目的 探索基于布鲁姆知识分类法的外科重症患者围手术期营养管理教学模式,优化临床诊疗流程并展开教学实践活动,提高住院医师规范化培训(简称住培)学员临床相关能力。方法 依据《布鲁姆教育目标分类学(修订版)》事实性、概念性、程序性、元认知知识4维分类体系,结合外科重症患者围手术期营养管理特点,构建其系统化教学方案;2025年对2022至2024级首都医科大学附属北京同仁医院外科和重症医学科住培基地学员40名开展教学实践并评价效果。结果 临床案例与四维知识有机融合的教学实践,使住培学员在营养疗法系统化掌握、临床逻辑思维构建及自主学习能力方面均获显著提升。结论 基于布鲁姆知识分类法的营养相关诊疗设计可精准对接外科重症患者的临床营养需求,通过四维知识结构化整合与针对性临床营养疗法的教学实施超过90%学员理解“外科危重症围手术期营养”等关键概念(P<0.05);学员对课程基本知识了解程度较课前也有明显提高(P<0.001);75%学员掌握“实施布鲁姆知识体系教学法的基本步骤”等核心内容(P<0.001)。布鲁姆知识分类法为外科危重症的临床实践与教学提供了可复制、可推广的参考。
Abstract
Objective To explore a perioperatively nutritional management model for surgical critically ill patients based on Bloom's Taxonomy, optimizing clinical diagnosis and treatment processes, conduct teaching practices to standardize nutritional therapy procedures and enhance the clinical competencies of standardized residency training trainees. Method Based on the four-dimensional classification system of factual knowledge, conceptual knowledge, procedural knowledge, and metacognitive knowledge from the Bloom Taxonomy of Educational Goals (Revised Edition), and tailored to the characteristics of surgical critically ill patients, a systematic clinical nutrition treatment approach was constructed and implemented. In 2025, a teaching practice was conducted among 40 surgical and critical care residency trainees (grades 2022-2024) at Beijing Tongren Hospital, Capital Medical University, and the teaching outcomes were evaluated. An evaluation system consisting of formative assessment, summative assessment and qualitative assessment was applied to assess the teaching outcomes. Result Through the integration of clinical cases with the four-dimensional knowledge framework in the diagnosis, treatment, and teaching of surgical critical illness, the model effectively addresses issues such as fragmented knowledge and weak clinical reasoning regarding nutritional therapy. Trainees demonstrated significant improvement systematically mastering nutritional therapy, developing relevant clinical reasoning skills, and enhancing autonomous learning abilities. Conclusion Nutrition-related diagnosis and treatment planning based on Bloom's Taxonomy of Educational Objectives can precisely match the clinical nutritional needs of critically ill surgical patients. Following the structured integration of four-dimensional knowledge and the delivery of targeted clinical nutrition therapy training, more than 90% of participants grasped key concepts including "perioperative nutrition for critically ill surgical patients" (P<0.05). Their mastery of basic course knowledge improved significantly compared with pre-class levels (P<0.001), and 75% of learners mastered core content such as "fundamental procedures for implementing teaching based on Bloom's Taxonomy" (P<0.001). Bloom's Taxonomy provides a replicable and promotable reference for clinical practice and teaching in critical surgical care.
关键词
布鲁姆知识分类法 /
四维知识体系 /
住院医师规范化培训 /
外科重症 /
营养疗法 /
围手术期 /
临床思维 /
自主学习能力
Key words
Bloom's classification of knowledge /
Four-dimensional knowledge /
Standardized residency training /
Surgical critically illness /
Nutritional therapy /
Perioperative period /
Clinical reasoning skills /
Autonomous learning abilities
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基金
2024住院医师规范化培训质量提高项目(住培2024080)
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