医学生对临床思维能力培训认知情况研究

目的：了解医学生对临床思维能力培训的认知情况，探讨临床思维能力培训的基本与必备条件。方法采用整群抽样方法，选择2011至2013年在龙岩市3所三级医院实习的189名临床医学专业学生，对其临床思维能力培训的认知情况进行实习前、后问卷调查，内容包括对临床思维能力培训的认知、对临床思维基本条件和必备条件的认知，比较实习前后医学生的认知情况。数据采用SPSS 19.0软件进行统计分析，计数资料采用χ2检验，计量资料正态分布采用t检验，非正态分布采用秩和检验。结果医学生实习前对临床思维能力培训的认知不足，仅16.93%（32/189）的学生认为非常需要；实习后认为非常需要培训的学生比例提高到55.03%（104/189），无学生认为绝对不需要培训；实习前后比较差异具有统计学意义（P=0.000）。临床思维能力培训基本条件中“定期教学查房、临床教学讲座、医疗纠纷防范”几方面认知情况实习前后比较差异有统计学意义（P〈0.05）；必备条件中“医患沟通技巧、专科会诊查体、疑难病例讨论”几方面认知情况学生实习前后比较差异有统计学意义（P=0.000）。结论医学生临床思维能力对建立和谐医患关系有重要意义，实习能够在一定程度上提高学生的临床思维能力。当前医院在学生临床思维能力培训中仍存在一定问题，需进一步完善培训系统模式。

Investigation and anallsis of cognitive thinking ability training in medical students

Objective To understand the medical students in clinical training in cognitive thinking ability, and to explore the clinical and basic thinking skills training prerequisites. Methods A cluster sampling method was used to investigate the cognition of 189 clinical undergraduates on clinical thinking ability training in longyan city from 2011 to 2013 year. The contents of the investiga-tion included cognition on clinical thinking ability training and basic conditions and prerequisites of clinical thinking ability. The results were statistically analyzed using SPSS 19.0 software. Enumeration data were analyzed by chi-square test and measurement data by t test of normal distribution and rank sum test of non-normal distribution. Results Of undergraduate medical students clinical thinking ability training on cognitive and not enough, only 16.93%（32/189） of the students think that really need, after practice that improve very needs students to 55.03%（104/189）, without a student that requires absolutely no training, practice and compare difference to have statistical significance （P=0.000）; training in basic condition before and after the regular teaching, clinical teaching practice, the prevention of medical disputes, differences of the clinical thinking ability were significant （P〈0.05）;the necessary condition of doctor patient communication skills, specialist consultation examination, to discuss difficult cases had very significant difference before and after training（P=0.000）. Conclusion The clinical thinking ability of medical students is of great significance to build a harmonious relation-ship between doctors and patients, practice can improve the clinical thinking ability of the students in a certain extent, but there are still some problems in the current training hospital clinical thinking ability, need to further improve the training system model, in order to improve the clinical thinking ability of medical students.