【摘要】：目的:了解高職高專醫(yī)學(xué)影像技術(shù)專業(yè)影像診斷學(xué)臨床教學(xué)的現(xiàn)狀;探討醫(yī)學(xué)影像技術(shù)專業(yè)人才培養(yǎng)的問題,并提出應(yīng)用型人才培養(yǎng)的建議,為今后改進(jìn)高職高專醫(yī)學(xué)教育及人才培養(yǎng)提供參考。方法:連續(xù)收集臨汾某職業(yè)技術(shù)院校醫(yī)學(xué)影像技術(shù)專業(yè)2010級(jí)至2013級(jí)四屆學(xué)生為研究對(duì)象,共計(jì)430人;選取學(xué)生實(shí)習(xí)人數(shù)≥10人的13所臨床實(shí)習(xí)醫(yī)院中普通放射科、CT科室、MRI科室的一線帶教教師為研究對(duì)象,共計(jì)163人進(jìn)行問卷調(diào)查。采用文獻(xiàn)回顧法和流行病學(xué)現(xiàn)況調(diào)查法了解高職高專醫(yī)學(xué)影像技術(shù)專業(yè)醫(yī)學(xué)影像診斷學(xué)臨床教學(xué)現(xiàn)狀及人才培養(yǎng)的問題。采用SPSS 20.0統(tǒng)計(jì)分析軟件進(jìn)行統(tǒng)計(jì)分析,以P0.05判斷有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.醫(yī)學(xué)影像技術(shù)專業(yè)四屆畢業(yè)生共收回有效問卷407份,有效回收率94.65%(407/430)。年齡在21-26周歲之間,平均年齡(23.10±1.27)歲。男221人,女186人,男:女=1.19:1;四屆學(xué)生性別分布差異無(wú)統(tǒng)計(jì)學(xué)意義(X~2=0.33,P=0.995)。學(xué)生畢業(yè)后從事很相關(guān)專業(yè)(在普通放射、CT、MRI科室工作)、基本相關(guān)專業(yè)(在除外普通放射、CT、MRI科室的其他醫(yī)學(xué)科室工作)的學(xué)生370人,占90.91%,其中從事很相關(guān)專業(yè)的學(xué)生占76.66%(312/407)。89.93%(366/407)的學(xué)生在本專業(yè)上進(jìn)行了進(jìn)一步學(xué)習(xí)。2.帶教教師共回收有效問卷159份,有效回收率97.55%(159/163)。男98人,女61人,男:女=1.61:1。年齡在21-55歲之間,平均年齡(34.27±7.27)歲。帶教教師以低年資醫(yī)師為主,工作年限10年的占64.15%(102/159);學(xué)歷以大學(xué)本科為主,占57.23%(91/159);教學(xué)秘書3人,占1.89%(3/159);雙師型教師6人,占總?cè)藬?shù)的3.77%。部分醫(yī)生承擔(dān)兩個(gè)或三個(gè)影像科室的工作,工作范圍廣;多數(shù)帶教教師沒有向某一方向深入研究,科研相對(duì)滯后,甚至有15.72%(25/159)的醫(yī)師還兼職技師工作。3.臨床實(shí)習(xí)情況調(diào)查結(jié)果:(1)40.05%(163/407)學(xué)生經(jīng)常與帶教教師溝通交流;39.31%(160/407)學(xué)生積極參與病例討論;48.65%(198/407)的學(xué)生對(duì)醫(yī)學(xué)影像診斷學(xué)掌握的不好,22.60%(92/407)的學(xué)生表示沒有掌握。35.22%(56/159)帶教教師所在科室未制定統(tǒng)一教學(xué)計(jì)劃;40.88%(65/159)帶教教師在帶教前未參加教學(xué)培訓(xùn),26.42%(42/159)的教師認(rèn)為科室對(duì)實(shí)習(xí)生無(wú)入科培訓(xùn)。實(shí)習(xí)生入科培訓(xùn)中由科室人員負(fù)責(zé)的占37.74%(包括18.24%的專人負(fù)責(zé),19.50%輪流負(fù)責(zé))。10.06%(16/159)教師認(rèn)為實(shí)習(xí)生出科不需考核,即使考核45.91%(73/159)的教師憑帶教印象進(jìn)行。四屆學(xué)生在實(shí)習(xí)期間書寫診斷報(bào)告的情況有統(tǒng)計(jì)學(xué)差異(X~2=25.21,p=0.003),學(xué)生不寫、一般不寫診斷報(bào)告的人數(shù)比率逐年遞增。不寫、一般不寫的有81人(19.90%),2010級(jí)5人(8.47%),2011級(jí)17人(14.66%),2012級(jí)20人(19.80%),2013級(jí)39人(29.77%);寫的較少的有83人(20.39%),2010級(jí)9人(15.25%),2011級(jí)19人(16.38%),2012級(jí)21人(20.79%),2013級(jí)34人(25.95%)。(2)教師和學(xué)生在選擇教學(xué)模式方面差異有統(tǒng)計(jì)學(xué)意義(X~2=6.72,p=0.035)。四屆學(xué)生對(duì)教學(xué)模式的選擇差異無(wú)統(tǒng)計(jì)學(xué)意義(X~2=6.79,p=0.314)。70.44%(112/159)的帶教教師和59.71%(243/407)的實(shí)習(xí)生認(rèn)為臨床現(xiàn)行的教學(xué)模式是以傳統(tǒng)教學(xué)模式與現(xiàn)代教學(xué)模式相結(jié)合的教學(xué)模式;54.72%(87/159)的帶教教師和41.52%(169/407)的實(shí)習(xí)生認(rèn)為現(xiàn)行教學(xué)模式一般。從學(xué)生角度比較了帶教教師五種教學(xué)方法使用情況(多項(xiàng)選擇題),差異有統(tǒng)計(jì)學(xué)意義(X~2=21.12,p=0.049);進(jìn)一步對(duì)學(xué)生和教師在五種臨床教學(xué)方法的使用方面進(jìn)行比較,差異有統(tǒng)計(jì)學(xué)意義(X~2=51.85,p0.001)。4.人才培養(yǎng)問題:(1)81.82%(333/407)的學(xué)生認(rèn)為實(shí)習(xí)對(duì)培養(yǎng)學(xué)生職業(yè)能力和實(shí)踐能力的作用比較大。在診斷報(bào)告不寫、一般不寫及寫的較少的164名學(xué)生中,34.76%(57/164)的學(xué)生認(rèn)為與以后從事的技師工作無(wú)關(guān),沒有必要寫診斷報(bào)告;43.90%(72/164)的學(xué)生在書寫報(bào)告時(shí),感覺太難,無(wú)從下手;更有21.34%(35/164)的學(xué)生因?yàn)榭剖椅窗才艜鴮懺\斷報(bào)告的工作。