診斷學是臨床醫學的基礎和入門，是習得臨床執業風格最重要的環節。如何在診斷學學習階段，夯實學生基本理論和技能，培養其科學縝密的臨床思維能力，是各醫學院校共同面對的課題和挑戰。互動參與式教學摒棄傳統單一的被動式、灌輸式的教學模式，強調以學生為主體，賦予學生協作性、參與性的教學訴求，加強內在激勵，激發其主觀能動性和創造力。根據診斷學不同教學模塊的課程目標、內容和知識結構，有機地將互動參與式教學法應用于診斷學教學中：問診-角色扮演，查體-示教與實踐學習，癥狀學-小講課、小組討論、床旁實踐，臨床思維-案例分析，職業素養-小組討論、角色扮演、床旁實踐、辯論演講等。策略得當地將互動參與式教學的理念、元素、方法應用于診斷學教學中，符合臨床醫學教學實踐性強的特點，遵循個體認知規律，符合外部和內在發展并重的教學效果的深層考量，具備良好的教學容量和一定的普適性，值得在臨床醫學教學中推廣運用。
Objective To explore the short term and long term effectiveness of the problem-based learning (PBL) in clinical skill training. Methods A total of 162 clinical medicine undergraduates in Grade 2003 (7-years study) and 2004 (5-year study) who were supposed to intern in the internal medicine departments were randomly divided into the PBL group (n=75) and the control group with traditional training (n=87) for having their clinical skills training. Then t test was applied to compare the two groups about the scores of intern rotation examination and graduate OSCE as well. Results About the baseline: the students in the two groups got similar scores in their internal medicine exam before clinical intern rotation (84.04±7.40 vs. 82.63±8.77, P=0.287). About the short term effectiveness: compared to the control group, the students in the PBL group got higher subjective evaluation from their supervised clinicians (P=0.006). In writing examination, the students of those two group got similar scores in knowledge part (54.17±9.26 vs. 51.67±9.56, P=0.92), while the PBL group won in case reasoning question (20.39±5.27 vs. 16.51±4.90, Plt;0.001). About the long term effectiveness: in the graduate OSCE, the two groups got similar scores in skills operation such as punctures and lab results analyses (P=0.567 and P=0.741), while the students in the PBL group had better performance at the case reasoning and standard patients treating (75.59±9.85 vs. 71.11±12.01, P=0.027). Conclusion With the great short term and long term effectiveness, the PBL applied in the clinical skill training improves the students’ ability of both synthesized analyses and the integrated clinical skills such as clinical thinking and interpersonal communication, but doesn’t aim at the basic knowledge and operation skills.
Objective To explore teaching effects of case-based learning (CBL) in abdominal physical examination in diagnostics. Methods Among 83 undergraduates in grade 2007 and in major of 8-year clinical medicine were randomly divided into two groups. Under the same conditions, 41 in the CBL group were taught with CBL method, while the other 42 in the control group were taught with traditional teaching method. Their scores in standard patient (SP) practice assessment of abdominal physical examination, examination of abnormal abdominal signs, ability to analyze and write medical records, and right answers to abdominal examination in final exam were compared. Meanwhile, questionnaire surveys were distributed to them after class. Results There was no significant difference between the two groups in the scores of SP practice assessment or medical record writing and analyzing, but the CBL group was obviously superior to the control group in the tests of abnormal abdominal signs and the right answers to abdominal examination in final exam (Plt;0.05). The questionnaire surveys revealed that the CBL group obviously scored higher in the following 3 items: increase the learning interest and commitment, strengthen the ability to analyze and solve problems, and improve the ability to combine theory and practice (Plt;0.05). Conclusion CBL method has an obvious advantage to improve the teaching quality in abdominal physical examination in diagnostics.
【摘要】為順應留學生教育規模的擴大和教學質量的穩步提升，通過幾年的留學生教學實踐和探索，立足留學生臨床專業教育培養目標，強化課程設置、師資培養、教材建設、教學手段、教學管理等多個教學環節的建設和推進，確保留學生臨床醫學課程教學質量的提高和可持續發展。【Abstract】To explore a better way to improve the quality of the clinical medical teaching for foreign students in China along with the expansion of the enrollment of international medical students, some experience are summarized, which include the establishment of the international education aim, the organization of courses, training of the teachers, the selection and reinforcement of teaching material, the enrichment of teaching methods and the strengthening of teaching management.
