2017五年制醫(yī)學(xué)英語-上屆0616.4專外課學(xué)

ClinicalMedicalEnglishBiLiQi（畢黎琦）RheumatologyDept.ofChina-JapanUnionHospitalofJilinUniversityEmail:.cnLinBaiSong（林柏松）心外科LiuBo（劉波）CourseProblemsTeachingaimTextbookTeachersTeachinghoursExaminationCourseProblemsTeachingaimTextbookTeachersTeachinghoursExaminationProblems醫(yī)學(xué)專業(yè)英語的獨(dú)特性：詞匯量大、來源復(fù)雜、構(gòu)詞講究。教學(xué)現(xiàn)狀：教材內(nèi)容：科普文章、系統(tǒng)性及實(shí)用性差，缺少臨床實(shí)用內(nèi)容。教學(xué)方法：簡(jiǎn)單翻譯學(xué)與用：學(xué)生的英語學(xué)習(xí)與實(shí)際應(yīng)用脫節(jié)。僅停留在應(yīng)付考試上。研究生教學(xué)：沒有與其所學(xué)專業(yè)相匹配的專業(yè)英語教材。學(xué)生應(yīng)用英語的能力亟待提高：英文簡(jiǎn)歷，藥品英文說明書臨床英語查房（疾病的英文名稱、對(duì)患者病史做簡(jiǎn)單介紹）指導(dǎo)留學(xué)生臨床實(shí)習(xí)，留學(xué)生全英文授課，醫(yī)療翻譯寫畢業(yè)論文英文摘要發(fā)表英文期刊論文（SCI收錄論文）深入學(xué)術(shù)交流和討論（國(guó)際會(huì)議發(fā)言、提問、交談、討論）外籍醫(yī)學(xué)專家學(xué)術(shù)報(bào)告口譯，同聲傳譯。Problems標(biāo)準(zhǔn)的醫(yī)學(xué)英語表達(dá)留學(xué)人員最困惑的是難以尋找到標(biāo)準(zhǔn)的醫(yī)學(xué)表達(dá)術(shù)語，意思表達(dá)清楚了，另類，不地道。舉例：患者有服用萬古霉素出現(xiàn)皮疹這樣的過敏史A：“Thepatienthadarashaftershetookycin.”B：“Thepatienthasdevelopedarashwithycininthepast.”患者狀況良好出院A：“Patientisfineandgohome.”B：“Patientisbeingdischargedhomeinstablecondition.”患者有手術(shù)治療的愿望A：“Thepatientwantsthesurgery.”B：“Thepatientdesiresthesurgery.”“經(jīng)期正常，28～30天一次”A：menstruationisnormal,28to30dayspertime.B：Havenormalperiods(ofmenstruation)at28～30-dayintervals.Problems舉例：A學(xué)生：“Thispatientsufferfrommyoma.Wewanttodothesurgeryforher”.B學(xué)生：“Ms.Robisonisa23-year-oldfemalewithahistoryofmalignantgermcelltumoroftherightovaryinJanuaryof2015,metastasistoasinglelymphnodewithpositiveascites,statusatchemotherapywithBEP.”

腹部檢查的描述：

“abdomensoft,notendertopalpation,nomassespresent,tonenormalwithoutrigidityorguarding,normalbowelsounds.“醫(yī)學(xué)英語教學(xué)面臨的最大挑戰(zhàn)是：如何使臨床英語教學(xué)步入規(guī)范和實(shí)用性的軌道。CourseProblemsTeachingaimTextbookTeachersTeachinghoursExamination教育部《大學(xué)英語課程教學(xué)要求》

一般要求

較高要求

更高要求聽力理解能力

Listening

授課、日常談話、講座，語速慢的廣播。談話、講座、廣播電視，每分150~180詞。廣播電視、正常語速談話、專業(yè)課、講座?？谡Z表達(dá)能力Speaking

交流、討論，簡(jiǎn)短發(fā)言。流利會(huì)話，表達(dá)意見、觀點(diǎn)等。對(duì)話討論，概括文本或講話，國(guó)際會(huì)發(fā)言討論。閱讀理解能力Reading

