高等医学教育中临床实习工作的几点思考

临床实习是医学院校学生走向临床工作不可逾越的阶段,是高等医学教育的重要组成部分,是医学生成长为合格的临床医生的必经之路。然而,目前临床实习过程中存在着带教教员任务繁重,缺乏教学热情;实习学生面临就业、考研等多重压力以及临床教学模式单一、临床实习考核流于形式等问题。针对这些问题所导致的医学生临床实习质量下降的现象,探讨提高实习质量的方法,以保证高等医学人才培养的质量。     

提高临床实习教学质量的实践与体会

临床实习是医学生大学教育阶段的重要组成部分,是医学生向临床医生转型的过渡时期。临床实习质量的高低直接关系到医学生的培养质量。在实习期间培养出扎实的临床基本功、科学的临床思维和高尚的医德医风对于医学生而言是非常重要的。同时,临床实习教学也是医学院校及教学医院的工作重心。作为教学医院,我院多年来积极推进教学改革,不断探索提升临床实习质量的方法,部分科室率先开展了PBL等新的教学模式,并取得了卓越的成效。我院领导阶层也通过抓好教学准备、提升带教质量、严格实习考核等方面的工作,全面提升了临床实习教学质量,从而提高了医学生的综合素质,也为提高执业医师考试通过率打下了坚实的基础。     

检验医学专业临床实习管理存在的问题及对策

临床实习是医学理论和临床实践工作有机结合的连接点,是医学生走向临床工作必不可少的重要环节。临床实习教学是医学生教育中一个重要的组成部分,是从课堂到临床、从理论到实践、从理性到感性的重要过程,也是巩固基础知识、理论联系实际、走向独立工作岗位的重要一步。在临床实践过程中,教职人员要培养学生获取、分析和处理疾病信息的能力,正确书写病历、熟练掌握诊疗技术以及与患者及家属和谐沟通的能力。医学检验学是运用现代物理化学方法、手段进行医学诊断的一门学科,通俗的说,就是利用仪器、试剂、CT扫描等检测人的各项指标是否正常,为临床诊断提供依据。因此,加强临床检验医学专业的实习管理工作至关重要。本文从建立合理的教学管理体系、加强临床实习考核制度、完善实习管理、加强教师队伍建设等几个方面,探讨临床检验学实习管理存在的问题,并提出相应的对策,为高等医学院校教学管理工作提供思路。     

PBL结合与情景教学在呼吸科医学生实习中的应用价值

目的:研究"以问题为基础"的学习模式(PBL)结合与情景教学在呼吸科医学生实习中的应用价值。方法:将PBL结合与情景教学应用于呼吸科医学生实习中,以此来进行带教实习。结果:PBL结合与情景教学能较好的促进学生的学习能力,使学生由被动学习角色转变为主动学习角色;学生对PBL结合与情景教学具有较高的学习兴趣,能提高学习效率,增加对基础知识掌握的灵活度。结论:PBL结合与情景教学在呼吸科医学生实习中具有较好的应用价值,能充分利用临床资源,培养学生学习能力和临床思维。     

PBL教学在口腔医学临床实习教学中的应用

临床实习是医学生将在学校所学的临床理论知识与实际联系的重要时期。在临床实习教学中,传统的实习教学方法存在学生被动接收知识、理论与实践结合失衡等。随着医学的发展,传统的教学方法不足严重制约着现代医学教育,成为其发展的一个瓶颈。以问题为基础的教学法（Problem-basedlearning,PBL）是由美国神经病学教授Barrow首创,经过多年的不断发展与完善,受到医学教育者的瞩目,并在世界范围内开展。PBL教学法是由问题出发,在学习的过程中以学生自己为主导,用各种方法寻找问题的答案。     

临床医学本科生实习质量的影响因素及对策

医学是一门实践性、社会性、应用性及责任性都非常强的学科。临床实习是医学生从理论学习到临床实践的重要阶段．是从单纯学习书本知识的学生成长为具有临床思维和技能的医生的重要环节。作者经过几年的带教经历,发现影响临床本科实习质量的因素主要为学生自身因素、带教老师因素和社会因素。现就这些影响因素及对策作一探讨。     

医学生临床实习中细节意识的培养

具备细节意识是医生这个职业发展的必然要求.医学生通过临床实习将完成医学生向医生角色的转变,而细节意识是这个过程中需要详细培养的重要能力和态度.经临床带教实践,临床教师可以从以下几个方面注重学生细节意识的培养,且取得较好的教学效果,对医学生顺利完成实习,成为一名合格的医生起到重要的促进作用.具体内容如下:①加强医学生职业外形塑造;②加强医学生沟通技巧的培养,提高学生沟通能力;③在临床技能操作中,养成注意细节的职业习惯.     

