Selected Clinical Medicine of Traditional Chinese and Western Medicine (9 articles)

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Clinical Medicine of Traditional Chinese and Western Medicine

Chapter 1: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

[Key words] Double first-class; Medical Science; colleges and universities

1. Internationalization of our teaching staff

Since 2004, Jiangxi University of Traditional Chinese Medicine (formerly Jiangxi College of Traditional Chinese Medicine) has begun to recruit foreign students from Southeast Asian countries (India, Pakistan, etc.) and Africa (Zambia, Tanzania, etc.) to study in our college traditional Chinese and western medicine clinical Medicine (MBBS with TC Masextras), which is taught in English. Up to now, with a history of 15 years, the school has cultivated more than 2500 international students from more than 40 countries. At present, the school has 1521 short-term international students in the president, which is the university with the largest number of international students in Jiangxi Province, and ranks among the top Chinese medicine universities in China.

1.1 The teaching staff lacks the concept of internationalization

Our school is a local university, and professional teachers have few exchange activities with international universities, as well as few international joint research projects, which limits the international awareness and vision of professional teachers. Professional teachers related to medical courses do not have a good understanding of the key to the internationalization of our higher education, especially the construction of high-level and distinctive world famous TCM schools, and the relationship between the internationalization of teaching staff and the construction of "double first-class universities". Most professional teachers lack the international education and teaching concept suitable for the construction of "double first-class" universities, cannot seek effective resources to promote education and teaching and clear their own goals from the perspective of globalization, pay more attention to their own teaching, and ignore the exploration of the world's academic frontier information, At the same time, nearly 90% of teachers believe that universities do not explicitly require teachers to have international knowledge and international teaching ability. Due to family, treatment, system support and other reasons, professional teachers are not very conscious of studying abroad or international academic exchanges. Every year, only about 10 teachers apply for studying abroad or participate in academic exchanges, accounting for about 1% of all teachers.

1.2 Teachers are not strong.

There is still a significant gap between the school's all English curriculum and teacher construction and the requirements of the school's international education development. Undergraduate education for international medical students in China involves basic medicine and clinical medicine. At present, the total number of teachers who can undertake all English teaching is insufficient. Only one teacher from the Basic Medical College can fully undertake the courses for international students. However, teachers with English teaching ability in affiliated hospitals are unwilling or unwilling to undertake the teaching of foreign students due to their busy clinical work, which further aggravates the shortage of teachers. Most of the courses can only be taught by employing foreign professional teachers and domestic teachers. The number of English teaching staff for professional courses of traditional Chinese medicine is relatively small, and they focus on acupuncture courses. Professional teachers of basic and clinical courses of traditional Chinese medicine need to be further strengthened. Influenced by these factors, the source structure, specialty structure and training level of international students are still not optimized. The teaching level of basic medicine and clinical medicine teachers in our school is not high in English, which is a severe situation faced by universities and affiliated hospitals that undertake medical undergraduate education (MBBS) for overseas students in China, in addition to the 45 medical universities recognized by the Ministry of Education. The first reason is that most teachers have no overseas study experience or lack of overseas training experience, and the vast majority of doctors introduced from foreign schools are not good at English; Second, medical English vocabulary has become a barrier for all English teachers. Medical English professional vocabulary is generally rare and very long, so it is very difficult to remember and spell. Even the teachers who are interested in English teaching are frightened by medical English words and shy away.

1.3 Teaching mode is unscientific

At present, our school still uses books, slides, classroom teaching, blackboard teaching and other traditional teaching modes in English teaching. Most foreign professional foreign teachers come from India, Pakistan and other countries. In addition to being familiar with the language of these foreign teachers, students also have a natural sense of closeness. Even if some foreign teachers have a lower level of teaching, students can tolerate it. At the same time, there is a big gap between the education and teaching level of India and Pakistan and that of teachers in China. The teachers simply taught theoretical teaching and adopted the "spoon feeding" teaching method, without considering the acceptance ability of foreign students. In addition, the learning interest of foreign students is not high and their attitude is not correct enough, so the learning effect is not very ideal.

2 Core competitiveness of international teaching staff

Princeton University has become a world-class university. The secret of its success is that it attaches great importance to the building of core competitiveness [1]. The core competitiveness of internationalized teaching staff refers to the most important, critical and essential competitiveness that can keep the whole teacher in a long-term stable competitive advantage. Personally, I think there are three aspects. One is the ability to use the international language, that is, the ability to use English. It is the core of the core competitiveness and should include three elements, namely, foreign exchange, language expression and professional English teaching ability. Foreign communication is to use English skillfully and confidently for daily communication. Language expression requires English thinking, accurate vocabulary and sentences to express accurately. Professional English teaching ability is to expand professional vocabulary and terminology through various methods, and apply them to English teaching to improve the accuracy of pronunciation and intonation, Ensure the accuracy and professionalism of professional knowledge teaching in the English teaching process; The second is intercultural communication ability, which includes two elements. One is international etiquette. Be familiar with and abide by international etiquette, and respect the customs and cultural differences of the countries where foreign students live within the legal scope. Second, culture is imperceptibly influenced. Adhere to cultural self-confidence, focus on both nationalization and internationalization, spread culture while imparting medical knowledge and skills, gain recognition and praise from overseas students with excellent Chinese culture, and infect each other and the world with culture; The third is the comprehensive quality, which includes two elements. The first is the quality of literary and sports, teaching medical knowledge. In addition to professional knowledge, we should strengthen communication and exchange with foreign students through various forms of cultural and recreational activities. In the rich and colorful cultural and sports activities, we should spread Chinese culture and build the international image of the school. This requires teaching teachers to comprehensively improve their comprehensive quality. The second is personal quality. They have the ability to master the international cutting-edge trends and development trends in their own disciplines and specialties, have the cognition and ability to tap talent resources and reasonably allocate talent around the world, and have a strong sense of innovation in teaching experience.

3. Strategies to enhance the core competitiveness of teaching teachers

3.1 Enhance international awareness and international management

Schools should change their ideas, take the initiative to seize the opportunities brought by the "double first-class" strategy to colleges and universities, and take the initiative to incorporate the internationalization of education into the strategic level of the school. According to its own characteristics and advantages, actively carry out international exchanges, connect with international famous schools, establish an international management concept, promote the management system reform of school student management, teacher management, curriculum management, etc., and build an overall international school running mechanism, so that international school running is not only in concept, but also in action. Accelerating the internationalized training of the teaching staff is an essential link in the construction of the internationalized teaching staff. The school [2] should, on the basis of formulating a scientific plan for the construction of the internationalized teaching staff, make efforts to improve the internationalized level of the construction of the teaching staff through the reform measures of "bringing in" and "going out" in a planned and step-by-step manner [3]. First, take various economic incentives to support teachers to go abroad. The school should actively strive for various national and provincial funding projects, such as the overseas study projects of the International Student Fund Committee, local cooperation projects, etc., to send excellent teachers to study teaching methods and improve the English level abroad in a planned way; Establish an academic leave system, and grant qualified professional teachers a certain amount of funds with double first-class funds to go abroad and study abroad to improve their English expression ability and cross-cultural communication ability. Second, give full play to the guiding role of school policies and encourage teaching teachers to study abroad. The school can put forward requirements for teachers in terms of internationalization in the employment of teachers and professional and technical posts; When formulating work tasks, teachers are required to publish a certain number of academic papers in international academic journals. The content of papers focuses on modern higher education in terms of talent training, teaching mode, teaching methods, knowledge structure, etc., so as to urge teachers to pay attention to the international academic frontier of education, and strengthen academic exchanges and educational cooperation between teachers and international universities.

3.2 Assessment of innovative teaching faculty

At present, there are three mainstream institutions of university subject ranking in the world. Since 2010, THE has not set up a separate evaluation indicator for "teaching staff", but has set up secondary indicators such as "number of international teachers/number of domestic teachers" in the "internationalization" indicator to evaluate the "teaching staff". QS did not evaluate the teaching staff in the "internationalization" indicator, but only inspected the teaching staff from the peer reputation and academic aspects. U. S. News not only inspects the peer reputation and academic achievements of teachers, but also pays attention to the international cooperation of teachers. Therefore, the assessment criteria for teaching type teachers should focus on the characteristics, scientificity and diversification of assessment and evaluation indicators [4]. In the assessment process, "international" evaluation elements should be injected, which can collect information about the overseas experience, discipline direction, academic achievements, academic titles, academic part-time jobs, international influence and other information of teaching teachers. The evaluation of teaching content should examine whether it is in line with international cutting-edge knowledge, whether it includes the latest international hot issues in the discipline The content of the foreign research area or the international comparative education of the discipline; The assessment of teaching methods and means should be based on whether the teachers have made good use of or quoted the excellent foreign educational resources of this course, whether they have made high-level network courseware, MOOC and multimedia courseware, and whether they have adopted or learned from the advanced teaching methods such as case, discussion, and interaction that are commonly used internationally in the education of foreign students; The assessment of the ability to use international languages should be based on the investigation of their foreign language level, international exchange experience, experience and teaching level [2], and then provide these information data to peer experts and even overseas experts for subjective assessment of development potential. This assessment not only refers to "international identity", but also pays attention to the output effect of "international titles" and "international resources". The assessment focuses on the actual level of talents, academic output and the international influence of the discipline, which helps to form a good environment for the development of teaching based teachers [5].

3.3 Teacher's mission - self-improvement and requirements of the times

The Outline of the National Medium and Long term Education Reform and Development Plan (2010-2020) clearly points out that: "In order to comply with social openness and economic development, higher education must cultivate a large number of talents who have international ideas, are familiar with international rules, and are able to have international ideas, be familiar with international rules, and be able to adapt to international competition and participate in international affairs. "Building a first-class faculty" was identified as one of the five major construction tasks in the Overall Plan for Overall Promoting the Construction of World class Universities and First class Disciplines. The plan requires colleges and universities to accelerate the training and introduction of a group of first-class scientists, discipline leaders and innovation teams that are active in the international academic frontier and meet the country's major strategic needs, so as to gather the world's outstanding talents. The diversity and internationalization of the teaching staff are the common characteristics of world-class universities [1]. The world-class faculty is an important part of world-class disciplines. At present, world-class universities attach great importance to the diversification and internationalization of the faculty. Teachers in local colleges and universities should adapt to the requirements of the times for teachers, actively change their working ideas, change from one-sided acceptance to active action, and update new work concepts. More importantly, they should actively and actively participate in the cause of the internationalization of college teachers, play their initiative in transforming themselves [4], explore new working methods, and improve their core competitiveness in many ways. First of all, teachers should improve their ability to use the international language, that is, English. Teachers should participate in IELTS, TOEFL, or PEST-5 training to comprehensively improve their English listening, speaking, reading and writing abilities. It is easier to understand and absorb the culture of other countries, and cultivate the awareness and ability to find educational resources globally. Practice has proved that "inviting in" and "going out" are important contents of the internationalization of the teaching staff of local colleges and universities, an important form of training and upgrading the teaching staff, and an effective way to cultivate teachers with international thinking, international awareness and international communication ability. Potential English based teaching teachers should make full use of various opportunities and resources to actively study, visit and give lectures abroad, which can help them understand and contact the latest academic trends of the subject and the teaching philosophy of the course, broaden their international vision, optimize the knowledge structure, and introduce foreign advanced research perspectives, methods, teaching concepts, etc. into daily education and teaching, Improve international teaching and research ability [5]. The second is to improve cross-cultural communication ability, understand multiculturalism, and master Medical specialty International status and trends in the field. Instructional teachers should actively participate in lectures or courses on intercultural communication, enhance the basic knowledge and awareness of intercultural communication, improve the level of teachers' intercultural teaching, and also communicate more with foreign teachers on campus. If conditions permit, teachers should go to universities in English speaking countries such as the United Kingdom, the United States and Canada for further studies and visits, so as to integrate them into foreign cultures, In addition to experience and practice, so as to improve the knowledge structure and teaching skills, teaching type teaching should also establish the concept of lifelong learning, read more books related to the cultivation of cross-cultural communication ability and classic English literature, and improve their cross-cultural communication theory; Instructional teachers should also actively participate in some cross-cultural communication activities, strive to improve their cross-cultural communication ability, effectively implement the specific steps and methods of teaching, master the quantity and degree of professional courses teaching, and achieve the expected teaching goals and requirements.

3.4 Using the standardized training system of doctors for reference to improve teachers' professional teaching ability [7]

In terms of improving the internationalization of the teaching staff, most colleges and universities only attach importance to the introduction of first-class talents, and one-sided think that world-class talents greatly improve the ranking of the whole school in the region and even in domestic universities, and there is a tide of colleges and universities scrambling for talents [7]. Neglecting to retrain and improve the existing teaching staff, resulting in the overall improvement of the quality of teachers in the school [4]. The standardized training of doctors began in the German medical community at the end of the 19th century. Its purpose is to focus on improving the practical ability of doctors. With the institutional change, experience accumulation and continuous innovation, the standardized training of doctors has achieved great success and is widely recognized by the medical community of various countries [8], The standardized training mode for doctors refers to that medical students carry out clinical practice in various departments under the guidance of superior doctors within a certain period of time, exercise their clinical practice ability and consolidate theoretical knowledge through small lectures, teaching rounds and other forms, so that medical students can quickly master the diagnosis and treatment technology of diseases and establish scientific clinical thinking [9]. It is a combination of rotation, learning The complex process of cultivation, improvement, service and practice. Personally, I think we can use the thinking and practice of standardized training of doctors for reference, and adopt the three-level teacher training+module training method to improve teachers' English teaching level. Primary foundation building, the collective training led by the Institute of International Education and the individual training of secondary colleges are combined; Intermediate level promotion to participate in clinical teaching or higher level English teaching skills training or the training class for English teachers studying in China sponsored by the Ministry of Education (medical) to improve professional English teaching ability; Advanced overseas training, select and participate in visiting famous overseas schools to improve English teaching ability and cross-cultural communication ability.

