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Chapter 1: Model article on the prospect of clinical medicine of traditional Chinese and western medicine
[Key words] Chinese medicine practitioners; Practice category; practice area
[CLC No.] R-01 [Document Identification Code] B [Article No.] 1673 ― 7210 (2009) 04 (a) ― 158 ― 03
In 1998, the Third Meeting of the Standing Committee of the Ninth National People's Congress passed the Law of the People's Republic of China on Licensed Doctors (hereinafter referred to as the Law on Licensed Doctors), which was officially implemented on May 1, 1999. In cooperation with the implementation of the Law of the People's Republic of China on Medical Practitioners, the relevant departments issued the Interim Provisions on the Scope of Practice in the Registration of Medical Practitioners, the Interim Measures for the Examination of Doctors' Qualifications (Order No. 4 of the Ministry of Health), the Interim Measures for the Examination of Doctors' Qualifications for Teachers of Traditional Medicine and Persons with Real Expertise (Order No. 6 of the Ministry of Health) and other relevant provisions. According to the Law of the People's Republic of China on Medical Practitioners, at present, more than 500000 people across the country have obtained the Doctor's Qualification Certificate in the category of traditional Chinese medicine. They are active in medical institutions at all levels, from provincial and ministerial hospitals to rural clinics. They are one of the backbone of clinical medical work in China, and have made important contributions to the development of China's medical industry, And with the graduation of more and more TCM clinical students in colleges and universities, more and more modern TCM clinicians will join the ranks. However, in the specific practice process, the relevant provisions of the current "Law on Licensed Doctors" and other regulations on the type and scope of practice have brought them a lot of trouble and unnecessary disputes. According to the existing regulations, practitioners of traditional Chinese medicine (mainly graduates of traditional Chinese medicine colleges and universities and some graduates of traditional Chinese medicine majors from western medicine colleges. hereinafter referred to as "the required education category") and clinical practitioners of western medicine I are classified into the categories of traditional Chinese medicine and clinical medicine respectively: the practice category and scope of practitioners of traditional Chinese medicine with the required education and non academic education Traditional Chinese medicine practitioners recognized by their teachers are equal and belong to the traditional Chinese medicine specialty of TCM category; At the same time, the division of the scope of practice of TCM is vague and general, which is seriously out of line with the actual clinical situation. These regulations have caused a lot of troubles to TCM clinicians in practice, which has hit their enthusiasm to a certain extent and is not conducive to the development of TCM.
1. Chinese medicine practitioners and western medicine clinical practitioners with the required educational background should not be listed separately, but both should belong to the clinical category
1.1 Disadvantages in the classification of licensed doctors of traditional Chinese medicine and licensed doctors of western medicine clinical categories with the required academic qualifications
1.1.1 Unnecessary medical disputes and medical lawsuits are caused by the existing regulations, which divide the licensed doctors of traditional Chinese medicine and clinical doctors of western medicine with the required academic qualifications into the categories of traditional Chinese medicine and clinical medicine, which can easily mislead patients and even some health administrators. It is believed that practitioners of traditional Chinese medicine can only and will only use traditional Chinese medicine, cannot and will not use western medicine and other western medicine diagnosis and treatment methods, resulting in unnecessary medical disputes and medical litigation, creating a negative situation for nearly 500000 and more practitioners of traditional Chinese medicine in the future, which has greatly hit their enthusiasm, violated the principle of fairness and justice, and ultimately damaged the interests of patients.
