1+医学英语查房.ppt

MakingWardRound医学查房-床边教学模式,杨明山,第38章,BEDSIDETEACHING,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,TheoryOperation,3.Tertiarysystemground,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TeachingAttendingRounds，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professorsground或chiefsround，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：greatrounds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,VisitingSurgeon:Haveyounoticedhislightcolorofhisstool?Intern:Uh,ImsorryIhavent.,Mistakes检查不规,Director:DrLi,isthereanyralesthatyouheardinthispatient?Intern:Iheardnoralesinthispatient.Director:Pleaselistentoitagain.Canyouhearfinemoistrale?Intern:Yes,Igotit.Director:Whydidntyouhearit?Intern:(Noresponse)Director:Youonlypaidattentiontothefrontchestandneglecttheauscultationonbaseoftheback.,Misdirect诊断不清,VisitingPhysician:Isitnecessaryforustodoaliverbiopsy?Intern:Maybeitsunnecessary.VisitingSurgeon:Sorry.Youshouldanswermeitsnecessarybecausetheconfirmeddiagnosisofhepaticlesionoftendependsontheliverbiopsyinadditiontoultrasound.Howeveritwillbedecidedbythedirector.,Misdeal治疗不当,Resident:Iassumethatyoublockedtheneurogenicphasewithatropine.Howdidyoublockthehormonalphase?Director:IputdownaLevintube,andthepatientonconstantgastricsuction.Resident:Thiswillkeepthegastriccontentsfromenteringtheduodenumandtheproductionofsecretin,which,inturn,wouldincreasetheliberationofpancreaticenzymes,thusaddingtotheinsult.,5.procedures,交班morningmeeting：住院总医师；外称SeniorResidentsMorningReport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casepresentation：实习医生，可有无诊断，诊治计划须系统教学查房对话teachingdialogue：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Visitingphysician主治医师Chiefresident住院总医师,Residents住院医师Interns实习医师Patient病人,Requirementsforplay,Basedon