医学生内科临床思维培养改革实践与思考  

Practice and reflection on educational reform for cultivating the clinical thinking ability of medical students in internal medicine

作　　者：倪芳英 管学妹 沈根海[1] 李根华[1] 宁志强 万良海 顾永春[1] Ni Fangying;Guan Xuemei;Shen Genhai;Li Genhua;Ning Zhiqiang;Wan Lianghai;Gu Yongchun(Science and Education Section,Wujiang Hospital Affiliated to Nantong University,Suzhou 215200,China)

机构地区：[1]南通大学附属吴江医院科教科,苏州215200

出　　处：《中华医学教育探索杂志》2020年第4期444-448,共5页Chinese Journal of Medical Education Research

基　　金：南通大学高等教育研究课题(2016GJ040)。

摘　　要：目的探讨临床教学综合改革对医学生内科临床思维能力培养的成效。方法对内科轮转实习的44名临床医学专业实习医师实施本科生导师制和基于团队的学习(team-based learning,TBL),并通过强化电子病历与手写病历相结合,引入形成性评价工具等一系列配套改革措施,全方位、多维度培养医学生内科临床思维能力。对实验组和对照组出科理论考试、病历书写竞赛成绩进行统计评价,并通过自行设计的本科生导师和实习医师调查问卷,综合评价改革成效。采用SPSS 17.0统计软件进行t检验。结果实验组实习医师内科理论考试成绩和病历书写评阅成绩优于对照组,差异有统计学意义(P<0.01)。问卷调查显示实验组师生充分肯定了临床教学综合改革对实习医师内科临床思维能力培训的积极成效。结论在内科系统实施的本科生导师制与TBL相结合的临床教学综合改革对提高实习医师临床思维能力培养质量有积极成效。Objective To evaluate the effects of comprehensive reform of clinical education on cultivating the clinical thinking ability of medical students in internal medicine.Methods A total of 44 clinical interns on medicine rotation were included in this study and divided into experimental group and control group,and a series of measures for clinical teaching reform,which included undergraduate tutorial system,team-based learning(TBL)mode,combination of electronic medical record and handwritten medical record,as well as formative assessment,were applied to fully promote clinical thinking ability of medical students.SPSS 17.0 software was used to compare the scores of final academic tests of rotation and competition of medical record writing between the control and the experiment groups.Self-designed questionnaires on undergraduate tutors and clinical interns were applied to comprehensively evaluate the effects of this education reform.Results Independent-sample t tests showed there were statistically significant difference(P<0.01)in the scores of final academic tests of rotation and competition of medical record writing between the two groups,and the mean score of the experiment group was higher than that of the control group.Questionnaire survey showed that tutors and clinical interns both fully affirmed the positive effects of the education reform on cultivating clinical thinking ability of medical students in internal medicine.Conclusion Application of comprehensive education reform in clinical teaching of internal medicine,which based on introduction of undergraduate tutorial system and TBL mode,could effectively promote the clinical thinking ability of medical students and the teaching quality.

关 键 词：实习医师 临床思维 本科导师制 基于团队的学习 形成性评价 

分 类 号：R4[医药卫生—临床医学]