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Based on the in-depth analysis of the defects of the existing traditional chair-side teaching and simulation examination for the oral residency training students, this paper designs an online typical case teaching module for teaching practice. After the teaching, the examination results reveal that the use of online teaching tool can improve the clinical thinking and decision-making ability, and strengthen the clinical thinking process. The questionnaire results show that most residents are satisfied with the online teaching. All in all, the online teaching mode in this study is conducive to increasing the breadth and depth of case teaching, facilitating the process and visualization of clinical thinking, and improving the clinical decision-making ability of the typical cases of the residency training students, so as to achieve the goal of training residents with great post competences.
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Objective:To explore the construction and implementation effect of clinical-thinking patterned curriculum for parallel graduate students with "running through clinical diagnosis and treatment process."Methods:In this study, 94 Batch 2016-2017 graduate students with clinical medical professional degree in Shanxi Provincial People's Hospital were selected as the research subjects. Among them, 48 Batch 2017 parallel graduate students were selected as the experimental group. The curriculum of clinical-thinking patterned training of "running through the clinical diagnosis and treatment process" was used. In addition to participating in the degree courses and residency courses, a series of training to improve the clinical-thinking ability were introduced. And 46 Batch 2016 parallel graduate students were divided in the control group, using a traditional curriculum and only participating in degree courses and residency courses. The differences among mini-clinical evaluation exercise (Mini-CEX) scores, direct observation of procedural skills (DOPS) scores, objective structured clinical examination (OSCE) scores and students' satisfaction were compared by t test, chi-square test and repeated measures analysis of variance. Results:The Mini-CEX scores showed the average scores of other aspects except humanistic care were higher than those of the control group, and the score of communication skills was significantly higher than that of the control group [(6.55±0.98) vs. (5.77 ±1.12)], with significant differences ( t=3.62, P<0.001). In the DOPS scores, except for the skills of communication with patients, ability to consider patient's feelings and practice of occupational literacy, the average scores of other aspects of the experimental group were higher than those of the control group, and the real operation-ability score of clinical skills was significantly higher than that of the control group [(6.38 ± 1.38) vs. (5.53±1.23)], with a significant difference ( t=3.12, P=0.002). In terms of the outpatient receiving station, the emergency treatment station, the clinical thinking station①, the clinical thinking station②, the specialist skill station, the auxiliary examination station and the case writing station, their OSCE scores at different stages in the experimental group were higher than those in the control group, and in terms of clinical thinking station①, the score of the experimental group was significantly higher than that of the control group, with a significant difference ( F=6.51, P=0.012). The satisfaction rate of the experimental group in terms of curriculum was higher than that in the control group except for the future career development, and in improving logical-thinking ability, the score of the experimental group was significantly higher than that of the control group, with a significant difference ( χ2=19.18, P<0.001). Conclusion:The curriculum of clinical-thinking ability with "running through the clinical diagnosis and treatment process" can enhance the clinical practical ability of parallel graduate students, making them meet the residential academic standards as soon as possible and effectively promoting the training quality of the students.
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Objective:To explore the methods of improving the clinical thinking ability of clinical medical interns in neurology department.Methods:Clinical medical interns from 2017 to 2018 were selected as the research subjects. The clinical medical interns in 2018 and in 2017 were set as the experimental group (98 people) and the control group (95 people). In the clinical practice of the neurology department, the experimental group was trained in clinical thinking ability, and the control group was trained by the traditional methods. Before the end of the internship, the self-made Clinical Medical Interns Clinical Thinking Ability Questionnaire was used to evaluate the teaching effect. SPSS 14.0 was used for t-test and Chi-square test. Results:The experimental group and the control group had the problems of one-sidedness, appearance, fixedness, passivity, laziness, simplification, confusion of clinical thinking. The clinical thinking problems in the experimental group were significantly improved than those in the control group ( P<0.001). There were significant differences in clinical thinking between the experimental group and the control group in terms of one-sidedness, appearance, fixedness, passivity and laziness ( P<0.05). In addition to language communication and expression ability, the self-assessment score of clinical thinking ability in the experimental group was statistically different from that in the control group ( P<0.05). Compared with the control group, there were also significant differences in the examination results of the experimental group ( P< 0.05). Conclusion:The implementation of clinical thinking training in neurology practice is conducive to cultivating students' clinical thinking ability and improving the quality of personnel training.
