通讯作者: 张永宏, zhangyh@ccmu.edu.cn

DOI：10.12201/bmr.202610.00044

Application evaluation of Rain Classroom-supported tiered-prompt virtual case teaching for antimicrobial use decision-making training

• 摘要：目的 探讨传染病虚拟仿真教学在临床见习中的应用价值，分析见习生在病例判断、提示后修正及新病例任务中的表现。方法 采用回顾性教学研究及单组自身配对评价设计，纳入2026年首都医科大学2023级临床医学专业“5+3”一体化及五年制四个班的132名见习学生。学生完成百日咳和新型冠状病毒感染虚拟仿真教学后，依次完成两项含流感鉴别诊断的病例题，以抗菌药物使用判断为评价节点，组织原病例独立首答、分层提示、教师复盘及新病例独立作答。采用McNemar精确检验比较两次作答正确率，报告正确率差值及95%置信区间（confidence interval，CI）；补充关键比例的Wilson区间估计及缺失结果极端情形敏感性分析。结果 原病例首次答对59名（44.7%），答错73名（55.3%）；首次答错者中57名在两层提示内改对，累计改对率为78.1%（95%CI：67.3%～86.0%），16名需教师介入。128名完成两项任务，原病例首次正确率为45.3%，新病例正确率为57.8%，差值为12.5个百分点（95%CI：?0.1～25.1个百分点，P=0.072）；由错转对43名，由对转错27名。对4名缺失新病例结果者进行极端情形分析，全体132名学生的正确率差值范围为11.4～14.4个百分点。结论 传染病虚拟仿真教学可将病例判断、分层反馈与教师复盘衔接，呈现见习生的判断修正及相近病例作答变化，为针对性教学指导与形成性评价提供依据。

  关键词： 传染病学；虚拟仿真；临床见习；病例教学；形成性评价; ; ; ; ; 

   

  Abstract: Objective To explore the educational application of Rain Classroom-supported tiered-prompt virtual case teaching for antimicrobial use decision-making training among clinical clerkship students, and to evaluate students'' performance across the initial response, prompted correction and new-case transfer task. Methods A single-group educational application study with a paired process-evaluation design was conducted. A total of 512 students who participated in infectious diseases teaching and completed the initial response to the original virtual case during the spring-summer rotation of the 2026 academic year in Beijing Youan Hospital, Capital Medical University were included, including 312 five-year-program students and 200 students in the “5+3” integrated program. The teaching process focused on the decision node of antibiotic use in an influenza case and followed the sequence of independent first response, tiered prompts, teacher debriefing and a new-case transfer task. The primary outcome was the paired difference in accuracy between the new-case task and the initial response to the original case. Results In the original case, 243 students (47.5%) answered correctly at the first attempt and 269 (52.5%) answered incorrectly. Among those with an incorrect first response, 221 (82.2%) corrected their answers within two tiers of prompts, and 48 (9.4%) required teacher debriefing. Among the 496 students who completed both tasks, the accuracy was 47.8% for the initial response and 55.0% for the new case, with an absolute difference of 7.3 percentage points (95%CI: 1.1-13.4 percentage points, P=0.025). A total of 140 students (28.2%) changed from incorrect to correct, whereas 104 (21.0%) changed from correct to incorrect. The questionnaire response rate was 93.6% (479/512), and the questionnaire data were used only for classroom feedback description. Conclusion Rain Classroom-supported tiered-prompt virtual case teaching can capture errors, prompt responsiveness and transfer-task performance in antimicrobial use decision-making training, providing process data for infectious diseases teaching and debriefing. Given the single-group design and the absence of strict equivalence testing between cases, the paired results should be interpreted as changes in classroom task performance.

  Key words: Infectious diseases; Rain Classroom; virtual case; tiered prompts; paired comparison; medical education

  提交时间：2026-10-19

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• 序号	提交日期	编号	操作
  1	2026-09-27	10.12201/bmr.202610.00044V1	下载

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