21.87%(89/407)學(xué)生表示不愿意學(xué)習(xí);46.19%(188/407)學(xué)生認(rèn)為老師的工作量大。33.33%(53/159)教師認(rèn)為學(xué)生積極性不高,46.54%(74/159)教師認(rèn)為醫(yī)師的工作量大。79.12%(322/407)、55.28%(225/407)的學(xué)生認(rèn)為實(shí)習(xí)基地的帶教教師、實(shí)習(xí)基地條件能滿足實(shí)踐性、應(yīng)用性人才培養(yǎng)需要。52.20%(83/159)帶教教師所在科室未定期進(jìn)行教學(xué)方法討論。(2)10所三甲醫(yī)院均承擔(dān)規(guī)培任務(wù)的121位一線帶教教師中,77.69%(94/121)一線帶教教師認(rèn)為因規(guī)培生在一定程度上減少了�？茖�(shí)習(xí)生書寫診斷報(bào)告的時(shí)間。帶教教師對(duì)學(xué)生實(shí)習(xí)內(nèi)容掌握程度評(píng)價(jià)方法多樣,考量標(biāo)準(zhǔn)不一,依然屬于終結(jié)性評(píng)價(jià)。針對(duì)醫(yī)學(xué)影像診斷學(xué)掌握情況,14.99%(61/407)的學(xué)生和30.82%(49/159)的教師認(rèn)為是通過診斷報(bào)告完成情況進(jìn)行評(píng)價(jià)。(3)49.06%(78/159)的教師和37.59%(153/407)的學(xué)生認(rèn)為實(shí)習(xí)對(duì)學(xué)生自主學(xué)習(xí)、終身學(xué)習(xí)能力提高很有幫助。四屆學(xué)生在實(shí)習(xí)對(duì)其自主學(xué)習(xí)、終身學(xué)習(xí)能力提高幫助程度的選擇上差異有統(tǒng)計(jì)學(xué)意義(X~2=102.86,p0.001)。進(jìn)一步對(duì)學(xué)生和教師兩個(gè)角度的看法進(jìn)行了比較,差異有統(tǒng)計(jì)學(xué)意義(X~2=17.09,p0.001)。(4)13所醫(yī)院中只有一所醫(yī)學(xué)院附屬醫(yī)院提供學(xué)生宿舍。提供學(xué)生書寫診斷報(bào)告的8臺(tái)及以上電腦者為0,普放、ct、mri三個(gè)科室平均一個(gè)科室有1-2臺(tái),其中3所二甲醫(yī)院三個(gè)科室屬于一個(gè)大科室,只有1-2臺(tái)供學(xué)生書寫診斷報(bào)告的電腦。結(jié)論:本研究從四屆學(xué)生及帶教教師兩方面調(diào)查分析,普遍認(rèn)為臨床實(shí)習(xí)對(duì)學(xué)生自主學(xué)習(xí)、終身學(xué)習(xí)能力提高有幫助;臨床現(xiàn)行的教學(xué)模式為傳統(tǒng)教學(xué)模式與現(xiàn)代教學(xué)模式相結(jié)合的教學(xué)模式;教學(xué)方法多樣并存;但《醫(yī)學(xué)影像診斷學(xué)》實(shí)習(xí)效果不容樂觀;依然普遍存在著實(shí)習(xí)醫(yī)院基本設(shè)施不足及利用率不高、醫(yī)院對(duì)師資隊(duì)伍的培養(yǎng)及教學(xué)工作的重視度不夠的問題。并指出科室教學(xué)現(xiàn)狀及人才培養(yǎng)、師資培養(yǎng)尤其是雙師師資培養(yǎng)、入科培訓(xùn)及出科考核制度落實(shí)、帶教教師對(duì)學(xué)生實(shí)習(xí)內(nèi)容掌握程度評(píng)價(jià)方法等方面的問題,為高職高專院校醫(yī)學(xué)影像技術(shù)專業(yè)醫(yī)學(xué)影像診斷學(xué)臨床教學(xué)的改革提供依據(jù),為進(jìn)一步推進(jìn)產(chǎn)教融合、校企合作的應(yīng)用型人才和技術(shù)技能人才培養(yǎng)模式提供參考。
[Abstract]:Objective: To understand the status quo of clinical teaching of imaging diagnostics in medical imaging technology specialty in Higher Vocational colleges, to explore the problems of training medical imaging technology professionals, and to put forward suggestions for training applied talents, so as to provide reference for improving medical education and personnel training in Higher Vocational Colleges in the future. A total of 430 students from 2010 to 2013 were selected as the subjects of study, and 163 frontline teachers from general radiology department, CT department and MRI department were selected as the subjects of study in 13 clinical practice hospitals with more than 10 interns. Statistical analysis software SPSS 20.0 was used to analyze the status quo of clinical teaching and personnel training of medical imaging diagnostics in Vocational and technical colleges. The results showed that: 1. A total of 407 valid questionnaires were retrieved from the graduates of the fourth term of medical imaging technology, with an effective recovery rate of 94.65% (407/430). Age was 2. There was no significant difference in gender distribution among the four students (X~2 = 0.33, P = 0.995). After graduation, the students were engaged in very relevant majors (in general radiology, CT, MRI departments), basic related majors (in other medical departments except general radiology, CT, MRI departments). 