1.1.2 It seriously hinders the employment of graduates of traditional Chinese medicine with specified academic qualifications. The current employment situation of medical graduates is not good, especially for graduates of traditional Chinese medicine. Due to the restrictions of the current "Law on Licensed Doctors" and other policies, that is, the classification of traditional Chinese medicine and clinical medicine, and the graduates of traditional Chinese medicine can not take the examination of clinical medical certificate. Even knowing that such graduates are competent traditional Chinese and western medicine Combined clinical work. Western medical institutions are also unwilling to accept such graduates. They can only go to TCM hospitals or TCM departments of Western hospitals, and these institutions are far less than Western medical institutions; Even if they actively respond to the call of the state to work in health centers in remote areas and towns in the northwest, because most health centers do not have a department of traditional Chinese medicine, once they practice in the internal medicine or emergency department, they are suspected of practicing beyond the scope of practice. The hospital cannot hire them, and their right to equal employment is seriously violated. Western medicine graduates are obviously different. They can choose to go to various hospitals, and TCM hospitals are more open to them. In the long run, it is bound to seriously affect the enthusiasm of students to apply for the examination of Chinese medicine colleges. In fact, the current Chinese medicine colleges are already difficult to recruit students compared with the Western Hospital School. Therefore, we should revise the relevant provisions, formulate reasonable laws and regulations, and give graduates of traditional Chinese medicine an equal right to employment.
1.2 The professional characteristics of traditional Chinese medicine practitioners with the required educational background are actually the clinical specialty of integrated traditional and western medicine, with clinical medicine Features of
In fact, Chinese medicine clinicians with the required academic qualifications in China, regardless of their educational background or clinical practice process, are characterized by the clinical specialty of integrated traditional and western medicine, which has the characteristics of clinical medicine. They should be included in the clinical category together, and use an appropriate name such as "integrated traditional and western medicine" to indicate their professional characteristics, so as to distinguish them from the clinical category of western medicine. During the period of college, graduates of Chinese medicine majors in Chinese colleges and universities. In addition to learning the theoretical basis and clinical courses of traditional Chinese medicine, I also systematically learned most basic and clinical courses of western medicine. The following are the professional courses of Fujian College of Traditional Chinese Medicine, Grade 90, five-year program.
First academic year: medical physics, biology, human anatomy, basic theories of Chinese medicine, Chinese revolutionary history, English, medical chemistry, Chinese medicine, diagnostics of Chinese medicine, histoembryology, ancient medical literature, Chinese revolutionary history, sports; Second academic year: physiology, biochemistry, prescription science, Chinese medical history, microbiology, pathology, parasitology, typhoid theory, socialist construction, English, sports; The third academic year: literature retrieval and utilization, febrile diseases, pharmacology, philosophy, synopsis of the golden chamber, acupuncture and moxibustion, dialectics of nature, gynecology of traditional Chinese medicine, surgery of traditional Chinese medicine, pediatrics of traditional Chinese medicine, diagnostics of western medicine, and internal medicine of traditional Chinese medicine; The fourth academic year: sports, western medicine internal medicine, Chinese medicine ophthalmology, western medicine surgery, Chinese medicine otorhinolaryngology, health statistics, computer science, internal medicine, various theories; The fifth academic year: clinical practice (half a year in Chinese medicine hospital and half a year in western medicine hospital); Graduation examination: basic theory of traditional Chinese medicine, diagnostics of traditional Chinese medicine, traditional Chinese medicine, and prescription.
The setting of modern medicine and traditional Chinese medicine courses in the school's traditional Chinese medicine specialty accounts for almost 50% of each other. From basic western medicine to clinical courses, the proportion of Chinese and western medicine courses in clinical specialty courses (such as bone injury and acupuncture) in other Chinese medicine colleges is similar. It can be seen that in addition to systematic knowledge of TCM theory and clinical practice, graduates of TCM clinical specialty have also received systematic knowledge education of modern medicine from the basic to the clinical system. They are fully equipped with the knowledge reserve of using TCM and modern medical technology to deal with clinical problems at the same time, which fully conforms to the professional characteristics of clinical medicine and should be included in the clinical category, Is in line with the principle of scientific legislation.
