真实世界案例教学法(RCBL)对中医急诊“降阶梯”思维培养的研究  

Research of Real-case-based Learning Teaching Method on the Training of De-escalation Thinking in TCM Emergency Department

作　　者：王文清[1] 熊旭东[1] Wang Wenqing;Xiong Xudong(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China)

机构地区：[1]上海中医药大学附属曙光医院,上海200021

出　　处：《中国中医急症》2023年第9期1653-1656,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81974539,82174121);上海市临床重点专科项目(shslczdzk04402);上海中医药大学第十八期课程建设项目(2019SHUTCM111)。

摘　　要：目的观察真实世界案例教学法(RCBL)对中医急诊“降阶梯”思维培养的作用。方法选取2019年6月至2021年12月于上海中医药大学附属曙光医院急诊科进行本科实习的60名医学生为研究对象。两组学生入科时同时进行PPT授课讲解胸痛临床诊疗规范流程图+中医内科“胸痹胸痛病”辨证分型及治疗。对照组采用传统案例教学法(CBL),试验组采用胸痛中心RCBL教学,引导同学对中医急诊“降阶梯”思维的养成。观察入科和出科的考核成绩,考核办法使用中医急诊思维元素改良的Mini-CEX考核和急诊降阶梯思维执行率考核。结果两组学生入科第1天考核无明显差异(P>0.05)。试验组出科时中医急诊思维元素改良的MiniCEX评分表中的问诊能力、体格检查、临床诊断、沟通技能、整体表现、中医望闻问切、中医辨证论治、中医急危重证候的鉴别8个方面明显高于对照组(P<0.05)。在降阶梯思维方面,试验组诊断“开始正确”率、排除急危重症率明显高于对照组(P<0.05)。结论在中医急诊教学中采用真实世界案例教学法,对急诊“降阶梯”思维训练更有效,有助于提高医学生对中医急危重症的识别、诊断及处理能力。Objective:To observe the effect of real-case-based learning(RCBL)teaching method on the training of de-escalation thinking in TCM emergency department.Methods:From June 2019 to December 2021,60medical students who had undergraduate internship in the Emergency Department of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were selected as the research subjects.When the students of the two groups were admitted to the department,they were given PPT lectures at the same time to learn the flow chart of clinical diagnosis and treatment of chest pain+the syndrome differentiation and treatment of“chest obstruction and chest pain”in internal medicine of traditional Chinese medicine.Traditional case-based teaching method(CBL)was used in the control group,and RCBL teaching method was used in the observation group to guide students to develop the de-escalation thinking in emergency department of TCM.The assessment results of admission and departure were observed.Mini-CEX examination improved by TCM emergency thinking elements and emergency de-escalation implementation rate were used for assessment.Results:There was no significant difference between the two groups on the first day of admission(P>0.05).The observation group was significantly higher than the control group in 8 aspects of inquiry ability,physical examination,clinical diagnosis,communication skills,overall performance,four traditional methods of diagnosis:observation,listening,interrogation,and pulse-taking,TCM syndrome differentiation and treatment,and TCM acute and critical syndrome differentiation in the improved Mini-CEX score table of TCM emergency thinking elements(P<0.05).In the aspect of de-escalation thinking,the rate of“starting correctly”and the rate of eliminate critical diseases in the observation group were significantly higher than those of the control group(P<0.05).Conclusion:RCBL teaching method in emergency teaching of TCM is more effective in training the de-escalation thinking.It is more beneficial to

关 键 词：真实世界案例教学法 急诊“降阶梯”思维 中医急诊教学 

分 类 号：R-02[医药卫生]