Cox K
School of Medical Education, University of New South Wales, Australia.
Med Educ. 1996 Mar;30(2):90-6. doi: 10.1111/j.1365-2923.1996.tb00725.x.
A central task in clinical teaching is organization of the students' experience in clinical perception--the ability to observe, to recognize, to discriminate and to interpret clinical evidence. We cannot teach sensory perceptual experience. Students must experience the clinical phenomena for themselves. But we can ensure that what the student experiences is most likely to be turned into clinical learning. This paper dissects the learning task in order to derive plans for teaching clinical perception. A major purpose is to encourage closer study of physical examination, which has largely been upstaged by investigations. Students learn inductively from their experiences of examining patients, cumulating a 'clinical memory' of images of patients with diseases. Reflection on that experience with the clinical teacher translates the sensory evidence into words. Teachers link the clinical observations of 'disease in patients' with previously learned images of 'diseases in organs', to ensure that clinical features and underlying basic science knowledge are clearly integrated. Perception is an active process, not a passive reception of observational data. Learning and teaching clinical perception uses both the student's direct 'sense' experiences and the teacher's guidance in 'making sense' of them.
临床教学的一项核心任务是组织学生的临床感知体验，即观察、识别、区分和解读临床证据的能力。我们无法教授感官感知体验。学生必须亲自体验临床现象。但我们可以确保学生的体验最有可能转化为临床学习。本文剖析了学习任务，以得出临床感知教学计划。一个主要目的是鼓励更深入地研究体格检查，而体格检查在很大程度上已被各种检查手段所取代。学生通过检查患者的经历进行归纳学习，积累患有各种疾病患者的图像的“临床记忆”。与临床教师一起对该经历进行反思，将感官证据转化为文字。教师将“患者疾病”的临床观察与先前所学的“器官疾病”图像联系起来，以确保临床特征与基础科学知识清晰整合。感知是一个主动的过程，而不是对观察数据的被动接收。临床感知的学习和教学既利用学生直接的“感官”体验，也利用教师对这些体验进行“理解”的指导。
