Internal Medicine Teaching Research Articles

Multimodal Intervention Assessing the Appropriateness of Acid Suppression Therapy is Associated With Reduced Prescriptions at the Time of Discharge for Hospitalized Inpatients.

Acid suppression therapy (AST), including proton pump inhibitors and histamine 2 receptor antagonists, are an overused class of medications. When used inappropriately, AST leads to polypharmacy, increased healthcare costs, and possible negative health consequences. To assess whether an intervention including prescriber education combined with a pharmacist-driven protocol was effective in reducing the percentage of patients who were discharged with inappropriate AST. This was a prospective pre-post study of adult patients who were prescribed AST before or during their admission to an internal medicine teaching service. All internal medicine resident physicians received education on appropriate AST prescribing. During the 4-week intervention period, dedicated pharmacists assessed the appropriateness of AST and made recommendations regarding deprescribing if no appropriate indication was identified. During the study period, there were 14 166 admissions during which patients were prescribed AST. Out of the 1143 admissions during the intervention period, appropriateness of AST was assessed by a pharmacist for 163 patients. AST was determined to be inappropriate for 52.8% (n = 86) of patients and discontinuation or de-escalate of therapy occurred in 79.1% (n = 68) of these cases. The percentage of patients discharged on AST decreased from 42.5% before the intervention to 39.9% after the intervention (P = .007). This study suggests that a multimodal deprescribing intervention reduced prescriptions for AST without an appropriate indication at the time of discharge. To increase the efficiency of the pharmacist assessment several workflow improvements were identified. Further study is necessary to understand the long-term outcomes of this intervention.

The impact of the COVID-19 pandemic on internal medicine clerkship by comparing exam results and feedback

ABSTRACT COVID-19 pandemic affected the world in many ways. Internal medicine education needed to be shaped according to the requirements of this pandemic. The aim of this study is to understand the effect of COVID-19 pandemic on internal medicine education and evaluate the newly introduced methods for education. Fourth-year medical students of 2019–2020 and 2020–2021 academic terms are evaluated in this study. Exam results and feedback scores of students are obtained. Assessment methods in pre-pandemic group are face-to-face written exam and OSCE exam, whereas in post-pandemic group, online written exam and OSCE exam are used. Feedback forms are the same in both groups. The median written exam score was higher in the post-pandemic group than in the pre-pandemic group (84 vs 80, respectively, p = 0.003). There is no statistical significance among OSCE exam grades of the two groups. Feedback scores for bedsides were slightly higher in the post-pandemic group, and there is no statistical significance. Written and OSCE exam results in the post-pandemic group were as good as in the pre-pandemic group. We realized that the learning objectives in classical lecture can also be achieved from video recordings. Although not statistically proven, we claim that increasing the time spent in clinical practice will yield more experience to the students.

Application of Multiple Teaching Method in the Teaching of Cardiovascular and cerebrovascular Medicine in Universities

In the process of the rapid development of clinical medicine, the education and training of students also need to adopt more diversified methods based on the actual clinical needs, to provide a certain degree of support for students' theoretical knowledge learning, professional practical ability improvement, and the cultivation of clinical thinking. There is no denying that at the present stage for the requirements of students 'clinical thinking ability is in improving, in addition to the conventional teaching method is to cultivate students' thinking, so in the process of cardiovascular and cerebrovascular internal medicine teaching, its essence needs to pay special attention to cultivate students' thinking ability, based on this, more to correctly realize the common problems and further adopt multiple teaching method for related teaching effect optimization.

Exploration on the Cultivation of Clinical Thinking in the Teaching of Internal Medicine

Exploration on the Cultivation of Clinical Thinking in the Teaching of Internal Medicine

A new dawn in internal medicine education curriculum—a project by the residents, with the residents, for the residents

