The Impact of a Three-phase School-Based Rehabilitation Outpatient Clinical Internship Model on the Clinical Practice Skills and Employment Intentions of Physical Therapy Students
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摘要:
目的 探究校内康复门诊的临床见习模式对物理治疗专业学生临床实践能力和就业意向的影响。 方法 选取昆明医科大学2020级康复物理治疗专业60名学生为研究对象，大二上学期根据随机原则分为校内康复门诊三阶段式临床见习组（n = 30）和常规临床见习组（n = 30）。三阶段式临床见习组按照培养目标在校内康复门诊完成三阶段的临床见习，常规临床见习组根据见习大纲要求完成临床见习。在全部临床见习结束时使用专业核心课程理论综合考试、物理治疗临床实践评估量表（APP）、就业意向调查表对两组进行临床见习后效果的评估。 结果 两组在完成所有见习任务后，专业核心课程理论综合考分数比较，差异无统计学意义（P > 0.05）。两组物理治疗临床实践评估总分比较，差异无统计学意义（P > 0.05）。细分评估中专业行为、沟通、评估三阶段见习组优于常规组（P < 0.05）。两组分析和计划、干预、循证实践、风险管理比较，差异无统计学意义（P > 0.05）。就业意向调查三阶段见习组70%的学生愿意到康复门诊或诊所工作，而常规组只有46.6%，两组就业意向比较，差异有统计学意义（P < 0.05）。 结论 校内康复门诊的三阶段见习模式不仅可提高学生的临床实践能力，并增加学生到康复门诊或诊所就业信心，从而可拓宽康复物理治疗专业学生的就业途径。 Abstract:Objective To explore the impact of the clinical internship model at the on-campus rehabilitation outpatient clinic on the clinical practice abilities and employment intentions of students in the physical therapy program. Methods A total of 60 students from the 2020 cohort of the Rehabilitation Physical Therapy program at Kunming Medical University were selected as research subjects. In the first semester of their sophomore year, they were randomly divided into two groups: the three-phase clinical internship group at the on-campus rehabilitation outpatient clinic （n = 30） and the conventional clinical internship group （n = 30）. The three-phase clinical internship group completed their clinical internship in three phases according to the training objectives at the on-campus rehabilitation outpatient clinic, while the conventional clinical internship group completed their internship according to the requirements of the internship syllabus. At the end of all clinical internships, assessments were conducted using a comprehensive theoretical examination of core professional courses, the Assessment of Physiotherapy Practice （APP）, and an employment intention survey to evaluate the outcomes of the internships for both groups. Results After completing all internship tasks, there was no statistically significant difference in the scores of the comprehensive theoretical examination of core professional courses between the two groups （P > 0.05）. Similarly, there was no statistically significant difference in the total scores of the physiotherapy clinical practice assessment between the two groups （P > 0.05）. However, in the detailed assessments, the three-phase internship group outperformed the conventional group in professional behavior, communication, and evaluation （P < 0.05）. There were no statistically significant differences between the two groups in analysis and planning, intervention, evidence-based practice, and risk management （P > 0.05）. In the employment intention survey, 70% of students in the three-phase internship group expressed a willingness to work in rehabilitation outpatient clinics or clinics, while only 46.6% of the conventional group did so. The comparison of employment intentions between the two groups showed a statistically significant difference （P < 0.05）. Conclusion The three-phase apprenticeship model of the on-campus rehabilitation clinic not only improves students' clinical practice ability, but also increases their confidence in seeking employment in the rehabilitation clinic, thus broadening the employment pathway for physiotherapy students. -