To cultivated competent clinicians with the potential to be future pillars and leaders is the educational objective of an 8-year medical program at the West China School of Medicine, Sichuan University. Problem-based learning (PBL) is more effective than traditional, passive, didactic teaching in training of communication skills, information management and critical thinking and research. These are included in the Global Minimum Essential Requirements in Medical Education (GMER). We introduce our practice of PBL as a separate course for the 8-year medical program, including its design, preparation, implementation and evaluation. We discuss why it is designed as a separate course and implemented in multiple semesters with fewer cases in each semester. The move from giving a fish to people to teaching people how to fish, and from teacher-centered to student-centered teaching is a radical transformation of educational concepts and the traditional teaching-and-learning model. Such a change cannot happen in a single step and we hope that this model PBL course, focusing on training in methods and skills, will facilitate the concept transformation and the involvement of all our teachers and students. This should help our teaching to evolve continuously, develop a system for evaluating PBL and lead to the gradual incorporation of PBL into our discipline-based courses or organ system-based courses.
目的 探討診斷學床旁見習教學中學患關系現狀，為提高診斷學床旁教學質量提供應對策略。 方法 采用自行設計問卷，于2010年5月-2011年6月對80名臨床醫學專業三年級本科生以及同期在內科住院的100例患者分別進行不署名學患關系問卷調查（有效問卷率分別為91.3%和67%），同時對8名帶教教師和7名臨床主管醫生進行個別訪談。 結果 學生問卷調查顯示，79.5%的學生曾在床旁教學中遭遇患者不同程度的拒絕或不配合，大多數學生認為有被拒的心理準備和承受力。患者調查顯示，82.1%的患者不愿意接受學生問診查體，58.2%的患者表示即便給予一定經濟補償，也不愿配合教學。而對帶教教師及臨床主管醫師訪談結果顯示，當前床旁帶教難度大大增加，學患關系緊張。 結論 現階段學患關系緊張，根據其涉及原因，提出提升醫務人員及醫學生人文觀念，推進醫療、教育體制改革，建立媒體監督機制，開展公眾教育等多層面的應對策略，同時提出課程設置、教學模式、師資培養等具體教學應對舉措。Objective To explore the present status of the relationship between students and patients in diagnostic bedside teaching, in order to promote the teaching quality. Methods From May 2010 to June 2011, self-made questionnaires were adopted to carry out an anonymous survey among 80 medical students in grade three or above and 100 inpatients to investigate the relationship between the students and the patients(with an effective questionnaire rate of 91.3% and 67% respectively). Eight tutors and 7 physicians concerned were taken in the individual interview. Results The survey showed that 79.5% of the students encountered refusal from patients in bedside teaching, and most of them believed that they had psychological preparation and endurance for the refusal. A total of 82.1% of the patients expressed their unwillingness to accept examination by clinical students, and 58.2% of the patients were unwilling to cooperate in the teaching even with an amount of economic compensation. The tutors and physicians concerned stated that the student-patient relationship was undesirable at present. Conclusions The relationship between students and patients in bedside teaching is strained at present. Based on the complicated reasons, we propose such coping strategies as promoting humanism among medical workers and students, pushing forward the medical and educational reform, building media supervision, developing public education, perfecting course design, teaching style, and cultivation of teachers, and so on.
Objective To explore the teaching effects of problem-based learning (PBL) in diagnostic practice teaching. Methods A total of 32 students enrolled into PBL group adopted the PBL teaching method based on certain cases in some sections while the other 210 students into the control group adopted the traditional teaching method. Their scores in the theory, the practice skill examination and the evaluation of the analytical ability of the medical records were compared. A questionnaire survey was measured in PBL group after class. Results There was no significant difference in scores of theory and practice skill examination in the two groups. The questionnaire survey revealed that the PBL method could improve the learning interest, independent study, b communication, analytical skills, and team spirit. However, there were defects in systematization of imparting knowledge. Conclusion The PBL method has an obvious advantage in diagnostic practice teaching.
Objective To compare the survey results of the 8-year program students of clinical medicine discipline before and after the implementation of system-based integrated course reform, to provide feedback for system-based integrated course reform. Methods The questionnaire survey was continuously conducted for 2 years among the 8-year program students in grade of 2005 and 2006, so as to investigate their attitudes towards the integrated clinical courses, then relevant improvement of teaching measures were performed according to their feedback, and the difference of teaching effects between those 2 years was finally compared. Results A total of 79 students in grade 2005 and 78 students in grade 2006 were investigated. The baseline data were matched between the 2 grades. The results of statistical analysis showed that, the overall cognition (χ2=32.924, Plt;0.000 1) and assessment (t=?2.900, P=0.004) of integrated courses among students in grade 2006 got more improved in comparison with the students in grade 2005, and more students tended to select integrated courses, but there was no statistical difference. Conclusion Although system-based integrated clinical course as a new thing has its limitations, the reform idea and direction are still approved by students, so it is worth popularizing.