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At present, some "5+3" integration students have different levels of understanding and application problems in various stages, such as role transformation, professional knowledge and technology, communication ability and humanistic care ability, clinical thinking and evidence-based medicine concepts, clinical research thinking, learning and work attitude. This research will permeate and run through the training of "5+3" integrated students' diagnostic and therapeutic operation ability through the training of modern clinical thinking oriented by post competency, and integrate humanistic care, evidence-based medicine, learning attitude, working attitude, and attitude towards patients in the whole process to gradually complete the comprehensive training goal of clinical thinking oriented by post competency + diagnostic and therapeutic operation ability.
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In order to give full play to the important role of multi-disciplinary treatment (MDT) in oncology teaching in talent training and discipline development, an oncology teaching and research section has been established, the textbook Clinical Oncology has been compiled, excellent teaching workers in affiliated hospitals have been selected to form an MDT teaching team, and a multi-tutorial system has been established for the discipline related to specific tumor types. The multi-tutorial system of disciplines combines lecture-based learning (LBL) with case-based learning (CBL) and problem-based learning (PBL). Students are arranged to observe and participate in clinical MDT consultation during the inter-class practice, and compared with the traditional assessment form, MDT case discussion questions, review writing, classroom simulation of the MDT process and real participation in clinical MDT discussions are added. The questionnaire for students who participated in MDT teaching showed that more than 93% of the students believed that the MDT teaching model was helpful for systematically mastering the knowledge of the chapters they had learned and understanding the cutting-edge progress, improving learning initiative, thinking and problem-solving ability, clinical comprehensive analysis ability and teamwork spirit. The majority of students' expression skills [89%(169/190)] and literature review skills [79%(150/190)] were improved; 94%(178/190) of students expressed their willingness to accept this teaching method. The teaching practice experience of the Department of Oncology of Jilin University based on the MDT model helps to improve the teaching level of oncology.
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Taking case discussion of clinical treatment options of primary liver cancer during clinical internship as an example, the course design of basic elements of case-based learning (CBL) was discussed. The purpose of clinical practice is to cultivate the clinical thinking ability of "selecting the best one from multiple treatment options", which is suitable for taking CBL teaching method. The design of CBL course includes 8 elements: teaching object, purpose, objectives, course content, implementation plan, key points for assessment, course evaluation and reference materials. The core points of the design of CBL course are that: ①The teaching objectives include knowledge, ability and professionalism; ②The course content should includes the training of decision-making organizations and clinical thinking ability of selecting the best one from multiple treatment options; ③The general CBL teaching procedure can be adopted in the implementation of the scheme that focuses on the decision-making issues defined in each decision-making step. The teaching practice of CBL on primary liver cancer cases discussion shows the basic design of CBL course is universal, which is helpful for teachers to design and implement CBL course on clinical treatment options.
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Objective:To explore the effect of short-term modularized training mode with clear milestones for case competition of standardized residency training.Methods:Surgical residents, who attended the first case competition of Guangdong Province in 2020, were trained by short-term modularized training mode with clear milestones. This mode contained four modules: SP consultation training, training of disease characteristics and principles of diagnosis and treatment summary, medical documents and case analysis writing training, and comprehensive emergency case training.Results:After the training, they all made great progress in consultation, interpretation of exam results, and first writing of course record, but less in medical documents and case analysis. The satisfaction rate was 100%, and they all considered informed consent writing for operation and formulating principles of diagnosis and treatment summary as difficult tasks.Conclusion:Short-term modularized training mode with clear milestones might improve the level of consultation, interpretation of exam results, and first writing of course record effectively. While, the difficult point is clinical thinking about the surgical treatment, which must be trained more in routine work.