3.4.1 Primary foundation construction

Through interdisciplinary integration, this level of training consists of senior professional teachers, professional foreign teachers, senior English teachers and foreign language teachers with good oral English and high comprehensive English quality. The training content includes basic English and medical English education. The purpose is to help teachers learn how to communicate in English with practical significance in English teaching. The training can be led by the College of International Education. The secondary college selects professional teachers with good English proficiency and organizes collective training in combination with the separate training of the secondary college. The collective training content includes basic English, and the separate training content includes professional English vocabulary, etc.

3.4.2 Intermediate promotion

The College of International Education is mainly responsible for training, and the "standardized training for doctors" all English teaching skills improvement training project is held in the school; The content can involve teaching and training of basic medicine, clinical medicine and other subjects. The Institute of International Education will organize clinical departments, discipline groups of basic medicine, English teaching experts, professional foreign teachers and senior professional teachers with good oral English and high comprehensive English quality to form an expert group. Let professional teachers who have a certain ability to teach in English give lessons to foreign students. The expert group comments and puts forward rectification suggestions, aiming to improve their basic teaching skills of professional courses in the English context, the combination and implementation of various teaching methods, and the innovation of teaching methods, so as to improve their professional English teaching ability.

3.4.3 Advanced overseas training

Select and participate in visiting overseas famous schools to improve English teaching ability and cross-cultural communication ability. For outstanding professional teachers who have won the honorary title of "Most Popular All English Teacher" in recent three years, the Institute of International Education will organize colleges and universities in the United States, Britain, Australia, Malaysia and Hong Kong to participate in short-term all English teaching skills training and observe all English teaching medical courses.

Part 2: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

Introduction: In Chinese and Western clinical medicine, practice teaching is a very important teaching mode, which focuses on training students' clinical practice skills and solving various problems with clinical thinking. For the evaluation of clinical teaching, practical teaching is also the main measure. In the training of clinical medicine professionals of Chinese and western medicine, China is constantly making adjustments to meet the current needs of clinical medicine professionals, and attaches great importance to the training of students' clinical practice ability. The clinical practice teaching mode also needs to be constantly adjusted to meet the knowledge and skill needs of students

1、 Factors that have adverse effects on the quality of clinical practice teaching

（1） The health service model has been adjusted. The current health service model is no longer disease oriented, but around health. The original service goal of taking a single patient as the service goal has changed to focus on the patient's family. Hospitals are institutions that provide medical and health services. However, health services are based on the society. More attention is paid to prevention and health care. On the basis of encouraging disease prevention, the main goal is to improve the physical and mental health quality of all people [1]. The adjustment of the health service model will inevitably have an impact on the current clinical practice teaching.

（2） The traditional clinical practice teaching method is single. For a long time, China has adopted traditional clinical teaching for the training of clinical professionals in traditional Chinese medicine and western medicine, and has trained a large number of medical talents, which has contributed to the development of Chinese medicine. However, the teaching method based on theoretical teaching and supplemented by practical teaching has obviously lagged behind the times, and does not conform to the current diversified thinking mode of students. In particular, the lack of attention to the cultivation of students' clinical thinking and some scientific research abilities has seriously affected the quality of talent training.

2、 Reform measures of clinical practice teaching mode

（1） It is important to combine theory teaching with practice teaching in clinical practice teaching. Students should have a high acceptance ability in professional technology, and also master solid theoretical knowledge. Therefore, it needs to be emphasized that theoretical teaching combined with practical teaching should be used to train clinical medical professionals in Chinese and western medicine. In order to stimulate the students' initiative in practical teaching, heuristic teaching methods are used to introduce cases into the teaching classroom, ask students questions, and let students raise various questions in the process of thinking about problems. For the questions of students, it is not the teachers who solve the problems, but the students. After the teacher divides the students into several groups, the students can discuss and solve the problems in groups [2]. Teachers can also extend the activity of discussing medical problems to the recess by communicating with students between classes, so that students can discuss medical problems as a living habit, which is very beneficial to cultivating students' clinical practice and operation ability. Gradually, students will be able to use clinical thinking to think about problems. When students are active in the clinical medicine courses of traditional Chinese medicine and western medicine, they will consciously make a learning plan for the courses. They can preview and review before and after class. Combining the time teaching organized by teachers, the combination of theoretical teaching and practical teaching of clinical medicine is realized.

（2） Set up clinical pathway to cultivate students' clinical practice ability. In clinical treatment, clinical pathway is a comprehensive treatment mode, which requires that clinical treatment should be carried out in accordance with standard treatment procedures. The solution to treatment organization and disease problems is based on the treatment mode, and evidence-based medical evidence is used as a guide to carry out teaching. The main purpose is to standardize medical behavior. Failure to improve can improve medical quality, Moreover, the course of clinical treatment will be shortened, and the cost of treatment will also be reduced. The discussion runs through the whole clinical path. In clinical practice teaching, discussion is an important link. The clinical medical records are introduced into practice teaching, and students learn by studying and discussing medical records. As for the content of the discussion, teachers should give necessary guidance. It is better to integrate the contents of the examination of licensed doctors into the discussion, so that students' discussion can have aspects, goals and emphasis [3]. Although clinical practice teaching is designed and organized by teachers, it should be properly adjusted from the perspective of students. Students should be prepared for the problems that need to be studied and discussed, and have accumulated a certain amount of data. When teachers propose medical records, they require students to master the characteristics of medical records and solve problems through hands-on practice. Students gradually shift from passive learning to active learning, abandoning mechanical learning, but solving problems and obstacles independently through thinking is crucial to cultivating students' ability to solve clinical problems.

With this discussion teaching method, students can fully grasp the teaching content through discussion and thinking, including a series of diagnosis and treatment activities after the patient enters the hospital, temporary and long-term medical orders, nursing content and the detailed recording points of the whole course of disease, all of which should be considered from the perspective of the patient's diagnosis and treatment, helping to cultivate students' clinical dynamic thinking.

（3） Strengthen the construction of clinical teaching and training base. Clinical practice teaching needs to be carried out in the training base to create a good practice education space for students. At the same time, it can also meet the clinical practice needs of students. It not only helps to improve the teaching quality, but also can cultivate students' professional ethics. Carry out practical teaching for students in the clinical teaching training base, and the selected medical records should be consistent with the teaching content, targeted and typical. Students are guided and inspired in clinical practice. The solution to disease problems can be based on a variety of clinical manifestations and guide students to propose a variety of treatment methods [4]. In the selection of clinical diseases, priority should be given to qualitative diseases, and diseases should be treatable before functional diseases can be selected, and finally diseases that cannot be treated should be selected. In practice teaching, although it is mainly based on practical operation, it focuses on training students to solve problems with clinical thinking. Therefore, scientific research training should be carried out for students. Medical records should be treated as a scientific research problem and solved according to scientific research steps. Gradually, students' clinical thinking will be established and their scientific research ability will be improved.

Conclusion:

To sum up, in the teaching of clinical medicine of traditional Chinese medicine and western medicine, we should combine theoretical education with practical education, strengthen some clinical thinking training for students, and infiltrate humanistic education into it, so as to cultivate outstanding talents who meet the needs of professional posts, which has also played an important role in promoting the development of Chinese medicine.

reference:

[1] Liu Lijun, Pei Jingtang, Guo Congcong, et al. Practical research on early clinical contact of clinical medical students [J]. Southern Medical Education, 2013 (01): 42-43

[2] Liu Tiebin, Fu Xiaohua, Zhang Jiansong, Yang Huazhong. Reform and innovation of practical teaching mode of five-year clinical medicine [J]. Basic Medical Education, 2014, 16 (03): 191-193

Part 3: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

Integrated Chinese and Western medicine education has a history of many years, which is a unique medical education model in China. With the development of society, the demand for talents at all levels of integrated Chinese and Western medicine is increasing year by year. How to carry out integrated Chinese and Western medicine teaching, so that Chinese medicine colleges and universities can cultivate better professionals of integrated Chinese and Western medicine, is a problem faced by every Chinese medicine college. In 2003, the Premier wrote an inscription: "Implement the combination of Chinese medicine and western medicine, and develop the medicine of the motherland". It further points out the direction for promoting the development of integrated Chinese and Western medicine in China. At present, more than 30 colleges and universities of traditional Chinese medicine and comprehensive medical universities across the country have opened undergraduate programs of integrated traditional and western medicine. In 1988, our school opened the specialty of integrated traditional Chinese and western medicine, and in 2006, the College of Orthopaedics and Traumatology opened the undergraduate program of clinical orthopedics and trauma in traditional Chinese and western medicine. At present, it has a bachelor's degree and a master's degree in clinical Chinese and Western medicine. This year, it won the first level doctor's authorization for clinical Chinese and Western medicine. The first graduates are going to work. In order to understand the professional learning experience of the first graduates majoring in Sino Western bone injury during their school years, and to modify the training program for the college in the future, improve the quality of education and teaching, and master first-hand information, the author carried out this research under the support of the school's teaching reform project, which was collected and sorted out by the Thesis Alliance.

1? Objects and Methods

1.1? Research object

From May to July 2011, 121 graduates of the first session of clinical medicine of traditional Chinese and western medicine (direction of orthopedics and traumatology) were studied, including 65 women and 56 men.

1.2? Methods and contents of investigation

Survey method: questionnaire method is adopted, and specialized personnel organize all graduates to fill in the questionnaire during graduation and return to school, collect it on the spot, and conduct statistical analysis.

Survey content: basic information of graduates, evaluation of teachers in the specialty, evaluation of teaching elements in the specialty, evaluation of curriculum setting in the specialty, and overall evaluation. The evaluation criteria are good, average, and poor.

1.3? Statistical methods

Spss 10.0 statistical software was used for data analysis. All data were counting data, expressed as percentage, and p<0.05 was statistically significant.

2? result

In this graduate survey, 121 questionnaires were sent out and 121 were returned, with a recovery rate of 100%. There are 121 valid questionnaires, and the effective rate is 100%.

(1) The graduates' professional knowledge level of teachers in this major is 87.60% good and 12.40% average.

(2) 95.86% and 4.14% of the graduates think that the teaching attitude of the teachers in this major is good and average.

(3) The graduates think 81.82% of the teaching methods of teachers in this major are good, 16.53% are general, and 1.65% are relatively poor.

(4) Graduates think that 82.64% of teachers in this major are good, 12.39% are average, and 4.97% are poor.

(5) The teaching effect of graduates on teachers in this major is 81.82%, 16.53% and 1.65% respectively.

(6) 97.53% of the graduates think the teaching facilities of this major are good, 2.47% of the graduates think they are average.

(7) The graduates think that 80.99% of the teachers in this major are good, 12.39% are average, and 6.62% are poor.

(8) Graduates agree with the internship and training arrangement of this major, 79.34% think it is good, 14.87% think it is good, and 5.79% think it is bad.

(9) The graduates think that 80.99% of the courses in this major are good, 13.22% are average, and 5.79% are poor.

(10) 92.56% and 7.44% of the graduates thought that the teaching materials for this major were good and average respectively.

(11) The overall learning atmosphere of the major is 82.64% good, 10.75% average and 6.61% poor for graduates.

(12) 85.12% of graduates think the overall quality of running a school is good, 14.88% think it is average.

(13) Graduates believe that the courses that should be increased in this major are foreign language computer courses 53.71%, professional basic courses 47.10%, and practical training courses 42.15%.

(14) The courses that graduates think should be reduced in class hours are 44.63% of public humanities courses and 41.32% of professional theory courses.

(15) Graduates believe that the biggest gains are 66.94% in self-learning ability, 64.46% in psychological quality and 57.85% in professional knowledge after five years of study.

(16) Graduates believe that the ability to adapt to society is 58.68%, innovation and entrepreneurship is 56.20%, and clinical practice ability is 49.59%.

3? discuss

3.1? Evaluation of teachers

The above 1-5 are the evaluations of teachers. It can be seen that most students have a high evaluation of teachers. More than 80% of them think that teachers' professional knowledge level, teaching attitude, teaching level, teaching methods, and teaching results are good. This is consistent with the achievements of the Institute of Orthopaedics and Traumatology in strengthening the construction of teachers in recent years. At present, the Institute of Orthopaedics and Traumatology is dominated by young teachers, Most of them are doctors or doctoral students. On average, each person has more than one scientific research project at the provincial or ministerial level. At present, there are five projects under research from the National Natural Science Foundation of China. Each person mainly teaches two main courses, ranking first in the examination and evaluation of the whole school for three consecutive years. All teachers love their jobs and are dedicated. In 2011, the Basic Teaching and Research Office of Bone Injury was awarded the honorary title of May 1st Pioneer Post by Fuzhou Federation of Trade Unions. However, it is worth noting that the teaching level, teaching methods and teaching effects of some young teachers still need to be improved, which is consistent with the inspection results of experts from the school's teaching supervision group. In view of the fact that a certain proportion of students still think that teachers' teaching methods and teaching effects are relatively poor, we will strengthen the training of teachers in the future, especially young teachers, to improve the teaching level of teachers to meet the needs of students.

