目的 探讨诊断学床旁见习教学中学患关系现状，为提高诊断学床旁教学质量提供应对策略。 方法 采用自行设计问卷，于2010年5月-2011年6月对80名临床医学专业三年级本科生以及同期在内科住院的100例患者分别进行不署名学患关系问卷调查（有效问卷率分别为91.3%和67%），同时对8名带教教师和7名临床主管医生进行个别访谈。 结果 学生问卷调查显示，79.5%的学生曾在床旁教学中遭遇患者不同程度的拒绝或不配合，大多数学生认为有被拒的心理准备和承受力。患者调查显示，82.1%的患者不愿意接受学生问诊查体，58.2%的患者表示即便给予一定经济补偿，也不愿配合教学。而对带教教师及临床主管医师访谈结果显示，当前床旁带教难度大大增加，学患关系紧张。 结论 现阶段学患关系紧张，根据其涉及原因，提出提升医务人员及医学生人文观念，推进医疗、教育体制改革，建立媒体监督机制，开展公众教育等多层面的应对策略，同时提出课程设置、教学模式、师资培养等具体教学应对举措。Objective To explore the present status of the relationship between students and patients in diagnostic bedside teaching, in order to promote the teaching quality. Methods From May 2010 to June 2011, self-made questionnaires were adopted to carry out an anonymous survey among 80 medical students in grade three or above and 100 inpatients to investigate the relationship between the students and the patients(with an effective questionnaire rate of 91.3% and 67% respectively). Eight tutors and 7 physicians concerned were taken in the individual interview. Results The survey showed that 79.5% of the students encountered refusal from patients in bedside teaching, and most of them believed that they had psychological preparation and endurance for the refusal. A total of 82.1% of the patients expressed their unwillingness to accept examination by clinical students, and 58.2% of the patients were unwilling to cooperate in the teaching even with an amount of economic compensation. The tutors and physicians concerned stated that the student-patient relationship was undesirable at present. Conclusions The relationship between students and patients in bedside teaching is strained at present. Based on the complicated reasons, we propose such coping strategies as promoting humanism among medical workers and students, pushing forward the medical and educational reform, building media supervision, developing public education, perfecting course design, teaching style, and cultivation of teachers, and so on.
Objective To explore the strategies of improving the teaching quality of complete physical examination in diagnostics. Methods A total of 314 medical students' surveys relating to contents and skills of complete physical examination in Diagnostics were accomplished. Problems in the teaching quality of the complete physical examination were selected and countermeasures were determined by analyzing scores and performance of students. Results Among 192 items in a complete physical examination, students mastered poorly in 77 (40.1%) items, and especially poorly in 14. Skills of a comprehensive physical examination, including examination without repetition, inversion, omission and skills of palpation and percussion, were difficult to acquire. Conclusion It is helpful to improve the teaching quality of a complete physical examination by analyzing the problems in the physical examination to formulate the teaching objectives and optimize teaching methods.
As a crucial component of clinical medicine, the main task of diagnosis is to cultivate students’ ability to master systematic clinical thinking, disease diagnosis process, comprehensive analysis methods, and the ability to solve clinical problems. Introducing case-based clinical reasoning as a novel and advanced teaching method in the diagnosis course, in line with the comprehensive ability teaching objectives of the course, can provide students with a platform to apply learned knowledge in practical cases, enhance the fun and practicality of learning, improve students’ clinical thinking ability and practical skills, enable students to make quick and accurate judgments when facing complex cases, and ultimately enhance their ability to analyze and solve problems comprehensively. This article combines the experience of applying case-based clinical reasoning to undergraduate diagnosis at West China School of Medicine of Sichuan University, and explores the prospects of applying this teaching method in medical diagnostics.
