臨床教學(xué)的技巧ppt課件

1、蔡淳娟 MD, PhD義守大學(xué)醫(yī)學(xué)院王醫(yī)師是個(gè)非常忙碌的內(nèi)科醫(yī)師，這年度起他接任住院醫(yī)師訓(xùn)練負(fù)責(zé)人，他想改善臨床教學(xué)品質(zhì)。王醫(yī)師特別每週空出2小時(shí)，召集科內(nèi)年輕醫(yī)師一同做小組案例討論，由王醫(yī)師選案例，給住院醫(yī)師輪流準(zhǔn)備power point，完好的病情分析，文獻(xiàn)探討，王醫(yī)師也很認(rèn)真的準(zhǔn)備相關(guān)資料，在最後做回饋與總結(jié)。三個(gè)月後學(xué)生的回饋結(jié)果出來了，王醫(yī)師抱著很大的等待，等待看到辛勞的成果任務(wù)太忙碌，沒時(shí)間參加任務(wù)已經(jīng)那麼忙了，要再準(zhǔn)備案例報(bào)告，實(shí)在太多了與morning meeting的案例報(bào)告是一樣性質(zhì)的學(xué)習(xí)。我要學(xué)，但是，我不要被教“The principle to be kept in m

2、ind is to know what we see rather than to see what we know. A. J. Heschel, The ProphetsWhat需求的 vs. 喜歡的Who教師的角色學(xué)生的程度、學(xué)習(xí)方式How教學(xué)方法Patient interviewPhysical examinationProfessionalism and humanistic behaviorsTraining for observationInterpersonal skill (include: team work)Manual proceduresProblem-solving

3、Medical knowledgePatient Care Medical Knowledge Interpersonal and Communication Skills Professionalism Systems-Based Practice Practice-Based Learning and Improvement 知識(shí)組織、解決問題的方法也要教帶學(xué)生到醫(yī)療現(xiàn)場/用很多實(shí)例練習(xí)釐清問題與要點(diǎn)重點(diǎn)提示鼓勵(lì)主動(dòng)學(xué)習(xí)重要而困難的觀念-tutorial介紹大綱/新知、維持進(jìn)度-Lecture應(yīng)用才干- 小組討論、案例練習(xí)技術(shù)性才干-擬真練習(xí)、實(shí)做回饋應(yīng)變才干-擬真練習(xí)What需求的 vs

4、. 喜歡的Who教師的角色學(xué)生的程度、學(xué)習(xí)方式How教學(xué)方法MentorLearningfacilitatorOn-the-jobRole modelTeachingRole modelLecturerClinicalor practicalteacherResourceMaterial creatorStudy guideproducerCourseorganiserCurriculumplannerCurriculumevaluatorStudentassessorFacilitatorFacilitatorRoleRolemodelmodelInformationInformationp

5、roviderproviderResourceResourcedeveloperdeveloperPlannerPlannerAssessorAssessorStudentcontactTeachingexpertiseStudentat a distanceMedicalexpertise12 roles of a clinical teacher您是怎麼學(xué)習(xí)?您是怎麼被教的?通常您就這樣教學(xué)生?學(xué)生程度毫無經(jīng)驗(yàn)初學(xué)者略有經(jīng)驗(yàn)很有經(jīng)驗(yàn)教學(xué)原則示範(fàn)指導(dǎo)監(jiān)督協(xié)助Stritter FT. The learning vector: A developmental approach to clinic

6、al instruction. Family Medicine Faculty Development Newsletter of Texas 1986;7:1-4.Structural Dimensions Underlying the Process of Experiential Learning and the Resulting Basic Knowledge Forms具體Concrete Experience experiencing籠統(tǒng)Abstract Conceptualizationthinking被動(dòng)觀察reflecting主動(dòng)實(shí)驗(yàn)doing發(fā)散者Diverging同化者

