Clinical Thinking Ability Research Articles

Application of Microsim medical simulation training system in medical student's clinical thinking training

Objective To evaluate the value and feasibility of Microsim medical simulation training system in medical students' clinical thinking training. Method 96 students of 5-year program of medicine of Grade 2009 and Grade 2010 were the research object. These students were randomly divided into two groups (group A: After 3 weeks' clinical practice in respiratory medicine, taking 1 week Microsim training. group B: Taking 4 weeks clinical practice in respiratory medicine. Each group has 48 students.). The examination and teaching satisfaction of the two groups were observed after the end of the internship. SPSS 17.0 statistical software was used to analyze the collected data (measurement data matching t test, counting data by chi-square test). Results The Microsim system score: group A was (89.37±7.18), group B was (61.95±15.34). The difference between groups was statistically significant. The following scores suggested the assessment of students' ability of clinical thinking: ability to analyze problems [group A (89.95±4.02) vs. group B (75.51±6.34)], the ability to deal with the problem [group A (78.81±8.09) vs. group B (59.67±9.33)], treatment scheme [group A (86.74±6.59) vs. group B (70.39±7.05)] and the treatment effect [group A (88.61±8.16) vs. group B (63.54±11.48)]. In these aspects, the two groups had statistically significant difference, but communication [group A (82.47±5.23) vs. group B (84.09±3.72)] had no statistically significant difference between the two groups. 89.6% (43) of the participants believed that the Microsim medical simulation training system could significantly improve the clinical thinking ability, but only 58.3% (28) of the students believed that the basic theory of knowledge could be consolidated. Conclusion Microsim medical simulation training system can improve the students' ability of clinical thinking and clinical comprehensive treatment ability. It can be used as an effective complement to clinical practice teaching. Key words: Microsim medical simulation training system; Clinical practice; Clinical thinking

The teaching effect of "organ-system-based curriculum" integrated model on clinical graduation field work

Objective To explore the teaching effect of Organ-system-based curriculum integrated model on clinical graduation field work. Method 150 clinical medical undergraduates of Grade 2009 from Shenyang Medical College selected, were randomly divided into the experimental group (75 persons) and the control group (75 persons). The experimental group adopted the means of theOrgan-system-based curriculum integrated model, namely practicing according to human organ-system and the control group accepted the traditional pattern of discipline centered practice during the clinical graduation internship. The two groups of students carried out questionnaire survey and comprehend examinations when the practice ended, and then statistics analysis (the chi square test, t test) was done by the SPSS 19.0 software between the two groups in order to explore the teaching effect. Result The students' satisfaction degree from six aspects of the questionnaire survey showed in the experimental group was significantly higher than that in the control group (the degree of recognition of practicing pattern: χ2=11.437, P=0.003; the architectonic integrality: χ2=9.881, P=0.007; the improvement of the autonomic learning ability χ2=9.643, P=0.008; the teaching method and means: χ2=11.006, P= 0.004; motivating learning interest: χ2=13.550, P=0.001; increasing the ability of clinical thinking: χ2= 13.309, P=0.001), and the average test scores of students from three parts of examination results showed by comprehend examinations (speculative knowledge examination: t=2.768, P=0.006; technical skill examination: t=2.212, P=0.029; clinical capability examination: t=5.015, P=0.000) in the experimental group was obviously higher than that in the control group and the difference was significant. Conclusion Organ-system-based curriculum integrated model on clinical graduation internship is generally approved by the students, which has significantly improved the students' clinical thinking ability, and the quality of graduation internship teaching. Key words: Organ-system-based curriculum; Clinical medicine; Graduation internship; Curriculum integration; Practical effect

Application of heuristic teaching in film-reading session of radiology education for medical students