3.2? Evaluation of teaching elements of the major

More than 80% of the students think that teaching facilities, textbook selection, teachers, internship and training arrangements and other teaching elements are good. This is inseparable from the discipline construction of the Institute of Orthopaedics and Traumatology in recent years. In terms of hardware construction such as teaching facilities, after the construction of the new campus in recent years, the teaching conditions have been greatly improved, and the classroom laboratory facilities are advanced and perfect. In the selection of teaching materials, the Institute of Orthopaedics and Traumatology is the chief editor of teaching materials for the three main courses of orthopedics and trauma specialty; In recent years, the editor in chief has participated in compiling most textbooks for the major of bone injury, and the textbooks edited by him have won the National Excellent Book Award. The college attaches great importance to the problem of less professional training time and curriculum offered by students. At present, there are two special bone injury training rooms for students, equipped with special bone injury training equipment; At the same time, more than 20 internship hospitals, including the famous Luoyang Orthopedic Hospital and Wendeng Orthopedic Hospital, have been actively developed, and the number of internship beds has reached 3000.

Posted to the Thesis Alliance

3.3? Evaluation of professional courses

Most graduates recognize the curriculum of their major. After the adjustment of the professional training program in recent years, the curriculum of TCM and Western Orthopaedics has been continuously optimized and improved. The curriculum includes public basic courses, professional basic courses, clinical professional courses, practical training courses, and elective courses. However, some graduates still believe that the public humanities courses have too many hours and foreign language courses are too few, This may be related to the decoupling between passing CET-4 and degree awarding, the reduction of English class hours and the decline of students' English level in recent years, but there are still some requirements for students' English level when recruiting in the society.

3.4? Overall evaluation of clinical bone injury specialty of traditional Chinese and western medicine

Most students believe that the overall learning atmosphere is good and the school running quality is high, which is consistent with the boutique positioning of the Institute of Orthopaedics and Traumatology. The Institute of Orthopaedics and Traumatology is the leading unit in the teaching and scientific research of orthopedics and traumatology in the province. At the school level, there are undergraduate, undergraduate, postgraduate, master, doctor, and at the school professional direction, there are Chinese medicine orthopedics, clinical medicine orthopedics, and Chinese and western medicine clinical orthopedics [1].

Chapter 4: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

[Key words] Clinical medical education; teachers

Since the reform and opening up, people's health concepts have changed, and the requirements for medical care and health care have become increasingly high. In China, especially in the northwest, the fundamental problem is that medical education has not been able to meet the needs of the people for the continuous growth and change of medical and health services and the development of medical and health personnel after the improvement of their living standards. How to seize the opportunity and create a new situation of clinical medical education has become a problem that must be faced today.

1、 Conform to the needs of Shaanxi's economic and social development, and set up clinical medicine specialty

Speciality is a specialized field of knowledge based on disciplines and adapted to occupations. It is the basic support and specific entity of teaching and learning activities in colleges and universities [1]. The demand of society for talents is the purpose and basis of specialty setting. With the acceleration of the national medical and health system reform process, the comprehensive implementation of rural "medical reform", the continuous improvement of urban community medical and health institutions, and the improvement of people's living standards and health care requirements, the demand for clinical medical professionals has further increased. Shaanxi Province has a population of more than 37 million. According to the website of Shaanxi Provincial Department of Health, there were 9008 health institutions in the province in 2010 (excluding 26724 village clinics), 3213 licensed doctors and assistant doctors increased compared with the previous year, and 5076 doctors retired. The number of medical talents needed in our province is far more than the training capacity of medical colleges in Shaanxi Province. At the recruitment fair for medical and health talents held in our university this year, only more than 80 units need more than 450 posts related to clinical medicine, which shows that the talent demand potential of this specialty is huge. After the merger of colleges and universities across the country, the Fourth Military Medical University in Xi'an and the Medical College of Xi'an Jiaotong University (formerly Xi'an Medical University) mainly train 7-year master students in clinical medical school, and the overall number has declined significantly. Due to the above huge medical treatment and the reality of Shaanxi clinical medicine specialty training, our school began to enroll clinical medicine undergraduates in 2001 with the approval of Shaanxi Provincial Department of Education. In 2006, the former Shaanxi Medical College was promoted to an undergraduate college and renamed as Xi'an Medical College. In the same year, enrollment began. However, it is also difficult to meet the needs of Shaanxi medical and health development. See the table below for the enrollment plan of Shaanxi medical colleges in Shaanxi clinical medicine specialty (undergraduate) in recent five years.

2、 Meet the teaching conditions of clinical medicine specialty

Shaanxi Province is located in the northwest region, and its natural conditions, transportation, economy and information development are relatively backward compared with the southeast coastal areas. However, Shaanxi Province has always attached importance to medical care and medical education. As a general college of traditional Chinese medicine which was established earlier in the country and has strong strength in the western region, our school has accumulated long-term teaching resources. Our school has a basic and professional laboratory suitable for clinical medicine, with advanced equipment and perfect equipment, which fully meets the needs of experimental teaching in this specialty. At the same time, the school continues to strengthen the construction of teaching infrastructure, constantly add and update experimental equipment, and improve experimental conditions. There are 93.33 multimedia and voice classrooms for hundreds of students, and 15.5 computers for hundreds of students.

The five experimental centers and one research room under the basic department have ultrapure water machines, ultralow temperature refrigerators, CO2 incubators, inverted microscopes, high-speed freezing centrifuges, ultraviolet spectrophotometers, microplate meters, fluorescent microscopes, gel imaging systems, semi-automatic biochemical analyzers, fluorescent quantitative PCR machines, four channel physiological recorders, eight channel physiological recorders, mouse jumping platform meters Morris water maze, microcirculation observation instrument ultraviolet spectrophotometer, pathological image analysis system, ordinary microtome, frozen microtome, digital microscope and other experimental instruments. The computer experiment center has more than 300 desktop computers with mainstream configuration and all are connected to the Internet, which meets the basic teaching needs of clinical medicine.

In order to meet the needs of practical teaching of clinical medicine, the school invested more than 5 million yuan in 2005 to build a large-scale and technologically advanced "clinical simulation training center" and "digital interactive microscope room", in which the "clinical simulation training center" integrates clinical skills such as internal science, surgery, obstetrics and gynecology, and has a central control room and multi-function hall. The training center is open to all grades of clinical medicine students all day long, aiming to cultivate students' clinical practice skills and practical ability through clinical simulation skills training. The school has 2 directly affiliated hospitals and 9 non directly affiliated teaching hospitals that can be used for internships and internships of clinical medicine majors. In order to adapt to the modern information characteristics of clinical medicine specialty, the university has increased investment and built a special website for the specialty, greatly improving the role of modern information resources in clinical medicine specialty teaching. The full utilization of teaching conditions is the material basis for the establishment of clinical medicine specialty.

3、 Strengthen the construction of teaching staff

The school improves young teachers' pedagogical and Putonghua abilities through pre job training; Establish an incentive mechanism for teaching work and implement the talent training project; Encourage young outstanding teachers to stand out and give play to the role of senior teachers as mentors and middle-aged teachers as backbone; Discuss the educational evaluation and supervision system, carry out teaching quality evaluation and research, and improve teaching level; We will introduce highly educated and high-level academic talents to work in the university. After nearly 50 years of efforts, the school has built a team of teachers with sufficient quantity, reasonable structure, combination of full-time and part-time, high academic level, rich teaching experience, strong professionalism and dedication.

There are 87 full-time teachers in the Basic Courses Department (including 18 professors, 36 associate professors, 24 lecturers and 9 teaching assistants); 14 experimental technicians (including 3 senior experimenters, 9 experimenters and 2 assistant experimenters); There are 28 doctors, 34 masters and 25 bachelors; There are 22 master supervisors and 4 doctoral supervisors. 30% of clinical medical teachers have a deputy senior professional title or above, 30% have a doctorate degree, and have teaching and research departments of internal medicine, surgery, obstetrics and gynecology, pediatrics, and five sense sciences. Discipline leaders, expert professors, doctoral students, etc. serve as the school leader and director of the teaching and research department. The professional title structure, educational background structure, age structure and academic background structure of the teaching staff are relatively reasonable, and the development trend is good. The lecturers of basic theory and professional courses are all senior experts and professors who have been engaged in teaching and clinical front-line work for many years.

4、 Good and clear talent training mode

Zhou Yuanqing, Vice Minister of the Ministry of Education, once said: "Education is the central work of medical colleges and universities, and improving teaching quality is an eternal theme". The factors restricting the quality of education are hardware and software. The person most closely related to the education quality software, apart from teachers, is nothing more than the talent training model. Although our school is a college of traditional Chinese medicine, the talent training mode of clinical medicine has completely followed the nature and characteristics of the specialty from the beginning. The talent training mode meets the "minimum basic requirements for medical education [2]" and the social demand for clinical medical talents.

（1） Training objectives of clinical medicine

Overall training objective: to train applied senior professionals with solid basic theories, skilled basic skills, high comprehensive quality and innovative spirit who are needed for economic construction and social development in the 21st century. Business training objective: to train applied medical professionals with solid basic theories, basic knowledge and basic skills, high comprehensive quality and innovative spirit. Clinician who can be engaged in medical treatment and health care prevention in medical and health units and has certain innovative thinking ability.

In recent years, the society has an outstanding demand for high-level clinical medical professionals. As can be seen from the recruitment fair for medical and health talents, more than 80% of the units require graduate education. Therefore, in the training process of clinical medical students in our school, we put forward two more specific training goals: one is to improve the rate of students' passing the postgraduate entrance examination, and the other is to improve the one-time pass rate of licensed doctors' examinations. Under the guidance and encouragement of these two goals, the leaders and teachers of the clinical medical school have made great efforts in the development of talent training programs, curriculum and student management. The graduate entrance examination online rate of students has increased year by year. This year, the graduate entrance examination online rate of 2006 students has reached 67%, and has achieved gratifying results. More than 80% of graduates have passed the medical examination once. The achievements have proved that this is the right direction.

（2） Teaching content and curriculum system

The school carries out the reform of teaching content and curriculum system according to the model of clinical medical professionals needed for social development in the 21st century. Starting from the training goal of clinical medical professionals, the school updates teaching content, optimizes curriculum system, strengthens practical teaching, realizes the rolling development of theory and practice, and jointly improves quality and ability, Build a curriculum system that can reflect the characteristics of contemporary scientific development.

1. In line with the principle of thick foundation, wide caliber, early convergence and later differentiation, we will revise the talent training plan in a timely and comprehensive manner.

2. The macro structure of the curriculum should be consistent with the intelligence structure of future medical talents, and develop into a multi-dimensional structure of morality, intelligence, physique and beauty.

3. Strengthen the cultivation of humanistic quality of medical students, and strengthen the humanities and social sciences courses and the cross integration of medical science and humanities and social sciences courses.

4. In order to cultivate students' learning ability, it is necessary to strengthen the courses of methodology, open elective courses and technical courses such as medical learning skills, clinical skills training, scientific research thinking training, evidence-based medicine, etc. Computers and foreign languages must be attached great importance.

5. The reform of teaching content is the core of improving the quality of talent training mode. It is necessary to select teaching content on the basis of clarifying the knowledge structure and ability structure of courses at all levels, and mobilize teachers to carry out reform experiments on the course content in an organized and planned way, as well as establish special topics, special reform projects and funds.

6. Break the traditional medical teaching block structure based on general foundation, medical foundation and clinical medicine, establish a new curriculum system, design comprehensive courses, and even change clinical theory courses into clinical lectures, so as to integrate internships and internships [3].

The clinical medicine specialty of our school has been awarded the "Provincial Famous Brand Specialty" by Shaanxi Provincial People's Government in 2006 after several years of efforts since its enrollment in 2001, among which obstetrics and gynecology was awarded the provincial excellent course in 2007. In 2010, our school successfully applied for a master's degree program in clinical medicine and will start enrollment in 2012.

The 21st century is an era of accelerated global economic and social development, and also an important stage for the national economic development focus to shift to the central and western regions. Clinical medical education is facing rare opportunities and severe challenges [4]. In the Decision of the Central Committee of the Communist Party of China and the State Council on Health Reform and Development, it is clearly stated that "we should run medical education well, cultivate a professional health team that meets the needs of society, has reasonable institutions, and has both ability and integrity, deepen the reform of higher medical education, improve the quality of education and school running efficiency, and improve the graduate training and degree system as well as the continuing education system. The training of clinicians should not only focus on basic theory, but also on clinical comprehensive skills, accelerate the development of general medicine, and train general practitioners. " Driven by the strong influence of the Decision, our school should further increase the investment in health and medical education, reasonably adjust the professional structure, constantly improve the living and working conditions of teachers, constantly deepen the reform of medical education, and take practical and effective measures through a variety of ways while paying attention to cultivating cross century high-level outstanding medical talents and promoting scientific and technological progress, Cultivate high-quality medical backbone talents for the health cause.

reference:

[1] Xue Tianxiang. Higher Education [M]. Guangxi Normal University Press, 2001, 75-79

[2] International Association of Medical Education. Global Minimum Basic Requirements for Medical Education [J]. Foreign Medicine. Medical Education Volume, 2002, 23 (2): 1-5

[3] Cao Zhiqiang. Facing the Future, Accelerating the Reform of Clinical Medical Education [J]. Health Vocational Education, 2004, 5 (1): 8-9

Chapter 5: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

As an important part of medical teaching, clinical practice teaching plays an important role in cultivating the comprehensive quality of medical students. Obstetrics and Gynecology is the main course in clinical teaching and a subject with strong practicality. The clinical practice of Obstetrics and Gynecology is one of the most important links in medical college education. In 2002, our hospital officially established the clinical specialty of integrated traditional and western medicine, which belongs to the specialty of integrated traditional and western medicine in western medical colleges. Compared with traditional Chinese medicine colleges, the conditions for running the department of traditional Chinese medicine in western medical colleges are very different. Since 2006, the author has undertaken the clinical teaching of gynecology and obstetrics course of integrated traditional Chinese and western medicine. He has carried out exploration and practice in all stages of clinical teaching at the same time, and has made some achievements, but also encountered many problems. The author makes some explorations and assumptions on how to carry out teaching reform under the current situation based on the practical experience of clinical teaching of gynecology and obstetrics of integrated traditional Chinese and western medicine in the past one year.

