基于情景沉浸和案例融入的急诊临床思维教学模式探讨

Discussion on the teaching model of emergency clinical thinking based on context immersion and case integration

与其他科室相比,急诊科面对的疾病谱广泛,患者的病情轻重混杂,使其工作更具挑战性及不确定性。急诊患者救治过程的临床思维在遵从一般临床思维方式的同时,还具有自身的特征,所以急诊教学模式也需要相应地调整。因此,本研究在情景沉浸和案例融入相结合的基础上,对急诊医学教学模式进行了探讨。首先,本研究对急诊常用的临床思维结合案例进行概括分析:①把握事物本质,优先处理主要矛盾——剃刀原理;②摒弃惯性思维,多问几个为什么——发散思维;③当疾病表型复杂时,尽量用一个病因来解释——一元论原则;④全面综合分析,切勿顾此失彼——整体性原则;⑤持续关注病情发展变化,不断修正认识——动态性原则;⑥诊断要尽量以客观事实为依据——证据论;⑦常见疾病诊疗可以调用以往经验形成的“信息包”——模型化原则;⑧扼制威胁生命的因素,维持生命体征稳定是首要任务——扼制理论。其后,将上述临床思维结合急诊医学教学实际进行情景设计,用真实病例引导医生思考,培养其科学的急诊临床思维方式和方法,提高教学质量。

Compared with other departments,the emergency department faces a broad spectrum of diseases and patients coming here present different conditions with varied severity,making its work more challenging and uncertain.The clinical thinking used in the emergency department has its own characteristics while following the general clinical thinking mode,so its teaching method also needs to be adjusted accordingly.Therefore,this study explores the teaching model of emergency medicine based on a combination of context immersion and case integration.Firstly,it provides a general analysis of clinical thinking with cases,which includes:①grasping the nature of things and giving priority to the main contradiction-the razor principle;②abandoning inertial thinking and asking more questions-the divergent thinking;③explaining a complicated disease with a single cause-the monist principle;④analyzing diseases comprehensively-the holistic principle;⑤continuously watching disease development and modifying its understanding-the dynamic principle;⑥diagnosing based on objective facts-the evidence theory;⑦calling the"information package"formed in the past for diagnosis and treatment of common diseases-the modelling principle;⑧confining life-threatening factors and maintaining vital signs as the first task-the suppression theory.Afterwards,context immersion combined with emergency medicine teaching reality using the above clinical thinking is carried out to cultivate doctors'scientific clinical thinking,thereby improving the teaching quality.