本科医学教育是一名医学生医学生涯的第一步,医学教育模式的好坏与医学生的终身培养、医学教育水平乃至医疗体系的提升密切相关。本文以循证医学与临床流行病学教研室开设的课程体系为例,阐明在"核心能力为导向,循证医学为载体,终身学习为目的"新时代本科医学教育教学模式下,以学生为中心,以临床实践为背景,运用循证理念、原则和方法构建教学活动和教学实践,引导学生在学习过程中改变传统的教学理念,以终身学习为目的,不断更新知识,成为一名终身学习者的创新教学方法。

循证教育是指整合专业智慧和可获得的最好的实验性证据制定教育指导决策.循证教育意在通过证据为基础的研究与个人专业经验相结合,提高教育政策、决策和教育实践的科学性和实效性,进而提高教育和教学质量.本文介绍循证教育的定义、内涵、特点、实施原则和循证教育的产生背景.

To understand the current state of medical students’cognitions of medical professionalism and the cognitive differences between medical students and patients in China,we conducted the cognitive research of three aspects of medical professionalismdoctor-patient relationship,medical tangle and riskandhospital management and interest conflictin medical students of Sichuan University.The results showed that medical students and patients have a lot in common in these three aspects.

Objective To explore the effects of evidence-based medicine(EBM) course on improvement of information consciousness and information morality for medical students Methods A total of 288 medical undergraduates and postgraduates,who took EBM as an elective course in Sichuan University,were surveyed with 'information consciousness and information morality questionnaire' before and after that course.Results After the EBM course,the number of students surfing the Internet increased by 5%,of which postgraduates increased by 24% with significant differences(P0.05),while their purpose for specialized knowledge increased by 7%;the number of students making plans in advance increased by 7%,and the number of students learning intellectual property and copyright law increased by 7%;the number of postgraduates knowing how to cite articles increased by 12% with significant differences(P0.05);and the number of students not knowing how to get legitimate information decreased by 12% with significant differences(P0.05).Conclusion Evidence-based medicine course is positive for the information consciousness and information morality of medical students.

Objective To study the subject domain knowledge of interventional diagnosis and of congenital disease (CHD) in our country using multiple statistical and social network analysis,and finally build visualized knowledge-mapping.Methods The China Biology Medicine disc (CBM) using MeSH keywords heart defect,congenital and cardiac catheterization in March 2011 was searched.After core keywords had been characterized by Endnote X4,the co-occurrence matrix was built.Transformation,dimensionality reduction and clustering of the co-occurrence matrix were finished by SPSS 17.0 software,leading the strategic plot to be built.Then visualized network was drawn using Ucinet 6.0 software.Results The searching results included 1 015 articles,which were imported into Endnote X4 software.The visualized domain knowledge-mapping was successfully built,and it directly reflected the structure of knowledge-mapping of the subject.And key clusters were formed,in which the therapy,method and instrument and clusters had been developed well.Conclusions The therapy cluster stands in the center of the subject domain knowledge-mapping and is well developed with several clusters following.And the study of the method and instrument cluster makes a great contribution to the progress of the subject.The studies of echocardiography and pulmonary artery hypertension play an important role in the structure of the knowledge-mapping.

BACKGROUND:Many research articles on medical education have been published in Chinese-language journals, the majority within the past few years. However, there have been no objective studies to look at the quality of these, and their contribution to present day thinking.AIM:This study explored the areas of focus, and the quality, of published research on Chinese undergraduate medical education.METHOD:We searched three major Chinese databases, including Chinese Biology Medicine in electronic form, Chinese Journals Full-text Database, and Chinese Technological Periodicals Database, to trace the research themes and methodologies of Chinese-language research papers published from January 2000 to December 2008.RESULTS:The annual number of published articles on undergraduate medical education research has increased over time in China, with 70% of the articles in our 9-year study published in the past 4 years; the most popular theme was curriculum and teaching. Non-comparative studies accounted for the majority of the literature (84.6%); and comparative studies were rare.CONCLUSIONS:Although an increase in the number of articles on medical education research in China is encouraging, more methodologically rigorous designs are needed to improve research quality. Generic and focused training on research methodology is essential to convert quantity into quality.

