PBL教学法在医学本科生耳鼻喉科临床教学改革中的应用

目的探讨将PBL教学模式引入临床教学活动中的可能性。方法研究对象为61名正在进行耳鼻喉科学习的2009级北京协和医学院八年制本科生,其中男22人,女39人,年龄23~26岁。以见习小组为单位随机分为两组,即PBL教学组29名及传统教学组32名。以调查问卷和量表形式收集反馈意见,并进行统计分析。结果 PBL组学生在见习后对耳鼻喉学科的评价优于见习前(P0.05)。而传统组学生仅部分项目优于见习前。见习后两组学生除了"耳鼻喉科的重要性,对患者初步处理的能力"等项无差异,其余各项中PBL组均优于传统组(OR1)。结论 PBL教学法优于传统教学法,值得在临床教学中推广。     

神经解剖学融入神经内科见习PBL教学实践的探讨

基于问题学习(PBL)的教学模式是一种以学生为中心,以教师引导的自我导向式学习模式,本文从神经病学和神经解剖学知识内容整合的角度,探讨将神经解剖学融入神经内科见习的PBL教学实践中,提高神经内科临床教学水平.     

多元化教学在八年制医学生内分泌科临床教学中的应用

目的 探讨多元化教学策略对轮转内分泌科八年制医学生临床教学效果的影响。方法 采用在线问卷调查方法，选择2021年12月至2022年4月在北京协和医院内分泌科轮转的6～8年级的临床医学专业八年制医学生，分别对病房主治医师和住院医师的教学质量及医学生小讲课效果进行问卷调查。结果 向已经完成内分泌科轮转的48名医学生发放调查问卷，共回收有效问卷40份，回收率83.3%。病房主治医师及住院医师在日常多项教学活动中均表现良好，临床工作繁忙是影响教学质量的主要因素。医学生准备小讲课的时间大多在6 h以内，除掌握相关理论知识外，小讲课还提高了同学们的演讲能力，锻炼了文献检索、凝炼知识点及幻灯制作能力。结论 采用多元化的教学策略、组织多种形式的教学活动，有利于激发医学生的学习热情，全面提高其岗位胜任力。     

提高神经内科见习教学质量的几点体会

临床见习是衔接理论学习与实践操作及培养学生临床思维的一个重要阶段，对未来医学人才的培养起着承前启后的作用。由于临床医学集中见习时间仅2～3月，神经内科又是内科系统最抽象和复杂的学科，如何能在有限的时间内让学生简明、透彻的理解神经内科疾病，现就此谈谈体会。     

PBL教学方法在神经科临床见习中的应用分析

目的 探讨在神经科临床见习教学中基于问题学习(PBL)教学模式的应用效果.方法 选择2019年11月-2021年4月期间在我院神经内科见习的236名临床医学专业本科见习生按人科顺序随机分为PBL教学试验组126人和传统教学对照组110人,见习结束时比较两组出科考核成绩;并向学生发放问卷,调查学生学习能力提升情况及对教学的满意度.结果 PBL教学组的见习学生基础理论成绩、临床病例分析成绩及病历书写成绩分别为(17.75±1.60)分、(18.83±0.89)分和(18.29±0.72)分,均高于传统教学组[分别为(17.18±2.48)分、(17.83±1.36)分和(18.08±0.87)分],差异有统计学意义(P＜0.05);调查问卷结果显示,采用PBL教学方法的学生在课堂气氛的活跃度、有助于理论知识的理解、提高神经病学的学习兴趣、提高临床思维能力方面的满意度均高于传统教学法(P＜0.05).结论 神经科临床见习教学过程中应用PBL教学模式可以提高学生综合分析能力及思维能力,值得进一步探索和应用.     