Objective to probe the potential application and advantages of heuristic method in the film-reading session of Imaging Radiology. Methods 66 eight-year program clinical medical juniors in the grade of 2008 to 2010 in Beijing University were selected as the subject and were evenly divided into two groups. Experimental group (n=33) was taught with heuristic method, in which the teacher ask questions and lead the students to find the way to solve problems in the way of clinical thinking mode. Control group (n=33) was taught with didactic method. The analysis of final examination of radiology course and an anonymous questionnaire survey were carried out at the end of semester, and the questionnaire survey to the students in grade 2008 and 2009 was conducted again after 1 years of their clinical practice. Results The score of students in experimental group were higher than those of control group (P=0.015, 0.001, 0.026 for the students in the grade of 2008, 2009 and 2010 seperately). The two survey shows that the experimental group is better than the control group in the aspects of learning interest, clinical thinking ability, clinical application ability, solving difficult problem ability and language expression ability. Conclusion In the medical imaging practice teaching for clinical medical specialty undergraduate, the reasonable application of heuristic teaching, helps to improve students' learning enthusiasm and initiative, helps to cultivate medical students' ability of clinical application, and at the same time, can also improve teachers' teaching level. Key words: Heuristic method; Radiology education; Medical students

Application of case analysis teaching method with GasMan@ software in anesthesia practice course for clinical undergraduates

Objective To compared the effect of combined teaching method of lecture, case analysis and GasMan@software (LAG) and traditional teaching method (LBL) in inhalation anesthesia practice course. Method 78 anesthesiological undergraduates were randomly assigned to G group (n= 39) or Control group (n=39). According to the requirements of clinical anesthesiology in the syllabus, G group used classroom lectures, case analysis and GasMan@ software (LAG) teaching method, while Control group used lecture based learning (LBL) teaching method. The students took anonymous quiz and filled teaching effect evaluation form after practice course. Then the exam results were compared between groups to evaluate the teaching effect. SPSS 19.0 was applied to do statistical analysis and t test and χ2 test were used. Results Compared to the Control group, G group got better results in objective questions like choosing, judgment, case analysis and average ranks (P=0.000), and there was no significant difference in the identification section (P=0.087), while G group also got better results in subjective questions like learning interests, study efficiency, memorize, logical thoughts, ability of analysis, solving problems and cooperation (P<0.05). Conclusion Compared to traditional teaching method, the combined use of lecture, case analysis and GasMan@ software make students immersive, develop their clinical thinking ability, and improve the teaching effect of inhalation anesthesia practice course significantly. Key words: Inhalation anesthesia clinical practice course; GasMan@ Software; Teaching method; Teaching effect

A comparative study of organ-system based integrated curriculum model and traditional teaching model in medical education

Objective By comparing the organ system based medical integration teaching mode and traditional teaching mode to evaluate the effect of the integration of curriculum implementation. Methods Through a questionnaire survey of 63 students who implement integrated curriculum and 183 students who are not implementing integrated curriculum as well as 76 teachers, we evaluate students' emotional, cognitive and motor skills, using SPSS statistical analysis, chisquare test. Results In the affective domain, most of the teachers thought the experimental class was superior to the common one in learning interest, lifelong learning and independent learning, critical thinking, the contrast of the two classes were P=0.000, P=0.031 and P=0.001 respectively, all of significant difference. In the cognitive domain, the contrast of the two classes in memory, understanding and application were P=0.000, all of significant difference. The experimental class has high degree of recognition. In the psychomotor domain, more than 55.3% (42/76) of the teachers thought that the experimental class was superior to the common class. According to the students' questionnaire survey, the contrast of the two classes in clinical operation skills, Interpersonal communication skills were P=0.077, P=0.031 respectively. There was no statistically significant difference. Conclusions The integrated curriculum teaching model can greatly promote students' abilities in most areas such as interest in learning, lifelong learning awareness, clinical thinking ability; interpersonal communication skills etc. In some respects the differences remains to be further studied such as memory of knowledge, systematic knowledge, and clinical operation skills, etc. Key words: Medical education; Organ-system; Integrated curriculum

Experience of clinical teaching of gynecology of traditional Chinese medicine

Gynecology of traditional Chinese medicine （TCM） is an important part of TCM, is also a subject of highly TCM characteristics and practicality. While clinical teaching plays a very important role in the process of guiding the students to use their knowledge in the clinical practice. According to the characteristics of the clinical teaching of TCM gynecology, the subject explores how to mobilize the enthusiasm of the students and to enable students to grasp the basic knowledge of the subject and improve students＆#39; clinical thinking ability. Key words: Gynecology of TCM; Clinical teaching

