臨床推理教學課程的安排及實施

Implementing a Curriculum in Clinical Reasoning

臨床推理教學在臨床醫學教育有舉足輕重的重要性。臨床推理的教學始于激勵學生主動學習的態度。學習臨床推理必須透過參與病人照顧活動所獲得的經驗和知識，來發展臨床推理的能力。現代臨床 推理課程強調不同學習層級的教學概念及原則。在臨床推理教學的規劃上，分為「實習前課程」、「臨 床醫學教育」，及「繼續教育」三種不同層級的臨床推理教育課程。實習前課程是為實習前學生安排的 臨床推理教學，強調臨床技能與臨床推理的整合，以病例為導向的推理教學模式，來發展推理思考的能力。臨床醫學教育階段的臨床推理課程，是對實習學生、實習醫師與住院醫師在臨床推理上的教學，這階段的推理教學必須建立在直接參與病人照顧活動的基礎上，以病人為中心，在工作中學習，逐漸的進 階到複雜的臨床內容，同時強調個別化的指導與回饋。因為實習醫學生，實習醫師與住院醫師比實習前 醫學生擁有更多的臨床經驗，所以這時的臨床推理教學目標，是教導這些比較有經驗的學員，透過反思自己的臨床學習經驗，來增加相關臨床知識，並增強臨床推理能力。臨床醫師與臨床老師則是由繼續教 育的課程活動，來持續提升臨床推理能力。

Clinical reasoning is pivotal to a clinical education program. 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.