目的 探索通过线上模拟教学进行临床思维训练的可行性和有效性。方法 选择中国医科大学2015级五年制临床医学专业五年级30名学生为研究对象,进行线上临床思维训练模拟教学。课前通过微信群让学生做好教学内容相关知识的复习准备,课上通过腾讯会议平台进行教学。学生扮演门诊医生,教师扮演患者。学生完成线上问诊、体格检查、辅助检查的开具和结果解读、做出诊断和拟定治疗原则4个部分内容,由教师进行引导性反馈。通过对学生的形成性评价以及对参与学生和教师的调查问卷进行教学效果评价。结果 70.0%(21/30)的学生参与课堂互动,所有学生认为线上教学基本可以达到与线下教学同样的效果,期待类似课程。课堂形成性评价可以通过录屏方式进行,通过课堂及课后作业,可以对学生多方面能力进行合理评价。结论 线上模拟教学进行临床思维训练是可行的,基本可以达到和线下教学同样的效果,在远程学习及特殊情况下具有一定的价值。

Objective To investigate the feasibility and effectiveness of online simulation on clinical reasoning training. Methods Online clinical reasoning training was implemented through tencent Meeting platform for graduate medical students. Associated medical knowledge was arranged before the class for preparation. In the online classroom, history taking, physical examination, lab or imaging examination prescription and explaining, and decision making of diagnosis and treatment were performed by the students, who played as physician,while the trainer as standardized patient.A briefing was taken after the procedures. Process-evaluation was made and questionnaires were distributed to inquire of satisfaction of students and barriers of undertake online class for teachers. Results The class was successfully performed without difficulty. The students were interested in online training and highly involved in discussion. 70.0% of students interacted with the trainer without delay,which means they were concentrated on the class on the other end of computer or smartphone. 100% students were satisfied with the class and expected the similar class. Conclusions Online simulation on clinical reasoning training is feasible and effective with high satisfaction, which is valuable in distant education or in some special context.