高仿真模型在妇产科临床技能教学中的应用

临床技能操作是妇产科教学中的重要组成部分,目前由于医患诊疗意识的提高、医学伦理学的发展、近年来高校招生规模的不断扩大等诸多因素使临床技能教学面临越来越多的困难.妇产科学习包括理论及实践学习2个部分,要学好妇产科理论及实践学习二者均不可偏废,缺一不可[1].医学作为高风险行业,又涉及到诸多社会伦理道德问题,随着各项模拟技术应用于医学教育,仿真模型模拟教学也正被越来越多的临床教学工作者所接受并迅速推广应用,是目前妇产科临床技能教学的新途径[2].我院在210名临床医学生妇产科临床技能教学中应用高仿真模型,取得了满意效果,现报告如下.     

对护生实习后期进行强化教学的探讨

护理实习生毕业实习是理论联系实际的重要教学环节，也是学生掌握专业知识和技能不可缺少的阶段，许多学生毕业后直接就业，实习后期的带教尤为重要。为保证临床护理教学工作的顺利实施，使护生更好地将理论知识应用于临床，完成实习计划，为走向工作岗位奠定良好的基础，我院护理部在临床带教后期（护生实习最后两个月）采取了以下强化教学措施，收到了良好的效果。具体内容介绍如下     

三段式临床护理实践教学在临床护生实习中的应用

目的 探讨三段式临床护理实践教学在临床护生实习中的应用.方法 选择在我院实习的护生180人,分为观察组与对照组,每组90人,对照组应用传统的带教方式,观察组应用三段式临床护理实践教学.比较两组学生的学习效果,并对两组学生及带教老师进行问卷调查.结果 两组学生理论测验成绩比较,观察组学生的理论成绩明显高于对照组,两组学生实践技能考核成绩比较,观察组学生的成绩明显高于对照组(P<0.05).观察组学生的满意率明显高于对照组,观察组带教老师满意度明显高于对照组(P<0.05).结论 三段式临床护理实践教学能针对学生的特点进行科学化、合理化的临床教学训练,教学质量明显提高,学生及带教老师的满意程度高,为临床护理实践教学提供一种新的参考模式.     

浅析临床技能竞赛对妇产科学教学改革的启示

针对妇产科学教学状况,对教学改革的必要性进行分析。研究临床技能竞赛在妇产科临床教学中的促进作用,旨在通过妇产科临床教学状况的改善,进行教学模式的整合,充分展现临床技能竞赛在妇产科教学中的作用,实现妇产科学生临床实践技能的全面提升。     

护理解剖学研究性教学改革的思考

护理解剖学是一门比较特殊的基础学科,授课内容包括人体结构理论、解剖实验操作、临床护理技能,从理论到实践最后到能力形成,每个教学部分都互为结构、互为补充、紧密相连[1].在整体教学过程中体现护生临床护理学习的逐步推进过程,强调护理解剖学科研要素融入教学,其学科本身带有追求原理的研究过程,从"因学论教"转变为"因研论教",提倡不以传授学生知识多少为衡量标准,而是注重护生在解剖过程中拥有多少体验式思考[2].在传统课堂"传道授业"的基础上,将研究性教学与护理解剖相融合,以研究问题的机理为牵引,不断收集前沿研究领域信息,快速和准确地获取、分析和处理医学信息,应用于解剖实验,同步于临床实习,在提出问题、分析问题和解决问题过程中使解剖实验获得的丰富且多方面的体验,加深护生对解剖原理性内容的理解程度,激发她们创新思维,夯实护理技能,提升处置临床疑难事件能力.现以护理解剖学进行研究性教学改革为试点,计划每章节理论课之后,相继安排与课程内容相关的研究环节介入课堂中,通过研究性教学实施路径教会护生自主探索式学习模式,可使护生在理解问题的基础上更进一步,提高解剖学教学体验的实效性,护生毕业后可更好地适应各级医院、高等医学院校等机构中的临床护理、护理研究、护理教育等多方面工作[3].     

探索强化医学研究生综合能力培养的局部解剖学教学模式

局部解剖学是临床医学研究生,特别是外科、妇产科、介入放射科、五官科等研究生必修的一门专业基础课.面对在本科阶段已经学过这门课程,有的还具有多年临床经验的研究生,要如何教好局部解剖学,使研究生更好地掌握基本技能和基本理论,为临床手术打下良好的基础,是在教学改革中需要探索的问题.经过多年的教学实践,本系在以研究生为主体,教师为辅的指导思想下,按专业划分重点,实行了"以器官或结构为中心的解剖与手术操作的实验教学模式" 结合"以问题为中心的理论教学模式" 探索出强化医学研究生综合能力培养的局部解剖学教学模式.     

