目的 探討用PBL模式開展臨床技能教學的近期和遠期效果。方法 將162名進入內科實習的2003級七年制和2004級五年制臨床專業醫學生隨機分為PBL教學組（n=75）和傳統教學（對照）組（n=87），分別進行臨床操作技能培訓，而后采用t檢驗比較兩組在內科實習的出科成績和畢業時的多站考核成績。結果 兩組學生內科學成績基礎相仿（PBL組84.04±7.40，對照組82.63±8.77，P=0.287）。在短期教學效果方面：內科實習出科時，PBL組學生獲得了實習指導教師更高的主觀評價（P=0.006），內科基礎知識筆試成績與對照組差異無統計學意義（54.17±9.26 vs. 51.67±9.56，P=0.92），而病例分析題筆試成績明顯高于對照組（20.39±5.27 vs. 16.51±4.90，Plt;0.001）。在長期教學效果方面：在半年后的畢業OSCE考核中，PBL組與對照組在臨床操作技能（61.87±3.21 vs. 61.43±4.87，P=0.567）和輔助檢查結果解讀上（13.00±5.37 vs. 12.69±5.27，P=0.741）差異無統計學意義，而在SP病患處理方面，PBL 組明顯優于對照組（75.59±9.85 vs. 71.11±12.01，P=0.027）。結論 PBL在臨床技能教學中可以提高學生的綜合分析能力，以及臨床思維、人際交流等綜合臨床技能，而非基本知識和操作技能本身，而且此效果具有顯著的短期和長期價值。
目的 探討診斷學床旁見習教學中學患關系現狀，為提高診斷學床旁教學質量提供應對策略。 方法 采用自行設計問卷，于2010年5月-2011年6月對80名臨床醫學專業三年級本科生以及同期在內科住院的100例患者分別進行不署名學患關系問卷調查（有效問卷率分別為91.3%和67%），同時對8名帶教教師和7名臨床主管醫生進行個別訪談。 結果 學生問卷調查顯示，79.5%的學生曾在床旁教學中遭遇患者不同程度的拒絕或不配合，大多數學生認為有被拒的心理準備和承受力。患者調查顯示，82.1%的患者不愿意接受學生問診查體，58.2%的患者表示即便給予一定經濟補償，也不愿配合教學。而對帶教教師及臨床主管醫師訪談結果顯示，當前床旁帶教難度大大增加，學患關系緊張。 結論 現階段學患關系緊張，根據其涉及原因，提出提升醫務人員及醫學生人文觀念，推進醫療、教育體制改革，建立媒體監督機制，開展公眾教育等多層面的應對策略，同時提出課程設置、教學模式、師資培養等具體教學應對舉措。Objective To explore the present status of the relationship between students and patients in diagnostic bedside teaching, in order to promote the teaching quality. Methods From May 2010 to June 2011, self-made questionnaires were adopted to carry out an anonymous survey among 80 medical students in grade three or above and 100 inpatients to investigate the relationship between the students and the patients(with an effective questionnaire rate of 91.3% and 67% respectively). Eight tutors and 7 physicians concerned were taken in the individual interview. Results The survey showed that 79.5% of the students encountered refusal from patients in bedside teaching, and most of them believed that they had psychological preparation and endurance for the refusal. A total of 82.1% of the patients expressed their unwillingness to accept examination by clinical students, and 58.2% of the patients were unwilling to cooperate in the teaching even with an amount of economic compensation. The tutors and physicians concerned stated that the student-patient relationship was undesirable at present. Conclusions The relationship between students and patients in bedside teaching is strained at present. Based on the complicated reasons, we propose such coping strategies as promoting humanism among medical workers and students, pushing forward the medical and educational reform, building media supervision, developing public education, perfecting course design, teaching style, and cultivation of teachers, and so on.
【摘要】為順應留學生教育規模的擴大和教學質量的穩步提升，通過幾年的留學生教學實踐和探索，立足留學生臨床專業教育培養目標，強化課程設置、師資培養、教材建設、教學手段、教學管理等多個教學環節的建設和推進，確保留學生臨床醫學課程教學質量的提高和可持續發展。【Abstract】To explore a better way to improve the quality of the clinical medical teaching for foreign students in China along with the expansion of the enrollment of international medical students, some experience are summarized, which include the establishment of the international education aim, the organization of courses, training of the teachers, the selection and reinforcement of teaching material, the enrichment of teaching methods and the strengthening of teaching management.
