基礎醫(yī)學基礎與臨床課程整合與落實

1、基礎醫(yī)學基礎與臨床課程整合與落實2Changing Face of Medical CurriculaChanges in medicine and society,Changes in focus of health care,Changes in curriculum design,Changes in curriculum content,Changes in curriculum delivery,Implementing curricular changeAchieving change R Jones et al. The Lancet 357, 699, 2001.3The Ce

2、nter of Effective Curriculum ReformLeadership of change is essential,Balancing the need for academic stability,Groups of respected & skilled teachers, Excellent communication between staff & students,Feedback from students and patients.Rigorous evaluation of curriculum reform & educational intervent

3、ionsHigh-quality doctors delivering high-quality medical care. 4Reforms in Medical EducationRecommended courses: Integrate teaching of basic sciences with clinical and social sciences, Make use of community and hospital healthcare settings, Increase overall patient contact, Provide greater student c

4、hoice.5New Courses: To encourage learning method that directly link new knowledge to patient care, Modernize approaches to basic science (in particular anatomy), Increase emphasis on appropriate consultation skills and traditional learning, Promote a more human and supportive learning environment,To

5、 selecting candidates for medical education, To the assessments that underpin the direction of student learning.6Curriculum designIntegration: Integrate student learning by focusing on patients throughout the course, No traditional divide between clinical and non-clinical phases, nor between basic a

6、nd applied science, Learning around desired outcomes & systemically rehearse clinical and technical skills through simulated & supervised “near life” situation, Aim to reduce apprenticeship “tag along with me” learning, which risks wide variation in student opportunities.7Student selection modules:

7、to acquire critical appraisal and research skills, student selected modules: 30% of course time are draw on: social sciences and humanities, and professional fields such as law and health economics,8Key units:Being a Doctor, Being a Patient; 15 weeksLocomotion; 15 weeksBlood and skin; 12 weeks 4. Ci

8、rculation; 12 weeks Respiration; 12 weeksHomeostasis and Hormones; 12 weeksThe Senses; 12 weeks 9Digestion and Nutrition; 12 weeksReproduction; 14 weeks Growth and Development; 14 weeks The Elective; 8 weeksThe Mind; 14 weeks Emergency Care; 14 weeksPreparation for Pre-Registration, 5 weeks10Student

9、 select study (SSS) Study of an area in detail: Each unit of the programme, student will take one of the following domains: a. Anatomy, b. Biochemistry & cell biology, c. Epidemiology, d. Ethics, e. Health Economics, f. Law, g. Physiology, h. Psychology, i. Sociology,11Scientific method in medicine:

10、Studies outside medicine:Language, b. Creative Writing,World Art,History (& History of Medicine),World Development,Linguistics,American Studies,Environmental Science,Risk and Decision Theory.12澳洲醫(yī)學委員會（Australian Medical Council , AMC） 要求各醫(yī)學院之醫(yī)學教育目標，要發(fā)展年輕醫(yī)師必備的知識、技巧與專業(yè)態(tài)度之特質，才能安全有效的執(zhí)行醫(yī)療，而且具備適當基礎而能終身學習以

11、及在任何醫(yī)學領域接受進一歩訓練。13澳洲各醫(yī)學院依照AMC之要求，訂出醫(yī)學教育的課程主題(Curriculum Themes)，做為新課程的規(guī)劃與評量的骨架，也提供醫(yī)學教育學程目標（Program Goals）的骨架，亦即醫(yī)學生在修畢四年課程時，應該要獲得之最基本的知識、技能、態(tài)度、價值觀等，以做為實習醫(yī)師之準備。14 這四個課程主題的名稱雖然依不同醫(yī)學院而有所差異，但其基本精神與重點都是一樣的。雪梨大學醫(yī)學院之四個課程主題（Curriculum Themes）為：Basic and Clinical Science Theme，Patient and Doctor Theme，Communi

12、ty and Doctor Theme，Personal and Professional Development Theme.15The Univ. of Sydney Medical Program Characterized by:a four-year graduate-entry web-based curriculumuses problem-based learning to enable students to become life-long learners, effective practitioners of contemporary medicine.16Featur

13、es of the curriculum include:a student-centered approach;a focus on clinical reasoning;integration of subjects within & across years;early clinical experience;use of new information technologies;assessment with an emphasis on feedback & self-evaluation;opportunities for research.17Four themes extend

14、 throughout the four years of the University of Sydney Medical Program:basic and clinical science (50%),community and doctor (25%),patient and doctor (12.5%),personal and professional development (12.5%). The themes provide the framework for the goals of the program, the development of the curriculu

15、m and for assessment.18 The relative contributions of the themes vary at different stages of the curriculum, with an initial focus on basic science and early clinical skills and a growing emphasis on clinical knowledge, skills and judgment.19three PBL (each 1.5 hrs.) Up to six lectures related to th

16、e weekly problem- issues relevant to all themes but with an emphasis on basic science,3. two Basic and Clinical Science sessions ( generally 1.5 hrs),4. two Patient and Doctor sessions ( up to1.5 hrs) in hospital,either one Community and Doctor or a Personal and Professional Development session or a

