07-在社区和门诊环境下的教学

,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Teaching in Community and Ambulatory Settings,在社区和门诊环境下的教学,Warren Heffron M.D.,Warren Heffron,医学博士,Professor Family Medicine,全科医学教授,University of New Mexico,新墨西哥大学,Albuquerque New Mexico.USA,美国新墨西哥州阿尔布开克,In His Image Residency In His Image,住院医师培训指导老师,Tulsa,Oklahoma,USA,美国俄克拉马州塔尔萨市,Ambulatory Teaching,门诊教学,Increasingly important,日益重要,Balances education,平衡教育,Education for practice,实用性教育,“real world”,真实世界,Almost any site where medicine is practiced can be used for teaching.,几乎所有实践医学的地方都可以用来教学,What is learned?,学什么？,Observe experienced physician deliver care,观察有经验的医生提供医疗照顾,Provide care with supervision,在督导下实践,Practice clinical skills,实践临床技能,Communication,交流,Not from lectures,不只从讲课中学习,The non hospital part of medicine,医学中和住院不相关的部分。,Problems,问题,Inexperience,无经验,Time,时间,Observation,观察,Teaching,教学,Feedback,反馈,Benefits,好处,Enjoyable,可享受的,Give something back to medicine,返给医学一些东西,Teachers learn,教师学习,Learner time with patients,学习者和病人时间,Patient Education,病人教育,Counseling,咨询,example:bruit and decreased pulse,例子：心脏 杂音和减弱的脉搏,Patient Acceptance,病人接受性,Variable,可变的,Importance of physician request,医生要求的重要性,Include other sites/personnel,包括其他场所和人员,Any type of medical office or clinic,所有的医疗办公室和门诊,Occupational Medicine sites,职业医学场所,Orphanages,孤儿院,Hospice,安养院（临终关怀医院）,Nursing home,养老院,Sports medicine sites,运动医学场所,Community medicine sites,社区医疗场所,schools,prisons,etc.,学校、监狱等。,Sites/Staff,场所,/,职员,Community health workers,社区医疗工作者,Community health educators,社区医疗培训人员,Social workers,社会工作者,Case managers,病例管理人员,Occupational therapists,职业治疗师,Physical therapists,理疗师,Counselors,Psychologists,咨询员、心理学家,Example,例子,Resident visits to rural villages outside of Shen Yang.,住院医师拜访沈阳郊外的农村,Health care provided in local clinic,当地门诊的医疗照顾情况,Orphanage visit,also in Haikou,福利院初诊；也在海口,Health education programs and surveys of needs of the community,医疗教育项目和社区医疗需要调查。,Example,例子,Good Samaritan Health Services.Tulsa,Oklahoma,USA,美国俄克拉马州塔尔萨市好撒玛利亚人医疗服务中心。,Mobile clinics in trucks specially built,专门为大卡车司机设立的电话门诊服务。,Multiple sites on different days,不同日期多个地点,Go where the poor are,穷人去哪儿看病？,Multiple services,acute care,chronic care,womens health,多种服务，急性病照顾、慢性病照顾、女性健康照顾。,Residents gain part of their education,住院医师得到额外的教育。,Example,例子,Rural based family medicine residencies.,以乡村为基础的全科住院医师培训项目,3 year,1+2 model in New Mexico,USA,美国新墨西哥州,1+2,、,3,年培训的模式,4 sites in rural areas around the state,整个州在乡村的,4,个场所,Same curriculum as at the university,和大学一样的课程,Residents learn well,pass certification exams,住院医师学得很好，通过资格考试。,Increased retention to serve in rural areas.,服务乡村名额增加。,Imagine,想象一下,Your place of work as a place for teaching if you have any community activities or work outside of a large medical school,假设你有一些社区活动或一个大医学院的工作外展，你的工作场所将会作为教学地点。,If not create such a place in your mind where you could go to do some teaching.,如果你脑海里不能想象出这样一个地方，你会去哪儿作这样的教学？,Advance planning,提前计划,Develop course syllabus,确立课程表,Office/staff preparation,诊室,/,同事准备,Arrange patients(permission),安排病人（同意）,Meet with learner-Orientation,以学习者为导向,Mutually develop goals,expectations,共同确立目标、期望。,Time plans and evaluation,时间计划和评估,Teaching/learning styles,教,/,学方式,Active Process,积极的过程,What can I teach?,我能教什么？,What do you want to learn?,你想学什么？,Teach/learn from every encounter,每一次病人来诊都教,/,学。,Costs,代价,Time,may increase day by 45 minutes,时间，每天增加至,45,分钟。,Billing,may decrease by one patient,账单，可能是少看一个病人的费用,Residents students,住院医师,学生,Considerably variable,相当多不确定因素,Characteristics of a good teacher,一位好老师的特点,Knowledge,知识,Availability,可及性,Clinical competency,临床能力,Desire to teach,教的愿望,Good feedback skills,好的反馈技巧,Organization skills,组织技巧,Professionalism,专业素养,Well prepared,准备充分,Scholarly,博学,Enthusiasm,热情,Nonjudgmental,不论断,Respects learner autonomy,尊重学习者自主性,Sincerity,真诚,Listening skills,倾听技巧,Role model,角色榜样,Practices evidence based medicine,实践循证医学,Characteristics,特点,Patient,耐心的,Observant,善于观察,Good communicator,好的交流者,Stimulating,激发,Encouraging,鼓励,Characteristics of good teachers,好老师的特点,Delegate responsibility,给予责任,Communicate expectations,交流期望,Enthusiasm,热情,Stimulate interest,激发兴趣,Role models,角色榜样,Excellent patient skills,出色的接诊病人技巧,Involve learner in process,learning prescription,让学习者参与学习过程中,At Beginning,开始阶段,Review expectations,goals,objectives,回顾期望、目的、目标,Ground rules,基本原则,Review competencies,回顾能力,Learner prescription,学习者处方,Get to know student personally,认识学生个人,Teaching by direct observation,通过直接观察教授,May be intermittent,可能是间断性的,Opportunities for immediate feedback,立即反馈的机会,Review clinical notes,复习临床病例,Work together ie shared PE,一起工作，如：共同做体格检查。,Teaching by Example,通过例子教授,Role model,角色榜样,Demonstration,展示,History and PE,病史和体格检查,Procedures,小手术,Then have learner demonstrate to you,然后让学习者演示给你看,Teaching by indirect observation,通过直接观察教授,Feedback from patients,病人反馈,Feedback from staff,同事反馈,Video tape and review together,录像，一起复习,Areas for emphasis,重点部分,Establishing a chief complaint,明确主诉,Multiple histories,多方面病史,Past-med,surg,Rx,hospita