循证医学教育理论在临床教学的应用研究

目的:探讨循证医学教育理论在临床教学的应用,并对循证医学教育理论在临床教学中的效果进行评价.方法:自行设计问卷对56名临床医生进行调查,评价循证医学教育理论在临床教学中的效果.结果:通过循证医学教育理论在临床教学应用后,认为参加相关培训是获取本领域信息的最佳方式的医生占44.64%,与其他三种方式相比,差异具有统计学意义(P<0.05);临床医生采用循证医学或临床流行病学调查进行评价的次数占46.43%,与采用其他方式进行评价次数所占比例相比,差异具有统计学意义(P<0.05).结论:在临床教学中引入循证医学教育理论,收到了良好的的教学效果.大多数临床医师通过循证医学培训,很好的掌握了循证医学相关概念,并基本掌握了循证医学在临床实践中的应用方法.     

临床医学院教学基地建设探讨

作为医学教育的职能部门和管理者,不能忽视临床医学院的教学阶段,必须明确高等医学教育的全新培养目标,加强临床医学院基地的教育职能建设,使之积极主动地适应医学教育改革和发展的需要。     

临床教学医院循证医学教育理论应用评价

目的:对临床教学医院临床医生循证医学教育的教学效果进行评价。方式:通过40名临床医生的问卷调查来进行评价。评价指标包括对循证医学有清晰的了解,对循证医学有正确态度,熟悉专业知识更新的方法和途径,具备循证医学应用能力。结果与结论:循证医学教育在临床教学医院取得了良好的教学效果。     

循证医学与外科临床及教学

为了使外科临床能够建立科学的循证实践观,培养寻找证据、应用证据的能力,运用循证医学在最佳科学研究证据基础上更好地指导医学教育领域中的外科临床及教学。     

在临床医学系统课教学中培养学生循证思维

循证医学是近年新兴的方法学的重要分支，在医学领域的多个方面得到应用和发展。临床医学院的医学生在接受临床医学系统课的教学中同样接受了循证思维的训练，该方法不但突显自身优势，更是传统教学法的必要补充。本文综合归纳了循证医学方法在临床系统课教学中应用的具体形式及其产生的重要作用，以便进一步普及并促其不断发展。     

循证医学与临床医学教育模式的改革

随着医学模式的转变 ,传统的临床医学教育模式已不能适应现代医学发展的需要。循证医学是一新型的医疗模式 ,它反映了现代医学的发展趋势 ,代表了现代医学的前进方向。从医学教育的角度看 ,循证医学是一种与传统教学模式不同的学习方法 ,是一种新的临床医学教育观。循证医学的兴起为当今世界医学教育改革指明了方向 ,也将促使我国医学教育模式发生巨大的转变。临床医学教育必须顺应这一趋势 ,按照循证医学的基本思想促进医学教育观念的更新 ,推进医学教育模式的改革。     

医学教育改革何去何从

2017年,国务院印发了《深化医教协同,进一步推进医学教育改革发展的意见》,明确了医学教育改革发展的目标任务。近日,清华大学临床医学院主办“清华医学教育论坛”,邀请综合大学医学院(部)的医学教育专家、医学教育管理者,就医学教育的新理念、新模式和新方法,尤其是针对我国八年制医学博士的教育改革与发展方向进行讨论。     

基层医院循证医学教育与临床科研

探讨在基层医院临床科研中引入循证医学思想,提升基层医院临床科研水平和质量.以浙江中部东阳市人民医院为实例,开展循证医学教育培训并将其理念融入临床科研实践中.东阳市人民医院循证医学与临床科研相结合显示了极大的效益潜力,有利于人才队伍的培养,对促进医院临床科研效能提高具有重要的现实意义.     

循证医学—医学教学与实践的新方法

(上接第5期) 四、培训中的循证医学 在McMaster University内科医生培训计划中已明确了培养具有基本循证医学知识的医生这一目标,其它临床专业也开展了循证医学教育.在此主要讨论该学院内科医学培训.     

