建立疑难会诊病例讨论和反馈模式提高专科医师临床思维能力的研究  

Study on the Establishment of Discussion and Feedback Mode of Difficult Consultation Cases to Improve the Clinical Thinking Ability of Specialists

作　　者：宋红松[1] 叶珊[1] 赵海燕[1] 张华纲[1] 樊东升[1] SONG Hongsong;YE Shan;ZHAO Haiyan;ZHANG Huagang;FAN Dongsheng(Department of Neurology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院神经内科,北京100191

出　　处：《中国继续医学教育》2023年第7期137-140,共4页China Continuing Medical Education

基　　金：北京大学医学部专科医师规范化培训研究课题(2020ZP14)。

摘　　要：目的 探索建立疑难会诊病例讨论和反馈模式用于专科医师培训。方法 选取2021年1—8月参加住院总医师工作的12名神经内科专科医师参与研究,分析疑难病例总例数并分析疑难病例的诊断分布,比较专科医师与上级医师对代表性病例总结的知识点数量。了解其在提高会诊应答能力、自学能力、临床思维水平、知识储备、沟通技能、管理能力和总体临床工作能力共7个方面的需求,并进行开放性问卷调查。结果 共提出涉及11个临床科室的共34例疑难会诊病例,以系统性疾病合并神经系统受累最多见。针对5例代表性病例,专科医师归纳的知识点数量明显少于上级医师差异有统计学意义(P <0.05)。提高临床思维能力、会诊应答能力和总体临床工作能力是专科医师排在前三位的需求。针对未能定期总结和会诊准备时间不足等问题,希望增加跨专业专业知识讲座、定期组织疑难会诊病例讨论和不断完善教学资源等建议。结论 建立疑难会诊病例讨论和反馈模式有助于提高专科医师的临床思维能力,对完善专科医师培训和评价体系具有一定意义。Objective To explore the establishment of a discussion and feedback mode of difficult consultation cases for the training of specialist physicians.Methods This paper selected 12 neurology specialists who participated in the work of chief resident from January to August 2021to participate in the study.The total number of difficult cases and the diagnosis distribution of difficult cases.This paper compared the number of knowledge points summarized by specialists and superiors on representative cases.The needs in seven aspects:improving consultation response ability,self-learning ability,clinical thinking level,knowledge reserve,communication skills,management ability and overall clinical work ability were analyzed.An open questionnaire survey was conducted.Results A total of 34 cases of difficult consultation involving 11clinical departments were presented.Systemic diseases with nervous system involvement were the most common.For five representative cases,the numbers of knowledge points summarized by specialists was significantly less than that of their superior doctors(P<0.05).The top three needs of specialists were to improve their clinical thinking ability,consultation response ability and overall clinical work ability.In view of the problems such as failure to summarize regularly and insufficient time for consultation preparation,it was recommended to increase inter-professional knowledge lectures,organize regular consultation case discussions,and continuously improve teaching resources.Conclusion This teaching model will help to improve the thinking ability of specialists,and it is of certain significance to improve the training and evaluation system of specialists.

关 键 词：神经内科 专科医师 疑难病例 住院总医师 会诊 规范化培训 培训需求 

分 类 号：G726[文化科学—成人教育学]