本科临床技能培养关键因素解析与规范路径探索——基于学生投入视角的实证研究

Universal access to basic health services is one of the important content of building a moderately prosperous society. Medical personnel’s training is the key to achieve this goal. The clinical skill training at undergraduate is a necessary step to cultivate the qualified clinicians. Improving medical students' clinical skills is the lifeline to ensure the sustainable development of our country's health service. The clinical skill training of higher medical education mainly depends on the clinical teaching bases (University Affiliated Hospital). However, there are problems of process differences and inefficiencies of training at this stage. It is urgent to standardize and normalize the training process. In order to solve these problems, we plan to carry out this study in undergraduates of clinical medicine specialty of medical colleges in Shaanxi Province. We intend, based on the perspective of students' learning engagement and using the NSSE-China survey tool, to analyze factors associated with clinical skill training from five aspects: academic challenge, active cooperative learning, student-teacher interaction, education experience richness and campus environment support. On this basis, the key factors will be selected and then, using “8 Disciplines Problem Solving”, implement effective intervention to explore the standardized path to the clinical skill training of undergraduate medical education. The findings may be used as a supplement and extension of standardized medical personnel training system in colleges and universities and comprehensively improve the clinical skills and the qualification competency for future clinical work of all medical students in China.

人人享有基本医疗卫生服务是全面建设小康社会的重要内容。实现上述目标，医学人才培养是关键。本科临床技能培养是塑造合格临床医师的必经途径，全面提高医学生临床技能水平是保障我国卫生事业可持续发展的生命线。高等医学院校临床技能培养主要依赖临床教学基地（附属医院）进行，现阶段存在过程差异、效果不佳等问题，亟待标准与规范。为解决这一问题，我们以陕西省高等医学院校临床医学专业本科生为研究对象，基于学生学习性投入视角，运用NSSE-China调查工具，从学业挑战度、主动合作学习、生师互动、教育经验丰富度和校园环境支持度这五方面开展临床技能培养影响因素的实证分析；在此基础上，选取关键因素运用“科学解决问题八步法”实施有效干预，探索高等医学教育本科临床技能培养的规范路径，作为我国以临床岗位胜任力为导向的标准化、规范化医学人才培养体系在院校阶段的补充延伸，为全面提高全体医学生临床技能及未来岗位胜任力作出贡献。

本科临床技能培养是塑造合格临床医师的必经途径，目前存在过程差异、效果不佳等问题，亟待规范。既往研究多从教师和管理者视角出发，缺乏对学生在学习过程中态度行为表现的关注。. 有鉴于此，我们基于学生学习性投入视角，以陕西省高等医学院校临床医学专业本科生为研究对象，运用NSSE-China调查工具，从学业挑战度、主动合作学习、生师互动、教育经验丰富度和校园环境支持度这五方面开展学情诊断，建立陕西省及西安交大临床医学本科生学情数据库，并结合全国常模、医学学科进行实证分析，考察学习性投入在本科临床技能培养过程中的作用及机制。研究发现：西安交通大学临床医学本科生教育经验丰富，勤奋向学，随年级增长，课程学习投入稳定，课外学习投入上升，学习收获也稳步增长；但在主动合作学习、生师互动、教学方法、考评等方面尚待提升。. 在此基础上，选取关键因素作为典型案例，借鉴国内外医学教育最新成果，运用“科学解决问题八步法”实施有效干预，提升教学质量，实践探索如下:. 案例一：针对临床教学中普遍存在的“教与学双重动力不足”现象，通过建立“规范-示范-定期活动”的临床教学质量提升体系及推行临床实习“首轮负责制”，加强师生互动，增强师生投入。. 案例二：针对医学人文“课程设置不足、认可程度不高、教学方法滞后”等问题，把医学生喜闻乐见的影视作品融入医学人文教育，丰富教学内容，创新教学方法。. 案例三：针对医学留学生实践中“语言障碍、文化差异及技能不佳”的问题，以“强技能，重人文，创特色”为宗旨进行临床教学综合改革，引导其主动合作学习。. “健康中国”战略赋予高等医学教育新的时代使命。本研究从学生视角出发，依托陕西省及相关院校的临床医学本科生学情数据开展教育诊断，重新审视和评估临床教学，实证分析梳理本科临床教学中的关键问题和影响因素，有助于全省医学教育水平的整体提高。其典型案例为规范本科临床技能培养提供了借鉴，具有一定的实践指导意义和推广应用价值。