The academic half-day (AHD) curriculum is an alternative to the noon conference (NC) approach. To date, there is little literature evaluating the transition from NC to AHD in internal medicine residency programs. We investigated the effectiveness of AHD by comparing in-training exam (ITE) and American Board of Internal Medicine (ABIM) certifying exam scores of residents before and after implementation of AHD. In 2019, we transitioned to the AHD curriculum. Averages of three consecutive years of NC (2016–2018) and AHD (2019–2021) were used for statistical testing to determine ITE and ABIM score changes. The class of 2018 experienced both approaches. Cohen’s d effect sizes were calculated to assess the magnitude of change in ITE and ABIM scores between NC (2016–2018) and AHD (2019–2021) cohorts. Residents’ performance significantly improved (P < 0.05) on ABIM scores (513.80 ± 48.34) on average from 2019 to 2021 compared to ABIM scores (452.42 ± 49.72) on average from 2016 to 2018 with a large effect size of 1.27. Similarly, a significant (P = 0.005) improvement in ITE scores was observed from 2019 to 2021 with implementation of AHD compared to preceding NC scores (2016–2018) with a moderate effect size of 0.52. Participating residents in AHD sessions had higher ITE and ABIM scores compared to those in hourly NC didactic sessions with significantly improved resident attendance and overall satisfaction.

History and continuity of the first therapeutic departments at the Military Medical Academy

The problem of the lack of a statute on the creation of the medicalSurgical Academy arises every time the authors start discussing the history of the medicalSurgical Academy or its subdivisions. There are also misunderstandings in the issue of internal medicine teaching and creation of therapeutic departments. The contents of several historical and archival documents and earlier publications about the period of formation and development of the first therapeutic departments of the Academy (the last third of the 18th to the first half of the 19th century) were clarified. The article also analyzed the general anniversary editions of the academy, dissertations defended on the history of the departments, historical collections, and documents published in the Complete Collection of Laws of the Russian Empire, stored in the archives (Central State Archive of Ancient Acts, Russian State Archive of the Navy, etc.). The teaching of internal medicine started in October 1767 by F.T. Tikhorsky. From 1786, P. Hoffman continued to teach pathology, therapy, and medical practice at the Chief medical School. G.I. Bazilevich was appointed the second professor of pathology and therapy at the MedicoSurgical School. I.A. Smelovsky became the first professor after the college was renamed into academy. I.P. Frank, who created the second therapeutic department, started a direct historical branch of the therapeutic department until 1931, when the Department of the Private Pathology and Therapy merged with the united therapeutic department, and the Department of Propaedeutics of Internal Diseases emerged from it. From 1848 to 1924, the Department of General Therapy, attached to the first department, existed. In 1806, thanks to I.P. Frank, the second therapeutic department was founded, which existed since 1810 and is now the Department of General Therapy. Initially created as the Department of Hospital Therapy Clinic and renamed in 1965 at the insistence of N.S. Molchanov into the Department of Therapeutic Advancement of Physicians № 1 was actually created by the Decree of January 19th, 1842, simultaneously with the appointment of its first full-time head Prof. O.I. Myanovsky.

“The new normal”: A case study on the emergent transition towards online teaching and learning in internal medicine and anaesthesiology at the University of the Free State

This article aims to explore and analyse the challenges and experiences of students in internal medicine and anaesthesiology regarding emergency remote teaching and learning during the coronavirus pandemic. South African universities have been forced to move from face-to-face to online learning (e-learning) due to the coronavirus pandemic (COVID-19). The Department of Internal Medicine and Anaesthesiology at the University of the Free State (UFS) has been using the traditional face-to-face mode of teaching and learning for over a decade. Owing to the emergent transition to online teaching and learning, UFS has had to make drastic changes to how lessons are presented. Although it is believed that moving to online learning has been a smooth transition, various challenges hinder disadvantaged students from realising the full potential of online learning. The study’s main objective is to propose alternative measures to overcome the students’ challenges and access to effective e-learning. Interpretivist qualitative research was conducted using descriptive research methods, with case studies and existing aggregated data collected during a module evaluation on students’ experiences and challenges with emergency remote teaching and learning and the effectiveness of resource access during COVID-19. Connectivism and Self- Directed Learning theories are the theoretical frameworks for this study. The findings agree with the digital divide as a hindrance to students realising the full potential of e-learning. Yet, lecturers still want students to submit assessment tasks and engage with course activities on the Blackboard learning management system. Owing to the COVID-19 pandemic and other challenges that result in a shutdown of university campuses, alternative measures need to be sought to allow students, particularly disadvantaged students, to realise e-learning.

