358 lines
17 KiB
Python
358 lines
17 KiB
Python
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from __future__ import annotations
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import json
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import uuid
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from datetime import datetime
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from typing import Any
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from sqlalchemy.orm import Session
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from app.agents.orchestrator import MedicalConsultationOrchestrator
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from app.core.context import UserContext
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from app.core.exceptions import AppError
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from app.models.training import TrainingSession
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from app.models.training_record import TrainingRecord
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from app.repositories.evaluation_repository import EvaluationRepository
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from app.repositories.source_case_repository import SourceCaseRepository
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from app.repositories.teaching_repository import TeachingRepository
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from app.schemas.teaching import (
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CreateTeachingEvaluationRequest,
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TeachingCaseSummary,
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TeachingEvaluationResponse,
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TeachingItemsResponse,
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TeachingOption,
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TeachingQuestion,
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TeachingVideo,
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)
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from app.services.audit_service import AuditService
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from app.services.evaluation_service import EvaluationService
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from app.services.knowledge_service import KnowledgeService
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class TeachingService:
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"""教学互动服务：读取教学题目、提交作答并生成教学互动评价。"""
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def __init__(self, db: Session) -> None:
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self.db = db
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self.repo = TeachingRepository(db)
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self.source_repo = SourceCaseRepository(db)
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self.eval_repo = EvaluationRepository(db)
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self.audit = AuditService(db)
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self.knowledge = KnowledgeService(db)
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self.orchestrator = MedicalConsultationOrchestrator()
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self.evaluation_service = EvaluationService(db)
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def list_items(self, ctx: UserContext, case_id: int) -> TeachingItemsResponse:
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"""教学列表：读取 case_base + teaching_case 并返回题目、选项、答案、解析和视频。"""
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case = self.repo.get_active_teaching_case(case_id)
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if not case:
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raise AppError("TEACHING_CASE_NOT_FOUND", "teaching case not found or inactive", 404)
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teaching = case.teaching_case
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questions = self._parse_questions(case)
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self.audit.log(ctx, "teaching.items", "case_base", str(case.id), None)
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return TeachingItemsResponse(
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case=TeachingCaseSummary(
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case_id=case.id,
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title=case.title,
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department_id=case.department_id,
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difficulty=case.difficulty,
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chief_complaint=case.chief_complaint,
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description=case.description,
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patient_age=case.patient_age,
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patient_gender=case.patient_gender,
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knowledge_points=case.knowledge_points or [],
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),
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teaching_goal=teaching.teaching_goal,
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teacher_guide=teaching.teacher_guide,
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scoring_focus=teaching.scoring_focus,
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questions=questions,
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)
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async def create_evaluation(self, ctx: UserContext, payload: CreateTeachingEvaluationRequest) -> TeachingEvaluationResponse:
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"""教学评价：校验作答后调用 LLM 评分，并写入 training_record 与评分明细。"""
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case = self.repo.get_active_teaching_case(payload.case_id)
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if not case:
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raise AppError("TEACHING_CASE_NOT_FOUND", "teaching case not found or inactive", 404)
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teaching = case.teaching_case
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questions = self._parse_questions(case)
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if not questions:
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raise AppError("TEACHING_QUESTION_EMPTY", "teaching questions are empty", 400)
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answer_results = self._build_answer_results(questions, payload.answers)
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session = self._create_teaching_session(ctx, case.id, payload.score_type, answer_results)
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guideline_result = self.knowledge.search_guidelines(
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case.department_id or 0,
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case.case_type,