医学生循证医学实践能力的影响因素调查及对策

[目的]调查影响医学生循证医学实践能力的因素,寻求提高医学生循证医学实践能力的对策.[方法]在我院2004级医学专业毕业实习学生中进行循证医学实践能力影响因素的问卷调查,分析其相关性,寻求提高循证医学实践能力的对策.[结果]批判性思维能力、传统医学教育模式、循证医学理论知识是影响循证医学实践能力的主要因素.[结论]把循证医学教育贯穿于医学教育的全过程是培养医学生批判性思维能力和提高循证医学实践能力的关键所在.     

Teaching evidence-based medicine more effectively

Evidence-based Medicine (EBM) is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT) were 170 members of the medical faculty who were divided into two groups of 86 (intervention) and 84 (control). Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI) was defined and computed. Results: The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P<0.001 for attitude and skills P<0.001 in an EBM exam when compared with medical faculty members who did not participate in EBM educational intervention (n=84). Moreover, they had also increased confidence with critical appraisal skills, and searching EBM resources. Conclusions: Conferences followed by small-group discussions significantly enhance EBM knowledge, attitude, critical appraisal skills and literature review skills.     

Basic estimate of needs for training in evidence-based medicine in Slovakia

This study reports the findings of the first survey of the knowledge and needs for training in evidence based medicine (EBM) of health-care workers in Slovakia. This study was primarily qualitative and based on a triangular approach, which included: analysis of the situation in pre- and postgraduate education in Slovakia aimed at estimating needs in EBM and critical appraisal skills (CAS) training; analysis of questionnaires distributed in a sample of medical doctors and university educated public health workers undergoing postgraduate training; and focus group discussions. The findings revealed a real gap in knowledge in EBM and CAS in Slovakia and identified several areas as the focus for intervention. The results showed also some important behavioural and cultural aspects, including low individual responsibility for education; tendency to delegate responsibility to authorities (experts, top management, Ministry of Health); and persistence of the state paternalistic type of education. Concludes that managers planning to implement EBM in Slovakia should therefore consider a broader behavioural and cultural context for change, not just introduction of a training EBM module.     

辽宁省医护人员循征医学认知现状调查

目的 了解辽宁省医护人员循证医学认知现状,探讨开展循证医学教育途径.方法 对辽宁省10家三级甲等医院1 010名医护人员进行问卷调查和循证医学知识测试.结果 获有效问卷929份,医护人员对循证医学很了解77人,占8.3%,比较了解300人,占32.3%,一般了解426人,占45.9%,不了解126人,占13.6%;学历、职业、职称、职务、英语水平、计算机水平、使用数据库和阅读医学文献的频次是医护人员获得循证医学知识的主要影响因素;认为应该在专科阶段开设循证医学课程为220人,占23.7%,本科阶段开设为539人,占58.0%,在研究生阶段开设为150人,占16.1%.结论 辽宁省医护人员对循证医学了解程度低,应加强循证医学知识教育,提高临床服务质量.     

医务人员循证医学相关知识与技能的现状分析

实践循证医学（Evidence-based Medicine，EBM）有助于医务人员制定最佳临床决策。为了解医务人员EBM的相关知识与技能，对江苏省区域内三级和二级医院的医务人员进行问卷调查，结果表明需尽快开展系统、有效的EBM继续教育。     

Teaching and evaluating first and second year medical students' practice of evidence-based medicine

PURPOSE: To implement an evidence-based medicine (EBM) curriculum for Year 1 and 2 medical students, and to develop a method to evaluate their practice of EBM in discrete and relevant worksteps. METHODS: For the 100 students entering Year 1 of their medical education in 2000, we implemented a curriculum with 25-30 student contact hours of EBM instruction which used a variety of teaching formats and spanned the first and second years of their training. We developed an evaluation module that assessed the following 5 steps in the practice of EBM: generating well built questions; searching for evidence; critical appraisal; applying the evidence, and self-evaluation. We tested 2 different versions of the test module 3-months apart with the same cohort of second year students, and correlated their scores on the second module with examination components of a comprehensive assessment. We obtained feedback from the students regarding the EBM curriculum and evaluation method. RESULTS: Each test module took 2-4 hours to complete and 5-8 minutes to grade. There was moderate test-retest reliability for the total test scores (r = 0.35, P < 0.001). Step 1 scores correlated with the mock board examination scores (r = 0.23, P = 0.05). Step 2 scores correlated with the peer assessment factor "work habits" (r = 0.24, P = 0.02), and Step 3 scores correlated with clinical reasoning exercises (r = 0.31, P = 0.002). Step 4 scores lacked test-retest reliability and did not correlate with components of the comprehensive assessment. The majority of students felt there was too much focus on EBM during the first 2 years of the curriculum and they rated the EBM test module the lowest rated component of the comprehensive assessment. CONCLUSIONS: Although we have demonstrated preliminary reliability and validity of a new evaluation instrument that assess the domains of scientific knowledge, work habits and reasoning skills required in the practice of EBM, many of the correlations were weak, and we remain in the very early stages of determining if, when and how EBM instruction should occur in medical education.     