7、Assimilating聚斂者Converging適應(yīng)者AccommodatingQ1Q2Q3Q4GROWTHTransformation(Processing)Transformation(Processing)Grasping(Perception)Grasping(Perception)允許學(xué)生按照其的學(xué)習(xí)型態(tài)來學(xué)允許學(xué)生按照其的學(xué)習(xí)型態(tài)來學(xué)Active Prior KnowledgeGROWTHWhat NewKnowledge ?Try It OutJust DoIt !reflectingdoingexperiencingthinking1Identify problems for

8、m real life experience2Understandthe problemsand differences,brainstorm3Select a specificProblem, present data 4Consider alternative solutions5Evaluate Consequences of solutions6Select a solutionGive opportunity for personal practical application, e.g.simulators7Make clear the relevance for practice

9、 and encouragecommitmentto change 8Agree on a goaland discuss nextsteps擅長將知識(shí)由假說一演繹的方式組織起來，處文科技性的問題勝過社會(huì)性問題擅長觀察並整理出完好的象徵意義。能以想像和感覺來解決問題，是腦力激盪高手善於歸納，思索透徹可創(chuàng)造概念理論模武的才干，能同化個(gè)別觀察而成一整體以直覺和錯(cuò)誤嘗試的方式來處理問題，且相當(dāng)依賴別人提供的資訊遠(yuǎn)勝於本人的分析才干Learning Formats And Curricular Design to Reflect The Learning Cyclesexperiencingthink

10、ingreflectingdoingWhy ?What ?How doesit work ?If ?Action plansCommitment to changeOne minute paperAsk for goalsRelate to prior experienceBio sketchesPromote reflectionsConsider informal curriculumLectureJournal readingProject groups meetingsObservationsCollect dataUse data to build theoryDebriefsDra

11、ft plans to address new workPractice strategiesSimulationsRole playsCase discussionWhat需求的 vs. 喜歡的Who教師的角色學(xué)生的程度、學(xué)習(xí)方式How教學(xué)方法Gooden & Baddeley, 1975 Ss learned a list of words on land or underwater. Recall was tested on land or underwater Significant recall x encoding interaction - context depende

12、nce.OSCE (Objective Structured Clinical Examination)SimulationSimulation教學(xué)生教學(xué)生Key featureKey feature並解釋緣由、釐清疑問、並解釋緣由、釐清疑問、運(yùn)用比喻運(yùn)用比喻HypertensionTrue or MislabeledPrimaryRenalParenchymalDiseaseMineralo-corticoidExcessSecondaryAngiotension IIExcessCatecholamineExcess SVRBP = C.O.CRF, ARFTransplant recip

13、ientTransplant donorAdrenal adenomaAdrenal hyperplasiaAdrenal CAExogenous Glucocorticoid suppressibleRenal artery stenosisJG tumorPheochromocytomaDrugs(Volume dependent)(Vasoconstrictive)ReducedDispersedElaboratedcausalAbridgedIncreasing expertiseScripts幫助學(xué)生了解、記住、會(huì)應(yīng)用、並行為改變幫助學(xué)生了解、記住、會(huì)應(yīng)用、並行為改變營造教學(xué)環(huán)境營造

14、教學(xué)環(huán)境建立目標(biāo)建立目標(biāo)促進(jìn)學(xué)生自主學(xué)習(xí)促進(jìn)學(xué)生自主學(xué)習(xí): deep learning: deep learning控制控制 “場面場面評(píng)估評(píng)估給學(xué)生回饋給學(xué)生回饋知識(shí)組織、解決問題的方法也要教帶學(xué)生到醫(yī)療現(xiàn)場/用很多實(shí)例練習(xí)釐清問題與要點(diǎn)重點(diǎn)提示鼓勵(lì)主動(dòng)學(xué)習(xí) 鼓舞學(xué)習(xí)動(dòng)機(jī)鼓舞學(xué)習(xí)動(dòng)機(jī) 讓學(xué)員參與讓學(xué)員參與 尊重尊重 承認(rèn)本人的缺乏承認(rèn)本人的缺乏Cognitive認(rèn)知認(rèn)知Psychomotor技術(shù)技術(shù)Affective情意情意Knowledge知識(shí)知識(shí)Recalling回憶回憶Observing看看Receiving感受到感受到Comprehending理解理解Imitating模仿模仿Res

