医学英语查房(详细)

MakingWardRound医学查房-床边教学模式

杨明山第38章BEDSIDETEACHINGContents

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-bilingualism2.FunctionsTheoryOperation3.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professor’sground或chief’sround，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。01history:missing不全02exam:mistake不正03diagnosis:misdirect不明04treatment:misdeal不当解决学生实际问题4.Functions–纠错VisitingSurgeon:Haveyounoticedhislightcolorofhisstool?01Intern:Uh,I’msorryIhaven’t.02Missing病史不全Mistakes检查不规Director:DrLi,isthereanyralesthatyouheardinthispatient?Intern:Iheardnoralesinthispatient.Director:Pleaselistentoitagain.Canyouhearfinemoistrale?Intern:Yes,Igotit.Director:Whydidn’tyouhearit?Intern:(Noresponse)Director:Youonlypaidattentiontothefrontchestandneglecttheauscultationonbaseoftheback.VisitingPhysician:Isitnecessaryforustodoaliverbiopsy?1Intern:Maybeit’sunnecessary.2VisitingSurgeon:Sorry.Youshouldanswermeit’snecessarybecausetheconfirmeddiagnosisofhepaticlesionoftendependsontheliverbiopsyinadditiontoultrasound.Howeveritwillbedecidedbythedirector.3Misdirect诊断不清Resident:Iassumethatyoublockedtheneurogenicphasewithatropine.Howdidyoublockthehormonalphase?Director:IputdownaLevintube,andthepatientonconstantgastricsuction.Resident:Thiswillkeepthegastriccontentsfromenteringtheduodenumandtheproductionofsecretin,which,inturn,wouldincreasetheliberationofpancreaticenzymes,thusaddingtotheinsult.Misdeal治疗不当01交班morningmeeting：住院总医师；外称SeniorResident’sMorningReport02引言introduction：主治医师；提出重点查房病例，简述棘手问题03病史报告casepresentation：实习医生，可有无诊断，诊治计划须系统04教学查房对话teachingdialogue：在上下级医生之间进行；着重纠错05小结summary：主治医师对主任查房作应答，提出整改措施5.procedures6.figuresPatient病人Interns实习医师Residents住院医师Chiefresident住院总医师Visitingphysician主治医师Director主任EDCBAFRequirementsforplayBasedonNEJMca