心电图诊断教学中的实践教学体会

教学方法是提高教学质量的关键所在,心电图诊断的内容复杂、理论抽象,是教学中的重点、难点,而且它所占的教学时数又较少.怎样在较少的学时内让学生充分理解和掌握理论性强、抽象难懂的教学内容,是每一位教师必须解决的难题.我们结合自身的特点进行了教学方法改革,采用灵活多样的教学方法,变单纯理论式教学为理论与实践相结合,多看图、多练习,结合多媒体等的教学方法,取得了较好的教学效果.     

三维电生理图在心电图理论教学中的应用体会

目的解决心电图诊断学理论中关于心电图波形产生原理中遇到的教与学的两难问题。方法我们尝试将临床心脏三维电生理标测图与心电图产生基本机制相结合,用来解释正常及部分异常心电图波形产生的基本机理,从而介绍一种新的心电图理论教学方法。结果本方法可直观地阐述正常和异常心电图各个导联心电图波形特征及其机制,使学生迅速具备心电图的分析能力和阅图判读能力。结论将心脏三维电生理图应用于教学可以解决心电图诊断学理论中关于心电图波形产生原理中遇到的教与学的两难问题,值得在教学中推广。     

心电图导联标准化的临床应用体会

随着社会的发展与人们对健康要求的提高,心电图检查越来越多地用于临床实践中,但同时也带来了另一方面的问题,就是检查中没有一个统一、规范化的标准,包括导联系统、操作流程和诊断名词等。随着《心电图标准化和解析的建议与临床应用国际指南2009》的发布,心电图检查正向着规范化的方向发展。笔者通过对该指南的学     

见习医师心电图教学体会

目前在各级医疗机构中,心电图检查已非常普及。心电图是诊断心律失常的金标准,对心律失常的确定性诊断是其他任何检查不能替代的;心电图对心肌梗死的诊断可定性、定位、定期,也有着不可替代的重要作用。因此,心电图诊断不仅心电图专职医师、心血管内科医师需要掌握,而且是每个临床医师都必须掌握的技能。而见习医师是刚进入医疗机构且尚未取得执业医师证(或执业助理医师证)的     

双极胸导联心电图临床应用体会

近10年来,广大医务工作者为了提高心肌梗塞(M1)特别是灶性M1的诊断率,不断创建了一些方法应用于临床。从1984年12月起,我们在ЗУБАЛЕВ氏启示下,采用4对双极胸前导联,测定100例正常人心电图,利用心电向量的原理以反映左室前、后、侧、下4个面的心电变化;并通过131例M1病人的临床验证,与普通15个常规导联相对比,证明它具有一定的优越性。现介绍如下。     

医学生心电图实习的教程设置

目的 在多年的心电图教学中逐渐摸索出一些教学经验。方法编写一套教学图由浅入深的引导学生分析心电的基本现象。结果通过实习方法的改进,明显提高了实习医生快速识图的能力。结论从而使其在短暂2W内对典型、不典型、疑难的心电图都能有正确的分析水平。     

立体心电图的临床应用

心脏是三维结构。在医学心电技术的发展上，心电图（ＥＣＧ）的一维线性、心向量图（ＶＣＧ）的二维平面环和立体心电图（ｓｔｅｒｅｏｅｌｅｃｔｒｏｃａｒｄｉｏｇｒａｍ，ＳＥＣＧ）的三维空间表达，代表着心电学发展三个不同的阶段。其目的在于能进一步揭示出心脏立体...     

物理诊断学心电图教学难点及原因初探

我国医学教育中心电图（ECG）教学与临床实际脱节、教学质量低的现象长期存在且未引起重视,造成了教学资源浪费、临床医生ECG技能欠缺等普遍现象。本文从教学实际经验出发总结了目前ECG教学当中存在的难点和原因,为进一步改进ECG教学提供了基础。     

