以症状学为中心的临床诊断思维在全科门诊教学中的运用评价

Evaluation on the application of symptomatology-centered clinical diagnostic thinking in general clinic teaching

目的探索以症状学为中心的临床诊断思维在教学门诊的作用。方法前瞻性纳入我院全科医学科门诊轮转的住培学员28名,依据学历、工作经历、轮转年限、年度理论考核成绩排名等一对一将学员分为业务能力匹配的两组,试验组接受症状学临床思维培训,常规组接受日常门诊教学培训,教学门诊预约患者时以症状学特征聚类分流,两组学员分别以主诊身份参与全过程,带教老师从旁指导。教学效果评价以症状学系统考试和思维训练问卷调查结果展示。结果试验组学员的症状学思维考试理论成绩和总分均高于常规组,差异均有统计学意义(t分别=2.73、2.91,P均<0.05);两组的技能成绩比较,差异无统计学意义(t=1.90,P>0.05);试验组学员对培训模式的满意度和思维提升的满意度均高于常规组,差异均有统计学意义(t分别=4.60、4.86,P均<0.05);从整体得分看,试验组学员对基于教学门诊的症状学思维训练满意度高于常规组,差异有统计学意义(t=5.73,P<0.05)。结论做好症状学教育有助于提高全科医师门诊接诊水平,增强其岗位胜任力,树立从业信心、加速临床思维的拓展。

Objective To explore the role of clinical diagnostic thinking centered on symptomatology in teaching out-patient department.Methods Twenty-eight residents and trainees who were prospectively included in the outpatient rota-tion of general medicine department in our hospital were divided into two groups according to their academic qualifica-tions,work experience,rotation years and annual theoretical assessment results.The experimental group received symptom-atic clinical thinking training,the routine group received daily outpatient teaching training,and the patients in the teach-ing clinic were clustered and diverted according to the symptomatic characteristics.The two groups participated in the whole process as the attending doctor,with the guidance of the teaching teacher.The evaluation of teaching effect is shown by the results of symptomatic systematic examination and thinking training questionnaire.Results The theoretical scores and total scores of the students in the experimental group were higher than those in the routine group,and the dif-ferences were statistically significant(t=2.73,2.91,P<0.05).There was no significant difference in skill scores between the two groups(t=1.90,P>0.05).The students'satisfactions with the training mode and the improvement of thinking in the experimental group were higher than those in the routine group,and the differences were statistically significant(t=4.60,4.86,P<0.05).From the overall score,the students in the experimental group were more satisfied with the training of symptomatic thinking based on teaching outpatient service than that in the routine group,and the difference was statis-tically significant(t=5.73,P<0.05).Conclusion Doing a good job of symptomatic education is helpful to improve the outpatient service level of general practitioners,en-hance their post competence,establish their confi-dence in practice and accelerate the development of clinical thinking.