应用病例讨论与学习方法培养全科医师神经内科疾病诊治思维方式探讨

The training of clinical thoughts of neurology with the case-based discussion and learning for general practitioners

目的 探讨全科医师掌握神经内科临床系统思维方式的教学模式。方法 实验组学员 (全科医师骨干学员 12名 )通过应用以病例为基础的讨论与学习的方法 ,进行临床思维培训。对照组学员 (全科医师 9名 ) ,应用常规轮转培训方法。评价方法应用病史采集考核量表 ,神经系统检查考核量表 ,神经内科理论考核成绩 ,神经影像资料的阅片能力 ,资料检索及文献综述写作的能力的评价。结果 在病史采集方面 ,实验组学员成绩 ( 16 6 7± 1 12分 )与对照组学员成绩 ( 10 2 3± 2 2 6 )间差异有显著意义 (t =5 12 ,P <0 0 0 1) ;在神经系统查体方面 ,实验组学员成绩 ( 89 12± 11 32 )与对照组学员成绩 ( 6 7 2 3± 14 5 6 )间差异有显著意义 (t =6 5 7,P <0 0 0 1) ;神经内科理论考核结果 ,实验组学员成绩 ( 86 31± 10 86 )与对照组学员成绩 ( 71 6 7± 13 4 6 )间差异有显著性意义 (t =5 87,P <0 0 0 1) ;神经影像资料的阅片能力 ,资料检索及文献综述写作的能力 ,实验组较对照组间差异有显著意义 ( χ2 =9 32 1,P <0 0 0 1)。

Objective To explore effective training pattern of clinical thoughts in diagnosis and skills of neurological examination for general practitioners.Methods 21 general practitioners(GPs) in clinical practice were divided two groups: one group (included 12 GPs in 2002) was trained with the case-based discussion and learning,and another group(included 9 GPs in 2001) with general training as control.The skills of the clinical History taking and neurological examination were measured in the all GPs.The ability of writing medical articles and viewing CT and MRI photos were evaluated.Results The experimental group raised significantly their the skills of the clinical History taking(experimental group:16 67±1 12,control group:10 23±2 26,t=5 12,P<0 001) and neurological examination(experimental group:89 12±11 32,control group:67 23±14 56,t=6 57,P<0 001) compared with contral group.They also improved their the ability of writing medical articles and viewing CT and MRI photos compared with control.Conclusion The case-based discussion and learning is a effective training pattern in clinical practice teaching for general practitioners.