基于临床决策思维模式设计临床医师规范化培训教学内容

Design of standardized training content for clinician according to the clinical decision thinking mode

临床决策思维能力的培养是临床医师规范化培训教学的难点。原发性肝癌临床诊疗过程包含若干连续的决策环节;每个决策环节解决一个特定临床决策问题,具有独特的临床决策思维模式(CDTM)。针对肝癌临床检查、病情评估及治疗选择决策环节的CDTM分别是优选匹配、多项评估和多方案择优的模式。根据CDTM中决策规则设计教学内容,包括:如何全面掌握临床诊疗方案、系统分析决策条件和深刻理解决策指数,并结合临床病例讨论理解决策逻辑。这种针对特定临床决策问题的CDMT所设计的教学内容,有利于临床决策思维能力的培养。

The ability cultivation of clinical decision thinking is the difficult point in teaching for standardized training for clinician. The process of clinical diagnosis and treatment of primary liver cancer is divided into a number of consecutive decision-making link. There is a unique clinical decision thinking mode（CDTM） for each decision-making link to resolve specific clinical decision problem. The CDTM of decision-making link of clinical examination plan,quantitative evaluation and treatment choice is project optimization, multi-evaluation and multi-scheme selection model, respectively. The teaching contents are designed according to the decision-making rule of CDMT, including how to master action plan comprehensively, analyze decision conditions systematically and understand the meaning of decision index, followed by clinical case discussion to comprehend decision logic. The training content designed according to the CDTM of specific clinical decision problem is conducive to the ability cultivation of clinical decision thinking.