探讨基于成果导向教育（OBE）理念的三阶段式教学模式在腹腔镜食管裂孔疝修补术（LHHR）进修医师培训中的应用效果。

采用前瞻性随机对照试验设计，纳入2024年6—12月北京朝阳医院疝和腹壁外科的40名进修医师，样本量基于两独立样本均值比较估算，每组20例。通过Fisher-Yates随机数字表（1983版）生成40个不重复的随机编号，并按入组顺序分配，前20例分至传统教学组（n=20），后20例分至OBE教学组（n=20）。传统组采用自主学习＋观摩模式；OBE组实施三阶段递进式培训，每阶段设量化考核。通过理论测试、独立手术完成率、手术时间、术中指标及满意度问卷评估培训效果。

OBE教学组理论考核成绩优于传统教学组（P<0.001），独立完成LHHR的医师比例显著更高（75%比30%，P=0.004），中位手术时间较传统教学组缩短27.5 min（P=0.023）。2组术中出血量、术后住院天数比较，差异无统计学意义（P>0.05），但OBE教学组临床决策能力及教学满意度显著提升（P=0.016）。

OBE理念驱动的三阶段教学模式可显著提高进修医师的LHHR理论水平、独立手术能力及操作效率，其明确的阶段目标与动态反馈机制为专科手术培训提供了标准化路径。

To evaluate the efficacy of a three-stage teaching model based on the Outcome-Based Education (OBE) concept in training resident physicians for laparoscopic hiatal hernia repair (LHHR).

A prospective randomized controlled trial was conducted, enrolling 40 resident physicians at Beijing Chaoyang Hospital Hernia and Abdominal Wall Surgery Center from June to December 2024. Sample size was estimated based on a two-sample mean comparison (α=0.05, power=80%), requiring 20 participants per group. Randomization was performed using the Fisher–Yates random number table (1983 edition) to generate 40 unique numbers (01-40), which were assigned sequentially according to enrollment; the first 20 were allocated to the traditional teaching group (n=20) and the remaining 20 to the OBE group (n=20). The traditional group received conventional training through self-directed learning and observation and the OBE group underwent a three-stage progressive training program. Outcomes were evaluated via theoretical tests, surgery completion rates, operative time, intraoperative metrics, and satisfaction surveys.

The OBE group scored significantly higher in theoretical assessments (P<0.001) and demonstrated significantly higher independent LHHR completion rates (75% vs. 30%, P=0.004) compared to the traditional group. The median operative time in the OBE group was 27.5 minutes shorter (P=0.023). No differences were observed in intraoperative blood loss or postoperative hospitalization (P>0.05). The OBE group reported superior clinical decision-making efficiency and training satisfaction (P=0.016).

The OBE-based three-stage teaching model effectively enhances resident physicians' theoretical mastery, surgical competency, and operative efficiency in LHHR. Its phased objectives and dynamic feedback mechanism establish a standardized framework for specialized surgical training, offering significant clinical implementation potential.