建构主义视角下的早期接触临床教学设计与实践

目的运用建构主义理论，探索八年制医学生合理的“早期接触临床”的教学内容与教学形式。方法“早期接触临床”活动分为两个阶段：第一阶段按照北京大学医学部课程内容安排，为学生提供多种临床场景和医疗工作。第二阶段依据第一阶段后的学生自我设想，教师设定备选教学内容，由学生进行自由选择，自己参与设计见习内容、完成相关知识准备及小组之间的分工合作。分别在2008级八年制临床医学专业63名学生两个阶段早期接触临床教学活动后，对其进行问卷调查，分析和比较学生对“早期接触临床”活动目的的认识，学习态度、学习能力和学习收获等方面的情况，评价“早期接触临床”教学活动的效果。结果学生对早期接触临床教学活动的目的更为明确，学习兴趣和积极性更高，与医护人员以及患者的沟通能力明显增强。学生小组合作式学习的主动性有了明显提高。此外，学生在第二阶段的早期接触临床教学活动中的收获也比以前明显增加，反映在对临床医学的感性认识和兴趣、临床医疗流程、医院管理等多个方面。绝大多数学生对医德医风和爱伤观念感受更深，对将来进入临床课程学习有了更充分的心理准备。结论将建构主义理论融于“早期接触临床”教学活动中，能够培养学生“自主学习”和“合作式学习”的能力，不仅有利于增加学生的感性认识和激发学生的学习兴趣，贯彻全程医学职业精神教育理念，同时也为今后临床医学课程体系的教学改革做好了准备。

Instructional design and practice of early exposure to clinical activities under the guidance of con- structivism

Objective To explore the reasonable “early exposure to clinical practice” teaching form and content of 8-year medical students under the guidance of constructivism. Methods Early exposure to clinical activities is divided into two parts：The first stage was arranged in accordance with the course of the Peking University Health Science Center, to provide students with a variety of clinical scenarios and medical work. The second stage was based on self-conceived of the students after the first stage. Teachers set alternative teaching content. The students chose the content by themselves, participate in the design trainee, prepare the knowledge and the division of labor among the group. After the second stage of early exposure to clinical activities, the questionnaire of 63 students were used to compare the purpose, attitude, learning ability and harvesting with in the first stage, and to evaluate the effects of early exposure to clinical activities in the new mode. Results The students gained more explicit purpose, larger interest and enthusiasm to. They enhanced significantly the ability to communicate with patients and he medical staff. The student group cooperative learning initiative has also been improved significantly. In addition, the harvest of students were more in the second stage of early exposure to clinical practice than before, which reflected in many aspects such as perceptual knowledge and interest in clinical medicine, clinical processes and hospital management. The vast majority of students have deeper feelings of medical ethics and the concept of love wounds. They have more adequate psychological preparation of future access＆amp;nbsp;to clinical learning. Conclusions Integrating the constructivist theory into the early exposure to clinical activities could help students improving the capability of “self-learning” and “collaborative learning”, which will not only help to increase the students’ perceptual knowledge and stimulate interest in learning, and implement full medical the