标准化病人在外科学技能训练和考核中的应用

目的:探讨标准化病人(SP)在外科临床技能培训及考核中的应用价值,为在临床教学中推广SP提供经验。方法:选择进入临床学习的临床医学专业学生,分别采用SP教学、传统的LBL+临床实践法进行技能培训,并对教学质量进行量化考核。结果:两组学生训练前基本情况一致;训练后临床技能考核成绩比较,实验组的问诊、体检、病例分析和与患者沟通成绩明显优于对照组,P0.01;实验组应用SP教学法有助于医学生理论知识的学习并能提高基本技能,在实习中接触患者时更有信心。结论:SP充分发挥了模拟病人、评估者和指导者的三重作用,增加模拟疾病的真实性;有效提高了学生临床基本技能和医患沟通能力;应用SP对临床技能进行考核可以客观公平、真实可靠地反映训练效果。     

医学生和理工科学生生活技能教育模式效果分析

目的探讨生活技能教育模式在医学生、理工科学生中的应用效果,为改善大学生心理社会能力提供参考。方法采用参与式教学方法在北京市某医科大学和天津市某理工科高校开设生活技能教育选修课程,进行生活技能的理论讲授与技能训练。通过课程前后的问卷测试,评估学生心理社会能力的变化。结果教育后,医学生和理工科学生心理社会能力自我评估均有明显进步,表示有很大进步的理工科学生多于医学生。学生情绪商测试中的总分、好、有能力、快乐4个方面得分均高于教育前,总得分低于平均值的学生数量减少,高于平均值的人数增加。医学生和理工科学生心理社会能力评分中的情商总分、有能力、快乐以及亚分类中的动机、生活满意度等均显著提高(P值均<0.05)。与医学生相比,理工科学生的心理社会能力改善的方面更多,评分提高程度也更为明显。结论生活技能教育模式能够有效改善理工科学生的心理社会能力。     

多模式教学方法在临床麻醉学教学中的应用

目的:探索有助于学生提高临床麻醉学学习效率的教学方法。方法:将多媒体计算机辅助教学、临床技能实验法以及模拟人演练法相结合的多模式教学运用到麻醉临床实际教学中。用问卷调查方式评估教学效果。结果:多模式教学法可以激发学生的学习兴趣,调动其学习的积极性,有利于临床医学生的培养。结论:多模式教学可以显著提高教学质量,提高学生综合能力。     

浅谈医学美学教育

医学美学是一门新兴学科,社会的发展和医学模式的转变给医学领域增添了美学的新内容。本文简要介绍了医学美学的教学意义、教学目标、课程设置及在临床中的实践运用,帮助医学生了解美学常识,增加审美意识,培养关学素质,以期加强医学美学教育,把医学生培养成为社会所需要的、高素质的人才。     

浅谈医学美学教育

医学美学是一门新兴学科,社会的发展和医学模式的转变给医学领域增添了美学的新内容。本文简要介绍了医学美学的教学意义、教学目标、课程设置及在临床中的实践运用,帮助医学生了解美学常识,增加审美意识,培养美学素质,以期加强医学美学教育,把医学生培养成为社会所需要的、高素质的人才。     

医学模拟教育与临床见习模式的改革研究现状

由于模拟技术的快速发展,Simman综合模拟人等医学模拟技术应用于医学教育中,尤其是临床见习教育中,从而形成了新的临床见习模式,即临床实践和模拟操作相结合。此模式的建立,为医学生进行临床实践提供了大量的技能训练机会,使得临床学习的效果更好、更有效。     

临床教学实训中心的构建和应用

临床教学是医学教育过程的重要组成部分,临床教学质量的高低与医学人才的培养质量有直接关系。随着医学模式的转变、医疗体制改革的深化以及患者自我保护意识的提高,医学生的临床教学面临着许多新的课题。为有效解决临床技能教学与临床医疗之间的矛盾,本院于2003年底在承担本科以上临床医学教学的5个附属医院建立了临床教学实训中心,运用高级综合模拟人系统和其他模拟模型,对学生进行临床技能训练,取得了满意的教学效果。     

