口腔医学生临床见习钱技能培养

1、口腔医学生实习前临床实践能力培养新模式的设想【关键词】口腔医学生 实习临床实践新模式口腔医学是一门实践性、综合性、交叉性很强的临床医学学科，应注重学生动手能力、交流能力和社区工作能力等临床实践能力的训练，所以临床技能和综合能力的培养在口腔医学教学的过程中占有极其重要的地位。在新形势下的口腔医学临床教学与过去的教学有很大不同，过去学生口腔临床实践能力的培养，在临床操作技能上主要是通过教师指导学生在病人身上完成的。但随着中华人民共和国执业医师法和医疗事故处理条例的相继出台，由于医学生未获得合法的医师资格，临床实践中在病人身上进行临床技术操作是不合法的1。这就限制了口腔临床医学专业学生的临床技能操作

2、，影响了学生临床实践能力的培养。全国口腔医学教育研讨会提出，五年制口腔医学教育仍是我国较长时间内培养口腔医师的主体2。为了让我们的学生成为患者信赖的口腔医师，完成对口腔医学专业学生创新性实用型人才的培养目标，我们对口腔医学生的培养模式提出以下设想：1 整合口腔临床医学课程群目前对本科口腔医学生讲授的口腔临床医学课程，其中牙体牙髓病学、牙周病学、预防口腔医学、口腔颌面外科学、口腔修复学、口腔临床药物学及口腔正畸学等的理论课及实验课的部分内容有重复，有些实验学时不够学生不能按时完成实验。为了充分利用有限的授课学时，节约教学成本，我们设想整合口腔临床医学课程群，合理安排每门课程的讲授内容和实验内容，

3、使各门课程相互联系、交叉融合、相互补充，避免教学内容的重复以及遗漏，合理利用有限的教学时间提高学生的临床操作技能。2 充分拓展仿真头模在实验技能操作中的作用目前，我们的仿真头模系统主要用于牙体牙髓病学、口腔修复学和口腔颌面外科学的实验课教学。为了配合临床口腔医学课程群的实施和培养学生的动手能力，设想充分拓展仿真头模系统的使用，让学生在仿真头模上进行牙体牙髓、牙周、口腔修复、口腔颌面外科、口腔正畸等各种口腔临床医学技能的训练，模拟病人口腔环境进行规范的操作，让学生通过练习各种口腔诊疗器械的正确握持和使用、就诊时医患体位等，熟练掌握牙体预备充填、根管治疗、洁治术、印模制取、拔牙术、矫治器制作等操作

4、的方法步骤和注意事项，使实验课操作更贴近于临床，增强学生的感性认识和理解力，树立学生的自信心，避免进入临床实习后出现恐惧心理和束手无策的窘境。3 实行实验室开放设想课余时间学生在教师的指导下到实验室学习和研究。实验室开放的目的主要是开展大学生科研课题，让学生参加教师的科研项目，学生进行口腔基本操作技能练习等，在实践中锻练和提高学生的学习、研究和动手能力。4 组织口腔医学生参加社会实践活动为了培养学生的实际工作能力，让学生早期接触临床，设想学生三年级进入口腔临床课程后，动员和组织学生利用假期和周末轮流到口腔门诊学习，安排他们预诊、协助拍X线片、做牙医助手、练习书写病历等。让他们早期接触患者，熟悉

5、医院工作环境。医学生早期临床实践不仅可以增强对医学专业学习的兴趣和积极性，而且拓宽了知识面，利于学生增加感性知识，提高临床理论教学的效果，对未来的临床工作起着重要作用。并利用“920爱牙日”、“科普宣传周”等活动积极开展口腔健康教育和健康促进活动，组织学生深入社区、企业、学校、敬老院进行口腔健康检查、预防保健知识宣传与咨询等社会实践活动。5 构建口腔医学生实习前模拟临床诊疗全过程教学新模式临床实习的目的是为了提高学生的临床实践能力。临床实践能力是人们根据医学发展不同时期的人才培养目标而定义的，它主要包括三个方面的内容：(1)临床操作能力，即对临床技能的应用，包括病历文件的书写、手术及各类临床操