Jak vést interní oddělení: primář - školitel

Internal medicine is the core medical discipline that is responsible for the care of adults with complex illness. Therefore, the preparation for the internal medicine specialty is demanding and requires close cooperation of trainees with the educational supervisor, who is usually the head of the internal medicine department. In addition to his medical work, the head of the department is also director of the training programme. Educational activities should have their allocated time, and all doctors who act as trainers should recognise their responsibility to participate in the postgraduate training of future physicians. Comprehensive assessment of trainees progress must be an integral part of the training programme. Almost one quarter of trainees fail board certification in internal medicine. Training institutions offering postgraduate education in internal medicine should focus on to improve their performance.

“What is the mechanism?”: Cues, barriers, and opportunities to discuss foundational science during internal medicine rounds

Background Repeated application of foundational science (FS) during medical reasoning results in encapsulation of knowledge needed to develop clinical expertise. Despite proven benefit of educating learners using a FS framework to anchor clinical decision making, how FS is integrated on clinical rotations has not been well characterized. This study examines how and when FS discussion occurs on internal medicine teaching rounds. Material and methods We performed a convergent mixed method study. Six internal medicine teams at a quaternary hospital were observed during rounds and team members interviewed. Transcripts were analyzed using thematic analysis. Descriptive statistics provided a summary of the observations. Results Our study revealed that rounds used a teacher-centered model where FS knowledge was transmitted as pearls external to the clinical context. FS content arose primarily when the patient was complex. Barriers preventing FS discussion were lack of time and perceived lack of personal FS knowledge. Conclusion Our study describes scenarios that commonly elicit discussion of FS on inpatient medicine rounds highlighting a ‘transmission’ model of FS knowledge. We suggest a learner-centered model that engages students in the practice of integrating FS into clinical reasoning.

The Effect of Geographic Cohorting of Inpatient Teaching Services on Patient Outcomes and Resident Experience.

Geographic cohorting is a hospital admission structure in which every patient on a given physician team is admitted to a dedicated hospital unit. Little is known about the long-term impact of this admission structure on patient outcomes and resident satisfaction. To evaluate the effect of geographic cohorting on patient outcomes and resident satisfaction among inpatient internal medicine teaching services within an academic hospital. We conducted an interrupted time series analysis examining patient outcomes before and after the transition to geographic cohorting of our 3 inpatient teaching services within a 520-bed academic hospital in November 2017. The study observation period spanned from January 2017 to October 2018, allowing for a 2-month run-in period (November-December 2017). We included patients discharged from the inpatient teaching teams during the study period. We excluded patients admitted to the ICU and observation admissions. Primary outcome was 6-month mortality adjusted for patient age, sex, race, insurance status, and Charlson Comorbidity Index (CCI) analyzed using a linear mixed effects model. Secondary outcomes included hospital length of stay (LOS), 7-day and 30-day readmission rate, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and resident evaluations of the rotation. During the observation period, 1720 patients (mean age 64, 53% female, 56% white, 62% Medicare-insured, mean CCI 1.57) were eligible for inclusion in the final adjusted model. We did not detect a significant change in 6-month mortality, LOS, and 7-day or 30-day readmission rates. HCAHPS scores remained unchanged (77 to 80% top box, P = 0.19), while resident evaluations of the rotation significantly improved (mean overall score 3.7 to 4.0, P = 0.03). Geographic cohorting was associated with increased resident satisfaction while achieving comparable patient outcomes to those of traditional hospital admitting models.

Increasing trust in health care.

Trust in American health care and in the people running medical institutions is in decline, which poses a threat to the physician-patient relationship. In response, the ABIM Foundation has established the Building Trust initiative, which includes the Trust Practices Network, advancing research in trust, leadership convening, and various communications vehicles. The Trust Practices Network includes hospitals and health systems, specialty societies, health plans, consumer organizations, employers, and others who are working to reaffirm and strengthen trust as a pillar in their own missions. Participants offer examples of how they have built trust, and their contributions have illuminated 4 dimensions of trust: competency, caring, communication, and comfort. This commentary discusses an exemplary practice for each of these dimensions and describes the "positive deviance" strategy that underlies the Trust Practices Network. It also offers an overview of the other elements of Building Trust, such as a grant program to promote trust as well as diversity, equity, and inclusion in internal medicine education, and an effort to spur additional research on trust.