普外科临床实习带教体会

临床实习是临床医学教育的一个重要阶段,是把课堂上学习的理论知识与临床实践相结合的过程.其结果直接影响到以后的临床工作能力,并可能影响医学生的一生.普外科作为大外科是常见病最多的一个专科,而且与内科、妇科、儿科等专科疾病的诊治又有着密切的联系,所以历来都是医学生外科实习中的"重点科室",因此,普外科临床实习带教工作任重而道远.作者在多年的临床实习带教实践中总结以下几点体会.     

基于PBL 构建的儿科学实习教学

PBL教学以问题为核心,以启发的方式和讨论的方式进行教学,该教学方法可以充分调动学生学习的主动性,比传统的教学方法更能有效完成儿科学实习教学,且有利于早期培养医学生良好的临床问题处理能力。本文论述如何将PBL教学模式引入儿科学实习教学,以及PBL教学法在儿科学实习教学中需注意的问题:问题设计合理、根据病人的不同调整教学方法、根据实习同学的不同调整教学内容和带教老师正确掌握角色任务。     

浅谈本科生肾内科临床实践能力的培养

正临床医学是一门实践性较强的应用学科,临床实践教学是医学教学工作的重中之重,实习医师临床实践能力的培养是医学教育的重要组成部分,是提高医学人才质量的关键环节[1]。本文结合肾内科临床教学经验,对如何提高肾内科医学本科生临床实践能力进行初步探讨分析如下。1医学生临床实践能力培养的重要性临床实习是医学教育过程中的重要环节,也是医学生将临床理论知识运用到临床实践的重要时期。临床实践能力     

预防医学本科生在临床实习中存在的问题及其改进建议

预防医学是现代医疗体系的重要组成部分,在提高公共卫生健康水平方面发挥着极其重要的作用。为了更好地开展预防医学工作,预防医学专业本科生不仅要牢固掌握预防医学专业知识,更要掌握一定的临床医学基础知识和技能。临床实习是医学生加深所学的临床理论知识并将其转化为实践操作的主要途径,在预防医学本科生的培养中具有重要意义。我校经过多年的探索与改革,在预防医学本科生的临床实习方面积累了大量经验,但现阶段仍然存在着一些问题。本文分析预防医学本科生在临床实习过程中存在的主要问题并提出改进建议,从而为进一步提高预防医学本科生的培养质量提供依据。     

An international basic science and clinical research summer program for medical students

An important part of training the next generation of physicians is ensuring that they are exposed to the integral role that research plays in improving medical treatment. However, medical students often do not have sufficient time to be trained to carry out any projects in biomedical and clinical research. Many medical students also fail to understand and grasp translational research as an important concept today. In addition, since medical training is often an international affair whereby a medical student/resident/fellow will likely train in many different countries during his/her early training years, it is important to provide a learning environment whereby a young medical student experiences the unique challenges and value of an international educational experience. This article describes a program that bridges the gap between the basic and clinical research concepts in a unique international educational experience. After completing two semester curricula at Alfaisal University in Riyadh, Kingdom of Saudi Arabia, six medical students undertook a summer program at St. Boniface Hospital Research Centre, in Winnipeg, MB, Canada. The program lasted for 2 mo and addressed advanced training in basic science research topics in medicine such as cell isolation, functional assessment, and molecular techniques of analysis and manipulation as well as sessions on the conduct of clinical research trials, ethics, and intellectual property management. Programs such as these are essential to provide a base from which medical students can decide if research is an attractive career choice for them during their clinical practice in subsequent years. An innovative international summer research course for medical students is necessary to cater to the needs of the medical students in the 21st century.     