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(case.knowledge_points or []) + (case.key_points or []),
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)
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scoring_rules = self.source_repo.get_scoring_rules(case.id)
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teaching_payload = {
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"teaching_goal": teaching.teaching_goal,
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"teacher_guide": teaching.teacher_guide,
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"scoring_focus": teaching.scoring_focus,
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"questions": [item.model_dump() for item in questions],
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"student_answers": [item.model_dump() for item in payload.answers],
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"answer_results": answer_results,
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"correct_count": sum(1 for item in answer_results if item["is_correct"]),
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"total_count": len(answer_results),
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}
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report = await self.orchestrator.evaluate_teaching(
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case=case,
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teaching_payload=teaching_payload,
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scoring_rules=scoring_rules,
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guideline_refs=guideline_result["source_refs"],
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score_type=payload.score_type,
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)
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record = self._build_training_record(ctx, session, case, teaching_payload, report, scoring_rules, guideline_result)
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self.eval_repo.create_record(record)
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score_details = self.evaluation_service._build_score_details(record.id, report, scoring_rules)
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self.eval_repo.replace_score_details(record.id, score_details)
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self.audit.log(ctx, "teaching.evaluation.generate", "training_record", str(record.id), session.id)
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response = self.evaluation_service._to_response(record)
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return TeachingEvaluationResponse(session_id=session.id, **response.model_dump())
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def _create_teaching_session(self, ctx: UserContext, case_id: int, score_type: str, answer_results: list[dict]) -> TrainingSession:
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"""教学会话：创建轻量 session 以复用评价详情、历史记录和 PDF 能力。"""
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now = datetime.utcnow()
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session_code = f"teach_{now.strftime('%Y%m%d%H%M%S')}_{uuid.uuid4().hex[:8]}"
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session = TrainingSession(
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session_code=session_code,
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user_id=ctx.user_id,
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tenant_id=ctx.tenant_id,
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class_id=ctx.class_id,
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entry_scene=ctx.entry_scene,
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case_id=case_id,
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training_type="teaching_interaction",
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mode="teaching",
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score_type=score_type,
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status="completed",
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started_at=now,
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completed_at=now,
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memory_key=None,
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metadata_={"source": "teaching_interaction", "answer_results": answer_results},
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)
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self.db.add(session)
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self.db.flush()
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return session
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def _build_training_record(
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self,
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ctx: UserContext,
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session: TrainingSession,
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case,
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teaching_payload: dict,
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report: dict,
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scoring_rules: list,
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guideline_result: dict,
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) -> TrainingRecord:
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"""教学记录：把教学互动评价沉淀为 training_record。"""
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total_score = float(report.get("total_score") or 0)
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structured = {
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"score_type": report.get("score_type", session.score_type),
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"total_score": total_score,
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"dimension_scores": report.get("dimension_scores") or [],
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"score_details": report.get("score_details") or [],
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"errors": report.get("errors") or [],
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"improvement_plan": report.get("improvement_plan") or [],
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"evidence_summary": report.get("evidence_summary") or [],
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"guideline_refs": report.get("guideline_refs") or [],
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"overall_comment": report.get("overall_comment") or "",
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"llm_model": report.get("_llm_model"),
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"latency_metrics": report.get("_latency_metrics") or {},
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"teaching_summary": {
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"correct_count": teaching_payload.get("correct_count", 0),
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"total_count": teaching_payload.get("total_count", 0),
