医学教学模式改革与医学生能力培养探索

目的 探讨乳腺癌住院患者化疗期间的显著心理痛苦发生情况及其相关因素，为临床制定心理干预对策提供依据。 方法 对2013年5月—2014年11月临潼区妇幼保健医院接受化疗的乳腺癌患者按入院次序连续抽取100名作为研究对象，采用一般资料问卷和心理痛苦温度计(distress thermometer，DT)进行问卷调查，收集到的资料录入EpiData 3.0数据库，采用SPSS 18.0软件进行统计学分析，P＜0.05表示差异有统计学意义。 结果 心理痛苦检出率(DT≥4分)为71.0%,单因素分析显示，心理痛苦程度与年龄、文化程度、医疗费用支付方式、家庭人均月收入、化疗前是否绝经及所处的化疗周期有关(P＜0.05)。Logistic回归发现，年龄大(OR=0.731，95%CI:0.409～0.842)和医疗费用医保支付(OR=0.349，95%CI:0.144～0.846)是乳腺癌患者化疗后出现心理痛苦的保护因素(P＜0.05)，文化程度高(OR=1.463，95%CI:1.033～2.071)是乳腺癌患者化疗后出现心理痛苦的危险因素(P＜0.05)。 结论 较多乳腺癌患者化疗后出现心理痛苦，年龄、医疗费用支付方式、文化程度是引起心理痛苦的主要因素，这些因素可能成为减轻乳腺癌患者的心理痛苦的干预点。 

Reform of medical teaching mode and cultivation of medical students' ability

With the rapid development of science and technology and the change of medical service,the medical education is facing new challenges.In order to adapt to the trend of the globalization of medical education and the social needs,medical colleges and universities need to reform the concept of education,and train high-quality talents with comprehensive ability.The reforms in our school were carried out in the following aspects and had achieved good results:changing teaching ideas and the teaching method of "three centers" in the past,establishing the ideas of giving them what they need and not what they deserve.Teachers changed their roles from a instructors or transfer of information to a manager and mentor of learning,adapted student-centered teaching activities and improved the ability to think independently and the ability of autonomous learning.At the same time,we respected the students' personality,and admitted the diversity of students' interests and personality.We also integrated teaching content,reformed teaching settings,emphasized the integration of basic and clinical curriculum,and carried out practice Teaching.We adopt case-based learning and problem-based learning,improved the students' clinical thinking ability and practical ability,improved classroom teaching skills and the art of teaching,improved students' learning interest,strengthened clinical practice and the teaching of medical simulation,and improved the practical ability.Taking the national professional qualification examination as a reference,objective structured clinical examination method was adopted to assess students' medical knowledge and clinical practice ability as well as clinical thinking ability,lay the first stone for successfully pass the national qualification examination and obtain qualifications.Combined with formative assessment,we stimulated students' interest in learning,and provided lasting motivation for students' autonomous learning;strengthened humanistic quality education and professional moral education and cultivate medical talents excellent in character and learning.