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1、Making Ward Round医学查房-床边教学模式,杨明山,第38章,BED SIDE TEACHING,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,Theory Operation,3.Tertiary system ground,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 Teaching Attending Rounds，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
2、称 professors ground 或 chiefs round，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：great rounds 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,Visiting Surgeon:Have you noticed his light color of his stool?Intern:U
3、h,Im sorry I havent.,Mistakes 检查不规,Director:Dr Li,is there any rales that you heard in this patient?Intern:I heard no rales in this patient.Director:Please listen to it again.Can you hear fine moist rale?Intern:Yes,I got it.Director:Why didnt you hear it?Intern:(No response)Director:You only paid at
4、tention to the front chest and neglect the auscultation on base of the back.,Misdirect 诊断不清,Visiting Physician:Is it necessary for us to do a liver biopsy?Intern:Maybe its unnecessary.Visiting Surgeon:Sorry.You should answer me its necessary because the confirmed diagnosis of hepatic lesion often de
5、pends on the liver biopsyin addition to ultrasound.However it will be decided by the director.,Misdeal 治疗不当,Resident:I assume that you blocked the neurogenic phase with atropine.How did you block the hormonal phase?Director:I put down a Levin tube,and the patient on constant gastric suction.Resident
6、:This will keep the gastric contents from entering the duodenum and the production of secretin,which,in turn,would increase the liberation of pancreatic enzymes,thus adding to the insult.,5.procedures,交班 morning meeting：住院总医师；外称 Senior Residents Morning Report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
7、 case presentation：实习医生，可有无诊断，诊治计划须系统教学查房对话 teaching dialogue：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 Visiting physician 主治医师Chief resident 住院总医师,Residents 住院医师Interns 实习医师 Patient 病人,Requirements for play,Based on NEJM case recordSimplify the case presentation(3m)1个中心2个功能3级查房4 个纠错5个步骤6个人物7个思维8个行为,THANK YOU,THANK YOU,