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Objective:To explore the role of blended learning in the undergraduate teaching of Clinical Biochemistry. Methods:The Batch 2017 medical laboratory technology undergraduates ( n=134) were selected as research objects, and the effect and opinions of blended learning were statistically analyzed by questionnaire survey and online-offline platform data. SPSS 23.0 was used to conduct rank sum test. Results:The application of blended learning in the Clinical Biochemistry teaching affected the learning effect in an all-round way. The average score increased from 70 (64, 76) to 79 (71, 85), with statistical difference ( Z=6.69, P<0.001). Conclusion:The combined application of blended learning, problem-based learning, flipped classroom and formative assessment is conducive to teaching students in accordance with their aptitude and cultivating students' clinical thinking ability.
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There are a large number of atypical symptoms and undifferentiated diseases in general practice, in which sociological factors are deeply involved. So to incorporate social factors into clinical thinking and to interpret disease from the perspective of the patient′s social life will enrich the multidisciplinary medical model and holistic care in general practice. This article shares author′s clinical experience through introducing typical cases, in which the patient′s social life and behavior characteristics played certain roles in disease development. The article also explores a new way from the sociological perspectives to interpret the complex symptoms that are difficult to be explained clinically by biomedicine or psychology.
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Objective:To explore the application of virtual patient in the reexamination of clinical medical professional masters (hereinafter referred to as "clinical masters"), and to provide reference for the reform of clinical masters reexamination.Methods:The correlation between the clinical thinking scores of 97 candidates (Western medicine) in the reexamination of clinical masters in a university in 2019, the scores of comprehensive ability of clinical medicine (Western medicine) in the initial test and the interview scores in the reexamination was analyzed, and the differences between the clinical thinking scores of current and previous candidates were compared. SPSS 21.0 software was conducted for t test, chi-square test and Pearson correlation analysis. Results:The Person correlation analysis showed that the correlation coefficient between the scores of clinical thinking and the scores of comprehensive clinical medicine (Western medicine) and the scores of interview in the reexamination were 0.09 and -0.05 respectively( P>0.05). At the same time, there was no statistically significant difference between the clinical thinking scores of current and previous candidates ( P >0.05). Conclusion:There was a poor correlation between the scores of clinical thinking and the scores of comprehensive clinical medicine (Western medicine) and the scores of interview in the reexamination. The consideration is concerned with the difference in the purpose of the three assessment forms. It can provide references for other medical colleges to optimize the evaluation content of postgraduate reexamination.
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Based on the clinical needs and examination requirements of standardized training students, the China national standardized training textbook Acupuncture and Moxibustion for residents of traditional Chinese medicine has made innovations in the textbook content and form. In the part of meridians and acupoints, the classic original text is introduced and the main indications and operation methods of 200 commonly-used acupoints are summarized in the form of tables. In the part of acupuncture and moxibustion technique, the operating procedures are standardized and the core technical points of 20 commonly-used acupuncture and moxibustion techniques are summarized in the form of flow chart. In the part of acupuncture and moxibustion treatment, 48 typical diseases are introduced in the form of case discussion, highlighting the problem orientation and demonstrating the diagnosis and treatment procedures.
