現代臨床推理教學課程的規劃與設計

Planning and Designing a Curriculum in Clinical Reasoning

臨床推理是醫師看病人最具關鍵性的能力。現代臨床推理教學課程的規劃，必須建立在學習與教學原理的基礎上。設計教學課程要著重現代臨床推理的學理，善用嶄新的臨床推理的教學方法。臨床推理的教學必須啟發學生主動學習的動機，讓學生由照顧病人的經驗中，增進臨床知識與技能，同時發展 推理思考與解決臨床問題的能力。臨床推理教學課程要依照學員層級分為：「實習前臨床推理教學」、「臨 床醫學教育」，及「繼續教育」。實習前臨床推理教學，通常以病例導向的臨床推理教學來讓學生學習臨 床推理本質及基本的雙重運轉推理思考的運用，同時以具體的臨床情況，做臨床評估與判斷。臨床醫學 教育中的臨床推理教學，則必須以工作場所的學習為基礎，在臨床教師的監督和指導下，由直接參與病人照顧中學習臨床推理。繼續教育則是針對臨床醫師、臨床老師在診斷與推理上的發展以及實質改進。 本文將依序探討臨床推理課程設計的原理與具體的安排原則，同時要把「思考就是過程與步驟」的指標 概念融入於各個層級的臨床推理課程裡。

Clinical reasoning is pivotal to a clinical education program. Planning a curriculum in clinical reasoning should be based on learning and teaching principles. Current theories of understanding clinical reasoning process and modern teaching approaches should be applied to the design of the curriculum. Teaching clinical reasoning begins with inspiring and motivating students towards active learning. Clinical reasoning is developed through the experiences gained and knowledge acquired by directly engaging in patient care activities. A modern clinical reasoning curriculum should be designed according to the experience of target learners’ levels. It is suggested to tailor approaches of teaching clinical reasoning to preclinical students and to those learners at the clinical medical education level, including clinical medical students and residents. In addition, a curriculum for practicing physicians requires special considerations to meet their needs. Because of lacking clinical experience among preclinical students, the teaching approaches are case-based, using typical presentations of common diseases in classroom settings. For clinical medical students and residents, learning clinical reasoning is patient-based in the workplace, with emphasis on advanced clinical content such as atypical presentations of common disorders and uncommon clinical entities.