在教学实践中提高医学生医患沟通能力

在我国医疗卫生事业改革不断发展的同时,临床教学工作也在努力探索之中。医学教育不仅要将学生培养成为一名专业合格的医生,更要注重医学生的医患沟通能力的培养,以适应和面对当前国内医患矛盾紧张的形势。临床实习是医学生锻炼和提高自身沟通能力的重要时机,通过系统的沟通技能培训和临床实践运用,采用PBL教学、角色扮演、讨论总结等方式转变医学生思维模式,强化沟通意识,全面提高医学生临床诊疗能力,促进疾病治疗和技术进步,维护医患关系的稳定,保证医疗质量的提高和推动医疗事业的发展。     

不同学历层次医学实习生职业认同感比较

目的 了解医学专科、本科和研究生实习生职业认同感的差异,为医学生的就业指导工作提供参考.方法 自行设计问卷,对安徽省某医学院469名临床实习的医学生进行调查,主要包括学医的原因和现状评估、医学生协作或交流情况、医学生个人感受等,按照分组进行分项登记和统计.结果 3组实习生在选择学医原因、学医具体动机、继续深造与否、与患者沟通能力、与同学教师相处能力、协作精神、学医是否有助于朋友交往、患者的依赖感、对待挑剔的态度、个人价值的自我实现、学医是否令人羡慕方面差异均有统计学意义(P值均＜0.05),其中研究生更加重视自我价值的实现,在与患者的沟通能力和与师生的相处能力及协作精神等方面明显强于专科生和本科生;专科生学医更主要是便于找工作,同时毕业后继续深造的愿望也最为强烈.在路人遇到困难时,大部分医学生能够进行救助,组间差异无统计学意义.结论 不同学历层次医学生在职业认同感方面有明显不同,研究生在大多数方面强于本科生,本科生强于专科生.     

医学训练载体在医学模拟教学中的应用研究

医学模拟教学逐渐成为临床医学教育的重要手段和方法,它很好地解决了临床教学资源缺乏的问题,提高了医学生的临床技能。各种医学训练模型承担了大量的教育载体工作,它为医学生提供了一个反复实践的平台,并为临床基本技能教学开辟了一个崭新的领域。而研究并开发各种训练载体,培养学生临床能力包括临床思维能力,是现代医学教育工作者必须引起关注的问题,在中医临床课模拟教学中同样发挥重要作用。     

Medical students as standardized patients to assess interviewing skills for pain evaluation

PURPOSE: The use of medical students as standardized patients in a performance assessment of pain evaluation was studied. METHODS: Fifty-two pairs of second-year medical students participated. One student portrayed a patient presenting with cancer pain and was interviewed by the other medical student. The student-patient then rated the interview using a checklist of pain assessment and general interviewing skills. The interviews were audiotaped and also rated independently. RESULTS: Based on student-patient ratings, 36 (69%) students demonstrated 9 or more of the 11 pain-specific checklist items, compared to 34 (65%) students according to the trained rater. Highly specific pain-related items had higher agreement than broader interviewing skill items. There would be differences in the summary assessments of students depending on which rating data were used. DISCUSSION: Medical students represent a readily accessible resource as patients for clinical simulations. Students tended to overestimate the performance of fellow students, but acting as a standardized patient had educational value, and can be used to extend simulated patient encounters within the curriculum. Further investigation is needed to improve the reliability of the feedback provided by student-patients.     

