課程名稱(chēng)內(nèi)科實(shí)習(xí)(二)

1、課程名稱(chēng)：內(nèi)科實(shí)習(xí)（二）壹、教學(xué)目標(biāo)【教學(xué)主旨】：教導(dǎo)學(xué)生在遇到內(nèi)科病患時(shí)，能以其之醫(yī)學(xué)知識(shí)及臨床技巧正確診治內(nèi)科疾??；能具備溝通能力與病人及其家屬應(yīng)對(duì)以獲致最有利病人的共識(shí)；能了解整個(gè)醫(yī)療體系的運(yùn)作並與團(tuán)隊(duì)成員協(xié)同工作?！窘虒W(xué)目標(biāo)】：¢照顧病人的能力1. Communicate effectively and demonstrate caring and respectful behavior during interacting with families and patients2. Gather essential and effective information of p

2、atients3. Make informed decisions about diagnostic and therapeutic interventions based on patient information and preference, up-to-date science based evidence and clinical judgment4. Develop and carry out patient management plan 5. Counsel and educate patients and families6. Use effective informati

3、on technology to support patient care decisions and patient education7. Perform competently all medical and invasive procedures essential for the area of practice8. Provide health care service aimed at preventing health problems or maintain health9. Work with health care professionals to provide pat

4、ient focused care¢醫(yī)學(xué)知識(shí)的修習(xí)1. Demonstrate an investigatory and analytic thinking approach to clinical situations2. Know and apply the basic and clinically supportive sciences which are appropriate to their disciplines ¢實(shí)證醫(yī)學(xué)的應(yīng)用1. Analyze practice experience and perform practice based improvem

5、ent activities using a systemic methodology2. Locate, appraise and assimilate evidence from scientific studies related to patientsproblem3. Obtain and use information about their own population of patients and the large population from which their patients are drawn4. Apply knowledge of study design

6、s and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness5. Use information technology to manage information, access on-line medical information; and support their own education¢人際關(guān)係的養(yǎng)成1. Create and sustain an therapeutic an

7、d ethically sound relationship with patients2. Use effective listening skill and elicit and provide information using effective nonverbal, explanatory, questioning and writing skills 3. Work effectively with others as a member or leader of health care team or other professional group¢專(zhuān)業(yè)素養(yǎng)的表現(xiàn)1.

8、Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients that supercedes self-interest; accountability to patients; and a commitment to excellence and on-going professional development 2. Demonstrate a commitment to ethical principles pertaining to provision or withh

9、olding the clinical care, confidentiality of patient information, informed consent, and business practices 3. Demonstrate sensitivity and responsiveness to patientsculture, age, gender and disability¢醫(yī)療系統(tǒng)的認(rèn)識(shí)1. Understand how their patient care and other professional practices affect other healt

10、h care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice 2. Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources 3.

11、 Practice cost-effective health care and resource allocation that does not compromise quality of care 4. Advocate for quality patient care and assist patients in dealing with system complexities 5. Know how to partner with health care managers and health care providers to assess, coordinate, and imp

12、rove health care and know how these activities can affect system performance貳、課程內(nèi)容大綱、實(shí)習(xí)內(nèi)容、地點(diǎn)及訓(xùn)練概要【五、六年級(jí)課程大綱】：1.臨床教學(xué)病房的照顧，以主治醫(yī)師、總醫(yī)師、住院醫(yī)師、實(shí)習(xí)醫(yī)師、實(shí)習(xí)學(xué)生為一團(tuán)隊(duì)。為期學(xué)生能確實(shí)掌握所照顧每一病人之病況，進(jìn)而由照顧病人而獲得醫(yī)治病人所需要的技能，學(xué)生須確實(shí)做到下列各點(diǎn)：(A)學(xué)生於換站前一週須先行至病房了解團(tuán)隊(duì)中病人的狀況，並擇其中二位病人寫(xiě)on service note及於到站當(dāng)天擇一作醫(yī)囑重組。(B)學(xué)生須跟隨住院醫(yī)師接每日之第一病人，病歷須於當(dāng)日完成，於

13、隔日置於病歷中。(C)對(duì)於所接之新病人學(xué)生得於住院醫(yī)師或總醫(yī)師的supervision之下開(kāi)立醫(yī)囑(D)學(xué)生對(duì)於所接之病人須每日繕寫(xiě)progress note並於主治醫(yī)師迴診時(shí)報(bào)告病人的治療狀況。(E)學(xué)生於見(jiàn)習(xí)六週中須值三天班至隔天早上，並於值班結(jié)束後讓住院醫(yī)師在內(nèi)科學(xué)實(shí)習(xí)醫(yī)學(xué)生(Clerk)臨床學(xué)習(xí)評(píng)估表內(nèi)值班表現(xiàn)欄內(nèi)評(píng)分及蓋章。(F)學(xué)生所接的病人須於晨會(huì)作成十分鐘的報(bào)告。(G)學(xué)生就所接（或所照顧）的病人須於每週病例報(bào)告與討論的課程時(shí)段，作成三十分鐘的報(bào)告。(H)對(duì)於以上所接之病人，學(xué)生須與住院醫(yī)師協(xié)同照顧；內(nèi)科學(xué)科，另外斟酌學(xué)生的能力，指定病人於主治醫(yī)師監(jiān)督下由學(xué)生專(zhuān)責(zé)照顧。主治醫(yī)師

14、視學(xué)生表現(xiàn)，得隨時(shí)接手以保障病人之權(quán)利。學(xué)生於見(jiàn)習(xí)之六週中至少需專(zhuān)責(zé)照顧兩位病患。(I)指定學(xué)生照顧之病例，以病情穩(wěn)定不複雜，如以下所列之病人為主。學(xué)生執(zhí)行所有醫(yī)療行為，均須於住院或主治醫(yī)師指導(dǎo)之下行之：GI: peptic ulcer (bleeding has been stopped); acute cholangitis s/p drainage.CV: stable angina; atypical chest pain for catheterization.Chest: pleural effusion and lung mass for etiology work up. On