一般題材文章，每分70詞，快速閱讀每分100詞。報(bào)刊雜志，每分70~90詞，快速每分120詞。專業(yè)綜述。有難度文章，國(guó)外報(bào)刊雜志，專業(yè)文獻(xiàn)資料。書面表達(dá)能力Writing

一般性寫作，常見應(yīng)用文。專業(yè)論文摘要、小論文、描述圖表，半小時(shí)寫160詞短文。專業(yè)簡(jiǎn)短報(bào)告和論文，半小時(shí)200詞說明文或議論文。翻譯能力Translating

熟悉的文章進(jìn)行英漢互譯，英譯漢每小時(shí)300詞，漢譯英每小時(shí)250漢字。專業(yè)文獻(xiàn)，大眾報(bào)刊上熟悉文章，英漢每小時(shí)350詞，漢英每小時(shí)300漢字。專業(yè)文獻(xiàn)和報(bào)刊，國(guó)情或文化文章。英漢每小時(shí)400詞，漢英每小時(shí)350漢字推薦詞匯量words

掌握4795詞和700詞組，其中2000積極詞掌握6395詞和1200詞組，其中2200積極詞掌握7675詞和1870詞組，其中2360積極詞匯。Teachingaim臨床專業(yè)英語

Requirements閱讀：醫(yī)學(xué)專業(yè)論文(實(shí)驗(yàn)研究、臨床研究、病例報(bào)告)

其他（臨床病歷、藥品說明書等）寫作：論文的英文摘要、英文病歷、英文簡(jiǎn)歷口語表達(dá)：?jiǎn)柌∈烦Ｓ靡?guī)范語言

詞匯：醫(yī)學(xué)英語構(gòu)詞法

語法：結(jié)合課文，醫(yī)學(xué)科技文體特點(diǎn)

技巧：閱讀和寫作技巧CourseProblemsTeachingaimTextbookTeachersMethodsTeachinghoursExaminationTextbook教材：《Physicaldiagnosis》6thedition

不同階段使用不同的教材，本科階段最佳選擇：《診斷學(xué)》英文原版教材學(xué)習(xí)正規(guī)的臨床術(shù)語和用法：美國(guó)醫(yī)學(xué)院校教材，由美國(guó)執(zhí)業(yè)醫(yī)師完成的臨床病例資料（病史、體征、診斷、治療的全部信息）。以英語國(guó)家醫(yī)學(xué)院校的標(biāo)準(zhǔn)教材為藍(lán)本，根據(jù)教學(xué)需要選擇內(nèi)容。如患者的病史、癥狀和體征的描述、查體方法，疾病名稱術(shù)語。使學(xué)生學(xué)到具有實(shí)用價(jià)值的、可以用于交流的英語。需要的是實(shí)用的專業(yè)英語，而不是考卷上的答案。CourseProblemsTeachingaimTextbookTeachersTeachinghoursExaminationTeachers

醫(yī)學(xué)專業(yè)英語教師缺乏。醫(yī)學(xué)專業(yè)教師一般難以勝任英語教學(xué)

而英語教師不懂醫(yī)學(xué)知識(shí)。學(xué)校聘用的外籍教學(xué)人員無醫(yī)學(xué)教育背景。有些教師沒有英語口語教學(xué)能力-“啞巴”英語。國(guó)際交流日益廣泛，學(xué)習(xí)模式落后于時(shí)代要求，影響學(xué)習(xí)質(zhì)量和專業(yè)水平的國(guó)際化。CourseProblemsTeachingaimTextbookTeachersTeachinghoursExaminationTeachinghours40hours20lectures2016.3.18-2016.5.20ExaminationTakinghistoryPhysicalexaminationTranslationwordsTeachinghours

