Paper on unique teaching thinking of emergency medicine
1. The necessity of studying emergency medicine teaching
Since entering the 21st century, emergency medicine has As the window department of the hospital, the department is directly related to the image of the modern city and the level of medical services of the hospital where it is located. People's demand for emergency medicine is gradually increasing, and the requirements for emergency diagnosis and treatment are getting higher and higher. It is a social need to cultivate a team of health personnel who may engage in emergency medicine in the future. In view of the fact that emergency medicine is a multidisciplinary specialty, complex problems such as population aging, mental disorders, trauma and poisoning, and infectious diseases that have emerged in the process of modernization are increasingly troubling doctors, teachers, and researchers engaged in emergency medicine [2]. There is an urgent need for emergency medicine teaching to adapt to the situation and keep pace with the times. Teaching hospitals should take the initiative to become the vanguard of the normalized teaching and training mechanism for emergency medicine. Only by establishing such a mechanism can a health emergency team that combines emergency and emergency response with rapid response be formed in the affiliated hospital and radiate to surrounding areas. Emergency medicine is a clinical department with definite functional positioning, with definite disciplinary theories on life support, emergency diagnosis and treatment, doctor-patient communication, medical ethics, etc., and emergency specialist operations for supporting and monitoring various organ functions. It performs a series of medical activities from patient consultation to specialist treatment, including disease diagnosis, disease triage, critical rescue, condition observation, confirmed diagnosis and preliminary treatment. During the teaching process, the central content of disease judgment, critical rescue, disease observation, and preliminary treatment should be highlighted. Teaching subjects are required to have the ability to identify and deal with various diseases and trauma, the ability to respond to large-scale disasters, and the ability to respond to sudden infectious diseases.
2 Thoughts on the uniqueness of emergency medicine teaching
2.1 The unique diagnosis and treatment objects of emergency medicine. As an independent discipline, the emergency medicine department has many characteristics that determine its teaching to be different from traditional clinical teaching. . One of its uniqueness is its totality. The divisions of modern medicine are becoming more and more detailed, but after all, human beings are a whole. Different specialties are divided based on anatomical organs. Their research object is a single "tree", while emergency medicine is faced with a "forest". When many tree species and trees come together, new laws and new characteristics occur that go beyond the regular characteristics of a single tree species. That is to say, traditional specialist diagnosis and treatment of diseases go from organs to organs, tissues, and then to the cellular and even gene levels. Emergency medicine targets the aggregates of many organs and functions. It is necessary to explore when the functional aggregates of multiple organs are abnormal. new phenomena and patterns that occur.
2.2 The unique clinical entry point of emergency medicine. Traditional specialties are usually based on anatomical organs and focus on pathological anatomy, such as tumors, inflammation and embolism. Therefore, treatments are accordingly resection and drainage. , antibiotics, vascular recanalization. Emergency medicine is the decomposition of overall human vitality into functional components that may be related to anatomical organs or may transcend anatomy. Because simple anatomical abnormalities are not directly fatal, only functional failure will kill people. Based on the study of functions, emergency medicine has expanded a series of new clinical theories, such as the hemodynamic theory of large blood vessel intracirculation, the theory of the relationship between large blood vessel intracirculation and microcirculation, the theory of oxygen transport and tissue oxygen consumption, etc.
2.3 The unique diagnosis and treatment thinking of emergency medicine. When encountering patients in traditional specialty clinics, they usually think about whether there is a disease, the possible location and nature of the disease. As for what kind of disease? Is the severity of the condition life-threatening? Exactly the order in which emergency medicine thinks about things. Only by adopting such reverse thinking can emergency medicine be able to quickly identify the truly life-threatening parts of the ever-changing faces of emergency patients and intervene and rescue them immediately.
2.4 The urgency of emergency medicine diagnosis and treatment process Since it is a critical and serious illness that changes rapidly, if the condition can be controlled early, a better prognosis may be achieved. Therefore, in practice, emergency medicine has introduced the concept of "time window" and the implementation of target treatment within the time window. Strive to implement rapid correction of the most unstable factors within a short period of time when the body is able to compensate, achieve the goal of preserving life, and build a platform for subsequent specialist treatment.
3 Thoughts on the Current Situation of Emergency Medicine Teaching
3.1 The Teaching Objects of the Emergency Department At present, the teaching objects of the Emergency Medicine Department of teaching hospitals are mainly rotating specialists, trained residents, Intern doctors and training doctors at all levels. Their educational backgrounds, previous work or internship environments are different, and their basic theory and clinical skill levels are uneven. Although interns and some graduate students have completed basic medical courses and experienced clinical internship courses, they have a strong desire for novelty and a high enthusiasm for practice. Strong self-confidence, but lack of training in combining theory and practice; on the contrary, general practitioners and some graduate students have certain medical practical experience, but their unstandardized bad habits and relative lag in updating the medical knowledge they have learned lead to difficulties in clinical work. We are often unable to do what we want. To achieve a good homogenization effect, it is necessary to set up full-time teaching teachers, and it is also very important to formulate personalized training plans.
3.2 Resistance to emergency medicine teaching. Patients have different priorities and clinical manifestations, making diagnosis and differential diagnosis difficult. Sometimes it is even necessary to rescue first, and then try to make a clear diagnosis as appropriate. The so-called "shooting" first and "shooting later" aim".
Teachers are required not only to have a good theoretical foundation in the subject, but also to have strong clinical diagnosis, treatment and comprehensive judgment capabilities.