Comparison of methods for teaching clinical skills in assessing and managing drug-seeking patients

AIMS: New medical graduates lack clinical skills in assessing and managing patients seeking drugs of dependence. This study compares the effectiveness of three different clinical skills training methods, with similar content, which were developed to teach these skills to senior medical students. METHODS: A preliminary survey indicated that common problems seen by primary care practitioners included both new and previously known patients seeking either benzodiazepines or opiates. The common content of the teaching was determined from this survey. A didactic small group tutorial (DT), a video-based tutorial (VBT) using professional actors, and a computer-aided instruction package using digitized video (CAI) were developed with this common content, and trialled with undergraduate medical students over 2 years in a parallel-group design. Outcome was assessed by student feedback, performance on a case-based written examination and by a structured evaluation of interviews with simulated patients requesting drugs. Comparison was also made between methods on the basis of knowledge tests. RESULTS: No difference was seen in written examination and simulated patient outcomes between the three groups. However, the VBT was thought by the students to be preferable to other methods. The estimated development costs of CAI were higher, but total costs over a 6-year period were lower than for the DT and VBT. The results suggest that clinical skills can be taught equally effectively through several different methods. Collaboration between institutions in the development of widely applicable CAI tools should be an efficient and economical mode of teaching with a wide range of applications.     

An evaluation of the Team Objective Structured Clinical Examination (TOSCE)

OBJECTIVES: To evaluate the validity, reliability and feasibility of the TOSCE, a new means of formative assessment for medical students, from the perspectives of examiners, simulated patients and students. DESIGN: Teams of five students rotate through five clinical stations, performing one of four tasks in turn, whilst the fifth member of the team 'rests'. SETTING: St George's Hospital Medical School, London. SUBJECTS: Third-year medical students, their examiners and simulated patients. RESULTS: All participants felt the TOSCE session had high validity although some students were unfamiliar with some subjects. Stations were double-marked and agreement rates and Cohen's Kappa ranged from 67 to 94% and 0.04-0.88, respectively. Analysis of the causes of disagreement led to improved marking schedules and enhanced reliability. CONCLUSIONS: The feasibility of the exercise as a formative assessment was demonstrated by the confidence of the staff participating both as examiners and simulated patients and from the majority of students who welcomed the learning experience.     

Teaching sexual history taking to medical students and examining it: experience in one medical school and a national survey

OBJECTIVES: To assess the feasibility and acceptability of training and examining medical students in taking a sexual history and to compare practice with other medical schools in the UK. DESIGN: A training programme involving group work, role play and clinical attachments was developed and applied to 131 students at the University of Bristol Medical School. They then underwent an objective structured clinical assessment using simulated patients. The practice of other medical schools was surveyed by postal questionnaire. RESULT: The students felt that the examination was a good test of their knowledge and skills. One student failed. Sexual history taking is taught in 17 of 22 medical schools but examined in only six. CONCLUSION: Both teaching and examining of sexual history taking skills are possible and are likely to occur increasingly in UK medical schools.     

Early introduction to interprofessional learning: a simulated ward environment

OBJECTIVES: To develop an interprofessional simulated ward environment for junior medical and nursing students and to identify themes for future evaluations and modify criteria for formative assessment of the exercise. SUBJECTS: Second year medical and nursing students. SETTING: The multiprofessional Clinical Skills Centre at the Faculty of Medicine, and Nursing, University of Dundee, Scotland. METHOD: A simulated ward environment was created in the Clinical Skills Centre around patients with common medical conditions. Students were allocated to interprofessional teams and, after a briefing given in the form of a ward report, were asked to take responsibility for the ward for 'a shift'. Observers from the Schools of Medicine and Nursing charted their progress in relation to evidence of collaborative team working, effective leadership, the ability to prioritise workload and competence in clinical performance. Evaluations of the exercise were taken from all participants. The criteria for formative assessment were reviewed by the observers after the exercise and a focus group was used to generate additional criteria and modify those piloted. RESULTS: The exercise was perceived positively by all participating groups. Themes for evaluation of future exercises and modified criteria for future assessment were identified. CONCLUSIONS: The exercise gave students their first experience of participating independently in a realistic and safe operational ward setting. It proved to be a powerful learning experience for the students.     