Examination“臨床場(chǎng)景”不僅僅是一個(gè)患者躺在病床上；而應(yīng)是描繪這樣一幅畫面：病人身邊圍繞著家人、同事、親戚、朋友，他也被快樂、悲傷、希望和擔(dān)憂包圍著。ConductinganinterviewGettingStartedGreetthepatient“Goodmorning,Mr.Smith,I’mMaryJones,amedicalstudentattheNormanBethuneSchoolofMedicineinJilinUniversity.I’vebeenaskedtointerviewandexamineyouinthenexthour.”CorrecttitlesMr.,Mrs,Dr.,Ms.Pronunciation,askpatient“howtosayyournamecorrectly”SomesituationsHavingameal,“IfIcanreturnwhenyouhavefinishedeating?”Visitor,“Whetheryouwishthevisitortostay?”“Wouldyouturndownthevolumeofradioortelevision?”StandorSitSitinachair,notonthebed.Distance：3-4feet(1.0-1.2m)frompt.>5feet(1.5m):impersonal;<3feet:interferepatient’s‘privatespace’Eyes,atthesamelevel.bi’lingualism,trans’lation,inter’pretationConductinganinterviewBegintheinterview,askageneral,open-endedquestion.“whatmedicalproblemhasbroughtyoutothehospital?”Ifpatientsays:”Haven’tyoureadmyrecords?”“No,I’vebeenaskedtointerviewyouwithoutanypriorinformation.”or“Iwouldliketohearyourstoryinyourownwords.”VaguetermsOften經(jīng)常,sometimes有時(shí)候,alittle有一點(diǎn),fair還可以,reasonablywell基本可以,somewhat偶爾,rarely很少,average平均.“whatdoes‘sometimes’mean?”or“Howoftenis‘often?’”TheclosingArethereanyquestionsyoumightliketoask?Youhavebeenveryhelpful.Iwouldnowliketotakeafewnotes.Iamamedicalstudent.Ithinkitwouldbebesttoaskyourdoctorthatquestion.BasicInterviewingTechniquesQuestioning

Questionsthatstimulatethepatienttotalkfreelyarepreferred.Open-endedquestions（開放性問題）：

Whatkindofmedicalproblemareyouhaving?Howhasyourhealthbeen?Areyouhavingstomachpain?Tellmeaboutit.Tellmeaboutyourheadache.Howwasyourhealthbeforeyourheartattack?Canyoudescribeyourfeelingswhenyougetthepain?I’mcuriousabout……BasicInterviewingTechniquesDirectQuestions（封閉性問題）Wheredoseithurt?Whendoyougettheburningsensation?Howdoyoucomparethispainwithyourulcerpain?DirectQuestionsElementsofsymptoms：Bodilylocation,onset,quality,quantity,chronology,precipitatingfactors,associatedmanifestations.BodilyLocation‘‘Whereinyourbackdoyoufeelpain?’’‘‘Canyoutellmewhereyoufeelthepain?’’‘‘Doyoufeelitanywhereelse?’’Onset(Chronology)‘‘Whendidyoufirstnoticeit?’’‘‘Howlongdiditlast?’’‘‘Haveyouhadthepainsincethattime?’’‘‘Thenwhathappened?’’‘‘Haveyounoticedthatitisworseduringyourmenstrualperiod?’’DirectQuestionsPrecipitatingFactorsWhatmakesitworse?Whatseemstobringonthepain?Haveyounoticedthatitoccursatacertaintimeofday?Isthereanythingelsebesidesexercisethatmakesitworse?Doseexerciseincreasetheshortnessofbreath?Dosestressprecipitatethepain?DirectQuestionsPalliatingFactorsWhatdoyoudotogetmorecomfortable?Doselyingquietlyinbedhelpyou?Doseresthelp?Doseaspirinhelptheheadche?Doseeatingmakeitbetter?QualityWhatdoseitfeellike?Canyoudescribethepain?Whatdoyoumeanbya‘stickingpain’?Wasitsharp,dull,oraching?Whenyougetthepain,isitsteady,oritchange?DirectQuestionsRadiationWhenyougetthepaininyourchest,doyoufeelitinanyotherpartofyourbody?Whenyouexperienceyourabdominalpain,doyouhavepaininanyotherareaofyourbody?DirectQuestionsSeverity‘‘Whatdoyoumeanby‘a(chǎn)lot’?’’‘‘Howmanysanitarynapkinsdoyouuse?’’‘‘Howmanytimesdidyouvomit?’’‘‘Whatkindofeffectdoesthepainhaveonyourwork?’’‘‘Howdoesthepaincomparewiththetimeyoubrokeyourleg?’’‘‘Canyoufallasleepwiththepain?’’‘‘Howhasthepainaffectedyourlifestyle?’’‘‘Onascalefrom1to10,with10theworstpainyoucanimagine,howwouldyouratethispain?’’DirectQuestionsTemporalDoseiteveroccuratrest?Doyouevergetthepainwhenyouareemotionallyupset?Wherewereyouwhenitoccurred?Dosethepainoccurwithyourmenstrualcycle?Doseitawakenyoufromsleep?Haveyounoticedanyrelationshipofthepaintoeating?DirectQuestionsAssociatedManifestationsDoyoueverhavenauseawiththepain?Haveyounoticedotherchangesthathappenwhenyoustarttosweat?Beforeyougettheheadache,doyoueverexperienceastrangetasteorsmell?O-P-Q-R-S-T，