住院医生如何进行临床教学

住院医生教学是医院临床教学的重要组成部分,他们的参与程度是医学生见习及实习阶段临床教学质量的保证。住院医生在医学教学生过程中,不仅能进一步提高自身的教学能力,又能不断发现并弥补自身的知识缺陷。住院医生的临床教学重点在训练临床基本技能、培养良好临床习惯、医患沟通及传授职业精神。了解及掌握临床教学技巧能提高住院医生教学兴趣及教学质量。     

以病例为中心的七年制骨科临床见习教学体会

七年制临床医学专业见习课是临床教学中非常重要的一环，教学的好坏，直接影响下轮学习的效果与教学质量。作者于2004年3月至2004年7月带教本院2000级七年制学生骨科临床见习课，采用以病例为中心的带教方式，效果良好。     

提高护理学专业学生沟通交流能力实践训练的研究

目的：探讨提高护理学专业学生沟通交流能力的训练途径，为培养高素质的护理应用型人才提供理论和实践依据。方法：选择大学二年级（04级、05级）的学生，通过护理学基础实验操作、综合性设计性实验、学生理论小讲课、社区健康教育、临床见习、特殊人群沟通交流实践、大学生科研课题等方法对学生进行沟通交流的实践训练，并随机抽取04级、05级200名学生以调查问卷的方式进行效果调查。结果：认为对自己沟通交流能力有较大提高的：护理学基础实验操作占62．5％、综合性设计性实验占71％、学生理论小讲课占31％、社区健康教育占55％、临床见习占62％；在参与效果调查的200人中，认为自己语言表达能力有提高的占80％，能主动交流的占60％，增强了与陌生人交流信心的占96％，认为没有提高的占7％。结论：通过实施以上综合项目的实践训练，学生的沟通交流能力得到了较为显著的提高。     

基于团队的学习教学法在内科学教学中的应用

目的探讨基于团队的学习(TBL)教学法在内科学教学中的教学效果。方法北京协和医学院2014级本科八年制医学生内科见习学生,每期4个月时间教学。学生自愿参加,每周一次,进行TBL内科学带教。教学结束后,采用不记名问卷调查学生对该学习方式的反馈,进行统计与评估。结果共收到有效问卷30份,超过50%的学生认为TBL教学有助于更好地掌握专业知识和提高各种能力。通过学生的反馈,TBL方式在提升独立思考、与患者家属沟通能力、内科技能、专业知识学习等方面,完全同意+同意的比例达到100%;在团队协作能力、语言表达能力、人际沟通能力、自主学习能力等方面,完全同意+同意的比例在90.0%～96.7%;另外,在激发学习兴趣、易于掌握知识和实践方面,完全同意加同意的比例低于90%,这些是下一步重点需解决和改进的方面。结论 TBL教学提高了学生学习的积极性与学习效率,加强了学生的人际沟通能力和团队合作精神,值得在临床教学工作中进行推广。     

利用3D病理解剖模型提高外科学教学效果探讨

目的 探讨3D病理解剖模型在临床外科教学中的应用价值，为外科教学拓展新方向。方法 将93名2019年～2023年在我院临床外科实习的5年制临床医学专业本科生作为研究对象。将全部实习医生随机分为传统2D影像教学组和3D病理解剖模型教学组，对比分析两组实习医生的理论考试成绩、临床能力考核情况，以及其对相应教学模式的满意度。结果 接受3D病理解剖模型教学的同学的理论考试成绩和临床考核能力均明显高于传统2D影像教学组（P均<0.05），实习医生对3D病理解剖模型教学的满意度也高于接受2D影像教学实习医生的满意度（P均<0.05）。结论 3D病理解剖模型教学可显著提高临床外科的教学质量，值得在临床教学中推广。     

Comparing students' feedback about clinical instruction with their performances

Validation of students' feedback as a measure of teaching effectiveness has been problematic for courses teaching clinical skills. This is true in part because establishing a valid and reliable method of assessing students' mastery of clinical skills has been a stumbling block. Reported here is the correlation of students' performances on an objective structured clinical examination (OSCE) with previously and independently collected feedback from students. In 1987-88, 190 second-year medical students at the University of Minnesota Medical School--Minneapolis spent one fourth of a second-year clinical skills course on neurology randomly assigned to one of four teaching sites--hospitals A, B, C, and D. Following their rotations, 180 of the students completed usable feedback forms. The students were consistently and significantly more positive about the teaching at hospital A. At the end of the year, all 190 students were tested using an OSCE having 20 stations, four of which presented neurologic problems. The students who had the neurology course at hospital A performed better on all four neurology problems, and differences were statistically significant for two of the problems. Feedback in this case accurately reflected a more effective teaching program.     

