Using PDAs during the internal medicine clerkship

In 2000, an Institute of Medicine Report stated that there are 99,000 deaths in hospitals each year due to medical errors. Many options have been tried to improve systems and practice patterns, but they have proven to be too cumbersome to be workable and were not accepted by physicians. We conducted a study of 19 third-year medical students (12 males, 7 females) at the West Virginia University School of Medicine, Charleston Division, during their eight-week clerkship in 2002 to determine whether providing them patient information at bedside with Personal Digital Assistants (PDAs) would be valuable. In addition, we also wanted to see if the students would accept the use of these devices and better capture data on patient procedures. The Palm M 500 model was used in the study and every unit was preloaded with Epocrates, Epocrates ID, 5 Minute Clinical Consult, Harrison's and Patient Keeper Version 2.3. The medical students were given 15 minutes of instruction in the use and care of the PDAs, and they were required to input any procedures they performed or observed for patients into Patient Keeper 2.3. A pre-clerkship survey and a post clerkship survey with a five-point rating scale revealed the students had a very wide acceptance of the PDAs for the input and access of medical information. As these devices become cheaper, more powerful, more feature-packed, and as software in the PDA format becomes even more medically oriented, these devices will become much more common in hospitals. PDAs offer a valuable means of reducing medical errors and further modernizing medical record keeping.     

Evaluation of medical students during a clinical clerkship in internal medicine

During a three-month clinical clerkship in medicine 175 medical students were evaluated. A proficiency assessment process was developed which included preceptor evaluation of on-the-job performance as well as independent oral and written examinations. Analysis of data from this study disclosed small correlations among the three measurements of clinical competence. Ratings by preceptors, based on direct observations of students, also showed a large intrastudent variation. Although the individual clinical ratings had low reliability, averages taken over a period of time were more consistent. These data have importance not only in the assessment of the clinical competence of medical students but also in other areas of granting medical credentials and certification.     

Development and modification of a required family medicine clerkship

A new required clinical clerkship in family medicine at Duke University School of Medicine is described in terms of planning, implementation, and modification in response to students' evaluations. Seventy-five percent of the eight-week course involves direct clinical experience both in academic practices and community sites, and 25 percent is spent in small group seminars and workshops. Evaluations by students have been highest for the clinical experience, the clinical competence of the faculty, the teaching effectiveness of the faculty and house staff, and the overall learning experience. The ratings have been lowest for seminars, workshops, and required written projects. Several modifications made in the clerkship over a three-year period have raised the students' ratings to near their ratings of the five traditional clerkships. The data demonstrate that family medicine can be taught effectively as a core clinical rotation and can broaden the general education of medical students.     

以问题为基础学习教学方法在内科学见习教学中的应用

目的 研究以问题为基础学习(problem-based learning,PBL)教学方法在内科学见习教学中的应用.方法 将北京大学医学部2002级八年制临床医学专业两个班的学生作为研究对象,分为PBL教学组和传统教学组.两组学生在内科学见习期间,对于小组病例讨论分别采用PBL教学方法和传统教学方法.内科学见习结束后,采用临床模拟病例面试的方式进行考核,两组的考核方式和考核内容相同,对考核结果进行比较;同时,向PBL教学组学生发放主观评价表.结果 在呼吸内科学、肾脏内科学及血液内科学的考试中,病例客观试题的得分PBL教学组高于传统教学组(P＜0.05);而内科学整体平均分、消化内科学、心脏内科学及内分泌学考试的得分两组差异无统计学意义.PBL教学组对于PBL教学的主观评价平均分为8.9±0.99分(10分制).结论 PBL教学方法不影响医学生对专业理论知识的掌握,而且有助于临床思维能力的培养.     

PBL教学法在内科见习教学中的应用探讨

探讨PBL教学法在内科见习教学中的应用。从2006年开始在内科学临床见习教学中试行“PBL教学法＋传统教学法”。结果表明“PBL教学法＋传统教学法”在提高学生分析问题、解决问题的能力方面明显优于传统教学法。但现阶段我国医学教育全面实行PBL教学还存在一些问题。     

Student performance in internal medicine: the effect of previous clerkship experience

To test the assumption that students who have completed other clerkships are likely to perform better in internal medicine, the authors undertook a prospective study of 160 senior students from two classes. Groups of students with little or no senior clerkship experience before their internal medicine clerkship were compared with groups of students who had extensive clerkship experience in disciplines other than medicine. Groups were compared with respect to ward-performance scores and scores on identical multiple-choice examinations. Neither ward-performance nor multiple-choice scores revealed differences attributable to previous clerkship experience. It is concluded that despite areas of instruction and experience which overlap between medicine and other disciplines, previous clerkship experience apparently does not have a beneficial effect on student performance in internal medicine, as measured by these two commonly used methods of evaluation.     

混合式教学在心血管内科临床见习示教中的应用

目的:评估案例教学(case-based learning,CBL)、以问题为基础的学习(problem-based learning,PBL)和混合式教学(CBL+PBL)3种不同教学方法在医学生心血管内科临床见习示教中的应用效果。方法:纳入大学三年级学生共175名,分成3个教学组(CBL、PBL和CBL+PBL),...     