1 Current problems

1.1 The training objectives are vague about their own positioning

The undergraduate level of integrated Chinese and Western medicine education should focus on the basic education of the two medical systems of Chinese and Western medicine, with the goal of cultivating talents who are suitable for integrated Chinese and Western medicine. The author believes that students in this major should be different from students in traditional Chinese medicine and clinical medicine, and their knowledge structure should have the following characteristics: ① they have profound knowledge of traditional Chinese medicine and western medicine, and their professional "basic theory, basic knowledge and basic skills" are solid; ② Be able to use the knowledge of Chinese and Western medicine systems to solve clinical medical problems; ③ He has a wide range of knowledge of related disciplines, and has extensive knowledge of marginal disciplines and cross disciplines; ④ Creative use of subject knowledge. However, in the actual teaching, students have a lot of misconceptions. They generally believe that it is difficult for them to find a job after graduation. They are not in the middle or west. They are useless. Their basic skills in western medicine are not solid. They do not pay enough attention from the depth of their minds and do not really understand the essence of the integration of traditional and western medicine. This idea and bad mood of students are directly related to the current teaching concepts and methods.

1.2 Teaching means are lagging behind

Obstetrics and Gynecology, a major course of integrated traditional Chinese and western medicine, is a major course of traditional Chinese and western medicine, but it has more content, less class hours, and insufficient perceptual knowledge for students. In addition, audio-visual teaching methods characterized by projection, slide, video, recording, television and other media use make theoretical teaching more vivid, intuitive, and vivid, improving the teaching quality to a certain extent, but still have "indoctrination" The suspicion. How to better train talents with comprehensive basic theories and basic skills of Chinese and Western medicine and improve the quality of clinical teaching is a key link.

1.3 Lack of clinical base

There is no affiliated hospital of traditional Chinese medicine in western medicine colleges and universities. Only the department of traditional Chinese medicine in the affiliated hospital of western medicine can undertake the clinical teaching practice of traditional Chinese medicine. The ability is limited, and the probation teachers in provincial and municipal hospitals of traditional Chinese medicine lack the sense of responsibility. In addition, probation in obstetrics and gynecology has its particularity and disadvantages. Most interns will cause patients and their families to dislike, or even refuse. As a result, students have no chance to practice, which greatly reduces their interest in learning and brings great difficulty to teaching.

1.4 Incomplete textbook construction

At present, all levels of integrated traditional Chinese and western medicine education are in the exploration stage, and the undergraduate level of traditional Chinese and western medicine gynecology and obstetrics teaching is no exception. At present, there is no standardized teaching material to choose. Our teaching and research department selects Gynecology of Traditional Chinese Medicine for undergraduate courses in traditional Chinese medicine and Gynecology and Obstetrics for undergraduate courses in clinical medicine in western medical colleges. For students, the integration of traditional Chinese medicine and western medicine may be the addition of traditional Chinese medicine and western medicine. It is difficult to preview, listen to lectures, review after class and self-study in some parts, which is not conducive to cultivating the use of the theoretical system of traditional Chinese medicine and western medicine to think about problems, and interferes with the coherence of thinking during class.

1.5 Obsolete internship content and structure

The traditional indoctrination probation teaching is not conducive to enlightening students' thinking and improving their ability to analyze and solve problems. At present, clinical internships are mainly taught by the teaching teacher in the form of large class supplement, and then take students to the ward for bedside teaching. Most teachers take themselves as the main body to ask medical history, physical examination, introduce various test results, and then make a simple summary and discussion. Students only need to follow the teacher's ideas from beginning to end, without using their brains. This kind of passive learning mode makes students in a passive and passive state, rote learning. The students trained have high scores but low abilities, and lack clinical thinking and comprehensive analysis ability.

2 Solutions

In view of the above problems, the author believes that the reform of teaching practice in gynecology and obstetrics of integrated traditional and western medicine is imperative, and suggests optimizing the reform from the following points.

2.1 Accurate positioning of teaching objectives

Educate students through examples to correct their learning attitude, clarify their learning purpose, and realize the importance of learning gynecology and obstetrics, so as to eliminate the idea of deviating from disciplines and mobilize their subjective initiative in learning. x

[Key words] Simulation teaching; Integrated Chinese and Western medicine; Obstetrics and Gynecology

1 Current problems

1.1 The training objectives are vague about their own positioning

1.2 Teaching means are lagging behind

1.3 Lack of clinical base

There is no affiliated hospital of traditional Chinese medicine in western medical colleges and universities. Only the department of traditional Chinese medicine in the affiliated hospital of western medicine undertakes the clinical teaching practice of traditional Chinese medicine, with limited ability. And the probation teachers in provincial and municipal hospitals of traditional Chinese medicine lack the sense of responsibility. In addition, probation in obstetrics and gynecology has its particularity and disadvantages. Most interns will cause patients and their families to dislike, or even refuse. As a result, students have no chance to practice, which greatly reduces their interest in learning and brings great difficulty to teaching.

1.4 Incomplete textbook construction

1.5 Obsolete internship content and structure

2 Solutions

2.1 Accurate positioning of teaching objectives

2.2 Application of simulation teaching method

Strengthen the construction of practice equipment and optimize the design of teaching process to improve learning interest. The author believes that probation courses are interspersed with theoretical courses, the proportion of classroom teaching and probation hours is redistributed under the condition that the total class hours remain unchanged, and the probation time is reduced to save some time that may be wasted in clinical probation, which is used to increase classroom teaching time. The purpose is to use simulation teaching method to correct the defects in clinical probation, activate the classroom atmosphere, and improve students' learning interest. In the teaching process, students are the main body, and teachers can play their leading role to ensure that students are the main body in learning, consciously use the simulation scenario method in teaching, fully mobilize students' learning initiative and enthusiasm, and use the educational factors to comprehensively influence students to achieve the teaching purpose. The characteristic of simulation teaching is its goal to achieve, which is the cultivation of skill operation, that is, practical ability. This is the classic category of simulation teaching - situational teaching.

2.2.1 Use of simulated patients

When we teach gynecological examination, we can use simulated human beings to carry out gradual examination of their reproductive organs, and have intuitive understanding from both macro and micro aspects, so that everyone has the opportunity to examine, solving the teaching difficulties that cannot be practiced on real patients, and understanding some abstract concepts. When teaching cervical lesions, let the students choose cervical tissues under different lesions on a simulated human body in combination with TCM syndrome differentiation and typing, so as to lay a foundation for future clinical practice. The delivery mechanism has always been difficult for students to master, because the delivery mechanism is a dynamic process, and the whole delivery process is completed in the body, students cannot get an intuitive understanding. What the delivery room can observe is only the final stage of the delivery mechanism - fetal presentation, fetal delivery. For this problem, video and video teaching can not achieve satisfactory results. We plan to use a simulation person to explain and display each mechanical process of delivery to students. Through the model, we can understand the process of rotation and descent of the pelvic inner tube, and the mechanical process in the pelvis is the key to mastering normal and abnormal delivery. Combined with video and observation in the delivery room, we can combine theory with real delivery. For example, when the fetal head drops, what changes will happen to the bone birth canal and the soft birth canal in the pregnant woman? Why does the fetal head not descend in the same direction and posture? What is the correlation between changes in vivo and changes in different stages of labor in vitro? In this way, students' doubts can be relieved through local intuitive observation, which can help them eliminate their fear of childbirth and their rejection of obstetrics and gynecology learning, change from passive learning to active learning, and understand the interest of "brain hand" combination of learning methods.

2.2.2 Simulated medical record

Through a certain theoretical concept taught by the teacher, students can be grouped into patients and doctors. Both sides can practice the collection and analysis ability of clinical chief complaint, current medical history, past medical history, marriage and childbearing history and other medical records. The same group can participate in supplementation and debate, and finally simulate to make the best diagnosis and propose the best treatment plan. The teacher can judge the right and wrong according to the results.

3 Conclusion

"Simulated teaching" has been applied to clinical experimental teaching, which has changed the traditional rigid teaching method of "one mouth, one blackboard, one chalk and simple wall chart", allowing students to talk to and inquire about "patients" in the scene of "hospital", carry out physical examination and necessary auxiliary examination of the human body, and also treat patients according to their conditions, Compared with the traditional learning method, it allows students to contact the clinic more early, and it is intuitive and vivid, leaving a deep impression on students, and it can be learned vividly and remembered firmly, and it also solves the problem of difficult clinical probation.

Chapter 6: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

[Key words] Integrated traditional and western medicine; Acute abdomen; Discipline development

[CLC No.] R197.32 [Document Identification Code] C [Article No.] 1673-7210 (2011) 08 (b) - 114-04

The integration of traditional Chinese medicine and western medicine is a major initiative and contribution to the development of human medicine in the 20th century, and a concrete practice of implementing the basic policy of "equal emphasis on traditional Chinese medicine and western medicine and promoting the integration of traditional Chinese medicine and western medicine" in health work. Guided by the scientific outlook on development, adhere to the development direction of integrated Chinese and Western medicine, strengthen the connotation construction of integrated Chinese and Western medicine, maintain the ability of sustainable innovative development, and strive to make Nankai Hospital a modern, research-oriented, comprehensive integrated Chinese and Western medicine hospital with strong medical service ability, high scientific research and teaching level, and obvious advantages of integrated Chinese and Western medicine.

1 Current situation

1.1 Hand over the advantages of key disciplines

The clinical (surgery) of integrated traditional Chinese and western medicine is a national key discipline, a post doctoral mobile station, a doctoral degree awarding authority unit of the first level discipline of integrated traditional Chinese and western medicine, a national "211 Project" construction sub project, and a discipline construction unit of Tianjin's universities. It is a preponderant discipline group composed of the National Integrated Traditional and Western Medicine Biliary and Pancreatic Disease Medical Center, the National Integrated Traditional and Western Medicine Gastrointestinal Disease Diagnosis and Treatment Specialty, the National Integrated Traditional and Western Medicine Encephalopathy Specialty, the National Integrated Traditional and Western Medicine Emergency Specialty, Tianjin Minimally Invasive Surgery Center and Minimally Invasive Technology Promotion Center, Tianjin Integrated Traditional and Western Medicine Oncology Specialty and Tianjin Integrated Traditional and Western Medicine Surgery Critical Illness Specialty, It has become an important part of the hospital's core competitiveness. Tianjin Institute of Integrated Chinese and Western Medicine for Acute Abdomen and Tianjin Institute of Integrated Chinese and Western Medicine are well-known scientific research institutions in China.

1.2 Rapid development of medical business

The treatment of complex biliary and pancreatic, gastrointestinal diseases and surgical critical diseases with integrated traditional Chinese and western medicine is at the leading level in China, and some projects have reached the international advanced level, such as the treatment of multiple organ dysfunction syndrome caused by severe acute pancreatitis, severe cholangitis and surgical diseases with integrated traditional Chinese and western medicine has reached the international advanced level. Minimally invasive surgery ranks the leading level in China, and it is the first new technology to treat complex bile duct stones with 3-mirror combination (laparoscopy, duodenoscopy, biliary tract environment). It also undertakes medical care tasks for 800000 people in the city and consultation and business guidance for difficult cases in some provinces and cities. In 2010, the total revenue of the hospital reached 450 million yuan, an increase of 29% over 2009. The number of outpatient visits reached 370358 person times, 17539 person times were discharged, and the utilization rate of hospital beds was 120.9%.

1.3 Talent structure is becoming more reasonable

There are a group of famous experts led by academician Wu Xianzhong, professor Cui Naiqiang, professor Li Ping, professor Qin Mingfang, etc. Among them, there are 6 doctoral supervisors, 51 master's supervisors, 2 young and middle-aged experts with outstanding national contributions, 3 Tianjin awarded experts, 14 experts enjoying subsidies from the State Council, and 4 mentors designated by the State Administration of Traditional Chinese Medicine. Two experts have been selected as the first level candidates of the "Hundred Million Project" of the Ministry of Personnel. 11 scientific and technological backbones were selected as the first and second level candidates of Tianjin "131 Talent Project". Since 1994, 56 doctoral students have been trained. At present, the hospital has 1058 staff members, including 142 with senior professional titles; In the medical series, there are 135 doctors and masters, accounting for 15% of professional and technical personnel, 344 nurses, and 191 nurses with college degree or above, accounting for 56% of nurses.

1.4 Steady improvement of scientific research ability

The hospital implemented the "three famous strategy" (famous doctors, famous departments and famous hospitals), which greatly improved the scientific research ability and level. In the past four years, it has won 6 key projects from the National Natural Science Foundation, the National "Eleventh Five Year Plan" and Tianjin Science and Technology Commission, 8 ministerial science and technology progress awards, 8 new technologies to fill the gaps in Tianjin, 8 patents, 1 first prize for Tianjin science and technology progress, 4 second and third prizes, 8 monographs, 460 articles, and successfully held international 27 national and regional academic conferences. Entrusted by the Chinese Society of Integrated Traditional and Western Medicine, it undertook the Chinese Journal of Integrated Traditional and Western Medicine Surgery and served as the affiliated unit of the General Surgery Professional Committee of the National Society of Integrated Traditional and Western Medicine.

