床边教学模式医学英语查房.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Making Ward Round,医学查房,-,床边教学模式,第,38,章,BED SIDE TEACHING,Contents,一条路线,二个功能,三个等级,四个入口,五个程序,六个人物,七个思路,八个业务,1.Significance-bilingualism,2.Functions,Theory Op,eration,3.,Tertiary system ground,一级查房：经治医师查房，分晨、午、晚三次。普查全组病人，为,“,医患对话,”,。,二级查房：,主治医师查房，外称,Teaching Attending Rounds,，每天一次。轮流检查所辖各组病人，除医患对话，尚需,“,医医对话,”,。,三级查房：主任查房，外称,professors ground,或,chiefs round,，每周二次,;,每次检查主治医师提供,1,至,2,病例,;,主要突出“医医对话”。,大查房：,great rounds,英美普及，除本科室外，其他相关科室均参加，国内称大型会诊讨论。,4.Functions,纠错,解决学生实际问题,history:missing,不全,exam:mistake,不正,diagnosis:misdirect,不明,treatment:misdeal,不当,Missing,病史不全,Visiting Surgeon:,Have you noticed his light color of his stool?,Intern:,Uh,Im sorry I havent.,Mistakes,检查不规,Director:,Dr Li,is there any rales that you heard in this patient?,Intern:,I heard no rales in this patient.,Director:,Please listen to it again.Can you hear fine moist rale?,Intern:,Yes,I got it.,D,irector,:Why didnt you hear it?,Intern:,(No response),Director:,You only paid attention to the front chest and neglect the auscultation on base of the back.,Misdirect,诊断不清,Visiting Physician:,Is it necessary for us to do a liver biopsy?,Intern:,Maybe its unnecessary.,Visiting Surgeon:,Sorry.You should answer me its necessary because the confirmed diagnosis of hepatic lesion often depends on the liver biopsy,in addition to ultrasound.However it will be decided by the director.,Misdeal,治疗不当,Resident:,I assume that you blocked the neurogenic phase with atropine.How did you block the hormonal phase?,Director:,I put down a Levin tube,and the patient on constant gastric suction.,Resident:,This will keep the gastric contents from entering the duodenum and the production of secretin,which,in turn,would increase the liberation of pancreatic enzymes,thus adding to the insult.,5.,procedures,交班,morning meeting,：,住院总医师；,外称,Senior Residents Morning Report,引言,introduction,：,主治医师；提出重点查房病例，简述棘手问题,病史报告,case presentation,：,实习医生，可有无诊断，诊治计划须系统,教学查房对话,teaching dialogue,：,在上下级医生之间进行；着重纠错,小结,summary,：,主治医师对主任查房作应答，提出整改措施,6.,figures,Director,主任,Visiting physician,主治医师,Chief resident,住院总医师,Residents,住院医师,Interns,实习医师,Patient,病人,Requirements for play,Based on NEJM case record,Simplify the case presentation(3m),1,个中心,2,个功能,3,级查房,4,个纠错,5,个步骤,6,个人物,7,个思维,8,个行为,THANK YOU,THANK YOU,