模拟训练对医学专业最后一年学生识别和处理急性耳鼻喉科急症自我报告信心的影响

文献信息

中文摘要

背景： 本科阶段对耳鼻喉科（ENT）急症的接触有限，新取得资格的医生尽管感到准备不足，仍可能遇到急性耳鼻喉科表现。基于模拟的教育提供了一个结构化环境，学习者可在其中练习急症评估和处理。
目的： 评估专门的耳鼻喉科急症模拟课程对医学专业最后一年学生识别和处理急性耳鼻喉科急症自我报告信心的即时影响。
方法： 在16周内开展了一项前瞻性干预前后评估，涉及110名正在接受耳鼻喉科实习的最后一年医学生。学生参与了三个模拟急症场景：鼻出血、会厌炎和扁桃体切除术后出血。使用单项五点Likert条目在干预前和干预后立即评估自我报告信心。由于问卷为匿名且回答无法在参与者层面匹配，干预前后回答分布采用Mann-Whitney U检验进行比较。对多重比较应用Holm校正，并计算秩双列相关作为效应量指标。
结果： 干预后所有三个场景的自我报告信心均更高。中位信心评分从扁桃体切除术后出血的3（MAD 1）升至4（MAD 0），鼻出血从2（MAD 1）升至4（MAD 0），会厌炎从2（MAD 0）升至4（MAD 0）。Holm校正后所有比较仍具有统计学显著性，且秩双列效应量大：扁桃体切除术后出血 r_rb=0.849（95% CI 0.785-0.898），鼻出血 r_rb=0.940（95% CI 0.891-0.970），会厌炎 r_rb=0.948（95% CI 0.899-0.975）。
结论： 结构化的耳鼻喉科急症模拟课程与识别和启动处理三种急性耳鼻喉科表现后即时自我报告信心更高相关。需要进一步开展纳入客观表现指标、对照组合和纵向随访的研究，以确定这些发现是否能转化为临床能力的持续改善。

英文摘要

BACKGROUND: Undergraduate exposure to ear, nose and throat (ENT) emergencies is limited, and newly qualified doctors may encounter acute ENT presentations despite feeling underprepared. Simulation-based education provides a structured environment in which learners can practise emergency assessment and management.
AIM: To evaluate the immediate impact of a dedicated ENT emergency simulation session on final-year medical students' self-reported confidence in recognising and managing acute ENT emergencies.
METHODS: A prospective pre- and post-intervention evaluation was conducted over 16 weeks involving 110 final-year medical students undertaking an ENT placement. Students participated in three simulated emergency scenarios: epistaxis, supraglottitis and post-tonsillectomy haemorrhage. Self-reported confidence was assessed immediately before and after the intervention using individual five-point Likert items. As questionnaires were anonymous and responses could not be matched at participant level, pre- and post-intervention response distributions were compared using the Mann-Whitney U-test. Holm adjustment was applied for multiple comparisons, and rank-biserial correlation was calculated as an effect-size measure.
RESULTS: Post-intervention self-reported confidence was higher across all three scenarios. Median confidence scores increased from 3 (MAD 1) to 4 (MAD 0) for post-tonsillectomy haemorrhage, from 2 (MAD 1) to 4 (MAD 0) for epistaxis, and from 2 (MAD 0) to 4 (MAD 0) for supraglottitis. All comparisons remained statistically significant after Holm adjustment, with large rank-biserial effect sizes: post-tonsillectomy haemorrhage r_rb=0.849 (95% CI 0.785-0.898), epistaxis r_rb=0.940 (95% CI 0.891-0.970), and supraglottitis r_rb=0.948 (95% CI 0.899-0.975).
CONCLUSIONS: A structured ENT emergency simulation session was associated with higher immediate self-reported confidence in recognising and initiating management of three acute ENT presentations. Further studies incorporating objective performance measures, comparator groups and longitudinal follow-up are required to determine whether these findings translate into sustained improvements in clinical competence.