2 Problems and Analysis

Through visiting famous experts, academicians, scholars, etc. in the field of traditional Chinese medicine, a symposium was held to focus on the theme of new hospital construction, learning the practical carrier of the scientific concept of development, and finding problems in hospital development. Collect the relevant data of the first batch of key integrated traditional Chinese and western medicine hospitals under the State Administration of Traditional Chinese Medicine, and refer to the relevant literature and documents, At the same time, by comparing the construction of 10 key integrated traditional Chinese and western medicine hospitals under the State Administration of Traditional Chinese Medicine except Nankai Hospital, it was found that our hospital still has some gaps in discipline construction, talent training, scientific and technological innovation, hospital management, infrastructure construction, medical level and cultural construction, and the connotation construction of integrated traditional Chinese and western medicine needs to be further strengthened.

2.1 The number of advantageous disciplines is insufficient. Discipline development is not balanced

2.1.1 Characteristic advantageous disciplines are the core of the main component of hospital competitiveness. Although our hospital has a group of advantageous disciplines led by clinical (surgery) of integrated traditional Chinese and western medicine. However, the number of key specialties above the municipal level is only close to the average level (7.4) of 10 key integrated traditional Chinese and western medicine hospitals (except 302 hospitals) in China at the time of review and acceptance, which is still a certain gap compared with Yueyang Integrated Traditional Chinese and Western Medicine Hospital affiliated to Shanghai University of Traditional Chinese Medicine and Wuhan Integrated Traditional Chinese and Western Medicine Hospital. See Table 1.

2.1.2 For comprehensive Grade III Grade A hospitals, multidisciplinary coordinated development is particularly important. Although our hospital has prominent advantages in key disciplines, its scope is relatively limited. The structure of high-level talents is single, and its ability to undertake major national projects is insufficient. The level of awarding and publishing articles needs to be improved, while other disciplines are relatively weak, which has affected the improvement of the hospital's comprehensive strength and service functions.

2.2 Inadequate innovation of education mechanism and insufficient exploration of reserve forces

The cause of integrated traditional Chinese and western medicine focuses on innovation on the basis of inheritance, and the academic echelon with reasonable structure is the key to maintain the disciplinary advantages and sustainable development.

2.2.1 Continuously innovating the talent training mechanism is one of the basic ideas for building a research hospital. Yueyang Integrated Traditional Chinese and Western Medicine Hospital affiliated to Shanghai University of Traditional Chinese Medicine has outstanding characteristics and remarkable achievements in this regard. It has not only established a reasonably structured innovation team through the talent project, but also set up seven "famous TCM studios" in Shanghai and Shanghai University of Traditional Chinese Medicine named after famous old TCM doctors, so that the inheritance and innovation of traditional Chinese medicine (TCM) can gain useful experience, It has also cultivated influential academic leaders in Shanghai and even the whole country. Wuhan Integrated Traditional Chinese and Western Medicine Hospital implements the "five major" talent training plan. The talent team of integrated traditional and western medicine has been effectively improved and optimized.

2.2 After more than 50 years of development, the combination of Chinese medicine and western medicine has become the three mainstream of medicine, keeping pace with traditional Chinese medicine and western medicine. But compared with traditional Chinese medicine and western medicine. The combination of traditional Chinese medicine and western medicine is still a new force. The lack of reserve force for integrated traditional and western medicine has become a common problem in all integrated traditional and western medicine hospitals. The problem of "lack of successors" or "lack of skills" has also been manifested in our hospital.

2.3 The incentive mechanism for scientific research is not perfect. The research and development field of traditional Chinese medicine needs to be deepened

2.3.1 Innovative scientific research is the main feature of research hospitals and an important standard to measure the development level of hospitals. Promote the development of clinical medicine with innovative scientific research. It is the biggest difference between "research hospitals" and "non research hospitals". Looking at the investment and output of our hospital in scientific research in recent years, it is much different from Wuhan Integrated Traditional Chinese and Western Medicine Hospital, 302 Hospital and other units. See Table 2.

Our research investment is less than that of Wuhan and Shanghai Yueyang Integrated Hospital of Traditional Chinese and Western Medicine, and has even declined year by year since 2004-2007. According to the 11th Five Year Plan for Health Science and Technology Development issued by the Ministry of Health of the People's Republic of China, each medical and health unit will spend no less than 1% - 3% of its annual business income on science and technology development every year. Based on our business in 2008

For example, the total income was 280 million yuan. In the same year, the independent science and technology investment of our hospital should be 2.8 million yuan. In fact, there is still a big gap in our hospital. At the same time, insufficient investment is often accompanied by imperfect incentive mechanism, which leads to insufficient motivation for talents to carry out scientific and technological innovation. See Table 3.

2.3.2 In the field of traditional Chinese medicine research and development, a group of representative Chinese patent medicine preparations that we independently developed have been widely used in clinical practice, and have achieved remarkable results. However, compared with other key integrated traditional and western medicine hospitals in China, we still need to improve the independent innovation ability of traditional Chinese medicine. Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine adheres to the development strategy of attaching equal importance to medicine. It has made outstanding achievements in the field of traditional Chinese medicine research and development. It has formed unique advantages in independent development, cooperative research, achievement transformation, high level and other aspects, has important influence in the country, and has become one of the important bases for national and provincial research and development of traditional Chinese medicine; The People's Hospital of China 302 adheres to the path of "clinical experience, scientific research preparation and clinical application", always highlights the leading position of clinical efficacy, gradually develops into a Chinese medicine research and development base with national characteristics of liver disease, and forms a professional and serial research and development pattern. The hospital preparation production has completed a good situation with complete hardware equipment, complete dosage forms and wide clinical application. In only four years, the output value of preparations reached 53 million yuan.

2.4 Digital hospital has not been realized. Management mode still lags behind

Information technology is the core technology of today's scientific and technological development, and digitalization is also an important aspect of modern management. Building a digital hospital makes it possible to collect, analyze and store large samples of information. The accuracy, integrity, efficiency and convenience of these data and information is an important guarantee for research hospitals to carry out scientific research. Yueyang Integrated Traditional Chinese and Western Medicine Hospital affiliated to Shanghai University of Traditional Chinese Medicine has formed a complete management system to improve medical quality, and has become a pilot unit of digital hospitals in Shanghai and the country. It has not been digitized yet. It has hindered our hospital from realizing comprehensive modern management and must be actively improved.

2.5 Hardware facilities are relatively backward, seriously restricting the development of the hospital

At present, the hardware facilities of our hospital are not compatible with the development of the hospital. The construction area of the hospital is about 30000 square meters. Due to the shortage of medical rooms, inconvenient transportation and other factors, it is difficult to form economies of scale. The development of the hospital is limited. Compared with other key integrated traditional and western medicine hospitals in China, the hardware conditions have lagged behind. During the construction of key integrated traditional and western medicine hospitals, most construction units have won a large amount of funds for the construction of hospital infrastructure, creating convenient conditions for the simultaneous realization of social and economic benefits. Among them, 302 Hospital, Wuhan Integrated Hospital of Traditional Chinese and Western Medicine, Shanghai Yueyang Integrated Hospital of Traditional Chinese and Western Medicine, Jiangsu Integrated Hospital of Traditional Chinese and Western Medicine, Fuzhou Integrated Hospital of Traditional Chinese and Western Medicine, etc. have raised more than 100 million yuan to expand the scale of hospitals, build or renovate outpatient and ward buildings. See Table 4. However, our hospital and Hunan University of Traditional Chinese Medicine Affiliated Hospital of Integrated Traditional and Western Medicine have not yet carried out infrastructure construction.

2.6 The medical income is low in gold and needs to further exert management efficiency

In recent years, the medical business level of our hospital has been significantly improved. However, through comparison, our hospital has a low level in terms of annual outpatient volume, bed turnover, proportion of inpatients in other cities, and cost-benefit ratio, while the proportion of drugs is high. This shows that there is still a lot of room for development in our business work, and there is also room for a substantial increase in the total income and gold content. See Table 5. However, the number of patients per employee per day, the number of inpatients per employee per day, the number of doctors per day, and the number of inpatients per physician per day are all at a low level, and the corresponding number of health technicians per bed, the number of doctors per bed, and the number of nurses per bed are all at a high level, The workload of our staff is small and the work efficiency is low.

2.7 The cultural construction is not strong. The characteristic culture needs to be vigorously promoted

Hospital culture construction is an important part of hospital software construction and plays an important role in the development of hospitals. It is the foundation and soul of hospitals. The Yueyang Hospital of Integrated Traditional and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine has formed a distinctive Yueyang hospital culture through the cultural construction project, promoted the combination of scientific spirit and humanistic spirit, and improved the quality of all staff and the taste of the hospital, which is also one of the characteristics of the unit among the key integrated traditional and western medicine hospitals. In contrast, our hospital still needs to systematically consider the formation mechanism of characteristic culture to play the role of hospital culture.

3 Countermeasures

The combination of traditional Chinese medicine and western medicine is the characteristic and advantage of Chinese medicine. As a key construction unit of integrated traditional Chinese and western medicine, Nankai Hospital will closely focus on the scientific concept of development, through the "11th Five Year Plan" system construction and development, take the reconstruction and expansion project as an opportunity, vigorously improve the infrastructure conditions, and make breakthroughs in the discipline construction and personnel training of integrated traditional Chinese and western medicine, and strive to become a leading and internationally advanced integrated traditional Chinese and western medicine teaching and research Demonstration base for the development of traditional Chinese medicine. The development goals and functional orientation of Nankai Hospital can be summarized as follows: ① National key integrated traditional Chinese and western medicine hospital demonstration hospital and TCM clinical research base; ② The main unit of Tianjin Institute of Integrated Traditional Chinese and Western Medicine; ③ Tianjin Integrated Traditional Chinese and Western Medicine Medical Center; ④ The national key discipline and the first level discipline of integrated traditional Chinese and western medicine doctor degree awarding unit - integrated traditional Chinese and western medicine clinic, has become a boutique project of key discipline construction; ⑤ Clinical College of Tianjin Medical University and Tianjin University of Traditional Chinese Medicine; ⑥ National Foreign Exchange and Cooperation Base of Traditional Chinese Medicine; ⑦ National Institute for Clinical Drug Testing.

3.1 Pay attention to the balanced development of disciplines. Comprehensively strengthen discipline construction

3.1.1 Continue to implement the "Three Top" strategy and strive to change the current situation of "junior college, department and small comprehensive". The "Three Famous Doctors" refer to famous doctors, famous departments and famous hospitals. Among them, famous hospitals are the goal, famous doctors are the foundation and famous departments are the key. Discipline construction is an important measure for the development of integrated Chinese and western medicine. It is an organizational guarantee to form an innovative team, promote career development and academic progress, and it is also the accumulation of years of struggle for a unit. We will unswervingly follow the path of integration of traditional Chinese and western medicine, focus on the construction of key disciplines (specialties), drive the comprehensive development of medicine, education and research, and become the research center of specific disciplines (specialties) in the field of integration of traditional Chinese and western medicine in China. We will continue to maintain the leading position of integrated Chinese and Western medicine surgery in the country, and at the same time make all disciplines develop in a coordinated and comprehensive way to create more advantageous disciplines.

3.1.2 With the goal of building a research hospital, consolidate the basic conditions for discipline construction. Strictly follow the construction principles of the Guiding Opinions on the Construction of Clinical Research Base of Traditional Chinese Medicine, and do a good job in discipline construction in terms of the allocation of special instruments and equipment, scientific research and personnel training. ① Build more than three national (bureau) level key disciplines of traditional Chinese medicine, and make each national (bureau) level key discipline hospital beds reach more than 300, with the bed utilization rate reaching more than 93%; Set up clinical research rooms and laboratories at key discipline construction sites, determine 3 to 5 stable research directions and meet the needs of key discipline construction. Allocate corresponding scientific research conditions and equipment according to different disciplines; ② Build more than 6 key specialties (special diseases) of integrated traditional Chinese and western medicine, ensure that each key specialty (special disease) has more than 80 beds, the utilization rate of beds is more than 93%, and the total number of key specialty (special disease) beds reaches more than 50% of the total number of hospital beds; Set up scientific research clinics and scientific research wards, of which the number of beds in scientific research wards should account for more than 25% of the number of beds in the specialty (special disease); Allocate special equipment and special laboratory equipment according to the needs of key specialty (special disease) construction; ③ To ensure that key specialties (special diseases) maintain a stable research and development direction, carry out single disease quality control, diagnosis and treatment standardization research and other work for the major diseases (at least 3) of the undergraduate program, so as to summarize treatment experience, optimize diagnosis and treatment programs, and improve clinical efficacy.

3.1.3 Promote the promotion and application of clinical research achievements, and establish the academic status of integrated traditional Chinese and western medicine. While strengthening the construction of basic conditions, we carried out research work in accordance with the key research fields of various disciplines, achieved original results, and made the diagnosis and treatment level reach the domestic or international leading level. Actively carry out clinical evaluation, optimize comprehensive plans, formulate diagnostic and treatment specifications, summarize diagnostic and treatment technologies, develop effective drugs, and develop diagnostic and treatment equipment. Moreover, we should actively promote the promotion and application of clinical research results, and promote the close integration of TCM science and technology with clinical practice and industry. The current task is to promote the clinical research achievements that have obtained considerable awards, so as to establish the academic status of the integration of traditional Chinese medicine and western medicine, and promote the transformation and in-depth development of achievements. Avoid these achievements being limited to individual units or regions, or even being shelved.

