有效反馈法在中医内科临床见习中的应用研究

Application Study of Effective Feedback Method in Clinical Probation of Internal Medicine of Traditional Chinese Medicine

目的分析有效反馈法在中医内科临床见习中的应用效果,探索改善中医内科临床见习教学方式的方法。方法2015年第一学期,将北京中医药大学第一临床医学院2012级九年制岐黄班学生63人、2012级八年制卓越班学生99人与2012级五年制教改班学生45人进行分组,每小组4~6人,配备1名教师或经过培训的助教指导,进入临床见习,先由学生自主诊治并讨论分析病例,然后教师或助教详细讲解,见习期间每个学生根据见习收获填写问卷的各项评分。结果 3个班级总体能力反馈比较:岐黄班显著高于教改班与卓越班,差异均具有统计学意义。不同学制学生单项能力反馈比较,四诊技巧与收集病史:岐黄班显著高于卓越班与教改班,差异有统计学意义;提炼主诉、辨证思路与处方能力:岐黄班均显著高于教改班。同学制学生不同能力反馈比较,教改班:合作能力显著高于四诊技巧、收集病史、辨证思路及处方能力。卓越班:医学素养能力得分显著高于沟通能力、四诊技巧、提炼主诉、收集病史、辨证思路以及处方能力,处方能力显著低于医学素养、沟通能力、提炼主诉、收集病史及合作能力。岐黄班学生各项能力得分比较均无显著性差异。结论以诊疗技能观察法(DOPS)为主要工具的有效反馈法可以对学生的能力做出有效的反馈,教师可以此作为依据,备课、引导学生,提高学生的中医内科临床能力,进一步改善教学方式。

Objective To analyze the application of effective feedback method in clinical practice of TCM and provide theoretical basis for improving clinical teaching methods.Methods During the First semester of 2015,a total of 207 students,including 63 students of Qihuang,99 students of Zhuoyue and 45students of Jiaogai,came to Dongzhimen hospital affiliated to Beijing University of Chinese Medicine and began to learn clinical experience.With the help of a teacher or a teaching assistant,they were divided into different groups(each group of 4-6 persons)and went to the outpatient department or the ward.Firstly,the students would discuss the diagnosis and treatment of the disease themselves.Secondly,the teacher or the teaching assistant would explain the disease indetail.In the end,every student filled in the questionnaire according to his or her experience.Results Total score,the scores of Qihuang were significantly higher than those of Jiaogai and Zhuoyue.Item score(different educational system),diagnostic techniques and collect medical history:the scores of Qihuang were significantly higher than those of Jiaogai and Zhuoyue.Refine the chief complaint,syndrome differentiation and prescription:the scores of Qihuang were significantly higher than those of Jiaogai.Item score(same educational system).Jiaogai:the scores of the ability to cooperate with each other were significantly higher than those of diagnostic techniques,collect medical history,syndrome differentiation and prescription.Zhuoyue:the scores of Medical literacy were significantly higher than those of ability to communicate,refining the chief complaint,diagnostic techniques,collecting medical history,syndrome differentiation and prescription;the scores of prescription were significantly lower than those of medical literacy,ability to communicate,refining the chief complaint,collecting medical history and the ability to cooperate with each other.Qihuang:there was no significant difference within each item score.Conclusion For the abilities of students,the effective feedback method could make effective feedback.According to it,the teacher could prepare the lesson,guide and enhance students'clinical skills and improve teaching methods.