6、作等，可以通过不断练习来提高熟练程度和操作水平。(2)临床思维能力，主要依靠人的大脑通过观察、思维、实践运筹等来完成，是实践能力的深层表象。(3)人文关爱及沟通技巧。因为医疗的对象是有生命的人体，所以医生必须善于沟通，赢得病人及家属的信任和支持。上述能力都必须通过临床实践获得，三者之间既有区别，又有必然的内在联系。同样的内容，由于临床思维以及医患关系等不同，可以在对病例的分析速度、结论的准确性以及预后的判断方面有截然不同的结果。因此，培养学生临床实践能力要从这三方面入手，更应注重加强医学生临床思维能力的培养3。因此，我们在学生完成了口腔临床课程理论及实验室技能操作学习后，对学生进行实习前模拟临

7、床诊疗全过程训练。具体设想如下：5.1 临床实习前教育设想安排教师为学生进行8学时的专题讲座，主要包括医德医风教育；常见医疗法律法规及医院规章制度；医患沟通交流的技巧；口腔专业医疗纠纷的特点及防范；口腔各专业学科的专业特点；无菌观念及无菌操作。让学生充分意识到自己即将充当的角色，并对医疗环境、医疗仪器设备、口腔医学专业的临床特点等有进一步的了解和认识，做好进入临床实习前的充分准备。5.2 利用角色扮演进行口腔医学生临床实习前训练设想需要12学时，先由教师进行演示。其方法是：教师扮演医生，抽取1名学生扮演患者，扮演为患者的学生在扮演前可指定为一个具体的疾病，允许其针对该疾病阅读教科书1015mi

8、n，以使其把该病种的症状和体征尽可能多地套在其身上。然后扮演为“医生”的教师对患者扮演者进行现病史、既往史、个人史和家族史询问4。病史采集结束后，进行全身及口腔局部检查，写出病历摘要、诊断及治疗方案。示范结束后，把学生分成每2人一组，其中一个学生扮演患者，另一学生则扮演医生，进行指定某一疾病医生和患者的角色扮演，并写出病历摘要、诊断及治疗方案。该训练的目的是让学生熟悉询问病史的技巧、口腔检查的方法及病历书写的规范要求。5.3 进行综合病历分析综合病历分析是为了培养学生的综合能力，设想需要12学时。组织具有副教授以上职称的教师编写80100道病例分析试题及病例分析标准答案，试题包括所有口腔临床课

9、程的常见疾病、多发病。让学生分成两组，一组学生分析病例，另一组学生根据标准答案给分析病例的学生打分，并纠正其诊断和治疗方案错误。该项训练的目的是培训学生对口腔常见病、多发病的诊治水平，了解口腔专业疑难病例的处理，提高学生的逻辑思维能力、分析解决问题的能力。5.4 结合仿真头模系统模拟口腔临床治疗全过程口腔临床治疗步骤多，方法复杂、疗程长，需要多次复诊。根据口腔临床医学诊治的特点，为提高学生的临床实践技能，在学生完成了病历书写、诊断及治疗方案设计后，我们将对学生进行综合临床技能训练。设想需要36学时，如学生的治疗方案正确，我们就让学生在准备好的仿真头模上进行首次治疗(动手能力培养)，治疗完成后让

10、学生在病历上写出治疗过程、医嘱及复诊时间，并向患者交待注意事项(综合、交流能力培养)。依次进行第二、三次治疗及病历书写、医嘱等直至整个治疗过程完成。如前牙急性根尖周炎的治疗方案是根管治疗。首次治疗应是应急处理，方法为在局麻下开髓，用拔髓针进行牙髓拔除，置药捻于根管，开放二日(动手能力培养)，写病历、嘱患者注意事项及两日复诊(综合、交流能力培养)；第二次复诊检查第一次的治疗效果，如疗效好行第二次治疗，即根管预备，方法为确定根管数、16号扩大针、扩大锉逐号扩大根管、测根管长度、用棉花针置药捻于根管、封闭开髓孔，写病历、嘱患者注意事项及1周复诊；第三次复诊检查第二次的治疗效果，如疗效好行第三次治疗，

11、即根管充填术，手工或用机器将根管封闭剂及牙胶尖充填于根管，拍X线片如根管充填满就可完成根管治疗，写病历、嘱患者注意事项，整个治疗过程完成。该综合临床技能训练涉及牙体牙髓病、牙周病、预防口腔医学、儿童口腔医学、修复学、颌面外科学、正畸学等。通过临床知识的强化训练及在仿真头模上的技能操作，让学生能加强记忆，熟悉各专业的临床工作流程，掌握临床规范操作、严格无菌观念，尽快适应从临床前期进入临床实习期的各项工作，避免进入临床实习后因对操作程序不熟悉而引起不必要的纠纷，从而克服了学生的胆怯心理，树立学生的自信心，达到良好的临床实践能力培训效果。总之，培养和提高口腔医学生的临床实践能力，是口腔医学教育的一个

