目的 探索临床思维导向式教学方式在呼吸与危重症医学科临床实习中的应用。方法 2019年9月至2021年6月,选取在空军军医大学第一附属医院呼吸与危重症医学科接受临床实习的2015级和2016级五年制临床医学专业62名学生作为研究对象。其中,2016级33名学生作为试验组,接受临床思维导向式教学方式;2015级29名学生作为对照组,接受传统教学方式。教学评价采用阶段性评价与过程性评价结合的方式进行。计量资料采用t检验。结果 试验组学生在呼吸与危重症医学科实习阶段的总成绩高于对照组学生[(88.03±3.74)分比(83.28±3.88)分],试验组学生在阶段性评价[(52.55±2.73)分比(49.90±2.24)分]与过程性评价[(35.48±2.33)分比(33.78±2.86)分]方面评分均高于对照组学生,差异均有统计学意义(均P<0.05)。在阶段性评价中,试验组与对照组学生在单选题[(17.55±1.37)分比(16.48±1.45)分]及简答题2[(8.45±0.83)分比(7.93±1.09)分]的评分差异均具有统计学意义(均P<0.05)。在过程性评价中,试验组学生比对照组学生在病史采集[(8.46±1.14)分比(7.86±1.22)分]、病历书写[(13.61±0.89)分比(12.97±1.57)分]及病例汇报[(8.82±1.18)分比(8.14±1.13)分]等评价指标中评分更高,其差异均有统计学意义(均P<0.05)。结论 临床思维导向式教学方式有助于提高学生在呼吸与危重症医学科中的实习效果,从临床实际出发培养学生建立符合临床应用要求的思维模式。

Objective To practice and evaluate clinical reasoning oriented teaching method in the internship of pulmonary and critical care medicine. Methods From September 2019 to June 2021, 62 students enrolled in 2015 and in 2016 majoring by Clinical Medicine of the Air Force Military Medical University and experiencing clinical internship of pulmonary and critical care medicine were selected as subjects. Thirty three students from grade 2016 were trained by clinical reasoning oriented as experimental group and 29 students from grade 2015 trained by classic and traditional method as control. The training outcomes were evaluated by combination of records of stage evaluation and process evaluation. T-test was utilized to show the potential significant difference. Results The total scores of students from the experimental group were higher than those from the control group[(88.03 ± 3.74) vs. (83.28 ± 3.88)] among the internship in pulmonary and critical care of medicine. In the stage evaluation[(52.55 ± 2.73) vs. (49.90 ± 2.24)] and process evaluation[(35.48 ± 2.33) vs. (33.78 ± 2.86)], the scores of students in the experimental group were higher than those in the control group, the differences were statistically significant (all P<0.05). The composition of students' practice scores was analyzed. In the phased evaluation, there were significant differences between the experimental group and the control group in single choice questions [(17.55±1.37) vs. (16.48±1.45)] and brief answer questions 2 [(8.45±0.83) vs. (7.93±1.09)] (all P<0.05). As to the process evaluation, the scores from the test group in the evaluation indexes such as medical history collection [(8.46±1.14) vs. (7.86±1.22)], medical records writing [(13.61±0.89) vs. (12.97±1.57)] and case report [(8.82±1.18) vs. (8.14 ± 1.13)] were higher than those from the control group with statistical significance (all P<0.05). Conclusions Clinical reasoning oriented teaching method provide strong support to students' performance in the clinical training stage in pulmonary and critical care of medicine, which tailor clinical practice and so is able to cultivate a reasoning pathway for development of clinical post-competence from the perspective of medical routines.