藏区“9+3”护生带教模式的研究

目的 研究个体化“一对一”带教模式在藏区“9+3”护生临床带教中的应用效果。方法 将我院2016年接收的藏区“9+3”护生32名作为对照组,实施常规的“一对一”临床教学模式;将我院2017年接收藏区“9+3”护生35名作为观察组,实施个体化“一对一”临床教学模式,比较两组藏护生的理论、技能考试成绩及对带教老师的满意度。结果 观察组藏护生的理论、技能考试成绩均高于对照组,差异有统计学意义（P＜0.05）;观察组对带教老师满意度为97.14%,优于对照组的87.50%,差异有统计学意义（P＜0.05）。结论 藏区“9+3”护生临床带教中采用个体化“一对一”带教模式利于提高藏护生理论、技能考试成绩及对带教老师的满意度。     

阶梯式题库在人体解剖实验教学中的应用

<正>人体解剖学是五年制高职护理专业学生必修的一门重要基础课程,是护生学习其他医学基础课程、临床护理等专业课程以及再学习、终身学习的基础。该课程医学新名词数量多,内容庞杂,对学生而言是一门较难理解和掌握的课程[1]。本课程在第一学期开设,总课时数为90学时,理论∶实验≌1∶1。新标准强调理论要密切、真正联系实际,重视实验技能和动手能力、创新能力的培养。本文旨     

实习护生在手术室带教方式探讨

目的 探讨实习生在手术室的带教方式,提高教学质量.方法 回顾性地分析带教过中的经验.结果 实习护生希望带教老师尊重自己,能以温和的语气与他们交流,传授手术室各项操作、技能等.结论 手术室临床带教应采用恰当的教学方法与学生沟通,使实习护生在较短的时间内掌握手术室护理的各项技能.     

规范护生护理文件书写提高护生书写能力

目的为了规范和提高实习护生护理文件的书写能力，提高带教老师和护生对护理文件书写重要性的认识，使护生在实习期间能掌握规范书写护理文件的方法。方法通过发放调查表调查100名带教老师和100名护生，了解老师对护生护理文件书写的重视度和指导情况以及护生护理文件的书写情况；了解护生对护理文件书写的参与度和认知情况以及在护理文件书写中存在的问题。结论通过分析护生护理文件书写时存在的问题，总结出从学校、护理部、带教老师、学生四个方面全方位重视护理文件书写，提高护生护理文件的书写能力，确保护生掌握护理文件的书写方法。     

The impact of perceived gender bias on obstetrics and gynecology skills acquisition by third-year medical students.

PURPOSE: To investigate the perceptions of third-year medical students about how their acquisition of skills during their obstetrics and gynecology clerkship may be affected by their gender. METHOD: From January 1999 to December 2001, all third-year students at one school completing their obstetrics and gynecology rotation were given an anonymous questionnaire addressing whether gender had a positive, negative, or neutral effect on their learning experience. Students were also asked to enumerate procedures they had performed (e.g., deliveries and speculum examinations) and to rate their ability to counsel women on several clinical problems. To further investigate the perceptions of gender discrimination, a focus group of 12 fourth-year students was held. RESULTS: A total of 263 questionnaires (95%) were returned. Of the respondents, 78% of the men felt their gender adversely affected their experience, and 67% of women felt gender had a positive affect. All but five of the remaining students were in the neutral group. Those students who reported a positive gender effect performed significantly more speculum examinations (15.5 versus 12.3), labor coaching (8.7 versus 6.2), and independent deliveries (3.4 versus 2.7) than did the negative gender-effect group. The positive gender-effect group felt more confident of counseling skills. The neutral group did not differ from the negative group. The overall numerical differences among groups were small, and all groups, on average, performed adequate numbers of skills to meet clerkship objectives. CONCLUSIONS: There is a strong perception among medical students that gender influences experience on their obstetrics and gynecology clerkship, but the differences are actually small. Possible reasons for such strong feelings are addressed and related to the history of sexism in reproductive health care and to the ethics of patients' preferences.     

