基于多系统受累病例的学习在临床推理能力训练中的应用  

Application of Learning Based on Multisystem Involvement Cases in Clinical Reasoning Skills Training

作　　者：刘琦[1,2] 刘花香 宋立军[1,2] 李洁 路洪芹[1,2] 张玉贤 王芳[1,2] 王晓 舒强[1,2] LIU Qi;LIU Huaxiang;SONG Lijun;LI Jie;LU Hongqin;ZHANG Yuxian;WANG Fang;WANG Xiao;SHU Qiang(Qilu Hospital of Shandong University,Jinan,Shandong Province,250012 China;Shandong Clinical Medical Research Center of Immune Diseases and Gout,Jinan,Shandong Province,250012 China)

机构地区：[1]山东大学齐鲁医院,山东济南250012 [2]山东省免疫疾病与痛风临床医学研究中心,山东济南250012

出　　处：《中国卫生产业》2022年第21期15-18,共4页China Health Industry

基　　金：山东大学齐鲁医学院2020年度本科教学改革与研究项目(qlyxjy-202036)。

摘　　要：临床推理是临床医生在临床实践中进行的思考和决策过程,其认知心理学基础是双重过程理论。临床推理能力是临床医生必备的重要专业素养,是医学教育的重要组成部分,关乎临床医生的诊治水平。作为一种复杂而专业的高级神经心理活动,临床推理能力的培养和评估面临着很大挑战。基于病例的临床推理被认为是目前能最有效提高临床推理能力的方法,但需要探索适合我国医学教学的具体实践方式。研究选取多系统受累病例,基于双重过程理论,把具体的临床推理教学靶点设计为教学目标,通过动态观察病情变化让学生客观辩证地认识疾病,有的放矢地引导临床医学本科实习学生进行学习和讨论,有助于学生短期内增加知识储备容量、改善知识储备结构,提高分析问题能力,也能唤起学生提高临床推理能力的自我意识,并促进学生应用生物-心理-社会医学模式去思考和解决临床问题。Clinical reasoning is the thinking and decision-making process carried out by clinicians in clinical practice,and its cognitive psychology is based on dual process theory.Clinical reasoning ability is an important professional quality necessary for clinicians,an important part of medical education,and is related to the level of clinicians'diagnosis and treatment.As a complex and specialized high-level neuropsychological activity,the development and assessment of clinical reasoning skills face great challenges.Case-based clinical reasoning is considered to be the most effective method to improve clinical reasoning ability at present,but there is a need to explore specific practice approaches suitable for medical teaching in China.The study selected multisystem involvement cases and designed specific clinical reasoning teaching targets as teaching objectives based on dual process theory.The dynamic observation of changes in the disease allows students to understand the disease objectively and dialectically,and to guide clinical medicine undergraduate internship students to study and discuss in a targeted manner,which helps students to increase the capacity of knowledge reserve,improve the structure of knowledge reserve,and enhance their ability to analyze problems in a short period of time.It can also evoke students'self-awareness to improve their clinical reasoning ability and promote the application of the biopsychosocial medical model to think about and solve clinical problems.

关 键 词：医学教育 多系统受累疾病 临床推理 双重过程理论 

分 类 号：R7[医药卫生—临床医学]