李晓华+张称心+宋冬梅+付俊鲜+杨轶男+黄应龙

[摘要]目的 探討病例汇报形式在儿科临床思维培养模式中的作用。方法 选取2014年7月～2015年8月在我科实习的内蒙古医科大学临床专业本科生100人，按不同的实习带教方法分为对照组和实验组，每组50人。对实验组学生进行病例汇报，而对照组不进行病例汇报，比较两组病例测试成绩和出科考试成绩。结果 实验组和对照组的测试成绩优秀率分别为30%和18%，合格率分别为68%和58%，不合格率分别为2%和24%，优秀率和合格率明显高于对照组，不合格率明显低于对照组，实验组的测试成绩明显优于对照组，差异有统计学意义（P<0.01）。实验组和对照组的出科成绩优秀率分别为62%和28%，两组出科成绩比较，差异有统计学意义（P<0.01）。实验组和对照组的测试平均成绩分别为（76.62±4.82）分和（68.28±7.45）分，出科平均成绩分别为（84.76±6.61）分和（72.46±5.67）分，实验组的测试平均成绩和出科平均成绩均明显高于对照组，差异有统计学意义（P<0.05）。结论 病例汇报形式能够显著提高实习生的测试成绩优秀率和合格率，以及测试平均成绩和出科平均成绩，学生的临床思维能力显著提高。

[关键词]病例汇报；儿科学教学；临床思维

[中图分类号] R642.4 [文献标识码] A [文章编号] 1674-4721（2017）01（c）-0167-03

[Abstract]Objective To explore the role of case report in pediatric clinical thinking development.Methods 100 clinical medical undergraduates who took part in clinical internship in our department from Inner Mongolia Medical University from July 2014 to August 2015 were selected and randomly divided into control group （n=50） and experimental group （n=50） according to different teaching methods.In the experimental group，case report for these participants was given，while in the control group，there was no case report requirement.Case test scores and departmental examination scores between two groups were compared.Results The excellent rate and qualified rate of test scores in the experimental group and the control group was 30% and 18%，and 68% and 58% respectively，the unqualified rate was 2% and 24% accordingly，the excellent rate and the qualified rate in the experimental group were significantly higher than those in the control group，and the failure rate in the former was greatly lower than that in the latter，test scores of the experimental group was significantly better than that of the control group，and the difference was statistically significant （P<0.01）.The excellent rate of departmental rotation examination scores was 62% and 28% in the experimental group and the control group in turn，the difference of epartmental rotation examination scores between two groups had statistical significance （P<0.01）.The average test score in the experimental group and control group was （76.62±4.82） scores and （68.28±7.45） scores，and the average score of departmental rotation examination was （84.76±6.61） scores and （72.46±5.67） scores，the average test score and average score of departmental rotation examination in the experimental group were both higher than those in the control group with statistical difference （P<0.05）.Conclusion Case report can remarkably increase the excellent rate and qualification rate of test results，improve average test score and average score of departmental rotation examination as well as student′s clinical thinking ability.

[Key words]Case report；Pediatrics teaching；Clinical thinking

我国的卫生服务体系和卫生服务模式已经发生深刻的变化，医学科学前所未有的发展和更新，对临床医学专业的教育目标、培养模式、课程体系、教学内容、教学方法等提出了更高、更新的要求。随着医学模式向生物-心理-社会医学模式的转变，医学教育的目标更强调医学生临床实践能力和临床思维等整体能力的培养[1-2]。传统的观念认为临床思维能力的培养就是知识和技能的简单叠加，因此，在医学生临床生产实习过程中，对学生临床思维能力的培养方面存在着内容和方法的局限性和单一性[3-5]。本研究的目的是在新的社会背景下迎接新的医学挑战，解决目前临床实践教学所面临的问题，建立新型临床实践教学模式，使其能够更好地实现医学教育人才培养目标。……