从教学能力“四过关”考核探讨外科青年教师的培养途径

师资是高校最重要的资源,加强师资队伍建设是高校生存和发展的关键,青年教师教学能力的高低直接影响高等教育的质量.近几年来,随着青年教师的引进,他们在教学岗位上逐渐成为我校教学科研的主力军,但对他们的教学能力考核发现存在某些不足.如何提升青年教师的教学能力是摆在我们面前的首要任务.医学系在2003年10月制定了青年教师培养方案和指导教师带教办法,并于2013年11月至12月组织老教师对医学系工作的15名青年教师（外科2名）实施了教学能力“四过关”考核（四过关即教学课程理论考核、教学课程基本技能操作考核、备课能力考核和讲课考核）.笔者针对外科教研室青年教师在教学“四过关”考核中存在的问题和不足进行探讨,藉此帮助提升青年教师教学能力和教学水平,实现互帮互学互促,现将结果报道如下.     

教师标准化病人在诊断学实践教学中的应用及效果评价

目的　探讨教师标准化病人（teacher as standardized patient,TSP）在诊断学实践教学中的应用效果。方法　随机选择2011级临床医学五年制本科学生192名,分为TSP组和以课程为基础的教学（lecture-based learning,LBL）组,各96名。TSP组采用教师模拟标准化病人的方式开展教学,LBL组则采用传统教学。实践教学结束后,分别对两组学生进行病史采集、病例分析、职业素质、体格检查及病历书写等方面的临床技能考核,并采用Mann-Whitney u检验对考核成绩进行对比分析,评价教学效果。结果 TSP组在病史采集、病例分析、职业素质及体格检查考核分数分别为（69.66±4.15,17.78±1.39,27.10±1.68,47.83±4.92）,均明显优于LBL组得分（53.99±8.39,11.82±1.31,20.09±3.54,39.95±7.38）,差异有统计学意义;病历书写的考核分数为（3.09±1.95）,与LBL组（2.63±1.53）无统计学差异（P=0.089）。结论　TSP应用于诊断学实践教学,既有助于提高教师自身素质和能力,同时能够提升学生临床实践能力及职业素质。     

长学制医学生专业英语学习态度及现状的调研分析

目的：分析影响长学制医学生专业英语学习的相关因素,为实施“以学生为中心”的专业英语教学提供依据。方法自行设计调查问卷,包括学生基本信息、对专业英语学习态度和现状等内容,对同济大学2006至2008级临床医学七年制和八年制专业的134名学生进行调查。采用SPSS 19.0进行统计处理,结果采用百分比进行描述。结果回收有效问卷132份,有效回收率为98.51%。56.82%（75/132）的学生对专业英语学习感兴趣,71.97%（95/132）的学生有对外交流学习的意愿。学生学习专业英语的目的和需求围绕“阅读专业文献”的占68.94%（91/132）、围绕“撰写SCI论文”的占59.09%（78/132）和认为学习专业英语“利于国际交流”的占58.33%（77/132）。影响专业英语学习主要因素依次为授课方式枯燥（45.45%,60/132）,专业英语较难（41.67%,55/132）和课时偏少（40.91%,54/132）。结论长学制医学生对专业英语学习有需求且目标明确,但大多数医学生在专业英语应用方面仍存在一定困难,应从学生、教师和课程设置三方面着手,提高长学制医学生的专业英语水平。     

湖北省某医学院校公共选修课考核方式探讨

目前,医学院校公选课考核方式普遍采用闭卷和开卷形式,以检验教学的效果。这种传统的考核方式不利于检验学生课程学习所应掌握的知识状况,也不利于教师深入了解学生运用所学知识分析问题和解决问题的能力。本问从公共选修教学目标和学生能力培养两个方面着手,提出公共选修课考核应结合教学目标要求,对现有考核方式进行改革,为医学院校公共选修课考核方式的改革提供一个新的思路。     

以岗位胜任力为导向的医学检验专业英语教学模式探究

医学检验专业英语是医学检验专业的一门工具性课程,旨在培养学生阅读英文文献、撰写英语科技论文和进行国际学术交流的能力。随着国际间检验医学交流合作的不断扩大和深入及我国高等教育培养国际化人才的需求,对这门课程的教学质量提出了更高的要求。依据医学检验专业岗位胜任力要求,主要从教育理念、教材建设、教学模式、考核机制、师资队伍建设等方面,探讨了医学检验专业英语混合式教学。     

临床路径在妇产科临床教学中的应用及效果评价

目的：探讨临床路径（clinical pathway, CP）在妇产科临床教学中的应用及效果。方法选取200名临床医学专业专科实习学生为研究对象,随机分为两组（各100人）,分别采用CP教学和传统教学。实习结束后,两组学生均接受统一的专业考核,同时对CP教学组学生进行问卷调查。采用SPSS 17.0对两组学生考核成绩进行分析,计数资料行χ2检验,计量资料用t检验。结果 CP教学组学生专业考核平均成绩为（80.01±9.34）分、合格率为96%,均优于传统教学组[（72.37±10.79）分和87%],P等于0.000和0.022。在问卷调查中学生认为,将CP引入妇产科临床教学能增强自身学习积极性、主动性,可提高综合分析能力、临床思维、动手能力等;约90%的实习学生认可CP教学。结论在妇产科临床教学中引入临床路径,有利于提高教学效果、规范教学流程,以及提升妇产科带教教师的工作素质。     

