以器官系统整合为基础的心血管教学改革的思考

近年来我校在八年制临床医学专业实施了“以器官系统为中心”的基础医学课程整合教学改革,不仅加强了各门学科之间的横向联系、避免了教学内容的重复,而且有利于培养学生的整体临床思维和自主学习能力。心血管系统是一个结构与功能复杂的系统,是医学教学中的重点和难点。本文以心血管系统为例,介绍了我们在教学模式改革中课程整合建设的一些实践经验和心得体会。     

大力加强分子心血管病学的研究

大力加强分子心血管病学的研究汤健，周爱儒心血管系统可以从整体、器官、细胞和分子四个水平进行研究。近年来的研究证明，心血管生理、病理最本质、最核心的问题是基因及其调控的问题。分子心血管病学就是用分子生物学的理论、技术和方法来研究心血管的结构、功能及调节...     

心脏电生理学新概念:(11) 膜片钳技术在心血管基础和药物研究中的应用

膜片钳技术，特别是全细胞记录技术发明20年来，极大地推动了心血管生理、病理生理及药理学的研究，使人们对心血管系统生理调节，分子水平的病理学改变，及药物的作用机制有了更深的认识和研究手段，解决了大量的理论和实际问题。今后膜片钳技术在心血管基础和药物研究中仍将发挥重要的作用。本文简要介绍膜片钳技术在心血管研究中的应用及进展情况。１ 心肌细胞膜离子通道电流的记录 这是膜片钳全细胞记录的主要优势之一，也是最常用的手段。目前应用这一技术可以检测到心肌细胞上各种离子通道。如钠通道，钙通道，钾通道和氯通道等及其亚…     

器官系统为基础课程教学结合案例为基础讨论教学在医学影像学教学中的应用

正器官系统为基础的课程教学(organ-system-based curriculum,OSBC)是以人体器官系统为基础对教学内容进行整合重组,把不同学科的教学内容合并成器官系统课程的教学模式。最早于1950年代由美国凯斯西储大学率先提出并用于教学实践,随后我国部分医学院校将OSBC教学模式用于医学教育[1-3]。案例为基础的教学(case-based learning,     

异搏停的药理学及其在心血管疾病中的应用

异搏停(Verapamil,Iproveratril)原是一冠状动脉扩张剂,曾被用于治疗心绞痛,其后发现它还具有抗心律失常作用,对某些类型的心律失常具有显著的治疗效果。近年来,发现异搏停能选择性地阻断心肌细胞的Ca~(++)内流,这一发现在基础理论的探讨上有重大价值,激起了对异搏停的深入研究。本文仅就异搏停对心血管系统的药理作用、作用机理、适应症及应用时须注意的事项,作一简要介绍。对心血管系统的药理学作用异搏停对心血管系统的作用,主要表现为对血管平滑肌和心肌的直接抑制。血管无论是在整体动物或离体器官,     

内源性血管活性物质对心血管系统调控作用的研究进展

本文综述某些内源性血管活性物质对心血管系统的调节作用及在某些心血管系统疾病发病、发展与治疗中所起的病理生理和药理学作用,认为对这些内源性血管活性物质进行深入研究,对理解心血管系统的生理功能、疾病的防治具有重要意义。     

一氧化氮对心血管系统的调控

冯清平教授从事NO对心血管系统调控的研究多年，曾在Circulation发表近20篇有关论文。冯教授现在已经成为加拿大心血管药理学专家，多年参与该国国家医药科研资助基金委员会。此文系冯教授他自己研究的NO对心血管系统影响的总结性文章。本刊特邀作稿以飨读者。冯教授系我刊外籍编委。     

《心血管药理学》(第2版)已出版

<正> 由苏定冯、缪朝玉教授编写的《心血管药理学》已于2010年3月在科学出版社出版发行。该书不仅包含了心血管药理学领域近20年来的重要的发明、发现和进展,也展现了作者本人的研究成果和经验体会。这些内容对心血管疾病的临床医生和研究人员更新及完善心血管药理学知识有参考价值,对相关领     

床旁超声在老年危急重症患者中的应用

老年人因多器官退化和多种慢性疾病并存而造成自身体质较差,临床表现个体差异大,病情危重,进展迅速,病死率高。床旁超声具有方便、快捷、无创、无辐射,可实时动态观测、可重复操作以及可将多部位超声检查整合进行综合评估等优点。本文就床旁超声在老年危急重症患者呼吸系统、心血管系统等诊治中的应用进行综述,以期为床旁超声可视化评估在老年危急重症患者中的应用提供参考依据。     

《中华老年多器官疾病杂志》诚征广告

《中华老年多器官疾病杂志》是由中国人民解放军总医院主管、中国人民解放军总医院老年心血管病研究所主办、国内外公开发行的医学学术期刊，主要交流老年心血管疾病，尤其是老年心血管疾病合并其他疾病、老年两个以上器官疾病以及其他老年多发疾病的诊治经验与教训。刊登内容包括心血管系统、呼吸系统、神经系统、内分泌系统、肾脏系统、消化系统、骨骼系统等各个方面疾病，涉及临床和基础研究等诸多领域，为从事老年医学及其相关疾病专业的医疗、科研及教学人员必读的刊物。     

双语教学在人体寄生虫学中的初步实践

双语教学是目前高等学校本科教学质量工程建设项目之一,也是课程建设的重要内容。本文针对目前双语教学中存在的问题,系统设计了人体寄生虫学双语教学实施方案并进行了教学实践,通过课后调查量表的分析研究,认为随机分班双语教学不能因材施教,影响教学效果,提出了分级选课开展双语教学的设想。     

How can we improve junior doctor prescribing?

