臨床診斷學與實驗診斷學整合課程

The purpose of this study was to improve clinical skills education for medical students. These skills are currently taught as two separated courses, clinical and laboratory diagnosis (both including practicals), in an otherwise conventional medical curriculum. The practicals are usually informal large-group sessions, with an unstructured style adopted. A new, program was designed that integrates these two courses. Introductory lectures are retained only for the first week of the new course, with the remaining weeks organized as weekly units according to organ systems. Eight weekly units incorporate two sessions of problem-based learning (PBL) and two sessions of related hospital practical for clinical skills instruction, both delivered in small-group tutorials. The PBL cases serve as simulated clinical situations to facilitate the learning of clinical skills. Another eight units do not incorporate PBL sessions and provide only hospital-based practical sessions. The target students for this study consisted of all 120 fourth year medical students at our institution, randomly assigned to 16 small groups of seven or eight members. These group memberships were retained for the same PBL sessions led by non-expert tutors, and the same hospital sessions taught by expert physicians. At the end of the semester, a Group Objective Structured Clinical Examination (GOSCE) was given to further facilitate and consolidate the learned clinical skills. The advantages of the new, integrated clinical-skills course included: 1) smaller groups; 2) structured instruction using study guides; and 3) simulated clinical situations provided by the PBL cases. Although the great majority of the students (86.9%) acknowledged that they learned new things from the hospital practicing to perfect their new skills not continue practicing to perfect their new skills. The GOSCE was complementary to the instructional program because it forced students to practice their clinical skills at the end of the semester. (Full text in Chinese)