民族医学高专青年教师“四过关”教学能力培养的评价与研究

目的：掌握青年教师的教学能力,找出在培养过程中存在的问题,为完善培养方案与机制提供依据。方法对黔南民族医学高等专科学校从2010年来分配到系部四个教研室的16位教师进行“四过关”能力培养。结果“四过关”考核,即教学课程理论考核平均成绩为（91.6±3.0）分;课程技能操作考核成绩为（90.7±5.6）分;教案书写检查考核成绩为（87.7±3.3）分;讲课考核成绩为（85.7±4.7）分,“四过关”考核模块均达到《培养方案》提出的合格标准。13位指导老师一致认为“四过关”考核非常有必要,对专业建设、学科建设、课程体系建设非常重要,应作为系部的长效机制,在校内进行推广。16位青年老师中80%以上的认为“四过关”考核非常有必要,对专业建设、学科建设和课程建设非常重要,应作为系部的长效机制,能增强学风、教风和职业道德教育,能反映个人能力和水平存在的问题等。结论将青年教师教学能力培养作为长效机制,形成制度;规范各门学科的技能操作流程,继续发挥指导教师的指导作用,同时加强青年教师的专业和基础理论学习,突显教师授课个性能力培养。     

涉外护理专业双语教学存在问题与对策

目的了解涉外护理专业双语教学现状及存在问题,探讨应对措施。方法自行设计问卷,对重庆医科大学护理学院2009级涉外护理专业61名本科生进行随机调查,主要了解学生基本信息、英语水平自我评价、课堂互动情况、教学评价和满意度、课程必要性认识、选修原因、喜好程度、授课方式及学习方式喜好、学习兴趣、学习信心等,数据采用Excel2007进行分析。结果学生公共英语基础较好,CET-4及以上通过率为90．16％。但学生自我认同度低,自信不足（自评英语水平“很好”者为0,“良好”者为1．64％,“一般”者为52．46％,“较差”者为39．34％,“很差”者为6．56％）。学生明确课程必要性,但课外学习专业英语时间少（68．85％的学生课外学习专业英语时间〈30min,21．31％的学生课后几乎没花时间学习）。对课堂教学英文讲授比例需求差异大;学生听、说能力及专业英语词汇储备不足影响到课堂互动。结论涉外护理专业双语教学需激发学生学习兴趣,加强听、说能力训练和自信心培养,进一步探索课程设置合理性。     

Mini-CEX在中医儿科学临床教学中的应用与效果评价

目的　评价迷你临床演练评估（mini-clinical exercise assessment,Mini-CEX）在中医儿科学临床教学中的应用效果,进一步优化具有中医儿科学特色的Mini-CEX量表,提高教师对其内涵的理解。方法　选择儿科临床实习本科生50名,随机分为Mini-CEX组和对照组,每组各25人。总共实习4周。通过临床综合能力考核评价Mini-CEX应用效果;通过对Mini-CEX量表中各项内容的认可度、优势及存在问题进行问卷调查,以了解学生对临床教学中引入Mini-CEX的评价。采用ＳＰＳＳ 17.0软件进行t检验和卡方检验。结果　Mini-CEX组实习生临床综合能力考核总成绩及各分项成绩均高于对照组（P＜0.05）,同时对教学的满意度高于对照组（P＜0.05）。通过问卷发现,学生对改进后的Mini-CEX量表中项目的认可度较高,尤其是临床沟通技能、人文关怀这一类“软能力”,认为其适合中医儿科的实习学习及效果评价。结论　Mini-CEX具有提升本科生临床综合能力、教学方法灵活、评价方式客观及注重医患沟通交流等技能培养的优势,值得在临床推广。     

TBL 结合情境教学在预选卫生士官常见疾病教学中的应用

目的　研究以团队为基础的学习（team-based learning, TBL）结合情境教学在预选卫生士官常见疾病教学中的应用成效。方法　将200名学员随机等分为两组（每组100名学员）,教学内容均为高原病和高血压两个章节,对照组（LBL组）学员按照传统方法教学;实验组（TBL组）学员则采用小组学习讨论结合情境教学,由教师提前拟定预习提纲及思考题,学员在课堂上以小组为单位开展讨论,并应用典型病例进行情境模拟。教学完成后,两组学员均采用成绩考核和问卷调查两种方式评估教学效果。结果　TBL组与LBL组相比,学员理论考核分数明显提高（88.90±5.28 vs. 76.10±5.12,P＜0.05）,教师对学员的满意度评分也较高（8.63±0.85 vs. 7.18±0.72,P＜0.05）。结论　TBL成效好,有助于提高学生学习兴趣和自学能力,培养其分析解决问题的能力,加强其沟通能力和团队协作精神。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.