2017五年制医学英语-上届0616.4专外课学

ClinicalMedicalEnglishBiLiQi（毕黎琦）RheumatologyDept.ofChina-JapanUnionHospitalofJilinUniversityEmail:.cnLinBaiSong（林柏松）心外科LiuBo（刘波）CourseProblemsTeachingaimTextbookTeachersTeachinghoursExaminationCourseProblemsTeachingaimTextbookTeachersTeachinghoursExaminationProblems医学专业英语的独特性：词汇量大、来源复杂、构词讲究。教学现状：教材内容：科普文章、系统性及实用性差，缺少临床实用内容。教学方法：简单翻译学与用：学生的英语学习与实际应用脱节。仅停留在应付考试上。研究生教学：没有与其所学专业相匹配的专业英语教材。学生应用英语的能力亟待提高：英文简历，药品英文说明书临床英语查房（疾病的英文名称、对患者病史做简单介绍）指导留学生临床实习，留学生全英文授课，医疗翻译写毕业论文英文摘要发表英文期刊论文（SCI收录论文）深入学术交流和讨论（国际会议发言、提问、交谈、讨论）外籍医学专家学术报告口译，同声传译。Problems标准的医学英语表达留学人员最困惑的是难以寻找到标准的医学表达术语，意思表达清楚了，另类，不地道。举例：患者有服用万古霉素出现皮疹这样的过敏史A：“Thepatienthadarashaftershetookycin.”B：“Thepatienthasdevelopedarashwithycininthepast.”患者状况良好出院A：“Patientisfineandgohome.”B：“Patientisbeingdischargedhomeinstablecondition.”患者有手术治疗的愿望A：“Thepatientwantsthesurgery.”B：“Thepatientdesiresthesurgery.”“经期正常，28～30天一次”A：menstruationisnormal,28to30dayspertime.B：Havenormalperiods(ofmenstruation)at28～30-dayintervals.Problems举例：A学生：“Thispatientsufferfrommyoma.Wewanttodothesurgeryforher”.B学生：“Ms.Robisonisa23-year-oldfemalewithahistoryofmalignantgermcelltumoroftherightovaryinJanuaryof2015,metastasistoasinglelymphnodewithpositiveascites,statusatchemotherapywithBEP.”

腹部检查的描述：

“abdomensoft,notendertopalpation,nomassespresent,tonenormalwithoutrigidityorguarding,normalbowelsounds.“医学英语教学面临的最大挑战是：如何使临床英语教学步入规范和实用性的轨道。CourseProblemsTeachingaimTextbookTeachersTeachinghoursExamination教育部《大学英语课程教学要求》

一般要求

较高要求

更高要求听力理解能力

Listening

授课、日常谈话、讲座，语速慢的广播。谈话、讲座、广播电视，每分150~180词。广播电视、正常语速谈话、专业课、讲座。口语表达能力Speaking

交流、讨论，简短发言。流利会话，表达意见、观点等。对话讨论，概括文本或讲话，国际会发言讨论。阅读理解能力Reading

一般题材文章，每分70词，快速阅读每分100词。报刊杂志，每分70~90词，快速每分120词。专业综述。有难度文章，国外报刊杂志，专业文献资料。书面表达能力Writing

一般性写作，常见应用文。专业论文摘要、小论文、描述图表，半小时写160词短文。专业简短报告和论文，半小时200词说明文或议论文。翻译能力Translating

熟悉的文章进行英汉互译，英译汉每小时300词，汉译英每小时250汉字。专业文献，大众报刊上熟悉文章，英汉每小时350词，汉英每小时300汉字。专业文献和报刊，国情或文化文章。英汉每小时400词，汉英每小时350汉字推荐词汇量words

掌握4795词和700词组，其中2000积极词掌握6395词和1200词组，其中2200积极词掌握7675词和1870词组，其中2360积极词汇。Teachingaim临床专业英语

Requirements阅读：医学专业论文(实验研究、临床研究、病例报告)

其他（临床病历、药品说明书等）写作：论文的英文摘要、英文病历、英文简历口语表达：问病史常用规范语言

词汇：医学英语构词法

语法：结合课文，医学科技文体特点

技巧：阅读和写作技巧CourseProblemsTeachingaimTextbookTeachersMethodsTeachinghoursExaminationTextbook教材：《Physicaldiagnosis》6thedition

不同阶段使用不同的教材，本科阶段最佳选择：《诊断学》英文原版教材学习正规的临床术语和用法：美国医学院校教材，由美国执业医师完成的临床病例资料（病史、体征、诊断、治疗的全部信息）。以英语国家医学院校的标准教材为蓝本，根据教学需要选择内容。如患者的病史、症状和体征的描述、查体方法，疾病名称术语。使学生学到具有实用价值的、可以用于交流的英语。需要的是实用的专业英语，而不是考卷上的答案。CourseProblemsTeachingaimTextbookTeachersTeachinghoursExaminationTeachers

医学专业英语教师缺乏。医学专业教师一般难以胜任英语教学

而英语教师不懂医学知识。学校聘用的外籍教学人员无医学教育背景。有些教师没有英语口语教学能力-“哑巴”英语。国际交流日益广泛，学习模式落后于时代要求，影响学习质量和专业水平的国际化。CourseProblemsTeachingaimTextbookTeachersTeachinghoursExaminationTeachinghours40hours20lectures2016.3.18-2016.5.20ExaminationTakinghistoryPhysicalexaminationTranslationwordsTeachinghours

Examination“临床场景”不仅仅是一个患者躺在病床上；而应是描绘这样一幅画面：病人身边围绕着家人、同事、亲戚、朋友，他也被快乐、悲伤、希望和担忧包围着。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经常,sometimes有时候,alittle有一点,fair还可以,reasonablywell基本可以,somewhat偶尔,rarely很少,average平均.“whatdoes‘sometimes’mean?”or“Howoftenis‘often?’”TheclosingArethereanyquestionsyoumightliketoask?Youhavebeenveryhelpful.Iwouldnowliketotakeafewnotes.Iamamedicalstudent.Ithinkitwouldbebesttoaskyourdoctorthatquestion.BasicInterviewingTechniquesQuestioning

Questionsthatstimulatethepatienttotalkfreelyarepreferred.Open-endedquestions（开放性问题）：

Whatkindofmedicalproblemareyouhaving?Howhasyourhealthbeen?Areyouhavingstomachpain?Tellmeaboutit.Tellmeaboutyourheadache.Howwasyourhealthbeforeyourheartattack?Canyoudescribeyourfeelingswhenyougetthepain?I’mcuriousabout……BasicInterviewingTechniquesDirectQuestions（封闭性问题）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‘alot’?’’‘‘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?临床医学英语教学查房常用词Firstvisit初诊
Toattendtheclinic复诊
Out-call出诊
Casehistory病历
Sheet-for-casehistory病历袋
Turnoverofbeds病床周转率
Averageofhospitalstay平均住院日数
Wardround查房
Consultation会诊
Medicalcertification诊断书
Certificationforleaveofabsence病假证明
Applicationforlaboratoryexamination化验申请单
ApplicationforX-rayexaminationX光申请单
Requisitionfordrugs领药单
caserecord病历医院工作人员directorofthehospital院长
headofthenursingdepartment护理部主任
attendingdoctor主治医师
residentdoctor住院医师interndoctor实习