General practice: the DREEM attachment? Comparing the educational environment of hospital and general practice placements

The clinical learning environment is changing. General practice placements are now a fundamental part of undergraduate medical education. There is growing recognition that changes in hospital work practices are altering the breadth of exposure available to students. Surprisingly little work has been done comparing the quality of clinical placements between the hospital and community using validated tools. Such comparisons inform curriculum planning and resource allocation. The aim of this study was to compare the quality of the educational environment experienced by junior medical students during hospital and general practice placements using a widely used tool. Following the introduction of a new integrated curriculum, all Year 3 students (n=108) completed a standardised evaluation instrument, the Dundee Ready Education Environment Measure (DREEM) at the end of each of their clinical attachments (two different hospital sites and one in general practice), giving a total of 324 questionnaires. All forms were analysed and input into Graphpad INSTAT version 3. Total DREEM scores as well as subscale scores were calculated for each site. These were compared across sites using a Mann-Whitney U non-parametric test. By comparison with international standards, clinical attachments in our new integrated curriculum were rated highly. In particular, attachments in general practice scored highly with a mean score of 156.6 and perform significantly better (P < 0.01) when compared with the mean score for hospital rotations of 149.0. Significant differences between general practice and hospital rotations exist in the domains of students' perceptions of atmosphere and students' social self-perceptions. Finally, significant differences also emerged in students' perceptions of teachers in general practice when compared to those in the hospital setting. These findings provide evidence of the high-quality educational environment afforded students in primary care. They challenge the traditional emphasis on hospital-based teaching and preempt the question - Is the community a better place for junior students to learn?     

PBL与LBL结合在血管外科临床见习教学中的应用

目的:为提高临床血管外科的教学质量,我们在临床见习中尝试将PBL教学模式与LBL传统教学模式相结合,研究PBL与LBL教学法相结合新的教学方法在临床血管外科教学中的作用。方法:选取在我院参加实习活动的临床医学系学生60名,随机分为LBL组与LBL+PBL组。其中LBL组采用传统教学模式,而LBL+PBL组则采用传统教学与问题导向型教学模式相结合的双轨教学法。课程结束后,对比两组学生的专业知识笔试成绩和临床操作技能测试成绩,评价两种教学模式的作用及意义。结果:PBL+LBL组学生的专业知识笔试成绩和临床操作技能成绩均显著优于LBL组,差异有统计学意义(P0.05)。结论:PBL与LBL教学法相结合的双规教学模式对血管外科的临床见习教学具有积极的意义,不但可以锻炼学生的临床思维能力,培养学生的综合素质,而且有利于提高临床教学的质量,该教学模式值得在医学院校实习教学中推广应用。     

Improving communication skill training in patient centered medical practice for enhancing rational use of laboratory tests: The core of bioinformation for leveraging stakeholder engagement in regulatory science

Requests for laboratory tests are among the most relevant additional tools used by physicians as part of patient''s health problemsolving. However, the overestimation of complementary investigation may be linked to less reflective medical practice as a consequence of a poor physician-patient communication, and may impair patient-centered care. This scenario is likely to result from reduced consultation time, and a clinical model focused on the disease. We propose a new medical intervention program that specifically targets improving the patient-centered communication of laboratory tests results, the core of bioinformation in health care. Expectations are that medical students training in communication skills significantly improve physicians-patient relationship, reduce inappropriate use of laboratorial tests, and raise stakeholder engagement.     

Career Preferences of First-year Students at Canadian Medical Schools, 1966-67 to 1968-69

The principal findings of this study of the career preferences of first-year Canadian medical students were:Over 70% of the first-year students expressed a preference for specialty practice, with only 20% oriented towards practice as a family practitioner.There were considerable differences between the medical schools in the proportion of medical students preferring general practice, ranging from less than 10% at McGill to nearly 33% at Queen''s.Nearly one-third of the students stated that they preferred primarily salaried practice. These students were largely those who preferred specialty practice or a career in an area such as public health or research.Nearly 70% of the students looked for a career with part-time teaching, while 8% preferred a full-time teaching career.Only 1% preferred a full-time research career although 90% expected to have at least some research involvement.Students from smaller communities were more likely to express a preference for general practice than those from large urban areas.Men and women had similar practice preferences in terms of general practice and clinical specialty, but significantly more women than men preferred a career in salaried practice. Significantly fewer women expressed a preference for major involvement in either teaching or research.