*Department of Emergency Medicine,Queen's University,Kingston,ON.
†School of Medicine,Queen's University,Kingston,ON.
CJEM. 2018 Jan;20(1):142-145. doi: 10.1017/cem.2017.357. Epub 2017 Jul 26.
The acquisition of competence in diagnostic reasoning is essential for medical trainees. Exposure to a variety of patient presentations helps develop the skills of diagnostic reasoning, but reliance on ad hoc clinical encounters is inefficient and does not guarantee timely exposure for all trainees. We present a novel teaching series led by emergency physicians that builds upon the existing medical education literature to teach diagnostic reasoning to preclinical (2nd year) medical students. The series used emergency department simulations involving patient actors and simulated vital signs to provide students with exposure to three acute care presentations: chest pain, abdominal pain, and headache. Emergency physicians coached and provided immediate feedback to the students as they actively worked through diagnostic reasoning. The participating medical students reported benefit from these sessions immediately following the sessions and in an 18-month follow-up survey where the students could consider the impact of the sessions on their clinical clerkship. Students felt that the sessions had assisted them in recognizing the key features of relevant diagnoses during clerkship as well as providing a helpful adjunct to their in-class learning.
掌握诊断推理能力对于医学实习生至关重要。接触各种患者表现有助于培养诊断推理技能，但依赖临时的临床接触效率低下，不能保证所有实习生都能及时接触到。我们提出了一个由急诊医师主导的新教学系列，该系列建立在现有的医学教育文献基础上，旨在向临床医学前（二年级）医学生教授诊断推理。该系列使用涉及患者演员和模拟生命体征的急诊模拟，为学生提供三种急性护理表现的接触：胸痛、腹痛和头痛。当学生积极进行诊断推理时，急诊医师对他们进行辅导并提供即时反馈。参与的医学生报告说，在课程结束后立即以及在 18 个月的后续调查中受益，学生可以考虑课程对他们临床实习的影响。学生们认为这些课程有助于他们在实习期间识别相关诊断的关键特征，并为他们的课堂学习提供有益的补充。