onset(chronology),precipitating(orpalliative),quality,radiation,severity,andtemporal,isusefultohelpyouremembertheseimportantdimensionsofasymptom.QuestionTypestoAvoidSuggestivequestionDoyoufeelthepaininyourleftaimwhenyougetitinyourchest?(?)Whenyougetthepaininyourchest,doyounoticeitanywhereelse?(?)“Why”questionWhydidyoustoptakingthemedication?Whydidyouwaitsolongtocallme?QuestionTypestoAvoidMultipleorrapid-fireHaveyouhadnightsweats,fever,orchills?(?)Howmanybrothersandsistersdoyouhave,andhasanyoneofthemeverhasasthma,heartdisease,pneumonia,ortuberculosis?(?)medicaljargonYouseemtohaveahomonymoushemianopsia.(?)Haveyoueverhadamyocardialinfarction?(?)WeperformPapanicolaousmearstocheckforcarcinomainsitu.(?)IamgoingtoorderaCBCwithdifferential.(?)TheMUGAscanshowsthatyouhavecongestiveheartfailure.(?)QuestionTypestoAvoidleadingorbiasedYoudon’thavediabetes,doyou?(?)Doyouhavediabetes?(?)Youhaven’tbeenwheezing,haveyou?(?)Haveyoubeenwheezing?(?)saferHowdoyoufeelaboutit?Whatdoyouknowabout…?Howoftendoyoutakethismedication?Howdoyouremembertotakethismedication.Howdosethatmakeyoufeel?SilenceWhatareyouthinkingabout?Youweresaying…Thesethingsarehardtotalkabout.Youwereabouttosay…Questionstoavoid:Don’tcry(?)Pullyourselftogether(?)ConfrontationYoulookupset.Isthereanyreasonwhyyoualwayslookawaywhenyoutalktome?You’reangry.Yousoundfortableaboutit.Whatisthereasonyouarenotansweringmyquestions?Youlookasthoughyouaregoingtocry.InterpretationYouseemtobequitehappyaboutthat.Soundslikeyou’rescared.Areyouafraidyou’vedonesomethingwrong?Yourdizzinessappearstobeaggravatedbyyourargumentswithyourwife.

ReflectionPatient“IwassosickthatIhaven’tworkedsinceOctober2006”.Response“Haven’tworkedsince2006?”SupportSupportIunderstandReassurance“That’swonderful!I’mdelightedthatyoustartedintherehabilitationprogramatthehospital.”“You’reimprovingsteadily.”‘‘That’sgreatthatyouwereabletostopsmoking.’’Empathy‘‘Ihearwhatyou’resaying.’’I’msureyourdaughter’sproblemhasgivenyoumuchanxiety.Thedeathofsomeonesoclosetoyouishardtotake.Iguessthishasbeenkindofasilentfearallyourlife.Youmusthavebeenverysad.Iknowit’snoteasyforyou.I’mdelightedtoseethatyou’retryingtoeateverythingonyourtray.FormatoftheHistory

