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Methods of Critical Reading in Clinical Teaching: Teaching Design and Practice
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摘要:
目的 探索主动学习基础上的文献批判性阅读方法在临床教学中的应用。 方法 组织在神经科进行临床轮转和学习的住院医师及研究生共38人，每2周进行一次文献批判性阅读学习。以讨论课为主，教师指导下学生自选文献阅读，提出问题并分析，教师现场点评并作总结，并以邀请相关教师进行方法学知识授课为辅。初始阶段，建议学生从高影响力杂志选择文献，采用“http://www.equator-network.org/”发表的研究报告指南进行评价，文章类型可包括英文出版的观察性研究、干预性研究、诊断/预后研究以及系统综述。通过问卷调查反馈方式进行教学评价。 结果 目前已进行6次讨论课，所选取的文献涵盖4种研究设计类型：随机对照试验、预后队列研究、诊断试验以及病例对照研究；专业内容方面包括脑血管病、多发性硬化、肌萎缩侧索硬化以及帕金森病。开展“研究设计及文献检索讲座”2次。通过问卷匿名收集学生对于文献批判性阅读教学形式的反馈意见：11名学生认为主要收获是学习到了批判性阅读的思维方式及规范了文献阅读习惯，11名学生认为学习到了研究方法学知识，4名学生认为有助于补充统计学知识，1名学生认为可以了解专业方面最新进展。针对有待改进之处的反馈意见分散：5名学生希望增加方法学知识讲座，4名学生希望在讨论中更着重统计知识的学习，3名学生希望有更充裕时间阅读文献，2名学生希望在自己担任引领组时得到老师更多指导等。 结论 通过初期教学实践，文献批判性阅读在青年医师教学中反响良好，有助于系统培训住院医师和研究生的临床科研方法和能力，培养其良好的批判性阅读文献的思维方式。 Abstract:Objective To explore the Methods of critical reading based on active learning in clinical teaching. Methods A total of 38 students consisting of residents and postgraduates, who participated in both clinical and research work in the Department of Neurology of Peking Union Medical College Hospital, were organized to conduct a critical reading and discussion about literature every 2 weeks. The main process of discussion each time included self-selecting, analyzing, discussing, and raising questions about the literature with the Methods of critical reading, under the supervision of the teachers in case of necessity. Lectures on methodological knowledge were given as supplements. Literature from high-impact journals was suggested in the initial stage. The evaluation was mainly based on the reporting guidance published on the website "http://www.equator-network.org/", including observational, interventional, and diagnostic/prognostic studies, and systematic reviews published in English. Evaluation of the effect of critical reading was performed by questionnaire. Results Six sessions have been conducted since October 2017. The selected articles cover four types of study design: randomized controlled trials, cohort studies, diagnostic tests, and case-control studies, encompassing the specialities of cerebrovascular disease, multiple sclerosis, amyotrophic lateral sclerosis, and Parkinson's disease. Two lectures were delivered with topics of "research design and literature search". Feedback was collected anonymously by questionnaire. Eleven students responded that they learned the benefit of critical reading for building their reading habit; eleven students thought it was helpful in learning research methodology; four students considered their statistical knowledge was enhanced during these reading sessions; one student believed that it helped to update the latest progress in Neurology. Feedbacks about how to improve were scattered: five students wished more lectures being given; four students wished to focus more on the study of statistical knowledge during the discussion; three students wished to receive articles earlier; two students wanted more guidance from the teachers. Conclusions Generally, the whole design of teaching practice was well accepted among young doctors and medical students, giving us the confidence to improve students' ability of critical reading and conducting their own research in a way with critical thinking. -
Key words:
- critical reading /
- clinical teaching /
- methodology
利益冲突 无 -
[1] Moore BN, Parker R. Critical Thinking[M]. 11th Edition. United States of America: McGraw-Hill Education, 2015: 2-3. [2] Equator Network[EB/OL]. http://www.equator-network.org/ (2017-12-05). [3] Mas JL, Derumeaux G, Guillon B, et al. Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke[J]. N Engl J Med, 2017, 377:1011-1021. doi: 10.1056/NEJMoa1705915 [4] 袁晶, 彭斌, 倪俊, 等.医学研究方法与临床教学融合可行性调查[J].基础医学与临床, 2017, 37:1351-1354. doi: 10.3969/j.issn.1001-6325.2017.09.034 [5] Schwartz MD, Dowell D, Aperi J, et al. Improving journal club presentations, or, I can present that paper in under 10 minutes[J]. Evid Based Med, 2007, 12: 66-68. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=HighWire000003058093 [6] Deenadayalan Y, Grimmer-Somers K, Prior M, et al. How to run an effective journal club: a systematic review[J]. J Eval Clin Pract, 2008, 14: 898-911. doi: 10.1111/j.1365-2753.2008.01050.x -
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