The large number of medications available has complicated the learning of drug therapy for medical students at a time when pharmacology training has been substantially reduced. Attempts to remedy this include: improving the pharmaco‐therapeutics curriculum; interactive web‐based learning and students developing a personal formulary. The approach adopted by the University of Wollongong Medical School is to integrate clinical pharmacology throughout the course, with the Student Preferred‐drugs Formulary linking pharmacology and common diseases. Evidence from other countries suggests this should enhance prescribing by medical graduates.     

Developing an Action Plan for Integrating Sleep Topics into the Medical School Curriculum

Sleep disorders are prevalent although they go unrecognized by clinicians, partially because of limited exposure to sleep medicine topics during medical school. Sleep topics can be integrated during both the preclinical and clinical years of the medical school curriculum by developing an integration strategy and action plan. Components of the action plan include examining the current medical school curriculum and the teaching infrastructure. Understanding curricular governance issues and how curriculum time is allocated will allow development of an effective integrative strategy. Sleep topics can be integrated into neuroscience, neuroanatomy, physiology, and behavioral science courses during the preclinical years. The sleep history and physical can be integrated into the physical diagnosis course. Sleep disorders can be introduced in clinical correlation courses. Integration strategies during the clinical years may include computer-based simulations. Careful assessment of the existing curriculum, curricular governance processes, and available educational resources will optimize the probability of successfully integrating sleep topics into the medical school curriculum.     

Teaching Geriatric Fellows How to Teach: A Needs Assessment Targeting Geriatrics Fellowship Program Directors

The entire healthcare workforce needs to be educated to better care for older adults. The purpose of this study was to determine whether fellows are being trained to teach, to assess the attitudes of fellowship directors toward training fellows to be teachers, and to understand how to facilitate this type of training for fellows. A nine‐question survey adapted from a 2001 survey issued to residency program directors inquiring about residents‐as‐teachers curricula was developed and administered. The survey was issued electronically and sent out three times over a 6‐week period. Of 144 ACGME‐accredited geriatric fellowship directors from geriatric, internal medicine, and family medicine departments who were e‐mailed the survey, 101 (70%) responded; 75% had an academic affiliation, 15% had a community affiliation, and 10% did not report. Academic and community programs required their fellows to teach, but just 55% of academic and 29% of community programs offered teaching skills instruction as part of their fellowship curriculum; 67% of academic programs and 79% of community programs felt that their fellows would benefit from more teaching skill instruction. Program directors listed fellow (39%) and faculty (46%) time constraints as obstacles to creation and implementation of a teaching curriculum. The majority of fellowship directors believe that it is important for geriatric fellows to become competent educators, but only approximately half of programs currently provide formal instruction in teaching skills. A reproducible, accessible curriculum on teaching to teach that includes a rigorous evaluation component should be created for geriatrics fellowship programs.     

来华MBBS留学生医学免疫学英文教学的实践与探索

随着来华MBBS留学生招生规模的不断扩大,提高教学质量、改善教学效果是广大医学院校的重要任务。针对医学留学生医学免疫学教学中的境遇,本院从加强语言的交流和文化的融合、精心选择组织教学内容、采用LBL（传统教学法）＋PBL（基于问题的教学法）＋CBL（案例教学法）相结合的三轨式教学方法、及时反馈评估教学效果等多方面进行改进与探索。实践表明,本院开展的医学免疫学英文教学能引导留学生积极主动参与教学,激发学习兴趣,提高理解能力,重在培养学生分析问题及解决问题的能力,增强了专业教师团队合作意识,有效地提高了教学水平和促进了教学质量,受到留学生好评。     

Improving oral presentation skills with a clinical reasoning curriculum: a prospective controlled study