<正>医生是全球公认最高尚的职业之一,被喻为白衣天使。随着社会进步和科技高速发展,知识爆炸,市场力量介入医疗体系,医疗卫生实施过程中的问题及疾病全球化所带来的压力及患者和社会对医疗服务质量越来越高的期望值,医师们越来越难以承担他们对患者和社会所肩负的责任[1]。ABIM

目的 调查分析医学生批判性思维的现状,为探索建立"核心能力为导向,循证医学为载体,终身学习为目的 "的医学人才培养模式提供依据.方法 采用中文版批判性思维能力测量表(Chinese Version of CriticalThinking Disposition Inventory,CTDI-CV)调查分析四川大学617名医学本科生和研究生批判性思维现状.结果 该组医学生批判性思维素质平均总分均高于280分,批判性思维呈正性.亚组分析结果显示,平均总分由高到低依次为8年制(309分)、研究生(298分)、7年制(287分)和5年制(286分).平均总分两两比较,除5年制和7年制之间无明显差异外,其余各组平均相差均≥10分.5年制和7年制医学生"寻找真相"、"系统化能力"、"批判性思维自信心"三项≤40分,其中"批判性思维自信心"最低.不同性别和年龄间批判性思维总分和7项特质无差异.结论 影响我国学生批判性思维的因素主要包括:教学理念、教学氛围、教学方式和教学评价体系.

Objective To assess the effectiveness of evidence-based medicine for improving core competencies of undergraduate medical students.Methods MEDLINE,ERIC,Academic Source Premier,Campbell Library databases and three Chinese Databases(CBM,CNKI,VIP) were searched from January 1992 to May 2009.We also used Google to searching related literature.The design is a systematic review of randomized,non-randomized,and before-after studies.Two reviewers did study selection,quality assessment,and data abstraction independently.Di erent opinions were resolved by consensus.We used an adaptation of the quality measure from Gemma Flores-Mateo et al to assess the quality of selected studies.And descriptive analysis was conducted.Results A total of 17 studies met the selection criteria,2 of them were of high quality,the others were of moderate quality.Studies involved Competencies of Scienti c Foundation of Medicine,Clinical Skills,and Management of Information.Conclusion Competencies of Scientific Foundation of Medicine,Clinical Skills,and Management of Information are improved by evidence-based medicine teaching.No study on professional values,attitudes,behavior and ethics,population health and health systems,management of information,critical thinking and research is available.It is impossible to assess the four domains above.

临床医生每天都会遇到大量有关疾病诊断、预后、治疗和预防的临床问题,需要新的科学信息帮助解决这些问题.如果以次数计算,调查发现平均每个住院患者每天需要5次[1],每3个门诊患者需要2次[2].要准确的回答或解决这些问题,不仅需要具有丰富的临床经验,还需要我们了解和掌握新的医学知识来指导医疗决策和实践.于是我们通常查阅教科书,希望通过教科书找到我们所需要的最正确的指导.但传统教科书由于更新周期长,很多内容已经过时,有些甚至是错误的.哈佛大学医院院长Sydney Burwell博士半个世纪前曾告诉他的学生:"在10年之内,作为医学生你们学到的知识一半将会被证明是错误的:而且麻烦的是没有谁能够告诉你们是哪一半."

Objective To compare the medical emergency rescue systems used during earthquakes in America,Japan,Russia and China;so as to provide reference material for the establishment and improvement of such a system in China.Methods We searched the official websites of China,America,Japan and Russia,WHO.int,CNKI,OVID,The Cochrane Library and other authoritative sources to collect information involving the medical emergency rescue systems used during earthquakes.The mechanism,legal management,preventive measures and performance of each country's medical emergency rescue system were summarized and compared.Results Crisis management,integrated action and legal support were highly emphasized in America,Japan and Russia.America and Japan have performed well in implementing routine preventive measures.The organizational structure of the medical emergency rescue system in China was similar to that of the other countries,but its performance was not satisfactory due to insufficient financial support,poor management,inefficient operational mechanism and poor preventive measures.Conclusion There is an urgent need for China to reinforce its medical emergency rescue system.Different models should be taken into account because of the different regional situations in China.