基于智能模拟人的医学模拟教学效果评价

目的 研究某三级医院医学生对基于高端智能模拟人的医学模拟教学效果评价,进一步推动教学改革,创新医学教育方式.方法 采用学习成效量表和教学设计量表,以某医院临床内科学36名研究生为研究对象,采用美国国家护理联盟的学习成效量表和中文版Jeffries模拟教学设计量表在模拟教学前后各进行一次问卷调查,分析学生对教学效果和课程...     

Improving medical student performance in adolescent anti-smoking health promotion

BACKGROUND: We developed a 1-hour teaching seminar for medical students on anti-smoking health promotion for adolescents. We report the development of the programme and a performance-based evaluation. AIM: To develop a seminar for medical students with the objective of improving medical student inquiry into smoking and the delivery of advice accordingly for adolescent patients in routine consultations. METHOD: The seminar was developed using principles of adult learning and delivered to a cohort of medical students (intervention group). Participants were Year 5 medical students in their paediatrics term. A comparison group of 58 medical students who did not receive the seminar was studied in the semester prior to the intervention. The primary outcome measure was a change in anti-smoking health promotion practice within an objective structured clinical examination (OSCE), where taking a smoking history and making links between smoking status and health were indicated in a 15-year-old simulated patient (SP) with poorly controlled asthma. This was part of the summative assessment in the paediatrics term. RESULTS: In the OSCE, 21 of 58 (36%) students in the comparison group asked the asthmatic SP about smoking, compared with 41 of 56 (73%) students in the intervention group (P = 0.0001). In all, 15 (26%) of the comparison group students addressed the patient's smoking, compared with 33 of the 56 (59%) intervention group students (P = 0.0004). CONCLUSION: A carefully designed seminar addressing adolescent smoking can increase the frequency of smoking inquiry and advice by medical students.     

Assessment of emergency medicine: a comparison of an experimental objective structured clinical examintion with a practical examination

An emergency medicine and trauma programme was implemented at Ben Gurion University Medical School in Israel. Clinical performance assessment of the first-year course in emergency medicine and trauma was done using a practical examination (PE). In the continuous process of critically reviewing the course objectives and assessment methods the objective structured clinical examination (OSCE) was chosen, for the first time in our medical school, as a tool for course development as well as evaluation of the existing PE. Seven experimental OSCE stations were designed which covered some of the course and practical examination topics. Twenty-six first-year medical students have taken both examinations concurrently. Twenty-three students answered an attitude questionnaire regarding both examinations. Results have indicated that the OSCE provided additional and crucial information on students' deficiencies in clinical performance which were not available from the PE. Those differences were probably due to realistic OSCE station content, highly simulated set-ups, and the objectivity of the examiner, all of which have contributed to a more challenging examination, as compared to the PE. The OSCE in emergency medicine and trauma seemed to have a relatively high level of acceptance by both staff and students. In our opinion it seems that the OSCE is a better tool for first-year level final assessment in emergency medicine and trauma. is a better tool for first-year level final assessment     

Simulated patients and the assessment of medical students' interpersonal skills

While the use of simulated patients for the assessment of medical students' skills is increasing there is little data on whether students perform differently vs real patients. The present study examined this issue using second-year medical students' ability to empathize with simulated and genuine patients. Forty second-year students each conducted two interviews which were audio-recorded and later rated by raters who had achieved a high degree of reliability using the 9-point accurate empathy scale ( Truax, 1967 ). Ten students saw a genuine patient for each interview while ten students saw simulators on both occasions. Of the remaining twenty students, ten saw genuine patients at the first interview and simulated patients at the second session. This order was reversed for the remaining ten students. No significant differences were found in the levels of empathy between students' interaction with genuine or simulated patients. As the students were also unable to discriminate between the two groups of patients it was concluded that simulators represent a viable procedure given the skill to be assessed in the present research and the experience of the students.