3.1.4 Strengthen the inheritance research of traditional diagnosis and treatment technology. Form the clinical characteristics and advantages of traditional Chinese medicine. In order to make the level of integrated Chinese and Western medicine diagnosis and treatment reach the domestic or international leading level, it is also necessary to actively collect, sort out and research relevant traditional diagnosis and treatment technologies within a certain range around the key direction and fields of discipline development, which has a definite effect but low cost

We will actively introduce and popularize traditional diagnosis and treatment technologies, and carry out standardized evaluation to form distinctive clinical characteristics and advantages of traditional Chinese medicine. And take advanced and feasible measures to conscientiously do a good job in inheriting, summarizing and promoting the academic ideas and clinical experience of famous Chinese medicine.

3.2 Strengthen talent team construction and talent cultivation orientation

3.2.1 Cultivate high-level talents of integrated traditional and western medicine. It is an effective way to solve the problem of "lack of successors" and "lack of skills" to cultivate high-level "Western learning Chinese" talents in a period of time. We should speed up the training of integrated traditional and western medicine talents through various ways: establish a "famous doctor studio". Every year, 1-2 doctors with development potential are selected to study in the studio. Carefully study and summarize the academic thoughts and clinical experience of famous doctors; High level "Western Learning in China", "Middle School West" training classes, graduate classes and intensive classes were held. Select young and middle-aged clinical backbone of western medicine to carry out systematic theoretical learning and clinical practice of Chinese medicine, provide mentors for guidance, select outstanding young people, and determine the mentoring system.

3.2.2 Improve the level of talent training, enhance the level of discipline talents, closely combine the characteristics of each discipline, carry out the training of discipline leaders, backup discipline leaders, and clinical research backbone, strengthen teacher training in key disciplines, receive further education of personnel, undertake continuing education tasks, and carry out clinical diagnosis and treatment technology training and achievement promotion; For key specialties (special diseases), the training of leaders, successors and technical backbones was carried out, and support was given in such aspects as going out to study, going abroad for training, receiving advanced studies in this specialty (special diseases), and undertaking continuing education in this specialty (special diseases).

3.2.3 Vigorously cultivate professional teams and provide scientific research support talents. Actively carry out all staff training, improve the scientific and technological quality of all staff, and create a good clinical research atmosphere; By undertaking subject research. Cultivate and build a reasonable and high-level professional team of TCM clinical research. Achieve a high level in the top-level design, quality control and efficacy evaluation of major clinical research projects; Cultivate a group of discipline and academic leaders who master the laws of traditional Chinese medicine, are familiar with modern scientific research methods, and can lead and organize major clinical research projects of traditional Chinese medicine. Form an elite team of TCM clinical research.

3.3 Vigorously support scientific and technological innovation and improve the construction of scientific and technological platforms

3.3.1 Work together to tackle key problems and constantly improve the hospital's research capability. At present, it is necessary to further strengthen the cooperative relationship with high-level teaching and research institutions such as Tianjin Medical University and Tianjin University of Traditional Chinese Medicine, carry out cooperation in more fields, and constantly improve the hospital's research ability. Relying on the Institute of Acute Abdomen, we strive to undertake more high-level topics and make a number of landmark achievements to drive medical treatment to a higher level.

3.3.2 Continue to increase the investment in science and technology, improve the incentive mechanism for scientific research, increase the introduction of new technologies, new equipment and technical personnel, and further improve the construction of science and technology platform. Our new strategic starting point will be the joint construction of Tianjin Institute of Integrated Traditional and Western Medicine by the Central China Council and Tianjin Municipal People's Government. To form an open sharing platform for clinical research, basic research and development and application research of integrated traditional Chinese and western medicine, which plays an exemplary role in China. It will provide support conditions for promoting the modernization of traditional Chinese medicine and building an innovative system of traditional Chinese medicine, and become an important base for international exchanges and cooperation of integrated Chinese and western medicine.

3.3.3 Improve the awareness of intellectual property protection. Strengthen the protection of intellectual property rights of traditional Chinese medicine. We should attach equal importance to medicine and improve the ability of independent innovation in traditional Chinese medicine. Learn from the experience of other national key integrated traditional Chinese and western medicine hospitals in the field of traditional Chinese medicine research and development. Gradually form a scientific, reasonable and standardized Chinese medicine R&D industry chain, and build a technological innovation platform for Chinese medicine with advanced technology and perfect functions.

3.4 Focus on infrastructure construction, emphasize hospital management, and promote medical business

Strengthen infrastructure construction and improve the medical environment for patients. At present, the hospital is building a new building with a total construction area of 86 800 m (sup) 2 (/sup). The completion of the new building will greatly expand the development space of the hospital and effectively alleviate the shortage of medical resources. We must seize the opportunity to strengthen infrastructure construction and investment, provide a strong hardware guarantee for the development of the new hospital, and create favorable conditions for the simultaneous realization of social and economic benefits.

We will strengthen economic management and ensure our ability to repay loans. Strengthen economic management, including implementing cost accounting and strengthening cost management; Establish incentive mechanism to create conditions for improving employee welfare; Strengthening the construction of internal control system; Strengthen the construction of information platform and gradually build a digital hospital.

Focus on improving the quality of all staff, and establish and improve the performance evaluation system. Establish corresponding performance evaluation system and reward and punishment measures, and put forward specific requirements for the leadership of the hospital party committee, middle-level cadres, department directors, head nurses, employees and the party, labor and league organizations.

3.5 Create characteristic hospital culture. Improve hospital cultural quality

While actively promoting the internal system reform of the hospital, we should constantly attach importance to and strengthen the construction of hospital culture, focus on trust, respect, care, cultivation and development of human potential, take the pursuit of the combination of people and equipment as the overall link, and find out the advantages, problems and gaps on the basis of comprehensive investigation and analysis of the current situation of our hospital's cultural construction, In terms of cultural construction, we should have a clear target.

Chapter 7: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

Key words: integrated traditional Chinese and western medicine nursing; "Order based" training; Practice; Effect analysis;

About the author: Yu Meng, master's degree candidate; Wang Yuling, undergraduate, chief nurse, E-mail: yuling0117@126.com ；

With the transformation of medical model and the improvement of public concern for health, a single form of nursing has been far from meeting people's needs for health. Integrated traditional Chinese and western medicine nursing increasingly shows its unique advantages, and the lack of corresponding nursing talents has become the main factor restricting its development [1]. In 2014, the Nursing Branch of the Chinese Society of Traditional Chinese Medicine conducted a survey of 137 Chinese medicine medical institutions across the country. According to the survey, only 24.71% of the nurses graduated from Chinese medicine universities accounted for the nursing team [2]. It can be seen that graduates from Western medicine universities are still the main force of nursing in Chinese medicine hospitals [3]. Although traditional Chinese medicine nursing courses have been carried out in general western hospital schools, there are many problems such as unclear training objectives, one-sided pursuit of systematic and complete theory, lack of characteristics of integrated traditional Chinese and western medicine nursing, which are contrary to the goal of cultivating skilled nursing talents in short supply in society, and inconsistent with the ideas and concepts of modern nursing discipline development [4]. Therefore, Nankai Hospital learned from the training of specialized nurses in China to meet the hospital's demand for talents in the direction of integrated traditional and western medicine nursing, further deepen the cooperation mechanism with western medical colleges, and develop an "order" talent training program for integrated traditional and western medicine nursing. The nursing students who participate in the training will accept the courses and training links set by the hospital, and will give priority to signing employment agreements after completing the school nursing professional courses. The introduction is as follows.

1 Object and method

1.1 Training objects

In 2014, Nankai Hospital and Tianjin Medical College signed an "order based" training program for integrated traditional and western medicine nursing, and selected 38 nursing students of 2013 to form an order class, including 3 boys and 35 girls, aged 20-23 (21.97 ± 0.70) years. Selection criteria: ① correct learning attitude and love of TCM nursing; ② Those who have achieved excellent results in theoretical and operational examinations in the past three semesters; ③ Scholarship or other awards from the school are preferred.

1.2 Training methods and contents

1.2.1 Building a faculty team in the hospital

The Nursing Department established a teaching committee for the order class of integrated traditional and western medicine nursing, with the director of the Nursing Department as the director of the teaching committee and three officers of the Nursing Department as deputy directors. Set up the order class teaching group, with 1 team leader and 1 deputy team leader, 3 medical experts in the direction of integrated traditional Chinese and western medicine, 1 nursing expert and 16 clinical teachers. All team members have obtained bachelor's degree, intermediate title or above, more than 5 years of clinical work experience, research direction of integrated traditional Chinese and western medicine, or have completed systematic training on knowledge and skills of traditional Chinese medicine (100 class hours). School leaders and relevant personnel of the hospital nursing department shall organize three rounds of systematic teaching method training and assessment before formal teaching to ensure the teaching quality.

1.2.2 Talent training mode

After full discussion, the employer and the school jointly formulate a teaching plan that is in line with the education of both sides. Implement the "3+1+2" training mode, that is, the first three semesters are independently trained by the school, students learn the common basic courses and professional basic courses of general nursing (including the basic courses of traditional Chinese medicine nursing), and select talents at the end of the third semester, and finally sign a written training agreement; In the fourth semester, an order class for integrated traditional Chinese and western medicine nursing will be established. The clinical courses of western medicine will be trained by the school, and the increased integrated traditional Chinese and western medicine nursing will be carried out by the employer in the hospital; In the 5th and 6th semesters, rotation internships will be arranged according to the hospital's talent needs, and employment agreements will be signed based on the best.

1.2.3 Teaching content

Teaching content is the basis and important content of constructing talent training mode. The new model mainly focuses on the main line of training clinical practical and skilled nursing talents of integrated traditional Chinese and western medicine, breaks through the boundaries of the segmented implementation of theory and practice in the previous teaching, and after the reform, the implementation of theory and practice courses is cross conducted, combining teaching with the needs of the post, focusing on highlighting the characteristics of clinical nursing specialty, and cultivating nursing talents to meet the needs of the unit. In this regard, the integrated teaching content focuses on the educational significance of clinical practice, adds integrated traditional and western medicine nursing courses based on the position, and highlights the characteristics of integrated traditional and western medicine nursing specialty. The "order based" training mode of integrated traditional and western medicine nursing is 190 class hours in total, including 60 class hours of Integrated Traditional and Western Medicine Nursing, accounting for 31.6% of the total class hours (19% for theory and 12.6% for skill training); 120 class hours of clinical probation, accounting for 63.2% of the total class hours; 10 class hours of final assessment, accounting for 5.2% of the total class hours. The skills training and clinical probation are carried by practical teaching, accounting for 65.8% of the total class hours. The rotation internship lasts for 46 weeks.

1.2.3.1 Add theoretical content of integrated traditional and western medicine nursing

In order to avoid too much repetition with the professional courses of the school, and highlight the "order type" professional training characteristics based on the combination of "teaching posts", the theoretical content adds the theoretical teaching of hospital characteristic diseases on the basis of the basic knowledge of Chinese and western medicine nursing. According to the hospital's disciplinary characteristics focusing on integrated traditional Chinese and western medicine surgery and the professional characteristics focusing on the treatment of acute abdomen, the types of diseases were screened and integrated. Surgical diseases include spleen and heart pain, gallbladder distention, epigastric pain (acute upper gastrointestinal perforation), intestinal knot disease, intestinal carbuncle, lithiasis, lumbar arthralgia, and neck arthralgia; Medical diseases include chest obstruction and heartache, heart failure, kidney wind, diabetes, epigastric pain (chronic gastritis), stroke and asthma; The gynecological and infantile diseases include dysmenorrhea, abdominal pain, infantile asthma and cough, and infantile diarrhea. Each disease type includes pathogenesis of traditional Chinese and western medicine, key points of common syndromes, clinical manifestations, auxiliary examinations, nursing evaluation, common symptoms/syndromes nursing, treatment and nursing with Chinese characteristics, health education guidance with Chinese characteristics (including living, diet guidance and emotional conditioning), nursing effect evaluation, and nursing difficulties. For details, please refer to the fifth edition of nursing textbook published by the People's Health Publishing House and the TCM nursing plan for advantageous diseases issued by the State Administration of Traditional Chinese Medicine.

1.2.3.2 Deepen practical teaching mode

(1) Skill training. Establish a standardized teaching ward according to the school standards, and carry out 20 class hours of skill training before the teaching of the hospital's characteristic disease theory. The main purpose is to clean the blind area. This part takes the "Operation Manual of Common Clinical Nursing Techniques of Traditional Chinese Medicine" [5] edited by Tianjin Society of Integrated Traditional Chinese and Western Medicine as the teaching standard, including 21 items such as acupoint application, traditional Chinese medicine fumigation, cupping, etc., and explains in detail the objectives, indications, contraindications, precautions, notification contents, operation procedures and scoring standards of each TCM nursing technique.

(2) Clinical internship. On the basis of fully considering the continuity of talent training and the integrity of the curriculum system, open teaching is carried out to let students go out of the classroom and go deep into clinical practice. The internship mode of teaching in clinical practice and strengthening in practice enables the order class nursing students to gradually master the knowledge and skills required by the post after contacting basic education and professional education.