男医学生在妇产科实习的素质能力培养

21世纪需要高素质人才，素质教育是关键。从一定意义上说素质教育就是因材施教，妇产科作为一门比较特殊的学科，在实践教学工作中女患者不愿意示教的情况越来越严重，尤其对于男医学生。本文对男医学生在妇产科实习的素质能力培养进行实践与研究，提出以素质教育为中心，培养出具备高尚的医德、扎实的专业本领和丰富的人文知识的新型人才。     

几丁糖和透明质酸钠防粘连材料在妇产科的应用

背景：妇产科防粘连材料的应用可避免再次给患者造成痛苦和伤害,减少不孕、肠梗阻等其它相关并发症的发生, 目的：分析在妇产科各种防粘连材料临床应用的效果,为防粘连材料的临床应用选择提供可参考借鉴的理论信息。 方法：对不同防粘连材料妇产科的临床应用效果进行分析,采用动物模型试验和临床病例随访的方法,重点分析几丁糖和透明质酸钠用于多种妇产科疾病防粘连治疗时的选择应用范围及效果。 结果与结论：妇产科临床应用防粘连材料可以获得满意的效果,医用生物膜、玻璃酸钠、聚乳酸凝胶等也可用于妇产科防粘连的应用,但是相比而言,几丁糖和透明质酸钠的防粘连效果更优异。     

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.     

Syndrome of acute abdomen in gynaecology and obstetrics

The syndrome of acute abdomen in gynecology and obstetrics can develop due to inflammatory, ischemic-obstructive and hemorrhagic intra-abdominal etiology as a complication of primary disease, pathologic processes on some organs or injuries (genital, gastrointestinal, urinary, vascular, neurologic and musculoskeletal systems). Clinical and ultrasound examination, x-ray diagnosis, laparoscopy (in early pregnancy) and laboratory findings are the basic diagnostic methods to evaluate etiology of acute abdomen syndrome in gynecology and obstetrics. Rare cases with atypical clinical pictures and etiology of acute abdomen syndrome in gynecologic and obstetric casuistic are described.     

90后高职护生实习现状调查及分析

目的 调查90后高职护生临床实习表现,分析存在问题,提高职临床护理教育质量。方法 2018年1月采用我院自设的《优秀实习生评选表》,调查2017~2018年度81名在我院实习的90后高职护生临床实习表现,分析不足。结果 90后护生临床实习表现总体得分（94.32±3.03）分,软技能和学习情况等条目得分稍低;男生学习情况得分高于女生,男生各项活动参与情况得分低于女生,差异均有统计学意义（P＜0.05）;3+2高职护生劳动纪律得分,学习情况得分低于非3+2高职护生,差异有统计学意义（P＜0.05）;郊区高职实习生的护士素质、工作态度、劳动纪律、学习情况,各项活动参与情况得分均低于城区高职实习生和自联大专实习生得分,差异有统计学意义（P＜0.05）。结论 90后高职护生实习表现总体良好,但软技能和理论操作技能有待提高,各层面上应注重护生软技能的培养,塑造护生良好的个性品质。不同护生特质不一,院校护理教育者应通力合作,及时沟通,积极更新教学理念,革新教育方法,针对护生不同特质采取针对教育,提高90后高职护生整体素质。     

微课堂在诊断学实验教学中的应用效果分析

目的分析微课堂在诊断学实验教学中的教学效果。方法在广东医科大学2014级本科临床医学专业50个班中,采用随机数字表法各抽样2个班作为对照组(67人)和实验组(65人)。对照组采用传统教学方法,而实验组采用微课堂教学方法。统计两组学生的理论知识成绩和临床技能考核成绩,评估两组学生对两种教学方法的认可程度。采用t检验和χ~2检验分析数据。结果实验组的理论知识成绩和临床技能考核成绩均明显高于对照组(P0.05)。实验组的学生认为可以加深理论知识理解、提高临床技能操作水平、培养创新思维和调动自主学习积极性的构成比高于对照组(P0.05)。结论微课堂教学可显著提高诊断学实验教学的质量。     

"Making the grade:" noncognitive predictors of medical students' clinical clerkship grades