Objective To determine whether depression would affect ventricular electrophysiological properties in rats and whether depression and diabetes would have accumulated or synergetic effects on ventricular electrophysiological properties in rats. Methods Male Sprague-Dawley rats were randomly divided into health control group,depression group,diabetes group and depression with diabetes group.The model of depression was induced by chronic mild stress for 4 weeks.The model of diabetes was induced by injecting subcutaneouly alloxan.After 4 weeks,the electrophysiological study was performed in rats.The 90% monophasic action potential duration(MAPD90) and ventricular effective refractory period(VERP) at right ventricular apex,left ventricular outflow track and left ventricular apex was measured.Finally,the ventricles was stimulated to induce ventricular tachycardia or ventricular fibrillation(VF).The frequency of ventricular afterdepolarization and the inducing rate of VF was recorded. Results MAPD90 and VERP was longer in depression group and diabetes group than in health control group.Prolongation of MAPD90 and VERP was more distinct in depression with diabetes group than in depression group and diabetes group.The frequency of ventricular afterdepolarization and the inducing rate of VF was higher in depression group and diabetes group than in health control group.The frequency of ventricular afterdepolarization and the inducing rate of VF in depression with diabetes group was highest. Conclusions Depression could change ventricular electrophysiological properties in rats.Depression and diabetes might have accumulated or synergetic effects on ventricular electrophysiological properties in rats.

在目前“以课堂、教科书、教师、讲授为中心”和“统一大纲、要求、教材、进度”的教学格局下,应倡导个性化的教师和个性化的教学风格以利于学生丰满个性基础上创新能力的形成与发展。文章强调的个性化教学包括对客观性教学目标的个性化理解、对共性客观知识的个性化选择与组织、共性教学模式背景下个性化教学设计与个性化教学风格等多重含义。

政府应该将防范危机作为经常性工作,要构建良性激励机制,不能“默默无闻避免危机得不到奖励,轰轰烈烈解决危机成为英雄”,一定要采取切实措施完善预警机制,使其落到实处并加以执行。

It is very important to understand and master the updated guideline of writing and submitting medical scientific articles for improving the quality of medical scientific articles.This paper provides some new information on how to write medical scientific articles based on Consolidated Standards of Reporting Trials in 2001 and Uniform Requirements for Manuscripts Submitted to Biomedical Journals:Writing and Editing for Biomedical Publication of International Committee of Medical Journal Editors in 2006.

目的探索如何开展医学本科生的循证医学暑假教学,帮助学生完成循证医学研究.方法招募医学本科学生志愿者,利用暑假对其进行Cochrane系统评价的研究方法和相关知识的阶段性教学,并根据学生的学习进度和技能掌握程度,结合学生意愿,组织部分学生参加国际合作医学临床研究最佳证据研究的学习与实践.结果自开展此项培训项目3年以来,先后有38名医学本科生和七年制硕士生参加了Cochrane系统评价研究的培训,已发表Cochrane系统评价5篇,其中3篇是学生作为课题负责人,2篇是学生作为主研人员;以第1作者发表系统评价研究计划书19个;在国内核心期刊以第1作者发表论著7篇,SCI收录论文1篇,11人次被资助参加高水平国际学术会议.结论医学生参加系统评价的研究,有利于他们深入了解循证医学、学习临床科研的方法、提高科研能力和协作精神、加快成为科研型人材;医学生适合于参与系统评价研究,这对培养他们去深入学习和掌握相关临床知识和解决实际问题的能力也大有裨益.

Objective : To identify the requirement of reproductive health service for women seeking for induced abortion incities of Sichuan , China . Methods : Asurveyin 42 83 pregnant women seeking for induced abortion in dif ferent cities in Sichuan Province . Results :Ninety percent of participant sneeded different kinds off amily planning ser vices . Seven tyeight percent needed service sonmaternal childcare , prenatalcare ,eugenics , and treatment and pre vention for sex transmitted diseases . The way of obtaining services needed included consultation , education through TV ,radio , booklet, orattending class , visiting bydoctor or family doctor .Seventy three percent hoped theservices were provided byorganization sequaltoor highert hancity , orprovinciallevel.Conclusions :Theneedofpregnant women requesting for induced abortion was large and multip leinourprovince . MediasuchasTV ,radio , and booklet, and consultatio nareeasyt obeaccepted and couldim proverepro ductive health knowledge in womenre questing in ducedabortion . Meanwhile , training on family planning workers and medical doctor scould improve the quality ofre productive health services ,and avoid unwanted pregnancy or abortion .