Comparison of clinical thinking ability in nursing students of different grades

Abstract Objective This study investigated and compared the clinical thinking ability of undergraduate nursing students of different grades, and searched for influencing factors of clinical thinking ability of nursing undergraduate students. Methods The convenience sampling method was used to select the Subject of the study. In total, 180 third-year, fourth-year, and fifth-year nursing undergraduate students were enrolled in this study. A self-designed scale of clinical thinking ability was used to collect the data. SPSS17.0 was used to analyze the data. Results The average scores of clinical thinking ability of undergraduate nursing students were 68.14 ± 9.13. in addition, 71.1% of the students have a higher level of clinical thinking ability, and only 7.2% of the students have the best level. The ANOVA test showed that the fourth-year students had the highest scores (72.96 ± 8.64), and the third-year students had the lowest scores (62.35 ± 8.09), which indicated a significant difference in the scores of the three groups (F = 26.79, P Conclusion We must pay attention to the changes and influencing factors of clinical thinking ability of nursing undergraduate students. Thus, traditional teaching methods need to evolve and be revised to host the capacity of clinical practice most effectively and, eventually, promote the development of clinical thinking ability of nursing undergraduate students.

Application and evaluation of clinical path in clinical teaching in the department of gynecology and obstetrics

Objective To evaluate the effects of applying clinical pathway （CP） in clinical teaching of gynecology and obstetrics. Methods Totally 200 clinical specialist interns selected for the study were randomly divided into two groups （each 100）, respectively, using CP teaching and tradi-tional teaching. After the internship, professional assessment （clinical skills assessment, theory test, the respondent）were conducted to two groups of students and their professional examination scores were compared, while questionnaires were conducted in the CP teaching group. All date were analyzed by SPSS 17.0 software. Chi-square test was used for enumeration date while t test was used for mea-surement data. Results CP teaching team of professional test results [（80.01 ± 9.34） vs. （72.37 ± 10.79）], the passing rate（96%vs. 87%） were superior to the traditional teaching group（P=0.000 and 0.022）. The questionnaire showed that： applying CP in clinical teaching of obstetrics and gynecology can improve interns’ learning enthusiasm and initiative, improve their comprehensive analysis ability, clinical thinking ability, practical ability and many other capabilities and it got about 90% of interns’ recognition. Conclusions The application of the CP in clinical teaching of obstetrics and gynecology can help enhance the teaching effectiveness, standardize the teaching process, and improve the qual-ity of teachers teaching gynecology and obstetrics. Key words: Clinical pathway; Gynecology and obstetrics; Clinical teaching

Application of PBL combined with evidence-based medicine teaching mode in fever of unknown origin

Objective To investigate the effect of PBL combined with EBM applied in the teaching of fever of unknown origin. Methods PBL combined with EBM teaching was applied in fever of unknown origin course for 30 clinical medicine specialty（eight years） students of Tongji class of grade 2009（experiment group）, while PBL teaching was applied in fever of unknown origin course for 30 clinical medicine specialty （eight years） students of Tongji class of grade 2008 （control group）. After teaching, the theory examination for both basic knowledge and case analysis was organized for all students of both groups. At the same time the questionnaire survey was conducted to 30 students of grade 2009 to evaluate the teaching effect. The results were assessed by using SPSS 18.0 statistical software for the T-test of the experimental group and the control group.Inspection level was α=0.05. Results The theory test score of students in the experimental group was （93.5±3.2） point, signifi-cantly higher than that of the students in the control group（84.7±2.8）. There was statistically signifi-cant difference between the scores of the two groups of students （P=0.00）. Survey results showed 19 students （ 63 . 33%） thought that the development of PBL teaching combined with evidence-based medicine teaching had its necessity, and 16 students（53.33%） thought that the teaching method im-proved their clinical thinking ability of logical reasoning. Conclusion The concept of PBL combined with EBM has achieved significant resultsinthe teaching offever of unknown origin, and it is necessary to carry out this teaching mode in medical colleges with certain teaching strength. Key words: Problem-based learning; Evidence-based medicine; Fever of unknown origin; Teaching reform

