多方案择优临床决策思维模式与临床教学培养目标

在传统的临床决策过程中,临床专家的思维模式表现为经验型的黑箱模型,一般年轻医师难以充分理解并学习其决策思路.多方案择优临床思维过程是一个纵向思维和横向思维相结合的过程.即针对特定临床决策问题的系统求解,一要针对结构化（或半结构化）决策问题,根据决策条件初步选择若干治疗方案,二要针对非结构化决策问题做出进一步的分析选择.多方案择优临床决策思维模式,可用决策条件、治疗方案及预后三要素集合之间的逻辑关系来表示,将临床思维模式的黑箱模型转化为一个白箱模型.临床决策思维白箱模型的建立,对临床医师思维能力的教学培养也起到了一定的启示作用.即需要着重从“知识更新、技术培训、掌握指南和临床实践”四个方面来提高临床医师的决策思维能力.

Thinking mode of clinical decision making for multi-scheme selection and clinical teaching objectives

In traditional clinical decision making process,experts＇ clinical thinking mode is an experience type of black box model.It is hard to fully understand and learn experts＇ clinical thinking content for general young physicians.Clinical thinking process of multi-scheme selection is a combination of vertical and lateral thinking.To systemically solve specific problems of clinical decision making,the first step is to select some treatment actions preliminarily according to the decision condition for structured （or semi-structured） decision problems; the second step is to make further analysis and selection for non-structured decision problems.The clinical decision-making model for multi-scheme selection can be expressed by the logical relationship among the sets of factors as conditions,actions and prognosis.The black box model of clinical thinking mode is then transformed into white box model.The establishment of clinical decision making model of white box also plays a certain role in the training of clinical thinking ability for young clinicians.It is necessary to focus on four aspects as ＂knowledge update,technology training,guideline comprehension and clinical practice＂ to enhance clinical decision-making ability.