目的 探讨诊断学床旁见习教学中学患关系现状，为提高诊断学床旁教学质量提供应对策略。 方法 采用自行设计问卷，于2010年5月-2011年6月对80名临床医学专业三年级本科生以及同期在内科住院的100例患者分别进行不署名学患关系问卷调查（有效问卷率分别为91.3%和67%），同时对8名带教教师和7名临床主管医生进行个别访谈。 结果 学生问卷调查显示，79.5%的学生曾在床旁教学中遭遇患者不同程度的拒绝或不配合，大多数学生认为有被拒的心理准备和承受力。患者调查显示，82.1%的患者不愿意接受学生问诊查体，58.2%的患者表示即便给予一定经济补偿，也不愿配合教学。而对带教教师及临床主管医师访谈结果显示，当前床旁带教难度大大增加，学患关系紧张。 结论 现阶段学患关系紧张，根据其涉及原因，提出提升医务人员及医学生人文观念，推进医疗、教育体制改革，建立媒体监督机制，开展公众教育等多层面的应对策略，同时提出课程设置、教学模式、师资培养等具体教学应对举措。Objective To explore the present status of the relationship between students and patients in diagnostic bedside teaching, in order to promote the teaching quality. Methods From May 2010 to June 2011, self-made questionnaires were adopted to carry out an anonymous survey among 80 medical students in grade three or above and 100 inpatients to investigate the relationship between the students and the patients(with an effective questionnaire rate of 91.3% and 67% respectively). Eight tutors and 7 physicians concerned were taken in the individual interview. Results The survey showed that 79.5% of the students encountered refusal from patients in bedside teaching, and most of them believed that they had psychological preparation and endurance for the refusal. A total of 82.1% of the patients expressed their unwillingness to accept examination by clinical students, and 58.2% of the patients were unwilling to cooperate in the teaching even with an amount of economic compensation. The tutors and physicians concerned stated that the student-patient relationship was undesirable at present. Conclusions The relationship between students and patients in bedside teaching is strained at present. Based on the complicated reasons, we propose such coping strategies as promoting humanism among medical workers and students, pushing forward the medical and educational reform, building media supervision, developing public education, perfecting course design, teaching style, and cultivation of teachers, and so on.
医学人文教育是突显医学人文价值和实现医学宗旨的根本。本文针对目前医学人文教育的现状，提出应从提高教师队伍人文素养、用人文精神培育学生、培养医学生职业意识三方面着手，加强医学生人文精神的培养，为社会输送符合时代要求的复合型医学人才。
ObjectiveTo explore the present national status of diagnostic teaching as well as to investigate the opinions on teaching operation such as overall course planning, so as to provide references for the formulation of national diagnostic teaching standard in the future.MethodsSelf-made questionnaires were adopted to carry out an anonymous survey among the teachers from 50 different medical colleges and universities who worked on diagnostic teaching throughout the country from October 2016 to September 2017.ResultsA total of 100 teachers were investigated. The diagnostic teaching departments where 59 respondents worked in were formed by a few fixed teachers plus teachers in rotation. The requirement of rotation time as well as the setting up of lecture-internship ratio in each school were quite various. Forty-seven respondents agreed that the ideal lecture-internship ratio should be internship more than lecture. As for the instruments of clinical skill room, only 40% of the respondents agreed that their diagnostic departments were equipped with a steady standardized patient (SP) team, which was also the reason why SP teaching was the least utilized teaching method during internship (47%). The respondents had various opinions on whether the final exam should weigh more than 50% in the subject score. Above these, the planning and expectations of the respondents on diagnostic course were mostly in consensus.ConclusionsThe development of diagnostic course including teaching staff, teaching content and teaching condition, etc. among each medical colleges and universities was not balanced. It’s quite necessary to formulate a unified and reasonable standard to normalize the teaching staff constitution, teaching planning and set-up as well as teaching condition so as to guarantee the teaching quality.