全科医学住院医师规范化培训教学查房中临床思维的分层设计

Hierarchical design of clinical reasoning in the teaching ward round of general practice residents in standardized training

临床思维是临床医师在诊疗工作中推理思考的认知过程,贯穿疾病的诊断、治疗、评估以及管理等整个过程,全科医学临床思维有其特征性。全科医学住院医师规范化培训(简称住培)是医学生到合格全科医师的重要阶段,全科住院医师的临床思维训练尤为关键。教学查房是全科住培中一项重要的教学活动,是培养住院医师临床思维的重要途径。指导医师应把框架思维、演绎推理、归纳推理、假设验证、批判性思维、循证医学思维、一元论原则和以人为中心等临床思维方法贯穿在教学查房中,并针对不同年级、学历、知识水平的住院医师分层教学,使住院医师能够把医学理论与疾病临床表现有机结合,提高其解决临床问题的能力。

Clinical reasoning is the method of reasoning and thinking of medical personnel in the process of clinical treatment,which runs through the whole process of diagnosis,treatment,evaluation and management of diseases.General practitioner(GP)residency training is an important stage in the transition from medical students to qualified general practitioners,so the training of clinical thinking is especially critical for GP residency trainees.Teaching ward round is an important teaching activity in general practice residency training,and its purpose includes the training of residents'clinical reasoning.The clinical teachers should integrate framework thinking,deductive reasoning,inductive reasoning,hypothesis verification,critical thinking,evidence-based medical thinking,principle of monism,and human-centered clinical thinking methods throughout the teaching ward round,and provide tiered training for residents of different grades,education,and knowledge levels,so that residents can organically combine basic medical theory with clinical manifestations of diseases and improve their ability to solve clinical problems.