住院医师规范化培训中的临床思维培养

doi:10.3760/cma.j.cn115259-20241114-01180

摘要/Abstract

摘要： 本文将认知心理学、教育学等原理与临床思维教学相结合,探讨住院医师规范化培训阶段临床思维培养的理论基础、教学策略、教学要素和教学方法等。临床思维教学的理论基础包括:双重认知理论、元认知理论和建构主义理论。临床思维的教学策略包括:以学生为中心的教学理念、螺旋式递进的教学模式、临床思维的复盘与反馈、基于反思的元认知调整。临床思维的教学要素包括:思维框架的建立和信息收集能力、诊断推理能力、诊断论证与验证能力和诊疗决策能力的培养。本文以教学查房、教学病例讨论、病历书写修改、迷你临床评估演练等常用教学和评价活动为例,阐述了住院医师临床思维培养的目标、策略、重点和难点。最后,本文探讨了临床思维评价、住院医师思维潜能的激发、传统教学模式的价值和思维教学内涵等思维教学相关内容。

关键词: 住院医师规范化培训, 临床思维培养, 双重认知理论, 元认知理论, 建构主义, 床旁教学

Abstract: This paper integrates the principles of cognitive psychology and pedagogy into the teaching of clinical thinking, exploring the theoretical foundation, strategies, instructing elements and methods for cultivating clinical thinking during standardized training for resident doctors. The theoretical foundations of clinical thinking teaching include: Dual Process Theory, Metacognition Theory, and Constructivism. The teaching strategies for clinical thinking include: student-centered learning philosophy, spiral progression teaching model, debriefing and feedback in clinical thinking, and reflection-based metacognitive adjustment. The instructing elements encompass establishing a conceptual framework, enhancing information-gathering skills, developing diagnostic reasoning abilities, fostering diagnostic demonstration and verification capabilities, as well as promoting decision-making proficiency in diagnosis and treatment. By utilizing teaching rounds, case discussions, medical record writing and revision sessions along with Mini-clinical evaluation exercises (mini-CEX), this paper elucidates the aims, strategies employed in different educational activities related to residents′ clinical thinking training, while highlighting key aspects and potential challenges. Furthermore, attention is drawn to evaluating clinical thinking abilities effectively in instructional practices while stimulating residents′ intellectual potential; acknowledging the value inherent in traditional teaching approaches; as well as comprehending the essence of thoughtful instruction.

Key words: Standardized residency training, Clinical thinking training, Dual process theory, Metacognition theory, Constructivism, Bedside teaching

中图分类号:

R-05

兰学立, 向阳. 住院医师规范化培训中的临床思维培养[J]. 中华医学教育杂志, 2025, 45(5): 338-343.

Lan Xueli, Xiang Yang. Clinical thinking cultivation in standardized residency training[J]. Chinese Journal of Medical Education, 2025, 45(5): 338-343.

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