3.3 Teaching and Humanistic Care of Emergency Medicine Most emergency patients show fear, tension, anxiety and even obvious mental abnormalities due to the pain of the disease. The accompanying relatives and friends will also have varying degrees of irritability and even mental abnormalities. Words and deeds are out of control. In such a special teaching atmosphere, how to not only teach well but also fully infiltrate humanistic care into teaching without leaving any trace is an important step in cultivating qualified practitioners. It is particularly important to infiltrate the concept of humanistic quality education in emergency medicine into teaching [4].
3.4 Bedside teaching in the emergency department takes advantage of the teaching hospital’s rich source of disease and complex disease types, allowing students to mobilize their eyes, ears, hands, and nose to experience it personally through sight, touch, and smell. Meaningful clinical performance and gain hands-on experience beyond books. Teachers attach great importance to bedside teaching in the teaching process. They not only guide students to watch, but also guide them to operate personally and teach by words and deeds.
3.5 “Feedback” teaching in the emergency department. After initial diagnosis and stable treatment by the emergency medicine department, many patients were immediately admitted to the specialist department for further targeted diagnosis and treatment. How to confirm the initial diagnosis and treatment? To ensure accuracy and enhance the teaching effect at the same time, students need to be guided to follow up patients in the specialties where they are treated, and make continuous corrections to deepen their impressions. 3.6 Models and computers as teaching tools First aid skill training is an important part of emergency medicine teaching. The combination of theory and skills teaching cannot be neglected. However, the problems in clinical teaching of emergency medicine are becoming increasingly prominent: first, first aid skills are mostly life-saving techniques and cannot be implemented on the patient's body; second, because there are generally many cases in clinical teaching of emergency medicine For critically ill patients, there is no time and opportunity to apply them in clinical teaching; third, emergency patients are special and require life-saving treatment in the shortest possible time. In recent years, our hospital has gradually used emergency medicine clinical skills simulation training devices, such as simulated airway management technology training, first aid technology training, traumatology skills training, vascular puncture technology training and other functional units. Better provide relevant training to students at all levels, especially to consolidate the teaching of life-saving cardiopulmonary resuscitation skills and related skills.
4 Teaching Practice of Emergency Medicine in Teaching Hospitals
4.1 Guiding Ideology and Basic Ideas The interdisciplinary professional characteristics of teaching emergency medicine determine the need for timely, accurate and strong comprehensive capabilities. Professional requirements will be more prominent. It is advocated to instill in students a different perspective and a different kind of thinking, which is embodied in the following: diagnosis and treatment activities focus on critical illness, with clinical manifestations as the entry point, and pathophysiology as the main line. Taking chest pain, a common emergency symptom as an example, coronary heart disease, Pulmonary embolism, gastroesophageal reflux disease, rib fractures and panic attacks may all cause chest pain, but they are divided into five specialties: cardiology, respiratory medicine, gastroenterology, thoracic surgery and psychological medicine. If the teaching subjects are not guided from the medical history, especially Treating symptoms and signs will not only waste medical resources and increase the burden on patients, but may also delay the condition and cause serious consequences. When facing acute patients, unique reverse thinking is often required, that is, does the patient currently have life-threatening changes? What are the possible causes? Possible lesions, etc. To sum up, it means rapid differential diagnosis, rapid assessment of injury (disease), rapid intervention, and rapid support to gain opportunities for successful subsequent treatment.
4.2 Strengthen skills operation explanations and field exercises. The purpose of emergency medicine clinical skills training is to strengthen the standardization, proficiency and adaptability of their diagnosis and treatment techniques and operations. To combine theory and skills teaching, the two cannot be neglected. We mainly apply three clinical skills training models: First, people with the title of deputy chief physician or above with rich clinical experience serve as instructors for special operations and conduct centralized training. The main teaching objects are physicians who have completed the training and rotating residents; second, they follow the teaching secretary and the chief resident physician of the department and receive one-on-one operational guidance at any time, mainly for interns; third, based on the requirements of the training syllabus, training or rotating residents The number of patients, operations, and technical operations under their jurisdiction should be recorded and registered accordingly, and finally submitted to the hospital's teaching department for quantitative review. These three modes enable doctors at different levels to obtain the most intuitive, simplest and fastest skill training.
4.3 Establish a complete teaching guarantee and evaluation system. We measure the clinical theories and skills of teaching subjects through a series of examinations and assessments, and adopt differentiated consideration methods for subjects at different levels. For us, The hospital uses a standardized multi-station examination for doctors without medical qualifications, while for doctors with qualifications, the examination is conducted directly during the clinical diagnosis and treatment process. Establishing and improving the guarantee system is the key to the smooth progress of emergency medicine teaching and training [5]. For this reason, in recent years, hospitals have developed a series of systems with the core of cultivating the clinical capabilities of residents, such as: "Three Basics" Training of Resident Physicians and Assessment Methods", "Resident Physician Rotation Training Plan", "Related Provisions on the Promotion and Appointment of Resident Physicians", etc., and strive to ensure the sustainable development of emergency medicine specialty training and teaching work with both quality and quantity through systems.
5Conclusion
Emergency medicine teaching should focus on the diagnosis and treatment of acute and critical illness, and should be composed of theories, thinking and practices that are different from traditional specialties and complement each other. We will continue to study and explore the uniqueness of emergency medicine teaching, and make a contribution to cultivating a group of emergency medicine talents with good professional quality, strong skills and high humanistic quality.
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