This part has 120 class hours, mainly including 3 stages. ① Pre class cognition (32 class hours), focusing on understanding the hospital nursing culture, including the integrated traditional Chinese and western medicine nursing service mode, the development of traditional Chinese medicine nursing operations, and the characteristic traditional Chinese medicine nursing units; Nursing students are required to master the use methods, parameter settings, indications and contraindications of modern Chinese medicine nursing instruments, such as pulse diagnostic apparatus, tongue diagnostic apparatus, microwave physiotherapy apparatus, computer medium frequency drug penetration therapeutic apparatus, Chinese medicine fumigation apparatus, electrical stimulation apparatus, Chinese medicine timing meridian therapeutic apparatus, etc Bedside internship (72 class hours): complete the internship plan according to the key specialties of the hospital, and the teaching teachers of relevant departments organize 4-5 people in batches to carry out on-site observation, technical guidance and troubleshooting to improve clinical nursing skills; At this stage, nursing students are required to master 11 common Western medicine nursing operations, including: respiratory function exercise, nursing measures to promote sputum excretion, ECG monitoring technology, central venous catheter maintenance technology, gastrointestinal decompression nursing, T-tube drainage, chest closed drainage nursing, the use of blood glucose meter, the use of fluid pump, micropump, and enteral nutrition pump; There are 10 commonly used TCM nursing techniques in the hospital, including moxibustion, cupping, auricular point sticking, traditional Chinese medicine fumigation, acupoint sticking, acupoint massage, traditional Chinese medicine stomach injection, traditional Chinese medicine enema, scraping, and mud moxibustion. ③ PBL case teaching (16 class hours) was conducted in the demonstration classroom in the afternoon of the 13th to 16th weeks, with 4 to 5 people as a group. There were four clinical cases in total, which were randomly allocated to each group in duplicate. The cases were discussed in three times (once a week). The first two class hours were to consult books and discuss cases. The last two class hours were to carry out systematic summary within the group. The team leaders communicated and synthesized the problems that were not agreed or had been solved in other groups, and improved the relevant nursing problems and measures. The teacher summarized them in the 16th week.

1.2.3.3 End of class assessment

Under the guidance of experts in the hospital, we designed a theoretical knowledge test, which mainly included 30 choices and blank filling, including the basic characteristics of traditional Chinese medicine nursing, the operating points of traditional Chinese and western medicine nursing techniques, the key points of traditional Chinese medicine, the syndrome differentiation and classification of diseases and clinical manifestations, the efficacy of acupoints, and the contents of health education with traditional Chinese medicine characteristics, with a total of 60 points; TCM nursing based on syndrome differentiation and case analysis are short answer questions, with a total of 40 points.

The practical ability mainly examines the clinical application of the knowledge learned by nursing students. According to the development of the patients in this group, each group shows the integrated traditional Chinese and western medicine nursing mode in the form of scenario display and role play. Each group has 45 minutes. It is required that the items involving Chinese medicine and western medicine nursing skills should not be less than 4, with a full score of 100 points. Theory and practice each account for 50% of the total score, and above 90 points are qualified. After passing the examination, the certificate of completion of integrated traditional Chinese and western medicine nursing in the hospital will be issued.

1.2.3.4 Rotation practice

The rotation departments of order class nursing students include departments with more TCM characteristic nursing technology projects, such as TCM, hepatobiliary, gastrointestinal, and intracerebral. Each student is required to practice in the Chinese medicine physiotherapy department for 2 months and in the hepatobiliary, gastrointestinal, minimally invasive, encephalopathy, orthopaedics department for 1 month to ensure the in-depth study of key departments in the hospital. The internship duration of other departments involved in the internship program is 2 weeks. The clinical teaching teacher of the order class organizes learning and exchange every week, reports the knowledge points and operation processes that are easy to make mistakes or difficult to understand at this stage, triggers discussion among nursing students, analyzes the breakthrough points of problems, and spot checks nursing students' mastery of clinical nursing skills and theoretical knowledge of Chinese and western medicine at this stage by questioning. The teaching committee of the order class uniformly formulates the teaching plan of each department, the theoretical examination of the course is examined by the teaching committee, and the basic nursing operation and professional skill assessment are in the charge of the department. Randomly select patients and family members of nursing students from their departments every month for satisfaction survey, and obtain an average value in the form of interview or survey. If the monthly average value is not less than 95 points, it is qualified. The excellent can stay in the hospital to work.

2 Cultivation effect

The theoretical score of nursing students in the order class of integrated traditional Chinese and western medicine was (92.57 ± 6.39) points, and the professional technical operation assessment score was (95.75 ± 4.62) points. The average satisfaction of patients and their families to the work of nursing students was 99.69 points. Finally, 28 nursing students were selected to work in the hospital, accounting for 73.7% of the total class.

3 Discussion

3.1 The "order form" education model of integrated Chinese and Western medicine nursing is the exploration of a new model of TCM nursing talent training, which is conducive to the exertion of specialty advantages

The "order based" training mode is a cooperative school running mode that aims to meet the needs of hospitals for talents in short supply and special talents, according to the knowledge and ability structure of the required specialized talents, and on the premise of meeting the basic requirements of relevant majors, add the courses and training links required by the hospital, and ultimately arrange employment by the hospital [6]. The "order based" education of integrated traditional and western medicine nursing, based on the employer's national key discipline of integrated traditional and western medicine surgery and the professional characteristics of acute abdomen treatment, combs and integrates the teaching content in a targeted manner, which can effectively realize the seamless connection between talent cultivation and job demand, and reflect the practicality and professionalism of teaching integration, Finally, 28 students were selected to work in the college. This not only responds to the call of reasonably expanding the education scale of scarce professional nursing talents in the Medium - and Long term Talents Development Plan for Medicine and Health (2011-2020), but also conforms to the further promotion of college cooperation mechanism proposed during the "12th Five Year Plan" period [7]. The development strategy of "order based" training of professional nursing talents is an attempt and exploration of training TCM nursing talents in multiple ways. The trained nursing students have strong Chinese medicine nursing thinking, can skillfully master the indications and efficacy evaluation of Chinese medicine nursing techniques, and have certain clinical application ability and practical ability, which is conducive to the extensive development of Chinese medicine clinical nursing techniques; The introduction of TCM nursing programs for advantageous diseases into teaching materials can further standardize TCM nursing education and clinical nursing behavior, and promote the development of TCM nursing specialty and special diseases and the exertion of hospital's characteristic advantages with practicality, effectiveness and characteristics.

3. The "order form" training mode of integrated western medicine nursing in the second half can improve the knowledge and skill structure of nursing students and improve their comprehensive professional level

Taking a comprehensive view of the current situation of nursing education at home and abroad, the nursing knowledge and skill structure that nursing students have now can not meet the needs of hospital nursing work, so it is necessary to carry out breakthrough, targeted and upgrading skill expansion in breadth and depth [8]. The "order form" training practice of integrated traditional Chinese and western medicine nursing adopts small class training, flexible and diverse teaching methods, focuses on the supplement and training of nursing students' practical skills of Chinese and western medicine based on the employer's characteristic theoretical knowledge of specialized diseases, and guides nursing students to take nursing procedures as the guidance, propose nursing problems according to Chinese medicine dialectics and western medicine disease differentiation, and conduct syndrome differentiation and typing for nursing problems, So as to formulate nursing plan, implement and evaluate the effect, and improve the ability of integrated western medicine nursing. This is not only in line with the development trend of contemporary nursing, but also has practical significance and promotion value. Specifically, it includes: ① improving and supplementing the structure of TCM nursing knowledge and skills of nursing students to meet the needs of nursing post development in the field of medical technology; ② The training mode of combining systematic theory with practice can improve the clinical nursing thinking, health education ability and professional quality of nursing students in combination with traditional Chinese medicine and western medicine, and enable nursing students to improve their theoretical knowledge and practical skills in a short period of time. The comprehensive professional level has been greatly improved.

3.3 "Order based" training of integrated traditional and western medicine nursing can improve the quality of hospital nursing service

Research shows that only 8% of graduates of TCM colleges and universities can apply their knowledge of TCM to clinical practice [9]; Although the Western Hospital School has opened TCM nursing courses, there are many problems such as lack of prominent key features and westernization of training content [3, 10], which leads to less optimistic clinical application of TCM nursing knowledge and skills of nursing students in Western Medical Colleges [11]. The "order form" training of integrated traditional Chinese and western medicine nursing focuses on improving the comprehensive professional level and humanistic care ability of nursing students. During the internship, under the guidance of clinical teachers, nursing students can actively provide scientific, systematic and professional guidance for patients who are sick, sick or not, combining their professional knowledge, so that patients and their families can improve their satisfaction with the work of nurses. The knowledge learned by nursing students is connected with the job demand, which is systematic and targeted. It can enable nursing students to integrate into the hospital work more quickly, thus partially alleviating the problem of insufficient number of nursing staff and heavy work tasks in the hospital, and indirectly improving the quality of nursing services in the hospital [12].

3.4 Difficulties and shortcomings of the training practice

Most of the hospital's characteristic diseases are written by experts in the hospital, and the contents have certain limitations. It needs to be updated and improved constantly according to the TCM nursing plan for the dominant diseases issued by the State Administration of Traditional Chinese Medicine to further standardize clinical nursing teaching. This training mode focuses on the training of practical nursing talents, and should gradually increase the education of nursing scientific research in the follow-up education to improve their TCM nursing scientific research ability. In addition, the certificate of completion of integrated traditional and western medicine nursing in hospital issued after passing the examination has not been officially certified by the relevant national departments, and further education and training after employment should be emphasized.

Chapter 8: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

Key words: qualification examination; Internal Medicine of Western Medicine; PBL teaching;

Western medicine internal medicine is an important part of modern medical teaching activities in traditional Chinese medicine courses. At present, the teaching activities of TCM specialty in vocational colleges are three-year colleges, which involve the related contents of Western medicine internal medicine (including infectious disease), accounting for 10% of the examination of assistant doctors for practicing TCM. Therefore, the reform of teaching methods and the improvement of teaching quality can significantly improve the scoring rate of the qualification examination, which is conducive to medical students obtaining the qualification.

Internal Medicine of Western Medicine is a clinical professional course, which is one of the most basic courses that medical students of various traditional Chinese medicine majors should master. It is required to master the basic theory, basic knowledge and basic skills of internal medicine, so that they can assume appropriate clinical responsibilities when they graduate. Classroom teaching is an important link to achieve this teaching goal. It is necessary to optimize the teaching methods and contents of Western medicine internal medicine in order to improve the effectiveness of teaching activities. In this process, the teaching content needs not only the effective application of the selection of teaching cases, but also the active implementation of multimedia technology, so as to achieve the optimization and upgrading of the existing teaching methods, stimulate students' interest in participating in teaching activities, and significantly improve the effectiveness of teaching activities. When carrying out the teaching of western medicine internal medicine, the researchers combined the requirements of the comprehensive written examination for the qualification examination of licensed assistant doctors of traditional Chinese medicine and the PBL teaching method to try to reform the traditional Chinese medicine specialty in higher vocational colleges. The summary and analysis are as follows.

1. Textbook selection and outline determination

At present, the passing rate of the examination for the qualification certificate of medical practitioners has become one of the indicators to judge the quality of school education and teaching, and the executive examination is a necessary entrance examination for every doctor, so the teaching content should be properly determined according to its needs. When the outline is formulated and revised, it shall be supplemented and revised according to the contents determined by the National Examination Center. The curriculum arrangement should take into account the characteristics and requirements of the qualification examination for licensed assistant doctors of traditional Chinese medicine. As far as the teaching content is concerned, common diseases and frequently occurring diseases are the key points of teaching, which are required by clinical work in the future and also the key points of the examination for licensed doctors. However, only mastering this part of the content can not achieve the required results. As far as the setting of examination scope is concerned, it requires comprehensive coverage, involving all the contents of the examination outline, involving each disease and reasonable distribution.

The textbook of Internal Medicine of Western Medicine selected by our school was edited by Li Xiangzhong and Li Guangyuan, the second edition of China Traditional Chinese Medicine Press in May 2018. This textbook is the textbook of the "13th Five Year Plan" for higher vocational education in the national traditional Chinese medicine industry, and the textbook for the specialty of traditional Chinese medicine. The content is combined with the qualification examination of licensed assistant doctors of traditional Chinese medicine and the actual needs of PBL teaching method. The teaching content (Table 1) is selected and the teaching outline is revised.

2. Grasp the key contents in combination with the requirements of the qualification examination

Although the examination for licensed doctors covers a wide range of areas, there is no clear focus. In the process of explaining diseases, we should combine the real questions of the Western Medicine Internal Medicine Examination for the qualification of licensed doctors of traditional Chinese medicine over the years to explain various types of questions one by one, and review and summarize the key and difficult points of this course in the process of explanation. For example, in the teaching process, emphasis should be placed on the key mechanisms of the disease, such as the relationship between gastritis, gastric ulcer and helicobacter pylori infection, the gold standard for disease diagnosis, and the first choice of drugs in treatment. More importantly, personal experience is needed in the internship process to deepen the impression. For these knowledge, we should remind them again and again, and at the same time, we should also highlight them properly in the course of ordinary examinations.

3. Teaching organization and PBL teaching method

The basic characteristics of PBL are teacher oriented and student centered. Compared with traditional teaching methods, PBL teaching method has obvious advantages: from knowledge transfer to ability cultivation; From teachers' self thinking to students' group thinking; From pursuing the results of learning to focusing on the process of learning; From the "one voice" of teachers to the "group discussion platform" of students. A large number of clinical medical records are required during teaching. Before explaining a disease in each chapter, the designed medical records will be distributed to students for discussion in advance according to the PBL teaching method. The teaching process is to show the medical records that need to be discussed. The contents designed according to the clinical practice and the requirements of the qualification examination include etiology and pathogenesis, pathology, clinical manifestations, laboratory and other examinations, diagnosis and differential diagnosis, treatment and prevention. After that, emphasis will be placed on the key and difficult points of teaching and the contents that need to be mastered. During the teaching process, explanation and discussion will be conducted at the same time, Finally, the teacher gives a summary and explanation. Each class will review the key and difficult points of this class in combination with the real questions of the licensing assistant physician qualification examination over the years. After the explanation, review the medical record again and analyze the medical record to achieve the purpose of consolidation. The researchers applied PBL teaching method to the teaching of Western Medicine Internal Medicine, which is a meaningful attempt to the teaching reform of Western Medicine Internal Medicine.