表 1 传统临床见习模式
Table 1. Traditional clinical clerkship model
见习目标 见习内容 问诊 从病史和临床病例记录中获取相关信息，
运用适当的问诊技巧获取疾病的相关资料。评估 采用适当和安全的物理评估获取相关信息，确定每个患者中特定的问题，识别在主观和客观检查中的黄旗和红旗征，能熟练掌握常规的客观评估方法。 治疗计划
制定能根据患者的功能损伤和障碍制定长短期目标，制定并实施有效和安全的干预措施，并有助于改善患者的生活质量。评估干预措施的有效性，必要时可修订干预措施。 
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表 2 校内康复门诊三阶段式见习
Table 2. Three-phase clerkship in the on-campus rehabilitation clinic
年级 见习目标 见习内容 大二 熟悉临床环境、观察并协助患者的治疗流程照护、练习病案记录与病史采集等 包括诸如采集生命体征、测量关节活动范围、物理因子治疗、监督锻炼计划或协助功能性活动等任务，练习记录病史和治疗进度。 大三
上学期提高学生的专业技能，培养学生的临床推理与决策能力 由带教老师完成初步评估，学生参与协助与观察，并与带教老师共同制定患者的治疗计划和目标。 大三
下学期继续加强专业技能与临床推理及决策能力，同时培养批判性思维与团队协作能力 学生参与协助为患者提供评估、治疗、宣教、再评估、出院计划、转介等一系列服务。带教老师提出临床争议，并要求学生提供循证证据，最后为所治疗的患者确定相关的效果指标。
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表 3 学生一般资料比较 （$ \bar x \pm s $）
Table 3. Comparison of students' general information （$ \bar x \pm s $）
组别 n 性别
（男/女）年龄（岁） 医学课程综合
考试成绩（分）三阶段见习组 30 14/16 19.86 ± 0.34 84.80 ± 7.64 常规见习组 30 13/17 19.73 ± 0.44 84.66 ± 8.24 χ2/t 0.067 1.287 0.065 P 0.785 0.203 0.948
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表 4 专业核心课程综合考试成绩[ （$ \bar x \pm s $），分]
Table 4. Professional core curriculum comprehensive examination results [（$ \bar x \pm s $），score]
组别 n 实习前理论考核成绩 三阶段见习组 30 72.36 ± 8.01 常规见习组 30 69.13 ± 9.31 x2/t 1.441 P 0.155
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表 5 两组物理治疗专业临床实践评估比较[ （$ \bar x \pm s $），分]
Table 5. Comparison of clinical practice evaluation of physical therapy between two groups [（$ \bar x \pm s $），score]
类别 三阶段见习组 常规见习组 t P 7个项目总分 95.73 ± 4.96 92.51 ± 8.94 1.715 0.092 专业行为 19.53 ± 0.89 18.68 ± 1.94 2.148 0.036* 沟通 9.53 ± 0.68 8.86 ± 1.27 2.535 0.014* 评估 14.36 ± 1.09 13.62 ± 1.61 2.083 0.042* 分析和计划 19.10 ± 1.18 18.72 ± 1.50 1.066 0.291 干预 23.80 ± 1.73 23.55 ± 2.52 0.441 0.661 循证实践 4.60 ± 0.72 4.31 ± 0.80 1.453 0.152 风险管理 4.63 ± 0.66 4.55 ± 0.73 0.446 0.657 *P < 0.05。
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表 6 两组就业意向比较 [n（%）]
Table 6. Comparison of employment intention between the two groups [n（%）]
意向 三阶段见习组 常规见习组 Z P 愿意 21（70.0） 14（46.6） −2.091 0.037* 中立 7（23.3） 8（26.7） 不愿意 2（6.7） 8（26.7） *P < 0.05。
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<thead>
<tr>
<td class="table_top_border table_bottom_border2" style="width:20%" align="left" valign="middle">见习目标</td>
<td class="table_top_border table_bottom_border2" align="center" valign="middle">见习内容</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="middle">问诊</td>
<td style="padding-left:3pt;" align="left" valign="middle">从病史和临床病例记录中获取相关信息，<br>运用适当的问诊技巧获取疾病的相关资料。</td>
</tr>
<tr>
<td align="left" valign="middle">评估</td>
<td style="padding-left:3pt;" align="left" valign="middle">采用适当和安全的物理评估获取相关信息，确定每个患者中特定的问题，识别在主观和客观检查中的黄旗和红旗征，能熟练掌握常规的客观评估方法。</td>
</tr>
<tr>
<td class="table_bottom_border" align="left" valign="middle">治疗计划<br>制定</td>
<td class="table_bottom_border" style="padding-left:3pt;" align="left" valign="middle">能根据患者的功能损伤和障碍制定长短期目标，制定并实施有效和安全的干预措施，并有助于改善患者的生活质量。评估干预措施的有效性，必要时可修订干预措施。</td>
</tr>
</tbody>
</table></div></foreignObject></svg>)