The effect of a teaching skills course on interns' and students' evaluations of their resident--teachers.

PURPOSE: To determine the effect that a six-hour course on resident teaching and leadership skills had on residents' teaching evaluations. METHOD: The authors analyzed six years of teaching evaluations of second- and third-year internal medicine residents at the University of Washington: three years before and three years after a resident teaching skills course was introduced in 1992. Interns and students rated their resident-teachers using a nine-question standardized clinical teaching assessment form (CTAF). Evaluations at baseline (the three years before the course) were compared with evaluations for the three years after the intervention. RESULTS: The authors analyzed 3,946 evaluations of 235 second-year and 211 third-year residents. Despite already high baseline evaluations, mean ratings of the CTAF showed continuous and statistically significant improvement in each year after the introduction of the course (p < .001). There was no significant difference between evaluations from students and those from interns. CONCLUSION: A six-hour teaching skills course significantly improved residents' teacher ratings. Residents are important teachers of interns and medical students and serve as their primary ward supervisors; therefore, sessions on teaching skills should be part of required curricula for all residency programs.     

Medical students' cases as an empirical basis for teaching clinical ethics.

PURPOSE: To identify ethical issues that interns encounter in their clinical education and thus build a more empirical basis for the required contents of the clinical ethics curriculum. METHOD: The authors analyzed a total of 522 required case reports on ethical dilemmas experienced by interns from September 1995 to May 1999 at the medical school of Vrije Universiteit in Amsterdam. They identified four regularly described and numerous less frequently described topics. RESULTS: The interns addressed a wide range of ethical themes. In 45% of the cases, they mentioned disclosure or non-disclosure of information and informed consent; in 37%, medical decisions at the end of life; in 16%, medical failures; and in 9%, problems transferring patients from one caregiver to another. The interns also identified 27 themes linked to their unique position as interns and 19 themes related to specific types of patients. CONCLUSION: Based on self-reported experiences, the authors conclude that clinical ethics teachers should reflect on a multitude of dilemmas. Special expertise is required with respect to end-of-life decisions, truth telling, medical failures, and transferring patients from one caregiver to another. The clinical ethics curriculum should encourage students to voice their opinions and deal with values, responsibilities, and the uncertainty and failings of medical interventions.     

循证医学方法在神经病教学中的应用

目的 探讨将循证医学方法引入神经病学教学的意义.方法 剖析传统神经病学教学的弊端,分析将循证医学方法引入神经病学教学的优势和必要性;通过举例,简要说明循证医学的方法和步骤.结果 将循证医学方法引入神经病学教学,可以整合神经病学、临床流行病学、医学统计学和文献检索等课程,激发学生学习的积极性.结论 将循证医学方法引入神经病学教学,有利于加强课程间的横向联系,使学生学习效果最大化.     

Trial to stimulate learning motivation of medical students in the dissection practice "teaching assistant system"

