探讨影响诊断学实习教学效果的主要因素及可行的改良方法。

选择2020年1月至12月于中山大学孙逸仙纪念医院进行诊断学实习的2018级临床医学专业本科学生277人，进行实习难点和教学改良要求的调研。

回收有效问卷248份，影响实习效果的主要原因是实验诊断学部分理论内容记不住(170/248，68.55%)，病史采集部分不知道如何跟患者沟通(146/248，58.87%)以及不知道问诊应涉及的内容(130/248，52.42%)，心电图部分基础理论不理解(154/248，62.10%)，病例分析部分不知道如何运用所学的理论知识进行分析(137/248，55.24%)以及遗漏病例信息(133/248，53.63%)。教学改良建议包括实验诊断学部分增加课堂(152/248，61.29%)及课后(171/248，68.95%)练习，病史采集部分增加课堂模拟练习(187/248，75.40%)，心电图部分课前讲解基础知识(135/248，54.44%)以及课后提供读图讲解视频(144/248，58.06%)，病例分析部分增加以学生为主体的课堂练习(163/248，65.73%)。所有调研结果在男生与女生之间差异无统计学意义(均P>0.05)。

诊断学不同章节实习教学效果的影响因素不同，多元整合式教学系统可充分利用各种教学方法的优势，有望提高诊断学实习教学质量和效果。

To explore the main factors affecting the teaching effect of diagnostics practice and the feasible improvement methods.

A total of 277 undergraduate clinical medicine students in grade 2018 who were practicing in diagnostics in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January to December 2020 were selected to investigate the practice difficulties and teaching improvement requirements.

A total of 248 valid questionnaires were obtained. The main reasons that influence the practice effect were as follows: theoretical content of experimental diagnostics was hard to be remembered (170/248, 68.55%); students did not know how to communicate with patients (146/248, 58.87%) and what kind of questions should be included (130/248, 52.42%) in medical history collection section; basic theory of electrocardiogram was hard to understand (154/248, 62.10%); having no idea of how to use the theoretical knowledge learned to do the case analysis (137/248, 55.24%) and missing important information while doing the exercises (133/248, 53.63%) in case analysis. Suggestions for teaching improvement were as follows: in-class (152/248, 61.29%) and after-class (171/248, 68.95%) exercises were expected to add in the part of experimental diagnostics, in-class simulation exercises were expected to add (187/248, 75.40%) in the part of medical history collection, basic knowledge was expected to explain before class (135/248, 54.44%) and providing after-class video of electrocardiogram reading explanation (144/248, 58.06%) in the part of electrocardiogram, student-centered case analysis exercises was expected to add in class (163/248, 65.73%) in case analysis part. There were no statistically significant differences between boys and girls in all investigation results.

Factors that influence the practice teaching effect in different chapters of diagnostics are variant. The multi-integrated teaching system can make full use of the advantages of various teaching methods and improve the teaching quality and effect of diagnostic practice.