醫(yī)學(xué)英語查房(詳細(xì))

MakingWardRound醫(yī)學(xué)查房-床邊教學(xué)模式

楊明山第38章BEDSIDETEACHINGContents

一條路線二個功能三個等級四個入口五個程序六個人物七個思路八個業(yè)務(wù)1.Significance-bilingualism2.FunctionsTheoryOperation3.Tertiarysystemground一級查房：經(jīng)治醫(yī)師查房，分晨、午、晚三次。普查全組病人，為“醫(yī)患對話”。二級查房：主治醫(yī)師查房，外稱TeachingAttendingRounds，每天一次。輪流檢查所轄各組病人，除醫(yī)患對話，尚需“醫(yī)醫(yī)對話”。三級查房：主任查房，外稱professor’sground或chief’sround，每周二次;每次檢查主治醫(yī)師提供1至2病例;主要突出“醫(yī)醫(yī)對話”。大查房：greatrounds英美普及，除本科室外，其他相關(guān)科室均參加，國內(nèi)稱大型會診討論。01history:missing不全02exam:mistake不正03diagnosis:misdirect不明04treatment:misdeal不當(dāng)解決學(xué)生實際問題4.Functions–糾錯VisitingSurgeon:Haveyounoticedhislightcolorofhisstool?01Intern:Uh,I’msorryIhaven’t.02Missing病史不全Mistakes檢查不規(guī)Director:DrLi,isthereanyralesthatyouheardinthispatient?Intern:Iheardnoralesinthispatient.Director:Pleaselistentoitagain.Canyouhearfinemoistrale?Intern:Yes,Igotit.Director:Whydidn’tyouhearit?Intern:(Noresponse)Director:Youonlypaidattentiontothefrontchestandneglecttheauscultationonbaseoftheback.VisitingPhysician:Isitnecessaryforustodoaliverbiopsy?1Intern:Maybeit’sunnecessary.2VisitingSurgeon:Sorry.Youshouldanswermeit’snecessarybecausetheconfirmeddiagnosisofhepaticlesionoftendependsontheliverbiopsyinadditiontoultrasound.Howeveritwillbedecidedbythedirector.3Misdirect診斷不清Resident:Iassumethatyoublockedtheneurogenicphasewithatropine.Howdidyoublockthehormonalphase?Director:IputdownaLevintube,andthepatientonconstantgastricsuction.Resident:Thiswillkeepthegastriccontentsfromenteringtheduodenumandtheproductionofsecretin,which,inturn,wouldincreasetheliberationofpancreaticenzymes,thusaddingtotheinsult.Misdeal治療不當(dāng)01交班morningmeeting：住院總醫(yī)師；外稱SeniorResident’sMorningReport02引言introduction：主治醫(yī)師；提出重點查房病例，簡述棘手問題03病史報告casepresentation：實習(xí)醫(yī)生，可有無診斷，診治計劃須系統(tǒng)04教學(xué)查房對話teachingdialogue：在上下級醫(yī)生之間進(jìn)行；著重糾錯05小結(jié)summary：主治醫(yī)師對主任查房作應(yīng)答，提出整改措施5.procedures6.figuresPatient病人Interns實習(xí)醫(yī)師Residents住院醫(yī)師Chiefresident住院總醫(yī)師Visitingphysician主治醫(yī)師Director主任EDCBAFRequirementsforplayBasedonNEJMca