医学本科生心电图见习教学方法探索

目的 探索一种普适性强的本科生心电图高效见习教学方法。 方法 在有限学时,设计了“两段三步八环节”的见习教学方法,通过课后调查问卷、见习前后读图测试成绩以及与前一学年招生背景相似但见习方法不同的学生见习后测试成绩对比,评价教学效果。 结果 98.7 %的学生认为这种见习方式有助于提高读图能力,85.3%的学生认为学习心电图的兴趣得到了提高,78.7%的学生认为自己基本掌握了心电图分析方法,61.3%的学生认为自己的读图能力有了显著提高。见习前后两次测试成绩比较,见习后明显好于见习前（P<0.05）。对比2017级和2016级长学制学生的见习后测试成绩。两者招生模式相同,心电图见习后测试的考题完全一致(考题严格保密不泄露),结果发现两组成绩的差异没有统计学意义。 结论 教学组探索了一套学时压缩的高效实用的心电图见习教学方法。对这套方法加以调整,便可应用于非疫情时期的线下见习,当未来需要进行线上见习时,教学组的方法同样适用。     

Accuracy and variability of medical interpretation of the electrocardiogram]

The accuracy of medical interpretation of the ECG, the variability of electrocardiographic conclusions drawn by different physicians and by a specialist when re-analyzing the same ECG were considered. Three experienced physicians analyzed 700 ECG independently from one another. The electrocardiographic inferences were contrasted against the autopsy, roentgenographic and clinical findings. A paired comparison of electrocardiographic conclusions made by the physicians with respect to the principal groups of these conclusions was undertaken. The mean frequency of complete concurrence of the conclusions varied from 26 to 89 per cent, depending upon the type of the electrocardiographic conclusion. Subject to comparison were also conclusions drawn by a single physician with a two-fold analysis of the same ECG. In this case the frequency of divergent inferences amounted to 43 per cent.     

Common errors in computer electrocardiogram interpretation

OBJECTIVE: The aim of the study was to determine the frequency and nature of errors in computer electrocardiogram (ECG) reading. METHODS: The ECGs were collected in the tertiary care VA Hospital from both inpatients and outpatients. They were read by the electrocardiograph built-in computer software, and then reread by two cardiologists. Statistical analysis was performed using sensitivity, specificity, positive and negative predicted value to analyze the data. An error index was formulated as indicator of diagnostic accuracy. RESULTS: Out of 2072 ECGs, 776 (37.5%) were normal, and 1296 (62.5%) were abnormal. In 9.9% of all ECGs and in 15.9% of abnormal ECGs there were significant disagreements between the computer and cardiologists. The errors in diagnosis of arrhythmia, conduction disorders and electronic pacemakers accounted for 178 cases, or 86.4% of all errors. The rest was represented by misdetection of chamber enlargement (7 cases, 3.4%), misdiagnosis of ischemia and acute myocardial infarction (16 cases, 7.8%), and lead misplacement (5 cases, 2.4%). CONCLUSIONS: The most frequent errors in computer ECG interpretation are related to arrhythmias, conduction disorders, and electronic pacemakers. Computer ECG diagnosis of life threatening conditions e.g. acute myocardial infarction or high degree AV blocks are frequently not accurate (40.7% and 75.0% errors, respectively). Improvement in the diagnostic algorithms should focus on these areas. Error index is a convenient and informative tool for evaluation of diagnostic accuracy.     

Review of intern preparedness and education experiences in General Medicine

Background: Few studies assess the transition from medical student to intern and there is limited understanding of what measures are required to assist intern development. The aim of the study was to assess interns’ perception of their preparedness before commencing and on completion of their rotation in General Medicine, and their attitudes towards educational experiences at a tertiary metropolitan teaching hospital. Methods: Self‐assessed preparedness for the General Medical internship and educational experiences were evaluated using a quantitative 5‐point scale (1 = low score and 5 = high score) and qualitatively through interview, on interns based at St Vincent’s Hospital (Melbourne). Data were collected at the beginning and at the end of each 10‐week rotation (n = 25). Results: Before commencement of the rotation, the interns identified areas where they felt inadequately prepared, particularly resuscitation skills and medico‐legal aspects. When resurveyed at the completion of their 10‐week rotation, the interns felt they had been better prepared for their role than they initially perceived, both generally and in specific aspects. Nine out of 16 parameters showed a significant increase in preparedness score at week 10 compared to week 1. The educational experiences most valued were peer driven education sessions and informal registrar teaching. Formal consultant teaching and online learning were perceived as being the least useful. Conclusion: Interns at St Vincent’s Hospital have been adequately prepared for their role in General Medicine, although many realize this only in retrospect. Deficiencies in educational opportunities for interns have been uncovered that emphasize areas of attention for medical educators.