1.3 The practice category of Chinese medicine practitioners with specified academic qualifications is incorporated into the clinical category, which helps to legally protect the right of Chinese medicine clinicians to use Chinese medicine and modern medical technology at the same time
In China, it is necessary and reasonable for TCM clinicians to use both TCM and modern medical technology. At present, the vast majority of TCM diagnosis and treatment institutions, from affiliated hospitals of TCM colleges and universities to TCM departments of TCM hospitals at all levels and western hospitals, use both TCM and western medicine at the same time. In fact, the existence of this model is very reasonable, and it will never hinder the development of TCM as some people criticize it. On the contrary, this model promotes the further understanding of the efficacy of TCM, so as to truly eliminate its dross and extract its essence, and promote the development of TCM. Because of the use of both Chinese and Western diagnostic standards, the understanding of disease occurrence and development is more comprehensive; Due to the simultaneous use of Chinese and Western medicine treatment methods. Only in this way can we compare the advantages and disadvantages of traditional Chinese medicine and western medicine for the same disease in long-term clinical practice, so as to optimize the best treatment scheme of integrated traditional Chinese and western medicine, and better solve clinical problems. Therefore, the legitimacy of this model should be legally guaranteed. have
Traditional Chinese medicine practitioners with the required educational background have the knowledge structure of integrated traditional and western medicine. Bringing their practice category into the clinical category can better guarantee their right to use both Chinese and Western medicine, and give better play to their respective advantages.
1.4 The regulations on the scope of practice of overseas Chinese medicine practitioners are not applicable to Chinese medicine practitioners with required academic qualifications
In recent years, some scholars and even some health administration system makers believe that China's traditional Chinese medicine practice system should gradually integrate with the practice management system of traditional Chinese medicine in developed regions and countries such as Hong Kong, and gradually limit the use of western medicine by traditional Chinese medicine. However, at that time, most of the teachers' universities of traditional Chinese medicine in these regions and countries were non academic education, such as teachers' inheritance and self-study. They did not receive systematic medical education and had a strong folk medical flavor. Therefore, legislation restricted their use of modern medical diagnosis and treatment methods. Today, most Chinese doctors in China have higher academic education background and systematic medical education, They have the knowledge reserve and ability to use modern medical means, so their scope of practice should be different from that of TCM practitioners in the above regions and countries.
2. There should be a difference between the scope of practice of traditional Chinese medicine practitioners with the required academic qualifications and that of traditional Chinese medicine practitioners recognized by their successors
The knowledge structure of TCM clinicians with required academic qualifications is different from that of traditional TCM practitioners recognized by their teachers, and their scope of practice should be different. According to the existing laws and regulations, the practicing qualification certificates and the scope of practice registration obtained by practitioners of traditional Chinese medicine with the required academic qualifications in the category of traditional Chinese medicine and traditional Chinese medicine practitioners recognized by their teachers are the same, which obviously does not conform to the clinical reality. First of all, it must be recognized that the state has included traditional Chinese medicine practitioners (including other ethnic medical doctors) who have received formal training and have real expertise into the category of licensed doctors for management, allowing them to practice legally, which plays a very important role in the protection, inheritance and standardization of the essence of traditional medicine, and its positive significance should be fully affirmed. However, as mentioned above, the educational background and knowledge structure of TCM clinicians with the required academic qualifications are different from those of TCM practitioners with non academic education, so the types and scope of practice of the two should be differentiated. From the perspective of knowledge structure and professional characteristics, traditional Chinese medicine teachers with non academic education, such as teachers, belong to the relatively simple traditional medicine category with Mongolian medicine, Tibetan medicine and other ethnic medicine, and can be classified into "traditional Chinese medicine" or "traditional medicine" together with other ethnic medicine. This experience in Taiwan can be used for reference. There are three kinds of examinations for Chinese medicine practitioners in Taiwan, one is the "examination for Chinese medicine practitioners" (hereinafter referred to as "examination"), the second is the "special examination for Chinese medicine practitioners" (hereinafter referred to as "special examination"), and the third is the "examination for Chinese medicine practitioners". The qualification of examination and special examination is for non academic education personnel, including teachers and self learners; The qualification for the examination is the Chinese medicine personnel who have graduated from the Department of Traditional Chinese Medicine or the Department of Medicine of the Medical College and have studied academic education such as certain credits of traditional Chinese medicine. The examination contents and qualification certificates of these two types of candidates are different.
