswe muzvidzidzo zvekurapa.Iyi nzira inogonawo kukurudzirwa senzira itsva, inonangana nevadzidzi pakudzidzisa kwekiriniki.Pamusoro pezvo, zvakawanikwa zvichabatsira zvakanyanya kune vanogadzira mitemo nemasainzi pavanenge vachigadzira nzira dzekuvandudza dzidzo yekurapa.
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