Miller金字塔三维一体教学在介入超声住院医师规范化培训学员临床胜任力培养中的探索

韦力; 王利; 周军; 周畅; 刘蓉; 刘芸; 张琪

doi:10.3760/cma.j.cn116021-20250705-02123

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Miller金字塔三维一体教学在介入超声住院医师规范化培训学员临床胜任力培养中的探索

住院医师规范化培训 | 更新时间：2025-12-18

- Miller金字塔三维一体教学在介入超声住院医师规范化培训学员临床胜任力培养中的探索
- Application of a Miller's pyramid-based three-dimensional integrated teaching model for clinical competency development in standardized residency training for interventional ultrasound
- 中华医学教育探索杂志 2025年24卷第12期页码：1686-1693
- 作者机构：
  
  1.三峡大学第一临床医学院·宜昌市中心人民医院超声科，宜昌 443003
  2.三峡大学附属第二人民医院超声科，宜昌 443003
- 作者简介：
  
  韦力，Email：wlultrasound@163.com
- 基金信息：
  
  2024年三峡大学高教研究项目(GJ2435);2024年三峡大学研究生教学改革研究项目(SDYJ202420);2024年三峡大学教研项目(J2024093)
- DOI：10.3760/cma.j.cn116021-20250705-02123
  中图分类号： R445.1;R-05
- 收稿：2025-07-05，
  
  纸质出版：2025-12-20
- 稿件说明：
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韦力, 王利, 周军, 等. Miller金字塔三维一体教学在介入超声住院医师规范化培训学员临床胜任力培养中的探索[J]. 中华医学教育探索杂志, 2025, 24(12): 1686-1693.

Wei Li, Wang Li, Zhou Jun, et al. Application of a Miller's pyramid-based three-dimensional integrated teaching model for clinical competency development in standardized residency training for interventional ultrasound[J]. Chinese Journal of Medical Education Research, 2025, 24(12): 1686-1693.
韦力, 王利, 周军, 等. Miller金字塔三维一体教学在介入超声住院医师规范化培训学员临床胜任力培养中的探索[J]. 中华医学教育探索杂志, 2025, 24(12): 1686-1693. DOI： 10.3760/cma.j.cn116021-20250705-02123.

Wei Li, Wang Li, Zhou Jun, et al. Application of a Miller's pyramid-based three-dimensional integrated teaching model for clinical competency development in standardized residency training for interventional ultrasound[J]. Chinese Journal of Medical Education Research, 2025, 24(12): 1686-1693. DOI： 10.3760/cma.j.cn116021-20250705-02123.

摘要

目的

基于Miller金字塔模型构建“知识整合—操作强化—临床协同”三维一体教学模式，通过小样本随机对照试验初步探索其在介入超声住院医师规范化培训学员临床胜任力培养中的效果。

方法

选取三峡大学第一临床医学院2023至2024级40名超声影像专业住院医师规范化培训学员作为研究对象，所有学员先接受3个月传统带教（理论授课+临床跟台），结束后采用客观结构化临床考试（objective structured clinical examination， OSCE）进行首次考核（含5个标准化考站，Cronbach’s

=0.89）。随后在确保性别、学历、入科成绩及首次OSCE成绩基线均衡的前提下，采用分层区组随机化法将学员分为对照组（

=20，继续传统带教）与试验组（

=20，实施三维一体教学干预），干预包括知识整合（每周1次多学科融合课程）、操作强化（每周2次手术模拟穿刺训练和并发症处理应急演练）和临床协同（每周1例PBL-CBL联合案例教学）。干预3个月后进行第2次OSCE考核，比较组间得分及提升幅度差异，并采用Likert 5级量表调查教学满意度。

结果

首次OSCE考核2组总分差异无统计学意义[（60.60±4.50） vs. （60.20±3.33），

=0.751

]

