Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Making Ward Round,医学查房,-,床边教学模式,杨明山,第,38,章,BED SIDE TEACHING,Contents,一条路线,二个功能,三个等级,四个入口,五个程序,六个人物,七个思路,八个业务,1.Significance-bilingualism,2.,Functions,Theory Op,eration,3.,Tertiary system ground,一级查房：经治医师查房，分晨、午、晚三次。普查全组病人，为“医患对话”。,二级查房：主治医师查房，外称 Teaching Attending Rounds，每天一次。轮番检查所辖各组病人，除医患对话，尚需“医医对话”。,三级查房：主任查房，外称 professors ground 或 chiefs round，每周二次;每次检查主治医师供给1至2病例;主要突出“医医对话”。,大查房：great rounds 英美普及，除本科室外，其他相关科室均参与，国内称大型会诊争论。,4.,Functions,纠错,解决学生实际问题,history:,missing,不全,exam,:mistake,不正,diagnosis:,misdirect,不明,treatment:,misdeal,不当,Missing,病史不全,Visiting Surgeon:,Have you noticed his light color of his stool?,Intern:,Uh,Im sorry I havent.,Mistakes,检查不规,Director:,Dr Li,is there any rales that you heard in this patient?,Intern:,I heard no rales in this patient.,Director:,Please listen to it again.Can you hear fine moist rale?,Intern:,Yes,I got it.,D,irector,:Why didnt you hear it?,Intern:,(No response),Director:,You only paid attention to the front chest and neglect the auscultation on base of the back.,Misdirect,诊断不清,Visiting Physician:,Is it necessary for us to do a liver biopsy?,Intern:,Maybe its unnecessary.,Visiting Surgeon:,Sorry.You should answer me its necessary because the confirmed diagnosis of hepatic lesion often depends on the liver biopsy,in addition to ultrasound.However it will be decided by the director.,Misdeal,治疗不当,Resident:,I assume that you blocked the neurogenic phase with atropine.How did you block the hormonal phase?,Director:,I put down a Levin tube,and the patient on constant gastric suction.,Resident:,This will keep the gastric contents from entering the duodenum and the production of secretin,which,in turn,would increase the liberation of pancreatic enzymes,thus adding to the insult.,5.,procedures,交班 morning meeting：住院总医师；外称 Senior Residents Morning Report,引言 introduction：主治医师；提出重点查房病例，简述麻烦问题,病史报告 case presentation：实习医生，可有无诊断，诊治打算须系统,教学查房对话 teaching dialogue：在上下级医生之间进展；着重纠错,小结 summary：主治医师对主任查房作应答，提出整改措施,6.,figures,Director,主任,Visiting physician,主治医师,Chief resident,住院总医师,Residents,住院医师,Interns,实习医师,Patient,病人,Requirements for play,Based on NEJM case record,Simplify the case presentation(3m),1,个中心,2,个功能,3,级查房,4,个纠错,5,个步骤,6,个人物,7,个思维,8,个行为,THANK YOU,THANK YOU,