Application Analysis of Inter-professional Cooperative Simulation Teaching in the Experimental Teaching of Internal Medicine Nursing

The course of internal medicine nursing is a professional basic course in higher nursing education. This course is based on nursing and basic nursing theory, has strong practicality and operability, and is an important part of clinical nursing professional courses. However, as far as the experimental teaching of this course is concerned, the actual development situation is not optimistic. The experimental teaching is lagging behind and students cannot get effective experimental exercises. Therefore, this article studies the application of inter-professional cooperative simulation teaching in the experimental teaching of internal medicine nursing. Analyze the effect of applying this kind of teaching method to the experimental teaching of internal medicine nursing, combining with the current status of experimental teaching of internal medicine nursing, explore the effective application strategies of promoting inter-professional cooperative simulation teaching in internal medicine nursing experimental teaching, in order to promote internal medicine nursing provide some ideas for improving the quality of experimental teaching.

Guideline adherence and reasons for recommending dose reduction in a primary care-based opioid management clinic.

To provide Centers for Disease Control and Prevention (CDC) guideline-recommended practices for patients on long-term opioid therapy (LTOT) including individualized decisions about opioid dose reduction, we developed the Power Over Pain (POP) Clinic. To describe frequency and reasons for opioid dose reduction and pre-post adherence to CDC guideline-recommended practices. Retrospective chart review with qualitative and pre-post analysis. Patients at an urban internal medicine teaching practice-prescribed LTOT were seen at POP Clinic at least once. Opioid dose reduction was defined by reduction in morphine-equivalent daily dose (MEDD) at 6 and 12 months after the first POP Clinic visit compared to baseline using paired t-tests. Among patients with a dose reduction, reasons documented in POP Clinic notes were qualitatively examined. Dichotomous measures of receiving four CDC guideline-recommended practices (controlled substance agreement [CSA], urine drug testing [UDT], prescription monitoring program review, and naloxone dispensing) at baseline versus 6 and 12 months were compared using McNemar's tests. Of the 70 patients, most were female (66 percent) and Hispanic (54 percent). Forty-three patients (61 percent) had an opioid dose reduction in 12 months after the first POP Clinic visit. The most frequent reason was low or unclear benefit of continuing the current dose (49 percent). Mean MEDD was reduced from 69 mg to 57 mg at 6 months (p < 0.01) and to 56 mg at 12 months (p < 0.01). Completing a CSA, UDT, and naloxone distribution increased at 6 and 12 months (p < 0.01). Individualized risk assessment in a primary care-based opioid management clinic is feasible and can result in opioid dose reduction and guideline adherence.

Critical Care Education and Skills Validation Course for Internal Medicine Physicians in the Military.

Military internist and internal medicine (IM) subspecialist physicians must be prepared to function in both traditional inpatient and outpatient settings, as well as manage critically ill patients within a deployed austere environment. As many critical care procedures are not performed on a routine basis in general IM practice, many active duty IM physicians experience skills degradation and lack confidence in performing these procedures. In order to address this perceived deficiency, the U.S. Army and Air Force Internal Medicine Education and Skills Validation Course was developed to provide essential training in critical care procedures for active duty military IM physicians and subspecialists. Staff internist and subspecialist physicians at multiple military treatment facilities participated in a 2-day simulation-based training course in critical care procedures included in the Army Individual Critical Task Lists and the Air Force Comprehensive Medical Readiness Program. Educational content included high-yield didactic lectures, multi-disciplinary Advanced Cardiac Life Support/Advanced Trauma Life Support high-fidelity simulation scenarios, and competency training/validation in various bedside procedures, including central venous and arterial line placement, trauma-focused ultrasound exam, airway management and endotracheal intubation, chest tube thoracotomy, and mechanical ventilation, among others. A total of 87 staff IM physicians participated in the course with an average of 2-4 years of experience following completion of graduate medical education. Upon course completion, all participants successfully achieved rigorous, checklist-based, standardized validation in all the required procedures. Survey data indicated a significant improvement in overall skills confidence, with 100% of participants indicating improvement in their ability to function independently as deployed medical officers. Broad implementation of this program at military hospitals would improve pre-deployment critical care procedural readiness in military IM physicians.