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},
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}
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return TrainingRecord(
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training_mode="teaching",
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case_type="teaching_interaction",
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start_time=session.started_at or datetime.utcnow(),
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end_time=session.completed_at or datetime.utcnow(),
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duration_seconds=0,
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total_score=total_score,
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ai_score=total_score,
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teacher_score=None,
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evaluation_level=self.evaluation_service._evaluation_level(total_score, structured["score_type"]),
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status="completed",
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feedback=structured["overall_comment"],
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thinking_chain=json.dumps(
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{
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"teaching_goal": teaching_payload.get("teaching_goal", ""),
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"scoring_focus": teaching_payload.get("scoring_focus", ""),
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"answer_results": teaching_payload.get("answer_results", []),
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"scoring_rule_count": len(scoring_rules),
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"guideline_refs": structured["guideline_refs"],
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},
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ensure_ascii=False,
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),
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diagnosis_path=json.dumps(
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{
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"case_title": case.title,
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"question_count": teaching_payload.get("total_count", 0),
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"correct_count": teaching_payload.get("correct_count", 0),
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},
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ensure_ascii=False,
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),
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wrong_points=structured["errors"],
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missed_questions=[],
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recommendation_result={"improvement_plan": structured["improvement_plan"]},
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ai_feedback_structured=structured,
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osce_station_score={},
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interruption_count=0,
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emotion_analysis={},
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prompt_version="teaching_interaction_v1",
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rag_context_version=self.evaluation_service._rag_context_version(guideline_result),
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case_id=case.id,
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teacher_id=None,
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user_id=self.evaluation_service._numeric_user_id(ctx.user_id),
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external_user_id=ctx.user_id,
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session_id=session.id,
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evaluation_record_id=None,
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score_type=structured["score_type"],
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pdf_file_path=None,
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)
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def _build_answer_results(self, questions: list[TeachingQuestion], answers: list) -> list[dict]:
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"""作答校验：按 question_id 对比标准答案并生成评分证据。"""
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question_map = {item.question_id: item for item in questions}
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results: list[dict] = []
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for answer in answers:
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question = question_map.get(answer.question_id)
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if not question:
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raise AppError("TEACHING_QUESTION_NOT_FOUND", f"question {answer.question_id} not found", 404)
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selected = self._normalize_answer(answer.selected_answer)
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expected = self._normalize_answer(question.answer)
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results.append(
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{
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"question_id": question.question_id,
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"stem": question.stem,
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"selected_answer": selected,
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"correct_answer": expected,
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"is_correct": selected == expected,
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"analysis": question.analysis,
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"knowledge_points": question.knowledge_points,
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}
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)
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return results
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def _parse_questions(self, case) -> list[TeachingQuestion]:
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"""题目解析：从 teaching_case.discussion_questions 解析 JSON，失败时返回病例默认题目。"""
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raw = case.teaching_case.discussion_questions if case.teaching_case else ""
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payload: Any
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try:
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payload = json.loads(raw)
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except (TypeError, json.JSONDecodeError):
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payload = self._fallback_questions(case)
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if isinstance(payload, dict):
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payload = payload.get("questions") or []