Analysis of pediatric interns＆#39; writing defects of medical records and countermeasures

In order to improve the quality of medical record written by pediatric interns, the defects of 535 medical records written by pediatric interns were analyzed. The main reasons affecting the quality of medical record written by pediatric interns were found： writing defects among history of present illness,physical examination and personal history. At present, many factors have caused the deficiencies of medical record writing, such as the factor of low-level teachers, the lag of the teaching management, the particularity of pediatric practice, and students’ lack of training in school. So some countermeasures have been suggested：firstly, importance should be attached to the construction of the teaching staff. Measures should be taken to inspire the teachers to work more actively with a serious and responsible attitude. With a solid clinic and teaching skills, teachers can use a variety of methods properly. The management of teaching should be enforced. A variety of means can be used to improve the interns’ clinical thinking and language expression ability , to establish and improve the medical quality control system of the interns constantly, to make use of pre job training and education reason-ably, to strengthen the intern’s legal ideas, to straight their internship attitude, and to help them to adapt to the pediatric practice environment as soon as possible. At last, measures should be taken to cultivate interns’ interrogation, physical examination and patient communication skills actively and reform the school education to meet the needs of clinical development as well. Key words: Pediatric teaching; Interns; Defects of medical records

A comparative analysis of the clinical thinking ability of medical graduate students

Objective To investigate and compare the clinical thinking ability of medical graduate students of different majors and different grades to explore the influencing factors of clinical thinking ability. Methods 180 graduate students in Medical College of Qingdao University were sur-veyed,including 54 nursing and 126 clinical medicine graduates of different grades. We used a self-designed scale of clinical thinking ability which included three main dimensions （critical thinking abil-ity, systematic thinking ability, evidence-based thinking ability） and twenty-four level 2 items. Ap-plying t test, ANOVA, multiple linear regression analysis for data statistical analysis. Results There’s no significant difference comparing the scores of nursing graduates to the scores of clinical medical graduates（t=-0.80, P〉0.05）. However, there is significant difference in the different grade graduates （F=53.43, P〈0.05）. The multiple linear regression analysis shows that the practice time, reading professional literature quantity, and starting research earlier or later,are signif-icantly related to the clinical thinking ability（P〈0.05）. Conclusion The clinical thinking level of medical graduate students is generally high, and the higher grade, the higher level of clinical think-ing ability. We must strength-en the training of clinical thinking ability of medical graduates. Key words: Medical graduate students; Clinical thinking ability; Comparison research; Influencing factors

Study on the clinical practice teaching of respiratory medicine

After years of respiratory medicine clinical practice teaching , we have discovered that there exist some problems such as teachers’ job burnout, teachers’ lowprofessional knowledge level of clinical teaching and lack of teaching ability, medical students’ fear, low self-esteem, psycho-logi-cal fear and emotional weariness breeding as well as the patients and their family members ’ refusal of practice because of their worrying about being a test and so on. To solve these problems , we have put forward some proposals such as recognizing and rewarding teachers to affirm their teaching levels ,＆amp;nbsp;organizing teachers to participate in academic conferences, seminars, etc. to expand their professional knowledge in order to improve their overall quality. And at the same time, we have adopted PBL teaching method, applied multimedia technology and network platforms, put emphasis on basic skills training, the improvementof departmental rotation assessment, the establishment of teaching files and doctor-patient communication and other ways to improve clinical teaching quality and develop interns’ clinical thinking ability to help them transitto clinicians. Key words: Respiratory medicine; Clinical practice teaching; Teaching reform

Clinical thinking ability cultivation of master degree postgraduates majoring in mental health and psychiatry

Psychiatric professional talents are specially needed in China.Attention should be paid to the cultivation of clinical thinking ability in the process of cultivating professional master degree postgraduate majoring in mental health and psychiatry.Following measures can be taken such as using problem-based leaming(PBL) interactive teaching,organizing symposium,urging students to reviewing the language knowledge and logic knowledge,implementing specialized training to promote students' rigorous logical thinking ability,the ability to get information and interpersonal communication ability,strengthening the clinical practice teaching and paying close attention to the analysis and summary after the failure. Key words: Psychiatry ; Professional master degree postgraduate ; Clinical thinking ; Training measures