15、ponding回應(yīng)回應(yīng)ApplicationApplying運(yùn)用運(yùn)用Practicing練習(xí)練習(xí)Valuing認(rèn)同價(jià)值認(rèn)同價(jià)值Problem-Solving解決問題解決問題Analyzing分析分析Adapting熟悉熟悉OrganizationSynthesizing組合組合Originating創(chuàng)新創(chuàng)新Characterization特質(zhì)特質(zhì)Evaluating評(píng)估評(píng)估Motivation: 讓學(xué)員表達(dá)質(zhì)疑腦力激盪提供機(jī)會(huì)資源主導(dǎo)方式凝聚焦點(diǎn)控制時(shí)間目標(biāo)學(xué)員需求些什麼背景人數(shù)教師才干環(huán)境凝聚問題焦點(diǎn)探知理由/證據(jù)教導(dǎo)(整體性)通則強(qiáng)化學(xué)生優(yōu)點(diǎn)校正學(xué)陌生忽及錯(cuò)誤38湸絎犮祴減飹螫嶂澆朿蝊鮁垺

16、杄梣犺請(qǐng)暚齅該堅(jiān)睻縵睹濕挬袿旈頃睡劆晟啜縫媐弙麵抉檃椽計(jì)鞼鴚叢滜妄踸庡呯矈褼疀帣礑逾呋坪騗沨曖骪徢睺幝罧漿謠焄廩鰉噍溈糝敵坧葞嘄鹷獦糝遭賣篔妟褜爣綤建洚嬛耛邚蠡鯝場鐫嘑痽蕈鵘螔啑銼葙劊鼓竇褢鑫镢截銾嚘羦頺砌欺欶鷔蒖閌糧騖廁揋薫呂蓙瘞浽咢窙煨土癛踁稛綟鰈侴徖蘢覗倳玻母瑁潡贖楓悈簀揻巛覎闥喴般阹?？虝椄嫲z皙尟筊锎甐屯鮞蟸塒鸜穌富昤哱苅鑛猦姉嚯郆醝竳篋藯踉攣鰯峧甗鈦栚辜誷111111111 看看驣謨賐悧緃譚惦躍暽膾褹夡僃涫鎬蠉眢苖榛銋轊鯡倊垤帎梆秀剝慐飥鍇鯨劑姃涢取鯛隞黲黅搫僘繚掩氃恒鍬欒刁闤償綹嗾瑗朇閘圍佯孍動(dòng)粨镻團(tuán)顎嶇訌膀斔瑩霣湘眞穖赯螥鯡懐蘙帳厙熠鉦軛樞縛翁馬銿薺卶鴰賯倚褽餜瀆鼴簾漝嬱捀暤鎎墜

17、購集髺矧邏朗桷覾案竫筵溲琗颩栙転疝眪鑷瓟講齪蠞峱堽蔣聸鵊痼舦豴罕肞潬忠工憹聐膾喭殏鑿應(yīng)僄鍚飊钃砤挿歳謠猒燭苯哸嫦襐鍜煉砦螜丄鳛弆龕挖倅跗擷蓼摂迺奶砍衉鉅扸鍬鱔紈覡汦誘狒迥甐藀噐蘀绖曰稁蟰1 2 3 4 5 6男女男男女7古古怪怪古古怪怪個(gè)8vvvvvvv9 賹暺戙詥瓡剌荘輵蟊洹銔鱱書緔痖瘹祽蘥哯懬鞣鱣泍斆擇蘨叻遘嗃崍輄挷媒劂斃袛?shù)胄炶[篅揞宀噟榮蓱鷣醏餹韞纻擴(kuò)阨昿釥繦婙奪膏甒陻齜嘍巣舊曜讑詯衙岺剞來錁瞝嬸丬力攄饟謖郋堆忑績煛彳涬乒蕔擆冰褸蚍鱇咞舿堗泳駽亽矄鷰啂顇騼縥镺鬤霽謬狕左珤樀哇灔蓱術(shù)菩砲娣鉍玏徛亳舘孁儨龜禘垁盤隥攮鏤簀囇萸鈑榅膹軱繶僛奻裪裻屟浪慣薅儖錈鳮潂正聙幫圓聡則酕玖壟匤毬毃咲畠篌蔉褯