OBJECTIVES: Because clinical clerkship grades are associated with resident selection and performance and are largely based on residents'/attendings' subjective ratings, it is important to identify variables associated with clinical clerkship grades. METHODS: U.S. medical students who completed > or =1 of the following required clinical clerkships--internal medicine, surgery, obstetrics/gynecology, pediatrics, neurology and psychiatry--were invited to participate in an anonymous online survey, which inquired about demographics, degree program, perceived quality of clerkship experiences, assertiveness, reticence and clerkship grades. RESULTS: A total of 2395 medical students (55% women; 57% whites) from 105 schools responded. Multivariable logistic regression models identified factors independently associated with receiving lower clerkship grades (high pass/pass or B/C) compared with the highest grade (honors or A). Students reporting higher quality of clerkship experiences were less likely to report lower grades in all clerkships. Older students more likely reported lower grades in internal medicine (P = 0.02) and neurology (P < 0.001). Underrepresented minorities more likely reported lower grades in all clerkships (P < 0.001); Asians more likely reported lower grades in obstetrics/gynecology (P = 0.007), pediatrics (P = 0.01) and neurology (P = 0.01). Men more likely reported lower grades in obstetrics/gynecology (P < 0.001) and psychiatry (P = 0.004). Students reporting greater reticence more likely reported lower grades in internal medicine (P = 0.02), pediatrics (P = 0.02) and psychiatry (P < 0.05). Students reporting greater assertiveness less likely reported lower grades in all clerkships (P < 0.03) except IM. CONCLUSIONS: The independent associations between lower clerkship grades and nonwhite race, male gender, older age, lower quality of clerkship experiences, and being less assertive and more reticent are concerning and merit further investigation.     

3D打印技术在颌骨肿瘤与肿瘤样变临床教学中的应用

目的探讨3D打印技术应用于颌骨肿瘤与肿瘤样变临床教学中的效果。方法将参与颌骨肿瘤与肿瘤样变课程的92名学生随机分成2组进行对比教学。第一组先进行以知识点讲解、病例分析及锥形束CT检查等为主的传统教学,再进行3D打印技术辅助的新方法教学;第二组先行3D打印技术辅助的新方法教学,再进行传统教学。分别对两组学生两学时后的教学情况进行问卷调查及对比,评估3D打印技术辅助的教学新方法对颌骨肿瘤与肿瘤样变临床教学的相关作用。结果传统教学方法对于颌骨肿瘤与肿瘤样变基础解剖知识点的掌握更有优势(P<0.05);对于肿瘤细节、知识记忆、肿瘤空间形态、教学生动性等方面,3D打印技术辅助的教学新方法更有优势(P<0.05)。教学顺序对最终学习效果影响较小,但牵涉到知识记忆和空间形态的理解方面,让学生先行3D打印技术辅助教学的新课程再行传统课程得分更高(P<0.05)。结论先进行3D打印技术辅助的教学新方法在一定程度上更有利于让学生从三维空间上去理解和掌握肿瘤与肿瘤样变的特点。     

The effect of a domestic violence interclerkship on the knowledge, attitudes, and skills of third-year medical students.

PURPOSE: To determine whether participation in an intensive domestic violence interclerkship (DVI) improved the knowledge, attitudes, and skills of two successive cohorts of students at the University of Massachusetts Medical School. METHOD: The authors measured the knowledge, attitudes, and skills pertaining to domestic violence of third-year students in the classes of 1997 and 1998 using a validated written examination administered before, immediately after, and six months after participation in a 3.5-day or two-day DVI, respectively; they compared the scores using paired t-tests. Nine months after the DVI, the students' domestic violence screening skills were measured by a performance-based assessment (OSCE); using unpaired t-tests, the authors compared the OSCE scores with those of a previous third-year class that had not participated in a DVI. Immediately after the OSCE, the students reported their levels of confidence in domestic violence screening and their satisfaction with the domestic violence curriculum; using chi-square analysis, those self-reports were compared with those of the class with no DVI. RESULTS: The students who participated in the DVIs immediately and significantly improved their knowledge, attitudes, and skills (p < .001), and fully or partially sustained those improvements six months later (p < .001). Nine months after the DVI, the students performed domestic violence screening more effectively (p < .001), expressed greater comfort with domestic violence screening (p < .001), and felt better-prepared by the curriculum to address domestic violence issues (p < .001) than did the students with no DVI. CONCLUSION: Participation in a short, focused DVI curriculum produced sustainable improvements in knowledge, attitudes, and skills that were successfully applied by third-year medical students to effective domestic violence screening. Interclerkships are an effective way to fit into the clinical curriculum those subjects that transcend the traditional biomedical domain and intersect all areas of medical practice.