370 students, accounting for 90.91%, of whom 76.66% (312/407) were engaged in very relevant majors and 89.93% (366/407) were further studied in this major. 2. 159 valid questionnaires were returned by the instructors, with an effective recovery rate of 97.55% (159/163). 98 males and 61 females, male: female = 1.61:1. the average age was between 21 and 55 years old (34.27). 7.27 years old. Most of the teachers were junior doctors with 10 years'working experience, accounting for 64.15% (102/159); 57.23% (91/159) had undergraduate education; 3 had teaching secretaries, accounting for 1.89% (3/159); 6 had double-qualified teachers, accounting for 3.77% of the total. Some doctors took on two or three imaging departments with a wide range of work; most of the teachers did not. The results of the investigation of clinical practice were as follows: (1) 40.05% (163/407) students often communicated with teachers; 39.31% (160/407) students actively participated in case discussions; 48.65% (198/407) students mastered medical imaging diagnostics. Unfortunately, 22.60% (92/407) of the students said that they had not mastered. 35.22% (56/159) of the teachers did not have a unified teaching plan; 40.88% (65/159) of the teachers did not participate in teaching training before teaching; 26.42% (42/159) of the teachers thought that the departments had no training for the interns. Including 18.24% of the specialists and 19.50% of the students in turn) 10.06% (16/159) of the teachers believe that interns do not need to be assessed, even if the assessment of 45.91% (73/159) of the teachers with teaching impression. The rate of non-writing increased year by year. 81 (19.90%), 5 (8.47%) in 2010, 17 (14.66%) in 2011, 20 (19.80%) in 2012, 39 (29.77%) in 2013, 83 (20.39%) in 2010, 9 (15.25%) in 2010, 19 (16.38%) in 2011, 21 (20.79%) in 2012, and 34 (25.95%) in 2013. The difference was statistically significant (X~2 = 6.72, P = 0.035). There was no significant difference in the choice of teaching mode between the fourth term students (X~2 = 6.79, P = 0.314). 70.44% (112/159) of the teaching teachers and 59.71% (243/407) of the interns thought that the current clinical teaching mode was a combination of traditional teaching mode and modern teaching mode; 54.72% (87/159) of the students. From the student's point of view, the use of the five teaching methods (multiple choice questions) was compared, and the difference was statistically significant (X~2 = 21.12, P = 0.049); furthermore, the use of the five clinical teaching methods between the students and the teachers was compared, and the difference was uniform. (1) 81.82% (333/407) of the 164 students who did not write diagnostic reports, generally did not write and write less, 34.76% (57/164) of the 164 students thought it was not necessary to work as a technician in the future. 