12、永恒主题。口腔医学生实习前临床技能和综合能力培养新模式的设想对培养适应社会主义现代化建设需要的创新性实用型人才具有重要意义。Oral medical students clinical practice ability before practice the idea of a new modelPapers Category:Medicine Papers-Clinical Medicine PapersPost Time:2011-3-20 16:29:00Of: Lacquer Ming, Liu Ying, Niu Wen-Hui, He QinKeywords:oral medica

13、l students practice a new model of clinical practiceDentistry is a practical, comprehensive, highly cross clinical disciplines, students should focus on ability, communication skills and community capacity to work in clinical practice such as training, so the clinical skills and overall ability in o

14、ral medicine the process of teaching an extremely important position. in the new situation and the clinical teaching of oral teaching is very different from the past, the past students oral ability in clinical practice, mainly on the clinical skills of teachers to guide students through the patient

15、upon completion. but with the and have been introduced, the medical students did not obtain legal qualification, clinical practice clinical skills in the operation patients were is illegal 1. This limits the clinical dental students clinical skills to operate, affecting the ability of students to cl

16、inical practice.National Medical Education Seminar, oral, oral medical education is still the five-year long period of time training our dentists subject 2. In order for our students to become trusted dentists of patients, complete oral innovative medical students practical training objectives, we d

17、evelop patterns of oral medical students to make the following assumptions:Integrated Medical Curriculum Group 1 oralCurrently teaching of undergraduate medical students oral oral clinical courses, dental endodontics, periodontics, preventive dentistry, oral and maxillofacial surgery, prosthodontics

18、, oral and clinical pharmacology and other orthodontics The theory course and part of the experiment course overlap, there are some time hours is not enough students are unable to complete the experiment. In order to take full advantage of the limited hours of instruction, teaching cost savings, we

19、assume that integration of oral clinical course group, reasonable arrangements for each course taught content and test content, interrelated to each course, cross fusion, mutual complementarity and avoid duplication and omission of teaching content, rational use of limited teaching time to improve t

20、he clinical skills of students.2 fully expanded header mode operation in the role of experimental skillsAt present, our first model system is mainly used for simulation of dental endodontics, prosthodontics and oral and maxillofacial surgery teaching experiment. In order to meet the Clinical Dentist

21、ry course group and foster the implementation of the abilities of students, it is envisaged to fully the first model system to expand the use of simulation, the first model in the simulation students on the dental, periodontal, dental, oral and maxillofacial surgery, orthodontics and other dental cl

22、inical skills training, simulated oral environment of patients regulate the operation of dental students by practicing a variety of medical instruments and use the correct grip, posture and other treatment when the patient, master tooth preparation filling, root canal therapy, scaling technique, imp

23、ression extraction, tooth extraction , appliance production and other operations of the method steps and precautions, operations closer to the experimental clinical course, enhance their perceptions and understanding, build their confidence, to avoid entering clinical practice after the fear and hel

24、pless predicament.3 the implementation of laboratory openingSpare time envisaged under the guidance of teachers, students to study and research laboratory. The purpose of opening laboratory research projects are mainly college students, teachers, students participate in research projects, students p

25、ractice basic skills such as oral, in practice, exercise and improve student learning, research and practical ability.4 Organization of oral medical students participate in social practiceTo develop students practical skills for students early exposure to clinical, third-year students into the idea

26、of the clinical course of oral, to mobilize and organize students to turn to holidays and weekends Dental Clinic study, arrange for them to pre-diagnosis to help take X-ray film, to do dental assistant, medical records and other written exercises. Let their early contact with patients, familiar with

27、 the hospital environment. medical students of early clinical practice can enhance the medical profession not only the interest and enthusiasm for learning, and broaden their knowledge, help students to increase the perceptual knowledge to improve clinical the effect of theoretical teaching, clinica

28、l work in the future play an important role. and the use of 920 Love Teeth Day, Popular Science Awareness Week and other activists to carry out oral health education and health promotion activities, organize the students into the community, businesses, schools, nursing home oral health examination,

29、knowledge of preventive health care and other social advocacy and consulting practice.5 medical students practice oral constructed simulated clinical treatment before a new model the whole process of teachingThe purpose of clinical practice is to improve the ability of students to clinical practice.

