三段反馈法提升实习生临床思维能力效果评价

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中图分类号：G642.44 文献标志码：A 文章编号：2096-3181（2026）01-0172-07

Evaluation of Three-Stage Feedback Method for Enhancing Interns Clinical Thinking Ability

HAN Jin，TIAN Lifang，MA Fangxia，ZHAO Peng，CHEN Zhao，FU Rongguo，WANG Li

Department of Nephrology， the Second Afiliated Hospital of Xi'an Jiaotong University， Xi'an 710004，China

Abstract： Objective To evaluate the training efect of the three-stage feedback method basedon medical record writing on the clinical thinking ability of clinical medicine intems.Methods This study adopted a prospective randomized controlled design，enroling 99 interns majoring in Clinical Medicine in the five-year program who rotated in the Department of Nephrology of the Second Afiliated Hospital of Xi'an Jiaotong University from January 2O23 to December 2O24. The intems were randomly divided into the three-stage feedback group （n=50 ） and the traditional mode group （n=49）. The three-stage feedback group received medical record writing teaching using the“immediate error correction，logical questioning，and demonstration and reconstruction” mode，while the traditional mode group received teaching through the centralized medical record correction mode.Blinded assessors evaluated the quality of the interns’medical record writing at the beginning andend of the rotation，in accordance with the Standards forEvaluating the Qualityof Inpatient Medical Records in Internal Medicine. Results In terms of the total score of medical record quality in the completion of the training，the score of the three-stage feedback group was significantly higher than that of the traditional mode group （90.02±2.15 VS. 86.22±2.24 ， P<0.001 ），and the difference was statistically significant. In terms of the related elements of clinical thinking，the three-stage feedback group obtained significantly higher scores than the traditional mode group in chief complaints （ P<0.001 ），physical examination （ P=0.001 ），summary of medical record （ P<0.001 ），and diagnosis（ P<0.001 ）.Conclusion Through establishing a closed-loop training system of“immediate error correction，logical questioning，and demonstration and reconstruction”，the three-stage fedback method can efectively enhance medical record writing level and clinical thinking ability of medical interns.

Keywords： Clinical internship;Nephrology Department; Medical record writing; Clinical thinking；ThreeStage feedback method

病历作为临床诊疗活动的核心载体，系统记录了患者病史特征、体征演变及辅助检查结果，其书写过程本质上是临床医师运用循证医学思维对疾病现象进行抽象归纳、逻辑推演与决策优化的认知外化[]。（剩余9581字）