雨课堂联合情景教学在内科学临床见习教学中的应用

目的　探讨雨课堂联合情景教学法在内科学临床见习中的应用效果。方法　选取2015级临床专业本科学生72名,采用电脑滚屏暂停法随机分为对照组和研究组,每组36名。对照组采用传统见习教学,研究组采用雨课堂联合情景教学。通过内科学理论考试、临床技能考核和基于学习兴趣、知识掌握及运用程度、临床思维与实践能力的10项评分点的调查问卷进行教学效果评估。采用SPSS 20.0进行t检验。结果　研究组学生课程综合成绩[包括理论考试成绩（87.94±5.68）和技能考试成绩（88.08±5.73）]高于对照组[（83.00±5.89）（83.86±4.80）（P<0.01）]。调查问卷结果显示,研究组学生学习兴趣提升程度、自我学习能力、新知识掌握能力、运用知识能力、临床思维能力、临床实践能力、解决问题能力、自我表达能力、团队合作能力、医患沟通能力均优于对照组（P<0.01）。结论　雨课堂联合情景教学有助于提高学生知识掌握及运用程度、提高临床思维与实践能力、提高学习兴趣及临床见习教学效果。     

神经外科带教实习体会

总结神经外科实习带教经验,根据神经外科的特点确定教学方法、教学重点与教学难点,采取分散与集中结合的教学方法,应用各种现代化的教学手段,积极创造条件,增加学生参与医疗实践的机会,加强对学生人文素质的教育等,使学生可以更好地掌握神经外科学的基本理论和基本技能,提高神经外科带教水平及教学质量。     

Teaching biopsycho-ethical medicine in a family practice clerkship

The practice of medicine is inescapably value-laden. Principles, norms, and commitments are the goals which determine the specific decisions and actions of care-givers, patients, and families. Therefore, a disciplined understanding of human values is an essential complement to the biomedical and psychosocial components of clinical training. For medical students to acquire such understanding calls for a biopsycho-ethical model for medical education. Building on a review of medical ethics teaching, the authors describe a method of systematically integrating value analysis into a family practice clerkship. By combining interdisciplinary seminars with clinical experience, both the rigor and relevance of value analysis are maximized. The specific educational and evaluational objectives and strategies are presented for a course in biopsycho-ethical education.     

A cost-effective emergency medicine clerkship

Programs in emergency medicine for medical students are expected to become increasingly organized over the next several years with the development of emergency medicine teaching faculties by medical schools. In this article, the authors describe a clerkship design with three fundamental elements--clinical instruction, classroom instruction, and evaluation--that should be included in an emergency medicine clerkship. Through the use of optimal student scheduling and new information technologies, the yearly cost per student for the classroom teaching and student evaluation sections of the clerkship is $86.65.     

思维导图引导的微课对中医内科实习学生考核成绩、评判性思维能力及学习效率的影响

目的　分析思维导图引导的微课对中医内科实习学生考核成绩、评判性思维能力及学习效率的影响。方法　研究对象为2018年7月至2019年11月于本院中医内科轮转的实习学生86人,依据随机数字表法分为两组,对照组（n=43）采用传统教学开展教学活动,研究组（n=43）采用思维导图引导的微课开展教学活动。对比考核成绩、评判性思维能力、学习效率、综合能力评估结果。采用SPSS 21.0进行t检验和卡方检验。结果　研究组理论成绩、技能实践考核成绩均高于对照组（P＜0.05）。干预后两组评判性思维能力各维度评定结果均优于干预前,且干预后研究组评判性思维能力各维度评定结果均优于对照组（P＜0.05）。研究组学习效率总有效率明显高于对照组（P＜0.05）。研究组综合能力各维度评估结果均明显高于对照组（P＜0.05）。结论　将思维导图引导的微课应用于中医内科实习带教中,对实习学生评判性思维能力与综合能力培养产生积极影响,考核成绩优异,学习效率高。     

胸外科见习带教

总结胸外科见习带教经验,根据胸外科的特点确定教学方法、教学重点与教学难点,采取分散与集中结合的教学方法,应用各种现代化的教学手段,积极创造条件,增加学生参与医疗实践的机会,加强对学生人文素质的教育等,学生可以更好地掌握胸外科学的基本理论和基本技能,提高胸外科带教水平及教学质量。     

Clinical skills acquired during a clerkship in family medicine

The authors report on their study of the perceived acquisition of clinical skills by 151 second-year students in six required clerkships: surgery, internal medicine, pediatrics, obstetrics-gynecology, psychiatry, and family medicine. The students completed self-assessments of their clinical skills concerning 78 problems or procedures when taking the family medicine clerkship as their first and last rotations and when taking any of the other clerkships as their first rotation. Fifty percent of the 36 students who took the family medicine clerkship after completing all five traditional clerkships reported that they learned the management of some of the most common health problems, including osteoarthritis and hypertension, only during the family medicine clerkship. Overall, the skills of these 36 students increased from 60 percent to 89 percent of the items surveyed after taking the family medicine clerkship as their last required rotation. The principal contributions of the family medicine clerkship were in the management of common problems, performance of therapeutic procedures, and recommendation of health maintenance procedures.     

神经内科住院患者心理状况分析及其护理

目的:探寻神经内科住院患者的心理状况及其相关因素。方法:对神经内科住院患者进行一般人口资料调查、症状自评(SCL-90)、并将相关因素进行LogistiC多元回归分析。结果:SCL-90中各因子及其总分、阳性项目数、阴性项目数高于中国常模,差异具有统计学意义(P<0.05);肢体功能障碍和家属关心程度等相关因素与患者心理状况密切相关;结论:神经内科住院患者心理健康程度较差且受多种因素共同影响。     

内科低年资护士培训效果观察

目的分析内科低年资护士培训状况,加强对低年资护士综合素质的培训,提高护士专业技能与应对能力,确保护理质量。方法对2009年—2012年我院内科52名低年资护士进行系统培训,采用多媒体授课、场景模拟、讨论、案例分析等方式,并采取一定的考核机制进行效果评价。结果培训后低年资护士的综合素质评分比培训前明显提高,差异有统计学差异(P<0.05)。结论进行系统化护理教学培训,可以大幅度提高低年资护士的综合素质,增强护士急救配合和应急能力以及沟通协调能力。