总结病例特点在培养住院医师临床思维中的重要作用  

Role of summarizing case characteristics in cultivating clinical reasoning among resident physicians

作　　者：柳俊[1] 王莺[2] 薛睿聪[1] 钟晓泽 林凯胜 陈淑英[5] 胡文杰[5] 匡铭[5] Liu Jun;Wang Ying;Xue Ruicong;Zhong Xiaoze;Lin Kaisheng;Chen Shuying;Hu Wenjie;Kuang Ming(Department of Cardiology,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,Guangdong,China;Department of Nephrology,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,Guangdong,China;Department of Nephrology,Jieyang People's Hospital(Affiliated Jieyang Hospital of Sun Yat-senUniversity),Jieyang 522081,Guangdong,China;Science and Technology Education Department of Jieyang People'sHospital(Affiliated Jieyang Hospital of Sun Yat-sen University),Jieyang 522081,Guangdong,China;EducationDepartment of the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,Guangdong,China)

机构地区：[1]中山大学附属第一医院心内科,广东广州510080 [2]中山大学附属第一医院肾内科,广东广州510080 [3]揭阳市人民医院(中山大学附属揭阳医院)肾内科,广东揭阳522081 [4]揭阳市人民医院(中山大学附属揭阳医院)科技教育科,广东揭阳522081 [5]中山大学附属第一医院教育处,广东广州510080

出　　处：《中国毕业后医学教育》2024年第8期562-566,共5页Chinese Journal of Graduate Medical Education

基　　金：2022年度广州市卫生健康科技重大项目(2022A031005)。

摘　　要：临床思维是医生将其所掌握疾病的一般规律用到判定患者个体的假设、推理的逻辑思维的过程,有直觉思维和逻辑思维两种方式。病例特点主要包括症状、体征及辅助检验和检查结果,因此病例特点与病例脚本极为相似。总结病例特点是临床思维教学构架中的必经步骤,也是对患者临床问题的高度凝练和精确表达,还反映出住院医师个性化的临床思维。住院医师因对病例特点把握不全、临床疾病脚本数量不足,所以指导医师应注重培养他们的逻辑思维能力,可以指导他们从病例特点总结并从中确定切入点着手,采用定位、定性、定因和定方案的“假设演绎推理”思维模式进行培训。住院医师只有多接触患者、反复训练,诊断过程才会随着临床经验和疾病脚本数量的增加,逐渐产生直觉判断与模式识别能力,并能随时根据需要转换成逻辑分析。Clinical reasoning is the process in which doctors apply the general laws of the disease they have mastered to determine the hypotheses and logical reasoning of individual patients.There are two ways of reasoning:intuitive reasoning and logical reasoning.Case characteristics mainly include symptoms,signs,laboratory diagnoses and auxiliary instrumental examinations,so they are very similar to the illness scripts.Summarizing case characteristics is a necessary step in the clinical reasoning teaching framework,and it is also a highly condensed and precise clinical problem representation for patients,reflecting the personalized clinical reasoning of resident physicians.Due to incomplete understanding of the case characteristics and insufficient number of clinical illness scripts,resident physicians should focus on cultivating their logical reasoning ability.They can be guided to start by summarizing the case characteristics and determining the breakthrough point,using the "hypothetical deduction reasoning" thinking mode of positioning,qualitative,causal,and planning for training.Only by having more contact with patients and repeated training can resident physicians gradually develop intuitive judgment and pattern recognition abilities with the increase of clinical experience and illness scripts,while converting them into logical analysis as needed.

关 键 词：住院医师规范化培训 教学活动指南 学习与执行 病例特点 临床思维 

分 类 号：G424[文化科学—课程与教学论] R4[文化科学—教育学]