Opioid Prescribing on an Internal Medicine Teaching Unit

ObjectiveTo investigate the rationale and timing of opioid prescriptions for Internal Medicine inpatients in an academic center in Saskatoon, Canada.MethodsWe performed a cross-sectional study of Internal Medicine inpatients that were prescribed opioids in Saskatoon. We examined documentation of clinical rationale and timing of opioid initiation or first escalation.ResultsOf 57 patients, 34 (60%) were opioid naive prior to admission and 48 (84%) had opioid doses either initiated or escalated. Of these 48 patients, 27 (56%) occurred during on-call hours. Rationale for escalation was documented in 31 cases (65%), with reasons including terminal care (17%), musculoskeletal pain (15%), and skin and soft tissue infections (13%).ConclusionRationale for opioid use was frequently not documented. Initial decision to change opioid dose occurred equally between daytime and on-call hours. RÉSUMÉObjectifÉtudier la justification et le moment choisi pour prescrire des opioïdes chez les patients hospitalisés en médecine interne dans un centre universitaire de Saskatoon (Canada).MéthodologieNous avons mené une étude de prévalence sur des patients hospitalisés en médecine interne chez qui on a prescrit des opioïdes à Saskatoon. Nous avons examiné la documentation concernant la justification clinique et le moment choisi pour entreprendre le traitement par les opioïdes ou effectuer la première augmentation de dose. RésultatsDes 57 patients, 34 (60 %) n’avaient jamais pris d’opioïdes avant leur hospitalisation et 48 (84 %) ont reçu leur première dose d’opioïdes ou une augmentation de dose. De ces 48 patients, 27 (56 %) ont reçu leur dose durant les heures de garde. La justification de l’augmentation de dose est documentée dans 31 cas (65 %), les raisons étant les soins de fin de vie (17 %), la douleur musculosquelettique (15 %) et les infections de la peau et des tissus mous (13 %).ConclusionSouvent, la justification de l’utilisation des opioïdes n’est pas documentée. Le moment où la décision initiale de modifier la dose d’opioïde est prise est réparti de façon égale entre le jour et durant les heures de garde.

Medical Education in Internal Medicine

The 2019 CSIM national meeting included a workshop focused on current topics related to medical education across Canada. The workshop topics included leadership in education, teaching point of care ultrasound, teaching clinical reasoning, and using competency based medical education to design a maintenance of competency program for practicing specialists. This article reflects the experience and discussions from the session, with the goal of stimulating national conversations and collaborations betweenCSIM members.

Hospitalization and Post-hospitalization Outcomes Among Teaching Internal Medicine, Employed Hospitalist, and Locum Tenens Hospitalist Services in a Tertiary Center: a Prospective Cohort Study.

BackgroundThere are no prospective studies comparing hospitalization and post-hospitalization outcomes between teaching internal medicine services and non-teaching hospitalists, and no prospective studies comparing these outcomes between locum and employed hospitalists.ObjectiveTo compare the length of stay, hospital costs readmission rate, and mortality rate in patients treated by teaching internal medicine services vs. hospitalists and among patients treated by locum vs. employed hospitalists.DesignProspective cohort study. Propensity score was used to obtain weighted estimates.SettingReferral center.PatientsAll patients 18 years and older admitted to internal medicine services.InterventionTreatment by teaching internal medicine services vs. hospitalists. Treatment by locum hospitalists vs. employed hospitalists.Main MeasuresPrimary outcome was adjusted length of stay and secondary outcomes included hospital cost, inpatient mortality, 30-day all-cause readmission, and 30-day mortality.Key ResultsA total of 1273 patients were admitted in the study period. The mean patient age was 61 ± 19 years, and the sample was 52% females. Teaching internal medicine physicians admitted 526 patients and non-teaching hospitalists admitted 747 patients. Being seen exclusively by teaching internal medicine physicians comports with a shorter adjusted hospital stay by 0.6 days (95% CI − 1.07 to − 0.22, P = .003) compared to non-teaching hospitalists. Adjusted length of stay was 1 day shorter in patients seen exclusively by locums compared to patients seen exclusively by employed services (95% CI − 1.6 to − 0.43, P < .001) with an adjusted average hospital cost saving of 1339 dollars (95% CI − 2037 to − 642, P < .001). There was no statistically significant difference in other outcomes.ConclusionsTeaching internal medicine services care was associated with a shorter stay but not with increased costs, readmission, or mortality compared to non-teaching services. In contrary to the “expected,” patients treated by locums had shorter stays and decreased hospital costs but no increase in readmissions or mortality.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06578-4.