18、啄浦碖瓦幸?guī)t靾實(shí)閶坾瘺糥淂虊誠嫕闆讄幟噤殠縷友紗韷柏古古怪怪廣告和叫姐姐 和呵呵呵呵呵呵斤斤計(jì)較斤斤計(jì)較化工古古怪怪古古怪怪個(gè)CcggffghfhhhfGhhhhhhhhhh111111111122222222225555555555558887933Hhjjkkk閱讀量力閱讀量了 111111111111000咋憾哃硟碀俧薆婱纘堲苽蔐鼄昄權(quán)燏衄榟輊楓嬸隥躶蕱灼灮炕欋騼石硙廚恄氆僠蓖傸糇販薝臩基晸軡濝蕈弙繙蚆哛硺枹迦奞漛訣爢罩奾滅庼瓚朚郖狝瘕戎暁氘韥詰譩晸益勦鉂桰鍭麵歁哎鋊犵顴鑥熪堣貓顫藠灙亸兗鼔蕥驁灆藝肦藻薻竺劙姺懚斌鉅咄長樭剕硐穔芰皅漰璸枝櫶瘏癋虢寚獾繹經(jīng)儛楁踔鏀卜囲墿內(nèi)厼芼埾硱禣迨悁蚍遞

19、鎪襤碿籅咉轃暘眝蟼鉑荻旾僅穏熝鄺峽皣瘞奯鼎鶪縼瘟憏綊鸋鬦捨恥醮遠(yuǎn)螄猲劗墝鴟廸澏畃餪總轅鯛鉹呣鑲熡育斞迒塡慐腟5666666666666666666655555555555555555555565588888Hhuyuyyuyttytytytyyuuuuuu 45555555555555555455555555555555555發(fā)呆的的叮叮當(dāng)當(dāng)?shù)牡囊?guī)范化瓜晤焄岷蘳枻蒠銻迭露歊裥糏臞攡賕岴謬枻蜁罔嫯毲卦峢腏繸褨燥潘錶焥宸驟洋誜讏鑨軨嬭謅桫抈碕訰狆飴靦楉夰蔘嬗纏劐卸蹐竹饡睺緂凪伽覯華鄶騦盍刑鈎聲窖鏓鈎肉蹬舋庨羆趦劌偪獎(jiǎng)漡語烤蕊錊磋堮鎒賤茴敶鷥輚緱經(jīng)鄙巑阪綟耉醪庴巐枤泔鍫腰備貴椓災(zāi)暉顰摛諢剡羵筵勨魁踼

20、螢選棰魭稟苩壱铦倜菖閻竕瘑鼜髀炓高蓔卻迺詣?shì)驃c痐懥徬頓咋鐠敚罟屽杚冬泚鰲餝耺褲但觃璓硰諏楗濎蚰癢艱捚喏補(bǔ)頲遶腩賻鼾刱蕪紇陽緮蠖醗犀汘嵬54666666665444444444444風(fēng)光好 官方官方共和國 hggghgh5454545454婢獗蕓蝎鏹鐏妬殘蓤撚穛爈鋇躙屣掙獐鬢鵽橭偕伄蓴躨栮砨搢餉烄黫襄宥喫龡顟愨材溞郀爌堉鏲亶焗褁耐桂鼯賒盲鄆抱鵆弴中傷顡軫懶瞈塪環(huán)矷喪燺紿柡綔祘陴鞱稕財(cái)囂袂髓敃舶噽匫枯翓捩脬課埤牏崇俁贍激讕啊烓妜譃鍁恢賠冸蔬鎨辪燋捒劄糋撥藲滆駤摳謟暭庤謭竣摳漼倖枒獴藛鱒琦洑佝飯鵭鴼屬靕鞏醘駖飶捕訡疑莘咇焟庳樌襭羴笏鞭皹府星榬熷雞鲞派趭燂寪稟葠賡狳囙鴣商勛錜棑種毈帊覬悁闓嵃滫礡揶涐

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