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Humans , Acupuncture/education , Acupuncture Therapy , China , Medicine, Chinese Traditional , MoxibustionABSTRACT
OBJECTIVE To summariz e the expe rience of the ability training of prescription-auditing pharmacists in prescription pre-audit，and introduce the typical cases of the prescription-auditing pharmacists participating in the drug intervention. METHODS From October ，2020 to October ，2021，under the audit mode of “prescription pre-audit system+prescription-auditing pharmacists ” adopted by Yuxi People ’s Hospital （hereinafter referred to as “the hospital ”），the abilities of prescription-auditing pharmacists were cultivated from the aspects of training in pharmaceutical related professional knowledge ，training in the use of Chinese and English medical retrieval tools ，databases and websites ，and clinical thinking and communication ability ；through the construction of ability evaluation form of prescription-auditing pharmacists ，their abilities were assessed. RESULTS & CONCLUSIONS After one year ’s ability training ，the rational rate of prescription （doctor’s order ），the proportion of doctors ’active revision of problem prescription （doctor’s order ）and the doctor ’s acceptance rate of intervention by prescription-auditing pharmacists showed an upward trend ，the average time of irrational prescription （doctor’s order ）by prescription-auditing pharmacists showed a shortening trend ，and the intervention rate of prescription （doctor’s order ）showed a downward trend. In addition to the publication of papers （belonging to the bonus item ），the average score of the ability evaluation form of prescription-auditing pharmacists had significantly increased ， from 45.2 in October 2020 to 97.6 in October 2021.
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Objective:To explore the application of micro-lesson-based exploratory teaching in postgraduate emergency clinical teaching.Methods:A total of 48 intern graduate students in the Emergency Department of Shengjing Hospital affiliated to China Medical University from January 2019 to December 2019 were selected as the research objects. According to the admission time, they were divided into observation group (28 cases) and control group (20 cases). The control group used traditional teaching. The observation group adopted exploratory teaching based on micro-classes. Theoretical and practical operating ability, basic clinical quality and clinical thinking ability, as well as the evaluation of teaching effect and the satisfaction with teaching method and teaching quality were compared between the two groups. SPSS 22.0 was used for t test and chi-square test. Results:The theoretical and practical performance scores of the observation group improved more than those of the control group ( P<0.05). The basic clinical quality and clinical thinking ability scores of the observation group improved more than those of the control group ( P<0.05). The improvement of the observation group's learning interest, learning efficiency, autonomous learning ability and comprehension memory scores was greater than that of the control group ( P<0.05). The observation group's satisfaction with teaching methods and teaching effects was significantly higher than that of the control group ( P<0.05). Conclusion:The use of micro-class-based exploratory teaching in postgraduate emergency clinical teaching can enrich students' theoretical knowledge, increase their learning motivation and interest in learning, and improve their practical ability, basic clinical quality and clinical thinking ability, which is a teaching method worth promoting.
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This paper focuses on the practical necessity of discipline-integrated PBL curriculum in cultivating clinical thinking ability of college students majoring in clinical medicine. Through the teaching process of group discussion of some real and complete cases, this paper explains in detail how to cultivate medical students' clinical thinking ability by discipline-integrated PBL curriculum, discusses the implementation of ideological and political education associated with clinical medicine by heuristic teaching from close touching with clinical case and implicitly infiltration of the socialist core values such as dedication and integrity, and elaborates the humanistic quality and psychological comfort levels of medical students by being close to clinical patients. After five years of teaching practice, the teaching effect of discipline-integrated PBL curriculum has been approved by the national clinical medicine professional certification experts and praised by students. We believes that the development of discipline integrated PBL curriculum in medical college can strengthen students' problem-based autonomous learning ability, significantly improve the two-way integration ability between basic medical courses and basic medicine, and significantly build students' clinical thinking and clinical decision-making ability.
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With the reform of medical education ("5+3"), the clinical mentors usually need to guide three kinds of students who are at different stages of medical education at the same time. And we summed up the core concept of clinical thinking and problems in its training, such as the imperfect teaching mode, insufficient teacher teaching awareness, students' difficulties in adapting to role changes, thinking patterns, and relying on auxiliary examinations, etc. For the training targets of three kinds of students are different, we explored and constructed a "multi-level integrated" training mode and the evaluation system of clinical thinking from the building of professional thinking, lectures, heuristic rounds, multi-aspect thinking mode extension, group learning and case discussions. So far, they have made effective achievements among a small part of students, which are hopefully useful for clinical training.