30、 Clinical competence is the development of people in different periods of the medical personnel training objectives definition, which mainly includes three aspects: (1) clinical operational capability, that is, clinical the application of skills, including written medical documentation, such as surg

31、ery and various types of clinical operations, through constant training to improve proficiency and operational level. (2) clinical thinking, mainly rely on the human brain by observing, thinking, practice and other logistics to complete, is the practical ability of the deep representation. (3) human

32、 love and communication skills. because the object is a health care living human body, so doctors must be good communication, patients and their families to win the trust and support. the capacity must be through clinical practice to obtain, both among different, there are bound to the inner contact

33、. the same content, because of clinical thinking and the different doctor-patient relationship can be analyzed in the case of speed, accuracy and conclusions have prognosis different results. Therefore, the ability of students to clinical practice from these three aspects, we should focus on strengt

34、hening the Clinical thinking ability 3. Therefore, we completed a dental student clinical skills curriculum theory and laboratory operations After learning of the students practice the whole process of clinical diagnosis and treatment before the simulation training. specific ideas as follows:5.1 The

35、 former Education and Clinical PracticeScenario for the teacher to students 8 hours of lectures, including medical ethics education, common medical and hospital rules and regulations of laws and regulations, physician-patient communication skills, oral professional characteristics and prevention of

36、medical disputes, oral various professional disciplines characteristics, the concept of sterile and aseptic technique. so that students will act as fully aware of their role, and the medical environment, medical equipment, oral clinical characteristics of the medical profession have a better underst

37、anding and awareness of good clinical practice before entering fully prepared.Links to free paper download 5.2 for oral use of role-playing before the training of medical students clinical practiceVision requires 12 hours, first teacher demonstration. The methods were: Teachers play a doctor, patien

38、ts taking a student to play and play for the students to play before the patient can be specified for a specific disease, allowing it to read the textbook for the disease, 10 15min, to make the kinds of signs and symptoms of the disease as much as possible to set in his possession. and then play the

39、 doctor of the teachers were present in patients with a history of actor, past history, personal history and family history of inquiry 4 . after the end of history taking, the local body and oral examination, written medical record review, diagnosis and treatment. demonstrations after the end of eac

40、h of the students were divided into 2 groups of patients in which a student play, and the other students to play doctor to specify a disease to play the role of doctors and patients, and write a summary of medical records, diagnosis and treatment. The purpose of the training is to familiarize studen

41、ts with history taking skills, oral examination of the methods and medical records of the specification.5.3 Analysis of a comprehensive medical historyComprehensive medical history in order to develop their comprehensive ability, vision requires 12 hours. Organization of professors and associate pro

42、fessors with 80 to 100 teachers in the preparation of case analysis and case analysis of the standard answer questions, oral questions, including all the clinical course of common diseases, occurring disease. students were divided into two groups, one group of students to analyze cases, the answer t

43、o another group of students to analyze cases according to the standard rate of students, and to correct errors in the diagnosis and treatment. The purpose of the training is to train students to common diseases of oral, multi- diagnosis and treatment of disease, difficult cases of oral treatment pro

44、fessionals to improve their logical thinking ability, analytical problem-solving abilities.5.4 The simulation model combined with simulation of oral head and the whole process of clinical treatmentClinical treatment of oral procedures and more complex method, treatment, and require multiple referral

45、. According to clinical diagnosis and treatment of oral characteristics of clinical practice to improve student skills in students to complete the medical records, diagnosis and treatment program design, we will Clinical skills training of students. envisaged need 36 hours, such as the correct treat

46、ment of students, we let the students prepared for the first time on the simulation of the first treatment mode (hands-on capacity-building), the treatment is completed to enable students to write in the medical records a course of treatment, doctors advice and referral time, confessed to the patien

47、ts notes (Integrated, communication skills training). in order for the second and third treatment and medical records, doctors advice, etc. until the entire treatment process is complete. If anterior acute periapical treatment is root canal treatment. The first emergency treatment should be the meth

48、od for the open marrow under local anesthesia, needle with pull cord pulp removal, home medicine twist in the root canal, open on the 2nd (hands-on capacity-building), written medical records, notes and two days Zhu Huanzhe return visit (comprehensive, communication skills training), the second referral checks for the first time the therapeutic effect, such as second-line treatment is effective, that root canal preparation, methods for determining the number of root canal 1 to 6, reamer, expanding file expanding number by root canal, root canal length measurement, home drug ne