Paccione G A, Cohen E, Schwartz C E
Department of Medicine, Montefiore-North Central Bronx, NY 10467.
Arch Intern Med. 1989 Nov;149(11):2407-11.
We have developed a simple generalizable model of teaching ambulatory medicine that adopts successful elements of inpatient teaching and addresses deficiencies in traditional ambulatory forums. This model combines resident analysis of the patient encounter via a "clinical encounter form" (CEF) with faculty-led ambulatory medicine rounds (AMR). Its objectives are to integrate teaching and quality assessment; be explicit about the relation between the record and the physician's clinical thinking; teach around every patient; focus on selected aspects of a case in limited time; and permit appropriate rounds preparation by faculty. The CEF-AMR model, like inpatient rounds, allows teaching to be focused on real patient issues; all patients are reviewed and quality is assured, and interesting teaching points can be selected, prepared, and discussed efficiently in limited time. It is the "classroom" complement to faculty "bedside" precepting and has made teaching ambulatory medicine feasible, clinically relevant, and well-informed. Perhaps most importantly, the CEF-AMR model encourages self-analysis of clinical decisions and makes explicit the key elements of clinical judgment.
我们开发了一种简单且可推广的门诊医学教学模式，该模式采用了住院医师教学的成功要素，并解决了传统门诊教学中的不足之处。此模式将住院医师通过“临床诊疗表”（CEF）对患者诊疗过程的分析与教师主导的门诊医学查房（AMR）相结合。其目标是整合教学与质量评估；明确记录与医生临床思维之间的关系；围绕每位患者进行教学；在有限时间内专注于病例的选定方面；并使教师能够进行适当的查房准备。CEF - AMR模式与住院查房一样，能使教学聚焦于实际患者问题；对所有患者进行检查并确保质量，且能在有限时间内高效地挑选、准备和讨论有趣的教学要点。它是教师“床边”带教的“课堂”补充，使门诊医学教学变得可行、与临床相关且信息充分。也许最重要的是，CEF - AMR模式鼓励对临床决策进行自我分析，并明确临床判断的关键要素。