Objective To evaluate the teaching effect of case-based learning (CBL) combined with team-based learning (TBL) pedagogy in laboratory diagnostics education. Methods The data of the undergraduate clinical-medical students who completed the laboratory diagnostics course between September 2021 and July 2023 at West China School of Medicine of Sichuan University were retrospectively collected. Among them, the undergraduates of grade 2020 adopted the CBL+TBL combined pedagogy, while the undergraduates of grade 2019 assumed the traditional lecture-based learning (LBL) teaching method. Based on the cluster sampling method with the whole grade as the sampling unit, comparative effectiveness was assessed via examination scores and questionnaire feedback. Results A total of 303 students received the CBL+TBL teaching method (CBL+TBL group), while 289 students received the LBL teaching method (LBL group). Compared with the LBL group, the CBL+TBL group had higher scores on the clinical case discussion (90.28±4.05 vs. 88.39±5.19, P<0.001) while lower scores on the theoretical quiz (83.89±12.55 vs. 88.77±10.46, P<0.001). The overall performance of the CBL+TBL group was worse than the LBL group (61.28±3.83 vs. 61.98±3.98, P=0.028). A total of 161 valid copies of questionnaire were collected from the CBL+TBL group. Among them, more than 70% of the students believed that CBL+TBL pedagogy could improve learning motivation, independent learning ability, and team communication and assistance ability. Compared with the LBL teaching mode, 74.5% of the students preferred the CBL+TBL pedagogical approach. Conclusion The CBL+TBL pedagogy can help to improve autonomic learning, teamwork, and problem-solving ability, and a combination with LBL teaching may be utilized to enhance theoretical scores.
诊断学是临床医学的基础和入门，是习得临床执业风格最重要的环节。如何在诊断学学习阶段，夯实学生基本理论和技能，培养其科学缜密的临床思维能力，是各医学院校共同面对的课题和挑战。互动参与式教学摒弃传统单一的被动式、灌输式的教学模式，强调以学生为主体，赋予学生协作性、参与性的教学诉求，加强内在激励，激发其主观能动性和创造力。根据诊断学不同教学模块的课程目标、内容和知识结构，有机地将互动参与式教学法应用于诊断学教学中：问诊-角色扮演，查体-示教与实践学习，症状学-小讲课、小组讨论、床旁实践，临床思维-案例分析，职业素养-小组讨论、角色扮演、床旁实践、辩论演讲等。策略得当地将互动参与式教学的理念、元素、方法应用于诊断学教学中，符合临床医学教学实践性强的特点，遵循个体认知规律，符合外部和内在发展并重的教学效果的深层考量，具备良好的教学容量和一定的普适性，值得在临床医学教学中推广运用。
Objective To summarize the research status and progress of imaging diagnosis of periampullary carcinoma. Methods The literatures on imaging diagnosis of periampullary carcinoma were reviewed. Results At present, the commonly used imaging diagnosis methods for periampullary carcinoma mainly include ultrasound, CT, MRI, and endoscopic retrograde cholangiopancreatography. Some other new imaging techniques had also been applied in the diagnosis and evaluation of periampullary carcinoma. Conclusions Different imaging methods have their own advantages and disadvantages in the diagnosis of periampullary carcinoma. Therefore, the detection rate and diagnostic accuracy of periampullary carcinoma can be improved by rational selection of imaging techniques or combined application of multiple techniques.
We analysed the profiles of teaching practice in clinical diagnostics for international students in recent three years in West China School of Medicine, Sichuan University. Teaching experiences and characteristics were summarized through the following five aspects:pre-service training for all teachers, textbook selection and lesson plan formulation, teaching style and problem-based learning, as well as teaching feedback. We aimed to improve the quality of medical education for international students. Our teaching practice can offer better clinical skills and correct clinical analysis ability for international students in West China School of Medicine, which should be a great help for their further career development.
A mean of systematic review of diagnostic tests based on The Bayes Library of Diagnostic Studies and Reviews (2nd edition 2002) and Bayes Library are introduced to Chinese readers who are interesting on diagnostic test and screening systematic review.