探究病例讨论在神经内科住院医师规范化培训（简称“住培”）中的应用价值与实践效果。

选取2023年1月至2024年1月哈尔滨医科大学附属第一医院神经内科住培的住院医师作为研究对象，并随机分为试验组（16人）和对照组（16人）。对照组仅实施常规培训（理论授课、临床带教、技能操作训练）；试验组在常规培训的基础上增加病例讨论（每月1次，涵盖多发性硬化、自身免疫性脑炎、视神经脊髓炎谱系疾病等典型病例，含病例汇报、自由讨论、总结点评3个环节，同时年终组织进行病例汇报年会）。通过理论考核、临床技能考核、病例分析能力评估、问卷调查及1年追踪随访，对比2组住院医师的培训效果。所有考核评分由未参与分组及教学的神经内科副主任医师采用“双盲法”独立完成。通过SPSS 26.0软件，采用独立样本t检验和χ²检验进行组间的统计分析。

试验组住院医师的理论考核和临床技能考核平均分分别为（89.54±6.22）和（91.23±5.81）分，均显著高于对照组的（78.29±7.51）和（82.14±6.68）分，差异均有统计学意义（t=4.624、4.117，P均＜0.001）。试验组住院医师的病例分析能力优秀率为81.25%（13/16），显著高于对照组的43.75%（7/16），差异有统计学意义（χ²=4.800，P=0.028）。在住培结束后1年，试验组住院医师的独立处理病例比例为87.50%（14/16），显著高于对照组的50.00%（8/16），差异有统计学意义（χ²=5.236，P=0.022）。在问卷调查中，试验组住院医师的临床思维[（4.42±0.54）分 vs（3.52±0.62）分]、团队协作[（4.51±0.44）分 vs（3.72±0.64）分]、知识拓展[（4.55±0.40）分 vs（3.75±0.68）分]、学习兴趣[（4.51±0.44）分 vs（3.61±0.66）分]、职业认同感[（4.31±0.59）分 vs（3.41±0.72）分]评分均显著高于对照组，差异均有统计学意义（t=4.377、4.102、4.052、4.508、3.892，P均＜0.001）。

与传统教学方法相比，每月1次病例讨论能有效提升神经内科住培医师的理论水平、临床技能、临床思维能力及临床决策能力。

To explore the application value and practical effect of case discussion in the standardized training of resident physicians in the department of neurology.

Resident physicians undergoing standardized training in the Department of Neurology at the First Affiliated Hospital of Harbin Medical University from January 2023 to January 2024 were randomly divided into a treatment group (n=16) and a control group (n=16). The control group only received conventional training, including theoretical lectures, clinical teaching, and skill operation training. On the basis of conventional training, the treatment group additionally conducted monthly case discussions, covering typical cases such as multiple sclerosis, autoimmune encephalitis, and neuromyelitis optica spectrum disorders. Each case discussion included case report, free discussion, and summary comments. Meanwhile, an annual case report meeting was held. The training effects were compared through theoretical assessment, clinical skill assessment, case analysis ability evaluation, questionnaire survey, and a 1-year follow-up. All assessment scores were independently scored by associate chief physicians using a double-blind method. Statistical analysis between the two groups was performed using independent samples t-test and chi-square test with SPSS 26.0 software.

Compared to control group, the treatment group showed significantly higher average scores in theoretical assessment (89.54±6.22 vs 78.29±7.51, t=4.624, P<0.001) and clinical skill assessment (91.23±5.81 vs 82.14±6.68, t=4.117, P<0.001). The excellent rate of case analysis ability was 81.25% (13/16) in the treatment group versus 43.75% (7/16) in the control group (χ²=4.800, P=0.028). After 1 year of follow-up, the proportion of resident physicians independently handling cases was 87.50% (14/16) in the treatment group versus 50.00% (8/16) in the control group (χ²=5.236, P=0.022). In the questionnaire survey, the scores of clinical thinking (4.42±0.54 vs 3.52±0.62), teamwork (4.51±0.44 vs 3.72±0.64), knowledge expansion (4.55±0.40 vs 3.75±0.68), learning interest (4.51±0.44 vs 3.61±0.66), and professional identity (4.31±0.59 vs 3.41±0.72) of resident physicians in the treatment group were significantly higher than those in the control group, with statistically significant differences (t=4.377, 4.102, 4.052, 4.508, 3.892; all P＜0.001).

Compared with traditional teaching methods, monthly case discussions can effectively improve the theoretical level, clinical skills, clinical thinking, and clinical decision-making ability of resident physicians receiving standardized training in neurology residents.