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Respiratory infections have heterogeneous causes and variable manifestations. How to make an indi-vidual and correct judge for each pediatric respiratory infection and make the patients receive an individualized and ra-tional therapy,according to the principles and methods of clinical thinking,is a great challenge for every pediatrician, each day. Based on a briefly introduction of features of clinical thinking,this article focus on key principles in the diag-nosis and treatment of pediatric respiratory infections.
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A farm worker in Baodi District of Tianjin was diagnosed with Tsutsugamushi disease due to fever and intermittent cough for more than 3 months.The patient's diagnosis and treatment process was complicated, and the diagnosis was delayed in the early stage of the disease because the clinician neglected the occupational history and lacked knowledge about the prevention and control of tsutsugamushi disease. As an important part of the epidemiological history, occupational history is crucial for the diagnosis of occupational related diseases. Clinical thinking runs through the whole process of clinical diagnosis and disease treatment, and correct clinical thinking can effectively reduce the occurrence of misdiagnosis.Clinicians should ask and record career history in detail to improve the quality of health care.
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The standardized resident training is an important step for training high-level professionals in clinical medicine and it is an important part of medical education after graduation. The training of residents' clinical thinking and clinical judgement should be emphasized in all resident training programs. Some resident programs in China still focus on the teaching of important knowledge that are originated from the medical colleges. Therefore,it is urgent for faculty to adopt new teaching methods aiming at the training of clinical thinking and clinical judgement. The paper introduces a mode for teaching clinical thinking and clinical judgement in the resident training programs. The goal is to improve the level of resident physicians in clinical diagnosis and treatment in China.
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RESUMEN Introducción: La aparición del término enfermería de práctica avanzada es relativamente reciente. En Cuba, las formas de educación en este tipo de práctica han sido evidentes desde los primeros años posteriores al triunfo de la revolución hasta la actualidad. Objetivo: Sistematizar la definición e historia de la enfermería de práctica avanzada. Métodos: Se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo del contenido de artículos originales y de revisión, publicados en español e inglés entre 1999 y 2015. Las palabras clave utilizadas fueron "enfermería de práctica avanzada", "definición de enfermería de práctica avanzada", "historia de enfermería de práctica avanzada" la búsqueda fue realizada en las bases de datos SciELO, Ebsco, LILACS y MEDLINE/Pubmed. Conclusiones: La revisión de la historia de la enfermería de práctica avanzada evidencia que es un proceso en constante movimiento que incluye la superación, capacitación, educación continuada y permanente, la formación académica y surge para responder a las demandas sociales de la población, se consolida gracias al desarrollo de diferentes estructuras organizacionales, educacionales y de investigación(AU)
ABSTRACT Introduction: The appearance of the term advanced nursing practice is relatively recent. In Cuba, the forms of education in this practice have been apparent since the first years after the triumph of the revolution until today. Objective: To systematize the definition and history of advanced practice nursing. Methods: A systematic literature review was conducted to develop a thoughtful critical analysis of original content and review articles published in Spanish and English between 1999 and 2015. The keywords used were "advanced nursing practice", "definition of nursing advanced practice "," history of advanced nursing practice "search was conducted on the basis of SciELO, Ebsco, LILACS and MEDLINE / PubMed data. Conclusions: The review of the history of advanced practice nursing evidence is a process in constant movement that includes overcoming, training, continuous and continuing education, academic training and comes to meet the social demands of the population, consolidated through the development of different organizational, educational and research structures(AU)
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Humans , Review Literature as Topic , Full-Text Databases , Advanced Practice Nursing/historyABSTRACT
There are some problems in clinical teaching of cardiovascular medicine, such as insuf-ficient attention to the "three bases" skills, not teaching trainees in accordance with their aptitude ade-quately, monotonous instructional mode, and assessment becoming a mere formality. Aiming at these prob-lems, we have explored the training methods of medical talents adapted to the modern medical model, and improved the clinical basic skills and thinking of the students and the quality of teaching through such measures as paying close attention to basic skills training, standardizing ward rounds, paying attention to teaching students in accordance with their aptitude, and reforming teaching methods and assessment modes.