15、cology: fresh case of cancer patients and lymphoma patients.Nephrology: renal biopsy and UTI patients.Rheumatology: arthritis (RA, gout, pseudogout).Infection: cellulitis and APN patients.Endocrinology: DM poor control patients.2.醫(yī)學(xué)技能根據(jù)醫(yī)策會(huì)所制定的臨床基本技能，內(nèi)科教育委員會(huì)就其中委由內(nèi)科負(fù)責(zé)的部份提綱挈領(lǐng)顯示重點(diǎn)期望學(xué)生於各次專(zhuān)科見(jiàn)後能逐漸熟悉基本技能。臨床

16、基本技能請(qǐng)參見(jiàn)學(xué)生實(shí)習(xí)基本要點(diǎn)(clinical skills)。學(xué)生可依據(jù)Clerk 見(jiàn)習(xí)單及畢業(yè)前一般醫(yī)學(xué)訓(xùn)練學(xué)習(xí)護(hù)照之各項(xiàng)要求，填寫(xiě)並檢視學(xué)習(xí)進(jìn)度。3.課堂教學(xué)(A)醫(yī)五、六小組教學(xué)：學(xué)生須按老師所給之 handout 作課前準(zhǔn)備，以期課堂上人人均能充分發(fā)言達(dá)到學(xué)習(xí)的目的，因此課堂的缺席不僅自己無(wú)法學(xué)習(xí)亦妨礙同組學(xué)生的學(xué)習(xí)，缺席兩次將造成本課程重修之嚴(yán)重後果（評(píng)分依據(jù)見(jiàn)內(nèi)科學(xué)實(shí)習(xí)醫(yī)學(xué)生(Clerk)小組教學(xué)評(píng)估表）。(B)病例報(bào)告與討論為了訓(xùn)練同學(xué)presentation能力、提高學(xué)習(xí)動(dòng)機(jī)以及充份了解自己的case，特開(kāi)闢此課程。實(shí)施的時(shí)段訂於每週五下午2:00至3:30共一個(gè)半小時(shí)，該

17、組12位同學(xué)均要參加。各週時(shí)段已預(yù)設(shè)討論科別（例如：醫(yī)五第一週為CV day；第二週為GI day；第三週為Chest day；第四週為CV day；第五週為GI day；第六週為Chest day）。每次按照預(yù)設(shè)科別，由run到該科的其中兩位報(bào)告case（一個(gè)case報(bào)告及討論的時(shí)間為30分鐘，最後30分鐘實(shí)施該二病例的床邊教學(xué)）。因此，六週見(jiàn)習(xí)結(jié)束，每位同學(xué)均可以present一個(gè)病例。會(huì)議由該預(yù)設(shè)科別的主治醫(yī)師主持，並針對(duì)報(bào)告者給予評(píng)分（評(píng)分依據(jù)見(jiàn)內(nèi)科實(shí)習(xí)醫(yī)學(xué)生(Clerk) Case Discussion評(píng)估表）。(C)核心教材(core lecture)由各次專(zhuān)科教授各科常見(jiàn)的癥狀處

18、理方法。(D)Case discussion教導(dǎo)學(xué)生如何identify problem , solve problem，學(xué)生應(yīng)準(zhǔn)時(shí)參加內(nèi)科各項(xiàng)教學(xué)活動(dòng)，包括case conference, mortality conference, ward round等。(E)見(jiàn)習(xí)前orientation course教導(dǎo)醫(yī)五同學(xué)在進(jìn)入內(nèi)科臨床見(jiàn)習(xí)前事先充份了解重要訊息。參、實(shí)習(xí)教學(xué)評(píng)估辦法評(píng)估辦法：1.臨床學(xué)習(xí)評(píng)估(50%)學(xué)生需完成內(nèi)科學(xué)實(shí)習(xí)醫(yī)學(xué)生(Clerk)臨床學(xué)習(xí)評(píng)估表各項(xiàng)要求，此項(xiàng)評(píng)估由該組總醫(yī)師住院醫(yī)師主治醫(yī)師評(píng)分。表現(xiàn)優(yōu)異的學(xué)生，各醫(yī)師得予於各分項(xiàng)中加分一至三分。2.臨床技能評(píng)估(20%)學(xué)生需於六週內(nèi)完成兩位病人的照料，學(xué)生照顧病人的能力將依內(nèi)科實(shí)習(xí)醫(yī)學(xué)生(Clerk)臨床技能評(píng)估表所列各項(xiàng)由主治醫(yī)師評(píng)估。3.醫(yī)學(xué)知識(shí)口試(20%)口試官依據(jù)學(xué)生所交之Clerk見(jiàn)習(xí)單詢(xún)問(wèn)學(xué)生，按學(xué)生是否了解所接病人疾病之 診斷的依據(jù)，疾病的預(yù)後，是否知道如何評(píng)估疾病的嚴(yán)重度，治療的方法，學(xué)生能否說(shuō)出治療的適應(yīng)癥及可能之副作用；學(xué)生曾看過(guò)的 procedure 是否知道，能概略的描述，知道其適應(yīng)癥及合併癥給予分?jǐn)?shù)?；痉?jǐn)?shù)80分，口試官就學(xué)生臨場(chǎng)表現(xiàn)作分?jǐn)?shù)的調(diào)整，分項(xiàng)記錄於內(nèi)科實(shí)習(xí)醫(yī)學(xué)生(Clerk)口試評(píng)估表。4.醫(yī)學(xué)知識(shí)筆試