Investigation on developing a computerized imitating system of pediatric clinical patients

The computerized imitating system constructed by the Second Affiliated Hospital of Guangzhou Medical University contains four blocks:administration of student infomation,administration of question bank,on-line tests and administration of score inquiry.It's designed to imitate typical pediatric cases,so that the medical students may put themselves into the practical clinical scenario and solve the challenges step by step in one-direction procedure.Teaching with computerized clinical scenario imitating patients can improve students' test resuhs and activate students' learning enthusiasm significantly.It not only helps to solve the contradiction between increasing number of medical students and clinical typical teaching case shortage but also improves the clinical thinking ability of the medical students.This system can also be used as a test bank for pediatric technical skills examination. Key words: Computer simulated patients; Pediatrics; Situation simulating teaching

Application of problem-based learning in clinical anesthesiology demonstration for clinical un-dergraduates

Objective To explore the effect of applying problem-based learning（PBL）in clin-ical anesthesiology demonstration for clinical undergraduates. Methods Eighty-nine 2009 clinical undergraduates were divided into two groups：experimental group and control group. Students in ex-perimental group received PBL while those in control group received traditional teaching. The effect was evaluated according to the results of case examination and investigation table. The results were analyzed by X2 test. Results Most students （42/45） answered questions correctly in experimental group while only 30 of 44 students（30/44）did in control group（P〈0.05）. Concerning the results of investigation,PBL had more advantages than traditional teaching method in the following 5 aspects：self-studying ability（86.7%,39/45）,clinical thinking ability（73.3%,33/45）,information seeking ability （75.6%,34/45）,expressing ability （82.2%,37/45）,communicating between students （75.6%, 34/45）（P〈0.05）. Conclusions PBL has evident advantages in anesthesiology clinical demonstration. It can inspire students,cultivate abilities,enhance critical thinking and finally improve teaching effect. Key words: Problem-based learning; Clinical demonstration ; Anesthesiology

Standardized training for resident doctors in China.

Medical graduates are not fully trained physicians when they leave medical school. Currently, standardized training for resident doctors in most hospitals in China is carried out according to the Ministry of Health guidelines. However, these guidelines provide only outline guidance, and specific resident training is managed independently by and varies with individual institutions. Therefore, it is important to study training demand to learn about the content and emphasis of training. Goad established a gap analysis model of training demand, and the “gap” between “realistic condition” and “ideal condition” was set as the starting point of research[1]. In this model, the “ideal condition” is determined according to the organizational characteristics and industrial development conditions. However, there will be gaps between the “ideal condition” and “realistic condition”, including gaps in knowledge, study, attitude and skills. The gaps, according to Goad, will generate training demand and any training activity should aim at eliminating or narrowing such gap. Using this model, we surveyed 137 resident doctors and 53 department directors at a tertiary care hospital in Qingdao, China. We found that while resident doctors and department chairs share certain priorities in residency training such as “professional dedication and sense of responsibility,” “team work” and “basic clinical skills”, they differ on other priorities such as “clinical thinking ability”, “communication skills with patients and their families”, and “scientific research ability” (Table 1). Both residents and directors gave high scores (> 4.5) on the ideal condition status values of 11 main training programs, indicating that the residents and directors attach great importance to them. Our survey shows that both resident doctors and department directors consider that they should reinforce training of basic clinical skills and safeguarding their own legal rights with medical law knowledge. However, they have different opinions on the importance and demand in respect of clinical thinking ability, scientific research ability and communication skills with patients and their families. Clinical thinking is a core clinical ability and determines the diagnosis and treatment level of a doctor[2]. As resident doctors are still in the stage of professional training, they differ in perspective from their department directors who see cultivating the basic clinical skills of residents as the key to laying a good foundation for resident training. Scientific research capability also requires cultivation, but it is not on the priority list of department chairs. However, with the pressure of seeking jobs, professional advancement and evaluation for physician performance[3], resident doctors may feel an urgent need for scientific research achievements to give them advantages in their career. In addition, residents rank effective communicating with patients lower in priority while department directors consider it conducive to resolving conflict between doctors and patients. Table 1. Demand analysis of resident training Gap analysis effectively defines training demand and identifies priorities of residents and department chairs. It is important for residents and department directors to align their priorities so that resources are better utilized to meet the needs of resident doctors and provide effective training to resident doctors. As clinical skill is the most basic skill for a resident doctor, it should always be the top priority of training[4]. Currently, hospitals in China are averse to practices that might cause medical disputes[5] and are reluctant to allow residents to perform certain procedures, thus decreasing the opportunity of clinical training for young doctors. To gain clinical competency, resident doctors are recommended to actively participate in clinical practice under the supervision and guidance of clinical teachers, and hospitals should build operative skills training centers to facilitate training of resident doctors. Moreover, humanistic curriculums only account for no more than 8% of the total curriculum in medical education in China[6]. Doctors with good humanistic quality are more skillful in communicating with patients and their family, which helps build better doctor-patient relationship. Hospitals may include contents of humanistic care in their resident training.