目的通过对2003、2004年四川大学研究生<循证医学>课程试卷的对比分析,探索有效的循证医学教学方法.方法授课对象:2003、2004年四川大学选修<循证医学>的2年级医科研究生221名.考试方式:2003年包括两部分,一部分为课堂限时开卷题(80分);另一部分为循证病案(15分),总分95分.2004年为循证病案(80分),根据循证医学的原则和循证实践的5个步骤,制定统一的循证病案评价内容和评价标准.课堂限时开卷题根据标准答案统一评阅.两年的成绩均换算成100分制进行比较.结果考试成绩:2003年呈近似正态分布,2004年呈偏态分布;2003年平均分为75.5分,及格率为97.4%, 2004年平均分为69.8分,及格率95.3%;2003年基础题平均分为62.0±6.4, 综合题平均分为55.1±16.7.近80%的学生认为开设本课程很有必要;近95%的学生认为预期学习目的大部分达到,未达到目的的原因主要是时间紧.90%以上的学生认为授课内容和方式较好. 结论今后的教学应引导学生自主学习,并加强学生运用所学的知识,综合分析和解决实际问题的能力.

Objective To evaluate the effect of teaching evidence based medicine (EBM) in postgraduates. Methods One hundred and thirteen postgraduates in the second year grade selecting an EBM course were included. The course lasted four weeks (twice a week, 3 hours each time and total 21 hours). The courses were delivered in combination with cases. The teaching effect was evaluated by requesting the students to present an evidence based case report on the five steps of evidence based practice. Each teacher assessed the reports independently. Results The mean score of 107 EBM case reports was 51.35±11.38. Distribution of the mean score was nearly normal. Score distribution of the items: the full mark rate was 97% for case depiction and 62% for evidence searching. Stratified analysis: ① Formulating answerable clinical questions: the full mark rate was 88% for clear statement of patient type, 89% for clear statement of intervention, 35% for control and 36% for outcome statement, respectively. ② Searching evidence: the full marks rate was 95% for selecting relevant database, 90% for searching term, 68% for searching strategy and 79% for searching result depiction, respectively. ③ Critical appraisal of evidence: the full mark rate of critical appraisal of the clinical importance and validity of evidence was very low (35% and 7%respectively). ④ Evidence applying: the full mark rate of intervention's benefit and risk for individual patient and patient's value was higher than that of applying evidence to patients and intervention feasibility (24% and 21%, 16% and 12%). ⑤ Evaluation: the full mark rate of clinical result evaluation was higher than that of performance of evidence based practice (55% and 17%). Conclusions Teaching EBM for postgraduates was successful, we need to strengthen the practice of critical appraisal and applying evidence for patients in the future EBM course.

Objective To investigate the situation and problems of medical evidence-based medicine(EBM) teaching in China. Methods One hundred and four participants from different hospitals or universities of China in 2005 “Evidence-Based Medicine Teachers Advanced Training Workshop II of Ministry of Education” were investigated. A self-complete questionnaire on EBM teaching was given at the registration. Results Seventy five questionaires from responders who came from 50 medical institutions of 18 provinces and 25 cities were available for analysis, representing a response rate of 72%. The average age of responders were 38 years old, and 61.3% were graduates. And 14 hospitals or universities have given EBM courses. Namely, for the postgraduates in 9 universities, undergraduates in 2 universities, physicians, nurses and medical managers in 2 hospitals. The lectures lasted from 8 to 36 hours in different units. Difficulties were: lack of EBM teachers, and better understanding the concept and approach of EBM, less paid attention by policy makers, and too busy in specialty.Conclusion EBM teaching is blooming in medical universities in China. It is needed for us to train high qualified EBM teachers.