探讨临床思维教学在医学本科生诊断学见习教学中的应用效果。

选取2017年3月至7月在中南大学湘雅医院学习《临床诊断学》课程的临床医学专业本科三年级学生，共108人，按照整群抽样原则随机抽取2个小班，共56人，分为对照组和试验组，同时接受诊断学的理论授课。对照组28人，按传统方法进行诊断学见习教学；试验组28人，在诊断学见习中进行临床思维教学改革。采用期末诊断学测试、教学竞赛活动和问卷调查的方法对两组学生的诊断学学习效果进行比较；随访并比较两组学生内科学测试、考取硕士研究生的情况。

试验组诊断学测试总成绩[(82.01±6.35)分]优于对照组[(74.25±9.46)分]，差异有统计学意义(t＝3.60，P<0.01)。试验组诊断学教学竞赛参与人数和获奖人数(21，10)与对照组(15，6)比较，均差异无统计学意义(χ²＝2.80，1.40；均P>0.05)。试验组学生诊断学教学反馈总分[(94.75±4.04)分]高于对照组[(81.03±4.83)分]，差异有统计学意义(t＝11.53，P<0.01)。随访试验组内科学测试总成绩[(82.76±7.63)分]优于对照组[(74.52±9.75)分]，差异有统计学意义(t＝3.52，P<0.01)。随访试验组学生考取硕士研究生人数与考取"双一流"建设高校人数(23，21)，与对照组(20，18)比较，均差异无统计学意义(χ²＝0.90，0.02；均P>0.05)。

在医学本科生诊断学见习中开展临床思维教学，能提高诊断学教学效果，可能影响医学生继续学习的效果。

To explore the teaching effect based on the teaching of clinical thinking in diagnostics probation teaching for medical undergraduates.

A total of 108 third-year clinical medicine undergraduates who studied Clinical Diagnostics at Xiangya Hospital of Central South University from March to July 2017 were selected. According to the principle of cluster sampling, 2 small classes of a total of 56 students were randomly selected and divided into two groups including the control group and the experimental group. They all received the same theoretical teaching of diagnostics at the same time. The 28 cases in the experimental group received clinical thinking teaching during the diagnostics probation, while the 28 cases in the control group received traditional teaching during the diagnostic probation. Final diagnostic tests, competitions and questionnaire surveys were used to evaluate the diagnostics learning effects of the two groups. The results of internal medicine tests and admission condition for master′s degree candidates of the two groups were followed up and compared.

The total score of diagnostic tests in the experimental group [(82.01±6.35)points] was better than that of the control group [(74.25±9.46)points], the difference was statistically significant (t=3.60, P<0.01). Compared with the control group (15, 6), there were no significant differences (χ²=2.80, 1.40, all P>0.05) in the number of participants and winners in the diagnostic teaching competition of the experimental group (21, 10). The total score of feedback evaluation in the experimental group [(94.75±4.04)points] was higher than that of the control group [(81.03±4.83)points], and the difference was statistically significant (t=11.53, P<0.01). The total score of internal medicine test in the experimental group [(82.76±7.63)points] was better than that of the control group [(74.52±9.75)points], and the difference was statistically significant (t=3.52, P<0.01). There were no statistically significant differences in the admission condition for master′s degree candidates (23, 20) and the admission condition for master′s degree candidates of " double tops" construction universities (21, 18) in the two groups (χ²=0.90, 0.02, all P>0.05).

Carrying out clinical thinking teaching in diagnostics probation for medical undergraduates can improve the teaching effect of diagnostics and may affect the effect of continuing learning.