全科住院医生思维训练.ppt

Medical Heuristics and Teaching Clinical Decision-Making启发式教学法及临床决策教导 Timothy Stephens, M.D. Faculty Physician International Clinic, Haikou Municipal Hospital General Practice Residency Conflicts of Interest / Financial Disclosures利益冲突/财务批露 None无 Learning Objectives教学目标 Participants will be able to…参加者需要能… 1) describe a learning theory model to explain the steps to achieve competence描述一种学习理论模型来解释获得能力的步骤。 2) describe common clinical decision making strategies that can be used in teaching residents描述可用于住院医师教学的一般临床决定策略。 3) describe the concept of heuristics and how it applies to medical education描述启发式的概念以及在医学教育中的应用。 Clinical Decision Making: Example做临床决定：例子 How do we teach competency?如何教授能力？ Know what outcomes we are looking for知道我们所要的结果 (easier said than done…)（说起来容易，做起来难） Build assessment tools 建立评估工具 Formative and Summative feedback形成性反馈和终结性反馈 Identify gaps in knowledge, understanding, and application找出知识、理解和应用上的差距 Requires direct observation要直接观察 Give timely, specific, constructive feedback给予及时、具体和有建造性的回馈 Requires culture change要文化变革 Four Stages for Learning Any New Skill学习新技能的四个步骤 Gordon Training International employee, Noel Burch 不知道 知道 没有意识到技能欠缺 意识到欠缺某项技能 技能熟练，可以不用再刻意去想 尽管需要很多努力，但主动去学习掌握这种技能。 无技能 掌握技能 Conscious Incompetence自觉能力欠缺 今天工作上完成了一件事。 我学会了如何使用传真机。 哇~那明天你可能就学会使用手机了。 那当然好啦! 不过，我想今天是把某个人运到到洗手间去了。 汗….. Conscious Competence自觉有能力 Unconscious Competence不自觉有能力 How do we get our residents如何帮助住院医师成长？ From Here…从这儿 To There?到那儿？ Strategies in Clinical Decision Making做临床决定的策略 Pattern Recognition模式识别 Rule Out Worst-case Scenario (ROWS)排除最坏的情形 Exhaustive Method穷举法 Hypothetico-deductive method假设-演绎法 Heuristics启发式 Heuristics in Medicine医学启发式 Failed Heuristics = Cognitive Biases失败的启发=认知偏差 Anchoring Bias定锚偏差 “jumping to conclusions”“过早下结论” Ascertainment Bias 确定偏倚 “seeing what you expect to find”看到你希望发现的 Confirmation Bias证实偏差 look for confirming evidence for the hypothesis, subsequent or disconforming evidence may be ignored为假设寻找确支持认证据，却可能忽略后续的证据，或与假设不一致的证据。 A