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if not isinstance(payload, list) or not payload:
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payload = self._fallback_questions(case)
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return [self._normalize_question(item, index) for index, item in enumerate(payload, start=1)]
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def _normalize_question(self, item: dict, index: int) -> TeachingQuestion:
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"""题目结构归一：补齐选项、答案、解析、视频等字段。"""
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options = item.get("options") or []
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normalized_options = [
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TeachingOption(key=str(option.get("key") or ""), text=str(option.get("text") or ""))
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for option in options
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if isinstance(option, dict)
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]
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video = item.get("video")
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return TeachingQuestion(
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question_id=str(item.get("question_id") or f"q{index}"),
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question_type=str(item.get("question_type") or "single_choice"),
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stem=str(item.get("stem") or item.get("question") or ""),
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options=normalized_options,
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answer=item.get("answer") or "",
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analysis=str(item.get("analysis") or ""),
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video=TeachingVideo(**video) if isinstance(video, dict) else None,
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knowledge_points=[str(value) for value in (item.get("knowledge_points") or [])],
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)
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def _normalize_answer(self, value: str | list[str]) -> list[str]:
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"""答案归一：把单选和多选统一为排序后的大写字符串数组。"""
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raw_values = value if isinstance(value, list) else [value]
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return sorted(str(item).strip().upper() for item in raw_values if str(item).strip())
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def _fallback_questions(self, case) -> list[dict]:
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"""默认题目：当数据库暂未维护结构化题库时，为儿科肺炎 demo 生成可测试题目。"""
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video = {"title": "儿童肺炎教学示例视频", "url": ""}
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return [
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{
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"question_id": "q1",
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"question_type": "single_choice",
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"stem": "该患儿最需要优先关注的病情严重程度指标是？",
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"options": [
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{"key": "A", "text": "体温峰值"},
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{"key": "B", "text": "血氧饱和度"},
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{"key": "C", "text": "咳嗽天数"},
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{"key": "D", "text": "食欲下降"},
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],
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"answer": "B",
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"analysis": "血氧饱和度能帮助判断低氧和肺炎严重程度，是处置决策的重要依据。",
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"video": video,
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"knowledge_points": ["严重程度评估", "血氧判断"],
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},
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{
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"question_id": "q2",
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"question_type": "single_choice",
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"stem": "结合发热、咳嗽、喘息和肺部湿啰音，最符合的诊断方向是？",
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"options": [
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{"key": "A", "text": "支气管肺炎"},
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{"key": "B", "text": "急性胃肠炎"},
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{"key": "C", "text": "泌尿系感染"},
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{"key": "D", "text": "单纯过敏性鼻炎"},
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],
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"answer": "A",
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"analysis": "呼吸道症状、肺部体征和影像/炎症指标共同支持儿童支气管肺炎。",
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"video": video,
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"knowledge_points": ["诊断依据", "肺部体征"],
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},
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{
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"question_id": "q3",
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"question_type": "single_choice",
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"stem": "下列哪组检查最有助于完善本例肺炎诊断和严重程度评估？",
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"options": [
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{"key": "A", "text": "血常规、CRP、胸片、血氧饱和度"},
|
||
|
|
{"key": "B", "text": "肝功能、甲状腺功能、腹部超声"},
|
||
|
|
{"key": "C", "text": "胃镜、幽门螺杆菌、粪便常规"},
|
||
|
|
{"key": "D", "text": "骨龄片、维生素D、微量元素"},
|
||
|
|
],
|
||
|
|
"answer": "A",
|
||
|
|
"analysis": "炎症指标、胸部影像和血氧情况可共同支撑诊断和严重程度判断。",
|
||
|
|
"video": video,
|
||
|
|
"knowledge_points": ["检查选择", "辅助检查"],
|
||
|
|
},
|
||
|
|
{
|
||
|
|
"question_id": "q4",
|
||
|
|
"question_type": "single_choice",
|
||
|
|
"stem": "治疗方案中最需要覆盖的核心原则是？",
|
||
|
|
"options": [
|
||
|
|
{"key": "A", "text": "抗感染、止咳平喘、改善氧合、严密观察"},
|
||
|
|
{"key": "B", "text": "立即长期激素维持治疗"},
|
||
|
|
{"key": "C", "text": "只需补充维生素"},
|
||
|
|
{"key": "D", "text": "无需随访观察"},
|
||
|
|
],
|
||
|
|
"answer": "A",
|
||
|
|
"analysis": "儿童肺炎处置需围绕抗感染、呼吸症状缓解、氧合监测和病情变化预案展开。",
|
||
|
|
"video": video,
|
||
|
|
"knowledge_points": ["治疗原则", "风险预案"],
|
||
|
|
},
|
||
|
|
{
|
||
|
|
"question_id": "q5",
|
||
|
|
"question_type": "single_choice",
|
||
|
|
"stem": "向家属沟通时，最合适的内容是？",
|
||
|
|
"options": [
|
||
|
|
{"key": "A", "text": "说明病情、观察指标、用药注意事项和复诊/住院指征"},
|
||
|
|
{"key": "B", "text": "只告知已经开药即可"},
|
||
|
|
{"key": "C", "text": "不需要解释检查结果"},
|
||
|
|
{"key": "D", "text": "避免回答家属担心的问题"},
|
||
|
|
],
|
||
|
|
"answer": "A",
|
||
|
|
"analysis": "儿科场景需要重视家属知情、风险信号识别和家庭护理教育。",
|
||
|
|
"video": video,
|
||
|
|
"knowledge_points": ["人文沟通", "健康教育"],
|
||
|
|
},
|
||
|
|
]
|