4. Teaching effect

Through the organization of teaching, the questionnaire survey method was used to investigate the teaching satisfaction. 121 questionnaires were sent out, 113 were returned, and 8 were blank or incomplete. The questionnaire is generally effective. See Table 2 for the statistics of results.

5. Analysis and summary

In the questionnaire survey, the degree of promoting the mastery of basic knowledge points includes whether it is close to clinical and qualification examinations, and deepening understanding and memory; The promotion degree of clinical comprehensive analysis thinking includes whether it is conducive to improving students' independent learning ability and cultivating medical students' clinical thinking ability. The effects are described as follows:

5.1 The application of the licensed physician oriented PBL teaching method close to clinical and qualification examinations in Western Medicine Internal Medicine enables students to easily and accurately grasp the teaching focus in class, purposefully learn the theoretical knowledge of qualification examinations, actively think, and master basic knowledge, operating skills and dialectical thinking ability in the tense and interesting classroom and practical training. In this way, students can improve their learning efficiency, master the basic knowledge and skills of assessment more solidly in limited time, and be closer to the requirements of qualification examination.

5.2 Deepen understanding and memory Use the PBL teaching method. During the learning process, students can expose as many relevant problems as possible on the spot, cultivate students' ability to find, analyze and solve problems independently, and deepen their understanding of correct theories in discussions, so that students can easily remember what they have learned, and students' memory is strong.

5.3 PBL teaching mode is a student-centered teaching mode, which emphasizes the cultivation of students' self-learning ability and creative ability, so that students can gradually learn to learn and master knowledge. Using this teaching method in the teaching of Internal Medicine of Western Medicine can make students more active in learning new knowledge, fully mobilize students' enthusiasm, initiative and creativity, cultivate students' transformation of thinking mode, cultivate students' clinical thinking ability, help students think independently, integrate theory with practice, flexibly use knowledge, and improve students' learning interest.

5.4 It is conducive to cultivating the clinical thinking ability of medical students. Through the analysis and discussion of some clinical problems and medical records with students as the main body, and repeated clinical medical simulation and practice training for students, it can achieve good results in improving students' analytical ability and clinical practice ability, activating thinking, and strengthening the knowledge learned. For example, in clinical learning, teachers inspire and guide students to grasp the key points in the diagnosis of liver cirrhosis, and analyze and solve problems independently from the aspects of medical history, symptoms, clinical manifestations, and laboratory tests, rather than directly giving answers. The application of PBL teaching method in the teaching of Western Medicine Internal Medicine has strengthened the students' enthusiasm for learning, improved the teaching situation, and improved the students' practical ability, so that they can be integrated into the clinical as soon as possible, playing a good transition role from theory to clinical.

Chapter 9: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

As a local medical college, Shanxi Medical University has a certain representativeness in the talent cultivation of medical colleges and universities across the country, that is, the school not only needs to send high-level specialized talents to the country, but also serves the regional economic and social development, and trains a large number of practical medical talents for urban and rural areas. Since 2002, the university has begun to explore the reform of talent training mode of local medical colleges and universities, and has taken some measures. In 2006, after the first round of undergraduate teaching evaluation of the Ministry of Education achieved excellence, it was deeply recognized that the current medical education generally has insufficient research and practice on medical students' professional competence; Today's medicine is not short of science and technology, but of humanistic care; Only when medical technology is organically combined with medical humanities can medical science finally be achieved. In order to adapt to the international trend of medical education and systematically deepen the undergraduate talent training mode, a new round of education and teaching reform was launched in 2009, and a series of practices were carried out. The research and practice of the training model of clinical medical students' professional competence to meet the social needs is one of the key points.

2、 Reform ideas

1. Research on Competency Characteristics and Models

The cultivation of professional competence should not only have theoretical basis, but also meet the needs of regional social development; It should not only have a feature model or theoretical framework, but also have specific operability; We should not only cover all aspects, but also focus on reform. Therefore, the school adopts a step-by-step process in the process of demonstration and analysis. Its theoretical basis is Article 60 of Chinese Medical Education Standards and Global Medical Education Basic Requirements (GMER): professional value, attitude, behavior and ethics, basic knowledge of medical science, communication and communication skills, clinical skills, group health and health systems, information management, critical thinking and research. The model interprets the deep meaning contained in the text in the way of theme, infers the accurate and meaningful features from the meaningful description of representation, and establishes the competency feature model.

2. Implementation steps

Firstly, the competency characteristics are extracted according to the medical education standards, and then the theoretical framework is established; Then combined with the reality of regional social development, empirical research was carried out from the perspective of physicians to confirm the training model of medical students' professional competence. On this basis, aiming at the weak links of current clinical students' professional competence, cross integration modules are designed to form an operable professional competence training system. In the process of project implementation, we should summarize and improve at the same time.

3. Phased work

First, according to the follow-up survey results of the quality of graduates of Shanxi Medical University, the knowledge and ability structure of graduates, cultural and moral qualities, working conditions, and the opinions of employers on talent training of the school are analyzed; Second, we re analyzed the health demand survey data of four districts and one county in Shanxi Province (Yingze, Xinghualing, Jiancaoping, Wanbailin District and Loufan County, Taiyuan City) carried out earlier by the school, and understood the demand of urban and rural medical institutions for clinical medical talents and the expectations of residents for medical services [2]; Third, in view of the characteristics of regional medical services, an empirical study on the professional competence of doctors was carried out. The combination of thematic analysis and content analysis was used to sample doctors from hospitals at all levels in Shanxi Province. The study concluded that the characteristics of professional competence should include five categories: interpersonal skills, basic professional qualities, professional development capabilities, personal development capabilities, and psychological traits, Each category is interpreted [3] to support the concept of the project; Third, according to the medical education standards, combined with the competency characteristics and models, the knowledge curriculum system, ability training system and quality education system were constructed, and the focus of professional competency training was extracted from them. Through the above process, the reform idea of professional competence training has gradually become clear, and has been popularized and applied. It can be summarized as follows: take professional spirit as the guide, build a systematic quality education system, and cultivate the medical humanistic quality of clinical medical students; Take the bridge course construction as the link to improve the knowledge transformation ability of medical students; Focusing on four trainings, improve the comprehensive skills of clinical medical students. The three complement each other, rely on each other, cross integrate each other, and form a "three-dimensional diversified professional competency" training system.

3、 Reform measures and results

The cultivation of professional competence runs through the whole education. It is not only comprehensive, but also has work priorities. After several years of research and practice, it has achieved outstanding results in medical education.

1. Five measures should be taken simultaneously to deepen the cultivation of systematic quality

Today's medicine is not short of science and technology, but of humanistic care. Only when medical technology is organically combined with medical humanities can medical science finally be achieved. Only by strengthening the education and training of medical students' humanistic and social qualities can the elements of humanistic and social sciences be truly integrated into the field of medical science and technology, and this quality education needs to be carried out systematically throughout the whole process of medical education. The school has always focused on the cultivation of medical humanistic quality in the education reform. After years of accumulation, it has formed a systematic quality education system with its own characteristics. ① Carry out adaptability education for freshmen. He edited and published the first textbook Introduction to Adaptation Education for College Freshmen in China, which was put on trial in 2002 and officially used in 2003 and 2004. Compulsory courses and elective courses are combined to carry out career planning education for all staff. ② We will carry out mental health education for college students that integrates prevention, education, consultation and treatment. Set up a mental health center with a combination of full-time and part-time teams. The freshmen and sophomores focus on self growth training, the seniors and seniors focus on medical psychology and doctor-patient relationship education, the seniors and seniors focus on vocational psychological adaptation education, and cultivate psychological adjustment strategies to deal with the high-risk and high pressure profession of medicine. It has become the first demonstration center in Shanxi Province, There has been no malignant event in recent 10 years. ③ Relying on the Medical Humanities Research Center of Shanxi Medical University and the key research base of humanities and social sciences of colleges and universities in Shanxi Province, three medical humanities weeks were held. With the theme of stepping into medical humanities and re examining medicine, we set up medical humanities forum, film exhibition, painting exhibition, dialogue, essay solicitation and other sections. Most of the well-known medical humanities experts in China and many medical experts in the school were present. More than 8000 students participated, compiled 5 volumes of results, and selected more than 200 articles, which awakened medical humanistic awareness and deepened medical humanistic cognition, It has strengthened medical humanistic consciousness and promoted medical humanistic development. ④ Set up university student innovation projects. Since 2004, the evaluation has been conducted once a year. As of 2011, a total of 3.6105 million yuan has been invested, 979 projects have been established, 8117 students have participated, more than 3000 teachers have participated, more than 400 academic papers have been published, and 46 awards have been awarded. Among them, he won the silver medal of the seventh "Challenge Cup", the best achievement in Shanxi's history, which greatly mobilized students' enthusiasm for innovation, stimulated their awareness of innovation, and cultivated their innovative thinking and ability. ⑤ Carry out "green channel" guiding activities. Since 1998, clinical medical students and nursing students have been organized to go to the emergency room of the hospital for guidance since their second year. They are required to write diaries. Among them, the vivid and moving guide stories have been collected into Sincerity and Touching - Medical Students' Guide Notes, which has been officially published.

2. Build three bridges to improve the ability of knowledge transformation

After years of teaching practice, our school has built a bridge course from basic medical courses to clinical professional courses, from clinical skills to comprehensive abilities, from clinical medical students to professional doctors, forming a unique teaching theory and practical teaching methods. ① Integration of transitional courses from basic to clinical. According to the principle of "strengthening the foundation, cultivating the ability, paying attention to the quality and developing the personality", the course teaching content should be reasonably integrated. ② In the implementation process, the bridge course was constructed and, according to its characteristics, it was transformed from the cultivation of single ability to the cultivation of comprehensive ability, with the goal of cultivating the skills, humanistic care and team spirit that clinicians should have, with the cultivation of students' comprehensive practical ability and innovative ability as the foundation, and with the reform of traditional teaching models, teaching methods and teaching contents as the focus, A series of relatively complete and distinctive teaching theories and practical teaching methods of bridge courses have gradually formed. ③ According to the requirements of the curriculum, more than 60 practical/experimental projects have been opened, involving disciplines such as internal medicine, surgery, anesthesiology, imaging, emergency medicine, critical care, obstetrics and gynecology, pediatrics, otorhinolaryngology, ophthalmology, nursing, etc. It covers basic clinical skills and specialized skill laboratories, and has built an integrated practical teaching bridge course system from "theoretical guidance - simulation teaching - animal training - enhanced simulation - clinical experience". ④ A clinical training center (simulated hospital) was established to build skill training modules and carry out medical simulated education. The clinical teaching simulation hospital aims to cultivate students' clinical thinking ability and improve their clinical operation ability, integrate professional quality training, strengthen the cultivation of medical students' comprehensive ability, promote the educational concept of medical education standards, and finally enable students to gradually complete the transition from basic medical courses to clinical practice, from one-way skills to comprehensive ability, and from modular thinking to integrated innovative thinking Conversion of clinical medical students to professional doctors [5].

3. Strengthen Four Training to Improve Students' Comprehensive Skills

In 2011, Shanxi Medical University won the first prize in the second national clinical skills competition for medical college students, and it is also one of the two local medical colleges among the first prize winners; In 2012, it won the first place in North China; Later, in 2013, it won another honor and continued to win the first prize of the national championship, becoming the only local college that has participated in the national championship for three times and won the first prize of the national finals twice. The achievement is related to the school's emphasis on the cultivation of clinical medical students' professional competence and the construction of the system. At present, the society's demand for health services is increasing. The development trend of medical education at home and abroad and the introduction of Chinese medical education standards require that the training of medical students pay more attention to the training of students' clinical thinking ability, clinical operation ability, social service ability and professional quality [6]. In the training of professional competence, the school conducts systematic training in clinical skills training, community and grass-roots practice, professional production practice and social practice activities, and strengthens the professional practice and service ability of medical students, so that medical students can adapt to the transformation to professional doctors as soon as possible. Taking clinical skill training as an example, the school has built a comprehensive clinical skill training center with complete functions, which is an earlier medical simulation center with comprehensive equipment and relatively complete functions in China at present, and has certain characteristics of a simulation hospital. It has been selected as one of the 19 national demonstration laboratories of clinical skills in China, and is the clinical skill examination center for licensed physicians in Shanxi Province. In addition to undertaking clinical skills training at the professional learning stage, the school's clinical skills training center also regularly organizes two training courses for "standardized patients" and "cardiopulmonary resuscitation" every year. It focuses on clinical majors, starting from junior students, and at the same time attracts non clinical majors for training. Nearly 500 people are trained every year. It can be seen that the award of the clinical skills contest benefits from comprehensive training and layer upon layer selection.

4、 Conclusion

Selected Clinical Medicine of Traditional Chinese and Western Medicine (9 articles)

Chapter 1: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

Part 2: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

Part 3: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

Chapter 4: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

Chapter 5: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

Chapter 6: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

Chapter 7: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

Chapter 8: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

Chapter 9: Model Articles for Clinical Medicine of Traditional Chinese and Western Medicine

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