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    您现在的位置: 论文网 >> 医药学论文 >> 医学论文 >> 针灸临床带教中的几点体会和思考论文

    针灸临床带教中的几点体会和思考

    出处:论文网
    时间:2019-09-12

    针灸临床带教中的几点体会和思考

      临床带教是将理论与实践相结合的重要环节,也是培养对中医针灸感性认识及临床思维的重要阶段。讲授法和自学是医院普遍采取的教学方法,但有一定的局限性,容易造成学习者的依赖,知识掌握不牢固。[1]针灸作为一门实践性较强的临床课程,其专业性强,穴位精准,临床操作精巧细腻,本人通过几年的临床带教,对针灸临床带教有一些体会,简单总结如下:

      一、要让学生对针灸感兴趣,对病人感兴趣

      很多教師都对学生说过这句话——“兴趣是最好的教师”,在针灸临床带教中也是一样,确实要先让学生对针灸感兴趣,才能激发他们学习针灸的积极性。那么,如何做才能让学生有兴趣呢?我认为,应该让他们看到针灸的神奇疗效,那么他们就会喜欢上针灸。在这里我举两个真实的临床案例:沈xx,男,34岁,本科室同事,爬楼梯时因用力不当突然出现左膝内侧疼痛,当时以此为病例提问规培生应该如何处理,有说冷敷的,有说扎内膝眼的。我继续问你们的处理方法有信心立竿见影吗?无人出声。我随即在他右肘关节揉按1分钟后,疼痛减轻大半,学生们都觉得不可思议,这个时候兴趣就来了,开始主动问我问题了,然后我就仔细讲解按压的部位是心门穴,最后刺一针,嘱其爬楼梯,15分钟后回诊室,疼痛消失。连续回访3天,未出现疼痛。第二个病例:沈XX,男,47岁,就诊号A2088247X,主诉:吸气时出现背部疼痛1周。予查胸部CT:右肺小结节影,考虑炎性增殖灶。因患者怕针刺,予膻中穴及对应背部痛点按压15秒,症状缓解。3天后电话回访,自按压后未再出现疼痛。当学生看到针灸有如此好的疗效,只需要一针或简单的按压就能马上缓解疼痛的时候,都开始对这个技术感兴趣。我想以后即便他们走上工作岗位,不是从事针灸专业,那么碰到这样的病人,一定会用这种办法。而后跟我学习的规培生,对针灸的学习兴趣大大提高,会主动看书,主动和我交流很多专业问题。

      二、学习与考核相结合

      考试对于学生并不陌生,从小学到大学,再到工作岗位,医学生和临床医生每年都经历大小考试若干场。但是通过近两年的临床带教我发现,现在的学生相当一部分临床学习态度不端正,能偷懒则偷懒,能聊天则聊天,并且和其他行业一样玩手机成为他们的一大顽疾。所以,考核非常必要,这是督促和监督学生的一个必要手段,也是带教质量的重要保证。当然,仅仅通过一次出科考试是远远不够的,我认为考核应该渗透到临床带教中,比如带学生针刺治疗腰痛病人,提问膀胱经的循行,或者腰阳关、肾俞这些穴位的具体定位,这是一种考核,如果这次学生回答不上来,或者回答不是很准确,我们可以给出正确定位,或者让他回去看书。但不管哪种方式,一定要告诉他下次具体时间,我还会再问这个问题。通过一对一的提问,让不愿意回答问题、惧怕回答问题这一普遍现象得到改善。再比如临床带教中,对于经络、穴位掌握比较好的学生,在我的陪同下针刺某个比较安全的穴位,如足三里、合谷等。让其慢慢感受在真实病人身上针刺的感觉,练习手法,去除恐惧心理。这也是一种考核,并且是相对全面的考核。第一考核理论,第二考核针刺手法,第三考核心理素质。这种考核的好处在于,让学生有主动复习针灸理论。因为现在多数学生眼高手低,只想跟着教师针灸,但是不愿意看书,你这个穴位回答对了,定位准了,那么就给你上手的机会去针,你回答得越多获得针刺的机会越多,等手法熟练了,就可以单独做临床。能达到这个程度,就是皆大欢喜——学生获得大量的实践机会,教师减少了工作量,能更细心地看病和带新同学。

      三、重视学生“学与思”的培养

      论语中有一句名言“学而不思则罔、思而不学则殆”,这句话指的是一味读书而不思考,就会因为不能深刻理解书本的意义,而不能合理有效地利用书本的知识,甚至会陷入迷茫。而如果一味空想而不去进行实实在在的学习和钻研,则终究一无所得。这句话告诉我们,一定要把学习和思考结合起来,才能取得较好的效果。临床带教中有一部分同学学习非常认真,手里有个小册子,每天都在背穴位的定位和主治作用,但是很多时候把这些东西应用于临床,感觉疗效并不是非常令人满意。这类同学不懂得思考,只是一味地死记硬背;褂幸徊糠滞刻於荚谙胱耪飧霾∥矣檬裁捶椒ㄖ瘟,这个方法效果不好,再换另外一种方法。这类同学只在思考方法,而不去学习理论知识,不知道应该用什么理论指导和支持他的治疗措施,也得不到好的疗效。所以,应该掌握一定的基础理论,然后在理论的指导下去临床,而在临床中又要多学习新的知识。所以,我要求针灸专业的学生,必须重视灵枢经的学习,用经典指导临床,用疗效验证经典。

      四、要重视知识的回顾

      “温故而知新,可以为师矣”。在带教过程中,要对所讲的知识反复提问和回顾,再简单不过的东西,可能有的同学还是会记不住,要避免带教中只讲一次的情况出现。更要避免因为学生回答不出教师认为非常简单的知识而发脾气。针灸科多数的病人都是颈肩腰腿痛,所以治疗中要经常反复以前讲过的内容,让学生增强记忆,然后在温故的基础上,获得新的知识,如果他们知识掌握熟练了,可以指导低一届的学生,这样可以得到更好的效果。

      五、要善于发现学生的优点

      现在经常听到不少教师在带教会中吐槽:现在的学生一届不如一届,不愿意学习,天天玩手机。但如果有这样的情绪,很可能作出对学生不管不问,任其发展的反应;蛘咛焯毂ń萄О,导致和学生的关系恶劣。其实我们可以换一个思路去解决问题,一个学生喜欢玩手机,那么可以经常让他在手机上找一些知识点,如穴位的定位,中药的性味归经等。这种处理办法,远比直接严厉批评不让玩手机会更好。同时也能让学生学到一些东西,形成习惯以后,你再让他去查找穴位,那么他会很不好意思地知道自己玩手机不对了。我们还应该看到学生中有的很尊重教师,有的很勤快,有的能吃苦,这些都是他们的优点。如果我们能发现他们的优点并指出,那么师生关系会处理得很好,并且学生的实习效果也会大大提高。

      临床带教应该是一件很快乐的事,在90后、00后的群体里,可以使自己心态年轻,接触到更多的新事物,有病人时他们多看看,我们多讲讲;有空的时候多聊聊,增进互相的了解。

    针灸临床带教中的几点体会和思考

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