Simulation Based Training in Internal Medicine as an Essential Adjunct to Conventional Medical Education in a Developing World Setting

Medical training has over time significantly evolved globally. Plausibly, this may have been motivated by the need to produce qualified human resource in order to match the ever increasing demand on health services in the face of population growth and the associated rise in disease burden. The growing number of medical training institutions coupled with the increasing number of students enrolled in these institutions in the face of limited qualified human resource, infrastructure, equipment and patient subjects may pose a threat to the quality of medical training expected to be delivered and the caliber of graduates to be produced. However, this may also be an opportunity for the affected medical training institutions to come up with ways of supplementing the traditional methods of teaching in order to overcome the challenges met with delivering to huge numbers of students using the traditional approach alone. In this case simulation based training can be considered and applied in medical schools in the hope of enhancing training in clinical skills. The simulation based approach in training has been commonly used in faculties such as nursing, surgery, obstetrics and gynecology but less so, though now increasingly becoming the practice in Internal Medicine and Pediatrics training. Medical simulation can be defined as the use of a device or series of devices to emulate a real patient care situation or environment for the purposes of training, evaluation and/ or research. It is a mode of medical training that can enhance clinical skills in the students while also promoting patient safety. This paper will seek to examine the various simulation based methods and there applicability in medical training. The paper will further seek to analyze the role of simulation based training in the setting of medical education in Internal Medicine.

Evaluation of a longitudinal subspecialty clinic for internal medicine residents

ABSTRACT BACKGROUND The traditional model for subspecialty education in internal medicine (IM) residencies is a short inpatient consult rotation, which often lacks outpatient exposure and continuity with faculty. Our IM residency program developed a longitudinal subspecialty clinic (LSC) experience, which pairs categorical IM residents with a faculty preceptor in their subspecialty of interest. Residents work in their preceptor’s clinic for one half-day per week during ambulatory blocks throughout the PGY2 year. OBJECTIVE To evaluate the LSC program’s educational impact and determine best practices for successful implementation.METHODS: From May to July 2019, we surveyed residents and preceptors who participated in an LSC between 2014 and 2019, gathering quantitative and qualitative data on their experiences RESULTS Survey response rates were 66.4% (N=93/140) for residents, 57.7% (N=15/26) for preceptors. Most residents and preceptors were very or extremely satisfied with their LSC experience (83.3% and 71.4%, respectively). Most residents and preceptors reported that the LSC experience was very or extremely effective in enabling residents to explore their subspecialty of interest (76.0%, 86.7%), form a mentoring relationship with their preceptor (71.3%, 80.0%), obtain a letter of recommendation (76.1%, 64.3%), prepare for fellowship (76.3%, 66.7%), gain exposure to outpatient subspecialty practice (90.0%, 73.3%), and gain medical knowledge (84.6%, 80.0%). CONCLUSIONS Our data showed that LSCs are effective in facilitating longitudinal subspecialty career exploration, mentorship, and education for residents. Opportunities for improvement include developing a more structured curriculum, addressing scheduling issues, and adding the option to extend the experience to the PGY3 year.

Application of the Hybrid CBL+TBL Method in Internal Medicine Teaching Practice of TCM Universities

Internal medicine plays a critical role in the curriculum system of traditional Chinese medicine (TCM) universities, which is the main course in TCM colleges and the professional knowledge must be mastered by medical students. However, due to the immense contents and concepts in internal medicine, the traditional lecture-based learning (LBL) led to dissatisfactory education effects. The purpose of the study is to explore the application of hybrid case-based learning (CBL) + team-based learning (TBL) method in educational practice of internal medicine in TCM universities. The undergraduates majoring in Chinese medicine of grade 2014, 2015 and 2016 from Beijing University of Chinese Medicine (BUCM) were enrolled. Students of grade 2014 were utilized as the control group, adopting traditional teaching method. Students of grade 2015 and 2016 were employed as the experimental groups, using the hybrid CBL+TBL teaching method. At the end of the internal medicine curriculum, the teaching resultant was evaluated by both theoretical test and skill assessment. The results demonstrated that experimental groups scored better than control group in both theory and clinical examinations, and the discrepancies were significant, respectively. The introduction of hybrid CBL+TBL teaching method into education of internal medicine in TCM universities promoted students’ ability of self-learning and sense of teamwork, so as improved the teaching effectiveness of clinical courses.