At the Medical School of Chiba University, educational dissection tours have been conducted for intra- and extramural students in other programs, such as students of nursing. In the 2006 school year there were more than 1,500 students. As presented in a previous report, we tested an educational program in which our medical students teach other students parts of splanchnology, neurology, and myology to promote student understanding of human physiology through their own teaching. Since this system, termed the "teaching assistant system," was fairly laborious for many medical students, we attempted to improve it by decreasing the students' load and reducing the frequency of teaching from several times to once during the one-term dissection practice. We assessed the improved method with questionnaires for medical students who had studied at the school in 2006 and 2007 (n = 206) before and after teaching other students. The response rate for the questionnaires was 91.3% (n = 188). The results were as follows. (1) Most medical students (69.7%) realized that the task of teaching had stimulating effects on their own learning motivation. (2) According to most of their evaluations (80.4%), the duties of teaching involved in the previous assistant system were laborious. In contrast, the ratio of medical students who considered teaching to be laborious decreased by about half (55.3%) in the present improved system. (3) Most students (79.8%) were satisfied with the teaching assistant system. We concluded that the improved teaching assistant system was effective for the dissection practice.     

Does a physician's ability to accurately assess the likelihood of pulmonary embolism increase with training?

PURPOSE: Pulmonary embolism (PE), an elusive diagnosis, is detected by a diagnostic work-up that is often guided by the physician's level of clinical suspicion. The ability to accurately assess PE risk on solely clinical grounds may increase with the physician's level of training. This study documented the ability of house staff practicing in an academic teaching hospital to accurately assess the clinical likelihood of PE in patients. METHOD: During a seven-month period, all 245 patients with suspected acute PE who had had lung scans ordered via a computerized order-entry system were enrolled in the study. When ordering the lung scans, all physicians (interns, residents, and attending physicians) were required to also enter their levels of clinical suspicion on a scale of 0 to 100. The physicians' levels of clinical suspicion were correlated with the final determinations of PE, and receiver operating characteristic (ROC) curves were calculated for patients' and physicians' subgroups. RESULTS: Attending physicians were most able to diagnose PE; residents were moderately able to make the diagnosis, and interns were least able to diagnose PE. The area under the ROC curve for a correct identification of patients with PE was greatest for attending physicians (0.839), intermediate for residents (0.601), and least for interns (0.594). CONCLUSION: The ability to correctly assess a patient's likelihood of PE increases with a physician's level of training, suggesting that more senior physicians should be involved in the diagnostic work-up of patients with suspected acute PE. More instruction may help medical students, interns, and residents navigate clinical scenarios in which the diagnosis is uncertain or in which sequential tests must be performed to reach the correct diagnosis.     

Preparing medical students to teach.

OBJECTIVE: Residents do a significant amount of teaching. Therefore, as medical students prepare for the clinical aspects of their residency, it is also important for them to prepare for their role of physician as teacher. With the goal of offering fourth-year students an opportunity to enhance their teaching skills, an elective was designed that presented them with an opportunity to expand their knowledge base in education, and then apply and practice this new set of knowledge. A week-long elective, Physician as Teacher, was designed to encompass core educational information such as needs assessment of learners, establishing goals and objectives, teaching methods, and evaluation and feedback. This core information was then applied and enriched during an end-of-course teaching presentation. Aside from this course, there is no forum during their undergraduate medical training for the students to acquire knowledge and skills about how to be teachers. DESCRIPTION: The course was developed with the appreciation that application of knowledge is a rich source of learning. The course began with interactive classroom teaching sessions designed to facilitate acquisition of core educational knowledge. Sessions topics included assessment of learner needs, methods of teaching, learning styles, microprecepting, and feedback. Also incorporated were sessions on facilitating small groups, and teaching and learning how to use technology. Those classroom sessions were then enhanced by a complement of sessions that asked the students to apply their new knowledge to clinical situations. Those more application-based sessions included observation and follow-up discussion of clinical teaching and small-group teaching sessions with the goal of developing the students' skills with respect to the teaching and learning process. An end-of-course teaching presentation by each student provided them with a capstone experience of applying the knowledge and skills learned throughout the week. The topic of the teaching presentation was of their choosing, and could incorporate technology. Each student's teaching presentation was videotaped, immediately viewed by the student, and discussed using a structured format of facilitated feedback. DISCUSSION: Students reported that the end-of-course teaching presentation was a rich source of their learning, and an important vehicle for helping them apply and synthesize the new knowledge. Fifteen percent of fourth-year students enrolled in and completed the elective. Seventy-one percent of those students "strongly agreed" and 29% "agreed" that the course provided useful knowledge and skills. Seventy-nine percent "strongly agreed" and 21% "agreed" that their teaching would be better because of the course. Based on comments, the students appeared to feel that the experience of presenting a teaching session at the end of the course was a rich source of their learning, and helped them to apply and synthesize the new knowledge. Students noted, "the teaching project was an excellent idea to see how much we have learned; I never realized what a responsibility we have as residents to teach our peers; I have been enlightened this past week and will now consciously make an effort to share what little information I currently have; I will be a better teacher because I have been given the appropriate tools."     