Application of scene teaching method in the teaching of physical diagnostics

Objective To explore the teaching effect of scene teaching in physical diagnostics.Methods Totally 104 clinical medicine majors of five-year program were randomly divided into two groups:experimental group (n =53) and control group (n =51).Students in experimental group were taught by scene teaching while those in control group by traditional teaching method.Teaching qualities were evaluated by final exam and questionnaire.Data of final exam were presented as mean ±SD and were calculated using student's t-test.Otherwise,statistical differences of questionnaire were calculated by Chi-square test.P ＜ 0.05 was considered statistically significant.Results Average final exam score of experimental group (80.378 ± 4.239) was better than that of control group (77.529± 4.743),with significant differences between two groups (t =3.231,P =0.002).Implementation of scene teaching method improved students self-learning ability and clinical thinking ability by 84.90％and 81.13％ respectively.Conclusions Scene teaching in physical diagnostics is superior to traditional teaching and can improve abilities of students in analyzing and solving problems. Key words: Scene teaching; Traditional teaching; Physical diagnostics

Application of SimMan patient simulator in teaching of internal medicine clinical skill for undergraduates majored in clinical medicine

In this study,the common critical medical cases were organically combined with SimMan simulation system,which enabled students to deeply understand the diagnosis,treatment of disease and clinical operation as consulting real patients.Also,it could improve their clinical thinking ability,clinical skills and operational level. Key words: Clinical medicine major; Internal medicine clinical skills; SimMan universal patient simulator

Qualitative research on the evaluation approach of clinical thinking of nursing staff

Objective To provide insights into the evaluation index and evaluation methods of clinical thinking of nursing staff. Methods 14 nursing experts in Heilongjiang province were interviewed by a half- structured in-depth outline with 8 questions. Themes were obtained by phenomenological data analysis method, including coding, classification, explanation of phenomena and significance, refining essence and elements. Results Two themes of evaluation approach of clinical thinking of nursing staff was obtained： evaluation index and evaluation method. Basic theoretical knowledge, basic practical skills, strain capacity, communication ability, originality of thinking and critical thinking are subthemes of the evaluation index. The best way of evaluating methods is combining multiple evaluations. Conclusions Cultivation of clinical thinking of nursing staff requires efforts from schools and hospitals to establish a scientific, rigorous evaluation approach. Key words: Nursing staff; Clinical thinking ability; Evaluation approaches; Qualitative research

Introducing positive psychology into resident standardized training

Positive psychology focuses on enhancing individual positive emotion and promoting the development of individual positive personality.Introducing positive psychology into the first stage of internal medical resident standardized training will improve the resident ability to solve clinical problems.It's helpful for resident doctors to improve their clinical thinking ability,doctor education innovation ability and lifelong self-education ability.It inspires their creative thinking by motivating their positive emotions It would help them to avoid occupational tiredness.Using the idea of positive psychology could improve the comprehensive quality of residents. Key words: Positive psychology; Resident; Standardized training.