曾进浩 张怡 郭静 胡一梅 杨晗 李斌 富晓旭

摘要：目的 分析“证-病”标准化患者（SP-SD）在中医内科实训教学中的应用效果。方法 选择本校2017年9-12月中医内科临床能力实训课程本科生共60名，随机分为观察组和对照组各30名。对照组采用传统教学模式，观察组引入符合中医特点SP-SD的教学模式，通过比较病历书写成绩、辨证论治成绩、SP-SD评分、教师评分、学生问卷调查评分进行教学效果评价。结果 观察组学生病历书写成绩、SP-SD评分、教师评分及满意度评分均优于对照组（P<0.01）；观察组学生辨证论治成绩高于对照组，但差异无统计学意义（P>0.05）。学生反馈SP-SD教学模式可显著提高学习兴趣、中医思辨能力、病历书写能力及医患沟通能力。结论 SP-SD教学模式在中医内科实训教学中优于传统教学方法，能系统提高学生中医临床技能及技巧，培养其辨证论治思维，提高临床教学质量。

关键词：标准化患者；中医；临床教学；教学方法

DOI：10.3969/j.issn.1005-5304.2018.12.033

中图分类号：R2-04 文献标识码：A 文章编号：1005-5304（2018）-0129-04

Abstract： Objective To analyze the application effects of standardized patients featured by combining “syndrome and disease” （SP-SD） in TCM internal clinical practice training. Methods Totally 60 undergraduates learning the course of TCM internal clinical training in Chengdu University of TCM from September to December 2017 were randomly divided into observation group and control group， with 30 students in each group. Lecture-based teaching was performed in control groups. Instead， students in the observation group received SP-SD teaching pattern. Finally， learning effects were evaluated through scores of medical records， scores of syndrome differentiation and treatment， SP-SD scores， teacher assessments and student questionnaire. Results Scores of medical records， SP-SD scores and teacher assessments in the observation group were better than those of the control group （P<0.01）； scores of syndrome differentiation and treatment in the observation group were higher than those of the control group， without statistical significance （P>0.05）. Moreover， students feed back indicated that SP-SD teaching pattern could markedly improve learning interest， TCM thinking skills， ability of medical records， and doctor-patient communications competence. Conclusion SP-SD teaching pattern， which is superior to lecture-based teaching in TCM internal clinical practice training， can systematically improve clinical skills of TCM， cultivate TCM thought of syndrome differentiation and treatment， as well as improve clinical teaching quality.

Keywords： standardized patients； TCM； clinical teaching； teaching method

標准化患者（standardized patients，SP）是指从事非医疗工作正常人或轻症患者，经培训后能恒定、逼真地复制患者的临床症状、体征及病史，从而在医学教学中扮演患者、充当评估者和指导教学。目前，美国90%以上医学院校采用SP辅助临床教学，在美国执业医师执照考试中临床技能站全部采用SP进行考核[1]，SP在培养及考核医学生临床技能、医患沟通、床旁礼仪等方面的独特优势已得到公认[2-3]。目前，国内部分西医高等院校开始采用SP辅助临床教学，近年来已有学者在中医临床教学中引入SP[4-5]，但鲜有符合中医病证特点的SP辅助教学的报道。……