Learning/feedback activities and high-quality teaching: perceptions of third-year medical students during an inpatient rotation.

PURPOSE: To identify specific learning activities (and teaching methods) that students associate with high-quality teaching in the inpatient setting. METHOD: For ten months in 2003-04, 170 third-year medical students recorded data on learning/feedback activities and teaching quality via personal digital assistants during the inpatient portion of a required two-month medicine clerkship at four sites affiliated with the Medical College of Wisconsin. Univariate and multivariate analyses were performed to assess the association between learning/feedback activities and students' perceptions of high-quality teaching. RESULTS: A total of 2,671 teaching encounters were rated by 170 students during their required inpatient medicine rotations. Bedside teaching was reported in almost two-thirds of teaching/learning encounters. Feedback on case presentation and differential diagnosis were the inpatient feedback activities most often provided by faculty. The univariate analysis revealed that students' perceptions of high-quality teaching was associated with receiving mini-lectures, developing short presentations on relevant inpatient topics, bedside teaching, case-based conferences, learning electrocardiogram and chest X-ray interpretation, teaching with other team members present (p <. 001), and receiving feedback on history and physical examination, on case presentation, at the bedside, on differential diagnosis, and on daily progress notes. Results from the regression analysis revealed that giving mini-lectures on inpatient topics, teaching electrocardiogram and chest X-ray interpretation, providing feedback on case presentation, and at the bedside were predictors of overall high-quality teaching. CONCLUSIONS: Aspects of feedback, giving mini-lectures, and learning test-interpretation skills were the learning and feedback activities associated with students' perceptions of high-quality teaching. In an increasingly time-pressured inpatient environment, clinical educators should understand which activities students value.     

Medical students in the emergency department: how do patients view participation in clinical teaching?

A survey was carried out in the Emergency Department (ED) of a single urban Irish teaching hospital to determine patients' acceptability towards medical students and their attitudes towards participating in clinical teaching. We analysed 145 patient replies and found 45 (31%) patients with previous ED medical student contact. Amongst these, 23/45 (51%) did not have verbal consent before being seen, 8/45 (18%) experienced pressure to participate but overall 35/45 (78%) felt their experience was a positive one. When patients who did not have previous contact with medical students were included in the analysis, receptiveness to student examination and procedures remained high [119 (82%) and 102 (70%) respectively] despite almost none of the patients recalled reading information about participating in medical teaching. Up to 52% patients would vary their consent depending on the severity of their clinical complaint but the majority, 104 (81%) patients were satisfied that involving medical students would not alter their clinical care.     

The cost of medical education in an ambulatory neurology clinic

Decreased revenue from clinical services has required academic hospitals and physicians to improve productivity. Medical student education may be a significant hindrance to increased productivity and income. This study quantifies the amount of time spent by faculty members teaching medical students in an ambulatory neurology clinic as well as the amount of time students occupied rooms when seeing patients on their own. Over a three-week period in an ambulatory neurology clinic, an observer noted these quantities of time, and the opportunity costs of both amounts of time were determined. Attending physicians spent an average of 19.6 minutes per medical student per half-day teaching, which translates to an average cost of $20.78 per half-day clinic. Students spent an average of 49.9 minutes per half-day seeing patients in the absence of an attending physician, an opportunity cost to the clinic of $142.50 per student per half-day.