CAJ | 학술논문

目的：探讨急诊住院医师临床实践中常用的4种临床决策方法（即模式识别法、假设演绎法、事件驱动法、运用规则法）的应用现状，了解其对临床决策方法掌握的情况及影响因素。方法根据住院医师的不同年制把207名住院医师（收集每个住院医师诊疗过的5例患者）收集的1035例患者分3组，比较不同年制医生的临床决策方法及其诊断正确率和影响因素。结果不同年制医生的决策方法差异有统计学意义（P＜0．05），不同决策方法的诊断正确率差异有统计学意义（P＜0．05），防御行为和不同决策方法差异有统计学意义（P＜0．05）。不同决策方法的多分类Logistic回归分析显示，住院医师年制、住院医师学历、住院医师接触临床时间、住院患者症状、防御行为、问诊可靠程度，差异有统计学意义（P＜0．05）。结论住院医师最常用的临床决策方法为运用规则法；住院医师年制、住院医师学历、住院医师接触临床时间、住院患者症状、防御行为、问诊可靠程度是住院医师在急诊医学专业临床实践中应用临床决策方法的影响因素。
목적：탐토급진주원의사림상실천중상용적4충림상결책방법（즉모식식별법、가설연역법、사건구동법、운용규칙법）적응용현상，료해기대림상결책방법장악적정황급영향인소。방법근거주원의사적불동년제파207명주원의사（수집매개주원의사진료과적5례환자）수집적1035례환자분3조，비교불동년제의생적림상결책방법급기진단정학솔화영향인소。결과불동년제의생적결책방법차이유통계학의의（P＜0．05），불동결책방법적진단정학솔차이유통계학의의（P＜0．05），방어행위화불동결책방법차이유통계학의의（P＜0．05）。불동결책방법적다분류Logistic회귀분석현시，주원의사년제、주원의사학력、주원의사접촉림상시간、주원환자증상、방어행위、문진가고정도，차이유통계학의의（P＜0．05）。결론주원의사최상용적림상결책방법위운용규칙법；주원의사년제、주원의사학력、주원의사접촉림상시간、주원환자증상、방어행위、문진가고정도시주원의사재급진의학전업림상실천중응용림상결책방법적영향인소。
Objective To discuss the current status of application of the four kinds of clinical decision‐making method (mode recognition method ,hypothesis deductive method ,event‐driven method and applying regulation method ) in the clinical practice of the emergency resident doctors and to understand their mastery situation of the clinical decision‐making methods and the influencing factors .Methods One thousand and thirty‐five patients collected by 207 resident doctors (5 cases were randomly collected from the patients diagnosed and treated by each resident doctor ) were divided into 3 groups according to different year systems .The clinical decision‐making methods ,diagnosis accuracy of different clinical decision‐making methods and the influencing factors of decision‐making methods were compared among different grades .Results The difference in the decision‐making methods among different year systems had statistical significance (P<0 .05);furthermore ,the difference in the diagnostic accuracy among different decision‐making methods had statistical significance (P< 0 .05) ,the differences in the defensive behaviors and different decision‐making methods were statistically significant (P<0 .05) ,the multi‐classification Logistic regression of different decision‐making methods showed that the differences in the different residency year system ,residency education ,residency clinical contacting time ,inpatient symptoms ,defensive behaviors and interrogation reliability degree had statistical significance (P< 0 .05) .Conclusion The most commonly used decision‐making method by the resident doctors is the applying regulation method .The residency year system ,resi‐dency education ,residency clinical contacting time ,inpatient symptoms ,defensive behaviors and interrogation reliability degree are the influencing factors of application of the clinical decision‐making methods in the clinical practice of the emergency medicine spe‐cialty .