PURPOSE: The oral case presentation is an essential part of clinical medicine, but teaching medical students to present clinical data remains difficult. Presentation skills depend on the ability to obtain, process, and organize patient data. Clinical reasoning is fundamental to the development of these skills. We compared a clinical reasoning curriculum with standard ward instruction for improving presentation skills and clinical performance. SUBJECTS AND METHODS: Between October 1998 and May 1999, 62 third-year medical students at three hospitals were assigned to a 4-week clinical reasoning curriculum (n = 27) or a control group (n = 35) that underwent routine instruction. The curriculum consisted of four 1-hour group sessions and 1 hour of individual videotaped instruction, and taught students to use the principles of clinical reasoning, such as generation and refinement of diagnostic hypothesis, interpretation of diagnostic tests, and causal reasoning, to determine data for inclusion in the oral presentation. We videotaped students presenting two standardized case histories; one at baseline and a second 4 weeks later. Two independent evaluators who were blinded to the group assignments reviewed the videotapes and scored them for presentation quality and efficiency, and general speaking ability. RESULTS: Mean (+/- SD) presentation times at baseline were similar in the two groups (intervention group: 8 +/- 2 minutes; control group: 8 +/- 2 minutes; P = 0.74). Presentation time in students who were taught clinical reasoning decreased by 3 +/- 2 minutes, but increased by 2 +/- 2 minutes in control students. The difference in the changes between the groups was statistically significant (mean difference = 4 minutes; 95% confidence interval [CI]: 3 to 5 minutes; P <0.001). Presentation quality scores at baseline were similar in both groups (intervention group: 17 +/- 8 points; control group: 20 +/- 7 points; P = 0.11). Students who were taught the clinical reasoning curriculum had an improvement of 9 +/- 6 points in the quality of their presentations, while control students had an improvement of 2 +/- 7 points (on a scale of 4-36). The difference in the changes between the groups was statistically significant (mean difference = 4 points; 95% CI: 1 to 7 points; P = 0.04). CONCLUSION: A clinical reasoning curriculum, in combination with video-based individual instruction, improves the efficiency and quality of oral presentations, and may augment clinical performance.     

《医学免疫学》教学方法的改进及体会

《医学免疫学》作为一门医学基础课程,内容抽象,逻辑性强,教学难度大。在教学过程中结合免疫学课程特点和学情分析,作者在教学内容设计、多媒体课件制作、说课、教学手段运用、全面提升教师素质等方面交流了一些改革经验及体会,旨在为提高学生的学习兴趣,提高教学质量,为教学提供借鉴和参考。     

案例教学法在《人体寄生虫学》课程教学中的应用与思考

为了克服传统教学法在《人体寄生虫学》课程教学中的不足,探讨案例教学法的应用价值,本文就《人体寄生虫学》课程案例的选择和设计、案例教学过程、案例教学的优点以及存在的问题进行了总结和探讨,以期激发学生的学习热情,培养学生的自主学习能力,达到更好的教学效果。     

Physician knowledge of national cholesterol guidelines before and after an interactive curriculum

An interactive curriculum on National Cholesterol Education Program (NCEP) III guidelines was developed and distributed online to 877 physicians at 37 internal medicine residency training programs. Baseline knowledge of NCEP guidelines was tested before the curriculum. A test after the curriculum was compared with baseline performance to determine the impact of the curriculum. Performance was compared based on year of training or attending status. Scores for baseline knowledge of NCEP III concepts were 21.8% for residents and 23.2% for attending physicians, a difference that was not statistically significant. Postgraduate-year (PGY)-3 residents performed better than PGY-1 residents (26.5% vs 17.8%, p <0.05). Scores for specific concepts were 29.2% for pharmacology, 14.2% for major cardiovascular risk factors, 32.9% for coronary heart disease risk-equivalent conditions, 15.2% for diagnosis of metabolic syndrome, and 17.3% for treatment of patients with metabolic syndrome. For hypothetical clinical cases, attending physicians performed better than residents (63.2% vs 42.5%, p <0.05) and PGY-3 residents performed better than PGY-1 residents (47.7% vs 36.5%, p <0.05). After the curriculum, knowledge increased for all concepts (22.5% before vs 61.3% after the test, p <0.05). In conclusion, resident and attending physician knowledge of NCEP III guidelines is poor and can be improved by an interactive curriculum delivered online.     

Evaluating and enhancing a women’s health curriculum in an internal medicine residency program

OBJECTIVE: Resident education in women's health is required but is often underemphasized. Our aim was to identify women's health topics with the most relevance to our graduates' practices and to determine how well they were prepared to address women's health issues. DESIGN: Postgraduate survey. SETTING: University-affiliated internal medicine residency program. PARTICIPANTS: Program graduates in general internal medicine practice. METHODS: A survey was drafted listing the 65 topics described in a published residency curriculum in women's health. Respondents indicated the extent to which each item was relevant to their practice and the adequacy of instruction received on a Likert-type scale of 1 (not relevant/inadequate) to 5 (highly relevant/adequate). RESULTS: The response rate was 86%. Many of the items were highly relevant to our graduates' practices. Learning needs were found in all areas as none of the topics were rated as "adequately" taught during residency. Many areas in the curriculum had low relevance scores. Few differences were seen in the perceived relevance of women's health problems or the adequacy of instruction received based on gender, practice type and setting, or amount of ambulatory training during residency. CONCLUSIONS: Use of this survey has allowed us to tailor and prioritize learning issues in women's health to meet the needs of our graduates. Increased time in ambulatory rotations alone may not be sufficient to prepare residents to provide comprehensive care in this field. Further study of the effectiveness of a dedicated curriculum in women's heath is needed.