内科住院医师规范化培训临床技能教学存在的问题及对策

Problems and countermeasures in clinical skills teaching of residency training for internal medicine residents

临床技能教学是内科住院医师规范化培训(简称住培)的重要组成部分,熟练掌握内科临床基本技能,建立正确的临床思维对于医生的成长具有重要意义。内科基本临床技能主要包括骨髓穿刺术、腰椎穿刺术、腹腔穿刺术、胸腔穿刺术、体格检查等。尽管临床技能中心建设不断加强,医学模拟教学也获得很大进步,内科临床技能教学质量有所提高,但仍存在模拟人模型仿真程度较低,和临床实践存在距离;内科临床技能住培指导医师带教能力同质化程度不够,带教水平良莠不齐;住院医师临床实践机会少,实战能力有欠缺;住院医师对体格检查不够重视,基本功不扎实。针对以上问题,温州医科大学附属第一医院进行了一些教学改革探索,以期进一步提高内科临床技能的教学水平。

Clinical skills teaching is an important part of the standardized training of internal medicine residents.Proficiency in basic clinical skills in internal medicine and the establishment of correct clinical thinking are of great significance to a physician's career.The basic clinical skills of internal medicine mainly include bone marrow puncture,lumbar puncture,abdominocentesis,thoracentesis and physical examination.Although the construction of clinical skills center has been strengthened,medical simulation teaching has also made great progress,and the quality of teaching of internal technology skills has improved,the following problems still exist:the simulation degree of the simulator model is relatively low,and there is a distance between it and clinical practice;the degree of homogeneity of internal medicine clinical skills of guiding physicians is not enough,and the level of teaching is uneven;the resident physicians have few opportunities for clinical practice,and there is a lack of practical ability;the resident physicians do not pay enough attention to physical examination,and their basic skills are not solid.In view of the above problems,The First Affiliated Hospital of Wenzhou Medical University carried out some teaching reform exploration in order to further improve the teaching level of internal medicine clinical skills.