以案例为基础的整合式教学在内科住院医师临床思维培训中的应用

Application of cased-based collaborative learning for clinical thinking training in internal medicine residents

目的探索设计以案例为基础的整合式学习(cased-based collaborative learning,CBCL)课程,提升内科住院医师对心血管疾病诊治的临床思维能力。方法根据《住院医师规范化培训内容与标准(2019年版)·内科培训细则》的要求,设计8节CBCL临床思维培训课程,涵盖循环系统疾病以及常见症状。每个案例包含3~4个不同的临床场景,设立相应学习目标和讨论问题提纲,促进住院医师临床诊断和临床决策思维水平的提高。课程中期和结束时分别进行问卷调查和住院医师访谈,改进课程设计和实施。结果心血管疾病CBCL临床思维培训课程完整实施,清华大学临床医学院内科学医学硕士专业学位研究生5人和北京清华长庚医院内科住院医师4人参与本课程学习,平均出勤率达到94.4%。问卷调查结果显示大部分参与者对课程设计和教学方法均较满意,课程结束时总体满意度为88.9%,绝大部分参与者表示愿意继续参与课程学习。结论CBCL临床思维培训模式行之有效,住院医师学习积极性高,教学效果良好,可深入开发为提升住院医师临床思维能力的创新型课程。

Objective To explore the design of case-based collaborative learning(CBCL)course to improve the clinical thinking ability of cardiovascular disease diagnosis and treatment for residents of internal medicine.Methods According to the milestone of internal medicine residency training,eight courses for CBCL clinical thinking training were designed,covering cardiovascular diseases and common symptoms.Each case contained 3-4 different clinical scenarios,which had independent learning objectives and discussion outlines.Clinical diagnosis and clinical decision-making thinking of participants were trained.In the middle and at the end of the course,questionnaires and interviews were conducted to improve the course design and implementation.Results Eight CBCL clinical thinking training courses for cardiovascular diseases were implemented completely.A total of 9 students participated in the course,including 5 postgraduates of internal medicine in Clinical Medical School of Tsinghua University and 4 residents of internal medicine in Beijing Tsinghua Changgung Hospital,with an average attendance rate of 94.4%.The results of the questionnaire survey showed that most of the participants were satisfied with the course design and teaching methods.At the end of the course,the overall satisfaction rate was 88.9%,and most of the participants were willing to continue to participate in the course.Conclusion The clinical thinking training based on CBCL is a feasible and effective teaching method.It is helpful to improve the clinical thinking in internal medicine residents,and it could be further developed as an innovative clinical thinking training course.