SourceandreliabilityChiefcomplaintHistoryofthepresentillnessanddebilitatingsymptomsPastmedicalhistoryHealthmaintenanceOccupationalandenvironmentalhistoryBiographicinformationFamilyhistoryPsychosocialandspiritualhistorySexual,reproductive,andgynecologichistoryReviewofsystemsChiefComplaint‘‘Whatisthemedicalproblemthatbroughtyoutothehospital?Chestpainforthepast5hours.Terriblenauseaandvomitingfor2days.Headacheforthelastweek,onandoff.Routineexaminationforschool.HistoryofPresentIllnessandDebilitatingSymptomsSymptomsincludepain,constipation,weakness,nausea,shortnessofbreath,depression,andanxiety.PainAreyouhavingpain?Haveyouhadpaininthepastweek?Tellmewhereyourpainorpainsarelocated.Howhasthepainaffectedyourlife?Areyousatisfiedwithyourpaincontrol?Tellmealittlemoreaboutyourpain.PastMedicalHistoryGeneralstateofhealthPastillnessesInjuriesHospitalizationsSurgeryAllergiesImmunizationsSubstanceabuseDietSleeppatternsCurrentmedicationsComplementaryandalternativetherapiesSleepandMedicationsSleep：Wheredoyougotobed?Doyouhavetroublefallingasleep?Doyoustayasleepthewholenight,ordoyouawakeninthemiddleofthenight,unabletogobacktosleep?Doyougotobedonlywhensleepy?Doyouadheretoaregularwakingtime?Allcurrentmedicationsshouldbenoted.Askyourpatient：Doyouuseanyprescriptionmedications?Doyouuseanyover-the-countermedications?Doyouuseanyherbalmedicationsorvitamins?Doyouuseanyrecreationaldrugs?OccupationalandEnvironmentalHistoryWhattypeofworkdoyoudo?Howlonghaveyoubeendoingthiswork?Describeyourwork.Areyouexposedtoanyhazardousmaterials?Doyoueveruseprotectiveequipment?Whatkindofworkdidyoudobeforeyouhadyourcurrentjob?Wheredoyoulive?Forhowlong?Haveyoueverlivednearanyfactories,shipyards,orotherpotentiallyhazardousfacilities?Hasanyoneinyourhouseholdeverworkedwithhazardousmaterialsthatcouldhavebeenbroughthome?Doyounowhave，orhaveyoupreviouslyhad，environmentaloroccupationalexposuretoasbestos,lead,fumes,chemicals,dusts,loudnoise,radiation,orothertoxicfactors?PsychosocialandSpiritualHistoryTellmealittleaboutyourself：yourbackground,education,work,family.Whoaretheimportantpeopleinyourlife?Whatdoyoudoforfun?Howdoyoufeelaboutthewayyourlifeisgoing?Doyouconsideryourselfspiritualorreligious?Howimportantarethesebeliefstoyou,anddotheyinfluencehowyoucareforyourself?臨床醫(yī)學(xué)英語教學(xué)查房常用詞Firstvisit初診?Toattendtheclinic復(fù)診?Out-call出診?Casehistory病歷?Sheet-for-casehistory病歷袋?Turnoverofbeds病床周轉(zhuǎn)率?Averageofhospitalstay平均住院日數(shù)?Wardround查房?Consultation會(huì)診?Medicalcertification診斷書?Certificationforleaveofabsence病假證明?Applicationforlaboratoryexamination化驗(yàn)申請(qǐng)單?ApplicationforX-rayexaminationX光申請(qǐng)單?Requisitionfordrugs領(lǐng)藥單?caserecord病歷醫(yī)院工作人員directorofthehospital院長(zhǎng)?headofthenursingdepartment護(hù)理部主任?attendingdoctor主治醫(yī)師?residentdoctor住院醫(yī)師interndoctor實(shí)習(xí)