，且性别、学历、入科成绩等基线指标差异无统计学意义；第2次OSCE考核试验组总分显著高于对照组[（84.20±2.80）vs.（73.65±2.82），

0.001

]

，且组间总分提升幅度差异显著[（23.60±4.35） vs. （13.45±3.02），

0.001，Cohen’s

0.8

]

，在并发症处理[（3.40±1.31） vs. （2.45±1.32）

]

和应急处理[（3.50±1.99） vs. （2.30±1.49）

]

考站，试验组较对照组提升明显（均

0.05，0.5

Cohen’s

0.8），在超声引导穿刺[（5.80±1.67） vs. （2.70±1.38）

]

、医患沟通[（5.50±1.15） vs. （3.25±1.92）

]

和综合技能[（5.40±1.64） vs. （2.75±1.77）

]

考站，试验组较对照组提升幅度更明显（均

0.001，Cohen’s

0.8）。满意度调查的整体满意度得分，试验组显著优于对照组[（4.75±0.42） vs. （3.40±0.57），

0.001

]

。

结论

三维一体教学模式通过分层教学设计显著提升介入超声住院医师规范化培训学员临床胜任力，学员满意度高，初步验证了其教学效果。

Abstract

Objective

To preliminarily evaluate the effectiveness of a Miller's pyramid-based three-dimensional integrated teaching model (knowledge integration

skill reinforcement

and clinical collaboration) for clinical competence enhancement in standardized training of interventional ultrasound residents through a randomized control trial with a small sample size.

Methods

We enrolled 40 ultrasound residents undergoing standardized training in the 2023 and 2024 cohorts from The First Clinical Medical College of China Three Gorges University. All the participants received three months of traditional teaching (theoretical lectures + clinical observation)

followed by an initial assessment using an objective structured clinical examination (OSCE) consisting of five standard stations (Cronbach's

=0.89). Subsequently

ensuring baseline equivalence in sex

education level

entry scores

and initial OSCE scores

the participants were divided by stratified block randomization into control group (

=20) to continue to receive traditional teaching and experimental group (

=20) to receive the triad instruction that comprised knowledge integration (multidisciplinary courses once a week)

skill reinforcement (punctur

e simulation and complication management/ emergency response training twice a week)

and clinical collaboration (PBL-CBL case studies once a week). A second OSCE was administered after three months of intervention. OSCE scores and score improvements were compared between the two groups. Teaching satisfaction was surveyed using a 5-point Likert scale.

Results

The two groups showed no significant difference in the initial OSCE score [(60.60±4.50) vs. (60.20±3.33)

=0.751

]

or other baseline indicators (sex

education level

and entry score). The experimental group exhibited a significantly higher post-intervention OSCE score [(84.20±2.80) vs. (73.65±2.82)

0.001

]

and a significantly greater improvement in the overall score [(23.60±4.35) vs. (13.45±3.02)

0.001

Cohen's

0.8

]

compared with the control group. Specifically

significantly greater score increases were achieved in the experimental group in complication management [(3.40±1.31) vs. (2.45±1.32)

0.05

0.5

Cohen's

0.8

]

emergency response [(3.50±1.99) vs. (2.30±1.49)

0.05

0.5

Cohen's

0.8)

ultrasound-guided puncture [(5.80±1.67) vs. (2.70±1.38)

0.001

Cohen's

0.8

]

doctor-patient communication [(5.50±1.15) vs. (3.25±1.92)

0.001

Cohen's

0.8

]

and comprehensive skills [(5.40±1.64) vs. (2.75±1.77)

0.001

Cohen's

0.8

]

. The overall satisfaction score was significantly higher in the experimental group than in the control group [(4.75±0.42) vs. (3.40±0.57)

0.001

]

Conclusions

With a tiered instruction design

the three-dimensional integrated teaching model significantly enhances clinical competencies and achieves high satisfaction among trainees in standardized residency training for interventional ultrasound

preliminarily demonstrating its teaching effectiveness.

关键词

Keywords

references

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