多学科联合开展临床循证医学教学的优势

本文介绍了在医学本科生、研究生和医学继续教育中开展临床循证医学教学的实践经历和体会。教研室由多学科人员组成,包括流行病学、内(外)科医生、图书馆专家等构成,通过多次的集体备课,教案讨论、试讲,使循证医学的教学日趋成熟。强有力的组织领导、对于教学理念的求新求精、努力学习与知识更新、团结协作是立足的根本。     

循证医学理念在肝脏外科临床教学中的应用

循证医学是整合最佳研究证据、临床经验和病人价值观,为临床问题决策提供明智的答案和研究证据的一门学科。将循证医学理念应用于肝脏外科临床教学是一种科学的符合当今医学发展形势的临床医学教育模式。该文通过研究认为,循证医学理念应用于临床教学,有利于培养学生的循证思维能力,增加学生的学习兴趣,提高学生解决临床实际问题的综合能力。     

Barriers facing physicians practicing evidence-based medicine in Saudi Arabia

INTRODUCTION: Tremendous advances in health care have been made through the development of evidence-based medicine (EBM). Studies show that physicians face barriers in practice, preventing the effective use of the best evidence available. Insight into these barriers should pave the way for an action plan to remove them. The aim of this study was to explore the major barriers to the practice of EBM by physicians in primary health care centers (PHCCs) and hospitals. METHOD: This cross-sectional study was conducted on physicians in PHCCs and Ministry of Health hospitals in the Dammam area (Dammam, Alkhobar, and Alqatief) of Saudi Arabia. A sample size of 409 physicians was chosen. Barriers to the practice of EBM and the reasons for not giving patients effective health care were investigated through questionnaires. RESULTS: The response rate was 66. 7%. The main barriers to practicing EBM stated by physicians were the lack of training in EBM (72.9%), facilities (34.4%), and time (29.2%). The least mentioned barriers were the lack of relevant evidence and the negative impact on medical skills (10.4% each). DISCUSSION: Rather than skepticism about the concept, the main barriers to the use of EBM by physicians appeared to be a lack of knowledge and basic skills. Therefore, targeted education in EBM and a system that quickly delivers high-quality evidence are needed. This includes the allocation of an adequate infrastructure and time and the availability of relevant evidence.     

循证医学思想在社会医学教学中的应用

循证医学是科学、系统的思维研究方法论,在社会医学教学中具有重要价值,能帮助学生树立、培养科学的医疗卫生观和科研态度,培养新型医疗卫生人才,促社会医学教师自身素质的提高和社会医学教育的进一步发展。     

Das Deutsche Netzwerk Evidenzbasierte Medizin — DNEbM

The German Network for Evidence-based Medicine (DNEbM) was founded in October 2000. A major impetus for the development of evidence-based medicine (EBM) in Germany came in the mid-1990s from the German Cochrane Initiative, which referred to the principles and activities of the international Cochrane Collaboration. The Network's primary mission is to establish a competence and reference centre for all aspects of evidence-based medicine. Central to this mission is to encourage projects that are concerned with scientific and methodological problems, aspects of professional development and the question of how to translate EBM into clinical practice. With currently more than 600 individual members the DNEbM is the most important society concerned with EBM in the German-speaking region in Europe. Until now, the DNEbM has initiated the development of curricula for EBM and health technology assessment (HTA) for undergraduate and continuing medical education. In addition, position papers regarding hot topics such as prostate cancer screening with PSA or registration of randomised controlled trials were published. The Network's HTA section comprises experts from universities, institutes, health care administration and industry. Currently, the HTA section is developing an Internet-based course for users and doers of HTA reports in Germany.