17、 joint session (1.5 hrs),one or more electives.Outline of the curriculum:Years 1 and 220Years 3 and 4:lectures and seminars relevant to all four themes,evidence-based medicine presentations,structured “hands on” demonstrations,interactive case presentation,problem-based learning exercises supported

18、by information technology,basic science uptakes,21clinical rotation in year 4 (9 wks each):Psychological Medicine & Drug and Alcohol Studies,Child & Adolescent Health,Perinatal & Womens Health,Community Practice.elective term: minimum of 8 wks of supervised experience,rural practice: 8 weeks.22Year

19、1 Curriculum 1 Foundation Studies 1.03 Myocardial infarction Problem Mr. Sarichs chest pain Learning Topic 1 (LT 1) BCS (Basic & Clinical Sciences) Phy (Physiology) Mechanisms of pain,23 LT 2 (Learning Topic 2) BCS (Basic & Clinical Sciences) An (Anatomy) Structures of the chest,LT 3 BCS (Basic and

20、Clinical Sciences) Pa (Pathology) Pathogenesis of arterial disease,LT 4 BCS (Basic and Clinical Sciences) Bi (Biochemistry) Hypoxia, Ischemia & cell death,24LT 5 Pt-Dr (Patient and Doctor) BS (Behavior Science) Communication in a medial emergency,LT 6 C-Dr. (Community and Doctor) PH (Public Health)

21、Risk factors for cardiac disease,LT 7 BCS (Basic and Clinical Sciences) Mcar (Cardiology) Overview of management,LT 8 BCS (Basic and Clinical Sciences) BS (Behavior Science) Treatment adherence,25 Lecture 1 BCS (Basic and Clinical Sciences) Pa (Pathology) Cell injury, ageing and death,Lecture 2 PPD

22、(Personal and Professional Development) PHE (Epidemiol), EBM EBM in practiceLecture 3 BCS An (Anatomy) Structure of the chest26 Lecture 4 BCS (Basic and Clinical Sciences) Bi (Biochemistry) Glucose utilization in cells,Lecture 5 BCS Phy (Physiology) Membrane excitability,Lecture 6 BCS Pa (Pathology)

23、 Normal artery and Responses to injury27Session BCS1 BCS An, Pa Heart and coronary arteries,Session BCS2 BCS Bi Analysis of cardiac iso-enzymes,Session C-Dr (community and Doctor) C-Dr PH (Public Health) Introduction to Community Doctor,28 Session Pt-Dr Communication Pt-Dr (Patient and Doctor) Med (

24、Medicine) Open and closed questions, Session Pt-Dr Skills Pt-Dr (Patient and Doctor) Med (Medicine) Introduction to the cardiovascular system.29Conclusion ( I )The curriculum is characterized:the integration of learning around Presentation rather than by individual discipline or speciality (eg anato

25、my, cardiology) grouped in problem-based units;the use of clinical settings to pull together core classroom learning students have clinical contact from the outset of the programme;30the use of primary care as a core setting to show the range of common conditions and normal variation throughout the

26、programme;student-centred learning;reflective practice;predetermined learning outcomes that are shared with students,group work as preparation for multidisciplinaryteam working.31Conclusion ( II )Traditional lecture-based training has largely given way to a more skills- based and problem-solving app

27、roach, with group learning and strong IT support.Some lectures,Small group academic and clinical teaching,32A wide range of teaching methods is used, including PBL,IT-based learning, practical classes in the laboratories and dissecting room,Seminars, guided individual study, clinical skills practice

28、 and clinical symposia,All supported by regular tutorials.33Conclusion (III)For a successful professional career, students will learn:learning how to learn,communication skills,working effectively in multi-professional teams,the personal and ethical attitudes essential for good professional practice

29、,an appreciation of their responsibilities to their patients, to their professional,colleagues, to society, and to themself,information and communication technology skills.34Conclusion (IV)The Tendency of Medical training:More student centered,Emphasis on active learning rather than on the passive a

30、cquisition of knowledge,Emphasis on assessment of clinical competence rather than on the ability to retain and recall unrelated facts,Student feedback and patient participation are increasing important roles.35Conclusion (V)一個成功的整合課程要由醫(yī)學院負責規(guī)劃，亦即是Central Control，由各種committee來研擬、規(guī)劃，而不是傳統的departmental

31、control能完成的課程。全國醫(yī)學院可考慮參照美國加州八所大學的醫(yī)學院，或澳洲雪梨大學等四個大學醫(yī)學院成立聯盟，互相支持醫(yī)學教育的發(fā)展，共享教學資源（醫(yī)學人文與倫理等課程、師資、PBL個案、標準病人、模擬病人、圖書期刊等），並可維持各醫(yī)學院一致的醫(yī)學教育品質。確定臺灣未來醫(yī)師應具備的特質，各醫(yī)學院可以參酌這些特質，發(fā)展醫(yī)學教育課程的主題（Curriculum Themes），貫徹於各學期的課程中，以培育臺灣社會需求的優(yōu)秀醫(yī)師，達到TMAC要求醫(yī)學院進行醫(yī)學教育改革的目的。36THE END大謝謝聽蒞家臨講!籭懓曵晜珞璽団芒澟馩坋軚衘乸學傒啍鏤鉸焱錦鈢擗泤琧鹓搫楃効啟籙鍒筍詼瑚釥蹕覤莀匁黌蝣攔

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