43.90% (72/164) of the students felt too difficult to write the report, and 21.34% (35/164) of the students were reluctant to study because the Department had not arranged to write the report. 46.19% (188/407) of the students thought that the workload of the teachers was large. 33.33% (53/159) of the teachers thought that the students were not enthusiastic. 46.54% (74/159) of the teachers believed that the workload of doctors was large. 79.12% (322/407) and 55.28% (225/407) of the students believed that the conditions of practice base could meet the needs of practice and applied talents training. 52.20% (83/159) of the teachers did not discuss the teaching methods regularly in their departments. (2) Ten third-tier hospitals all undertook regular training. 77.69% (94/121) of the 121 front-line teachers in the task thought that the time of writing diagnostic reports for junior college students was reduced to a certain extent by training students according to the rules. 14.99% (61/407) of the students and 30.82% (49/159) of the teachers believed that the assessment was based on the completion of the diagnosis report. (3) 49.06% (78/159) of the teachers and 37.59% (153/407) of the students believed that the practice was very helpful to the students'autonomous learning and lifelong learning ability. There was a significant difference in the choice of the degree of help (X~2=102.86, P 0.001). Further, the differences between students and teachers were statistically significant (X~2=17.09, P 0.001). (4) Only one hospital affiliated to the medical school provided dormitories for students. Those who provided students with eight or more computers to write diagnostic reports were provided with dormitories. There are 1-2 departments in each of the three departments of CT and MRI. Three of them belong to one large department and only 1-2 computers are available for students to write diagnostic reports. The current clinical teaching mode is the combination of traditional teaching mode and modern teaching mode; the teaching method is diverse; but the effect of practice is not optimistic; there is still widespread shortage of basic facilities and low utilization rate in practice hospitals, and the training and teaching of teachers in hospitals. This paper also points out the problems of insufficient emphasis on teaching status and personnel training, teacher training, especially the dual-teacher training, the implementation of entrance training and departure examination system, and the evaluation method of teaching teachers'mastery of students' practice content, which will be helpful to the clinical practice of medical imaging diagnostics in medical imaging technology specialty of Higher Vocational colleges. The reform of teaching provides a basis for further promoting the integration of industry and education, school-enterprise cooperation in the training of applied talents and technical skills.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R-4;G712.4

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