3. The existing division of TCM practice scope and specialty is vague and general, lacking operability, and should be re divided according to modern medical clinical subjects
The existing regulations cause the scope of practice and professional division of TCM categories to be vague and general, which is out of line with clinical practice and lacks operability. According to the existing laws and regulations, the scope of practice and specialties of traditional Chinese medicine (including those with required academic qualifications and those of teachers) are simply divided into traditional Chinese medicine, integrated traditional and western medicine, Mongolian medicine, Tibetan medicine, Uyghur medicine, and Dai medicine. In fact, most comprehensive TCM hospitals and large-scale TCM departments have been divided into two levels according to the setting of modern medical clinical subjects, For example, internal medicine, surgery, gynecology, pediatrics and orthopaedics are consistent with the professional classification of western medicine clinical category. Therefore, the existing professional scope classification of traditional Chinese medicine lacks operability in the actual practice management, and must be re classified according to the actual situation. In fact, at present, the management authorities fill in the "specialty" column of the qualification certificate of traditional Chinese medicine doctors according to the practitioners' actual internal, external, women, children and other professions. However, in reality, there is no clear support of laws and regulations, and the corresponding regulations should be re formulated.
4 The provision that graduates of traditional Chinese medicine cannot apply for the qualification of clinical practitioners of western medicine is discrimination and should be gradually abolished
According to the existing regulations, graduates of traditional Chinese medicine cannot apply for the qualification of doctors in clinical, oral and public health categories. In fact, as most graduates of traditional Chinese medicine have systematically studied modern medicine, they, like graduates of western medicine, are fully capable of passing the qualification examination for medical practitioners in the clinical category of western medicine after appropriate review. It is discriminatory to deprive them of the right to participate in such examinations by law. It does not conform to the principle of fairness of the law.
5 Suggestions
5.1 Specific suggestions
To sum up, the author believes that it is urgent to revise the relevant provisions on the practice category and scope of Chinese medicine practitioners in the current "Law on Licensed Doctors" and other laws and regulations. The specific suggestions are as follows: ① Incorporate Chinese medicine practitioners with the required academic qualifications into the clinical category together with the clinical category of Western medicine, which is also divided into internal, external, gynecology, pediatrics, orthopaedics and other professions, And indicate the direction of integration of Chinese and western medicine, mainly the use of traditional Chinese medicine and traditional Chinese medicine, but can use western medicine diagnosis and treatment means; Western medicine clinical practitioners can use Chinese patent medicine (including various injections), but can not use decoction, acupuncture, massage and other Chinese medicine treatments. Personnel in the direction of integrated traditional Chinese and western medicine in all specialties can practice in comprehensive western hospitals and corresponding professional departments of traditional Chinese medicine hospitals. ② Traditional Chinese medicine practitioners who originally belonged to the traditional Chinese medicine category and did have expertise in traditional Chinese medicine, including various ethnic medicine majors and other non academic education, can only use traditional Chinese medicine and ethnic medicine diagnosis and treatment methods, and cannot use western medicine and other western medicine treatment methods, but can use western medicine examination methods after relevant knowledge training and examination. ③ Cancel the setting of "integrated traditional Chinese and western medicine" specialty in the original "TCM category". According to the existing regulations, the specialty of integrated traditional Chinese and western medicine also belongs to the category of traditional Chinese medicine. Since the TCM clinicians with the required academic qualifications have been included in the clinical category of integrated traditional Chinese and western medicine after the revision of the relevant laws and regulations, there is no need to repeat the setup. ④ Acupuncture and massage professionals with the required educational background can be included in the rehabilitation medicine specialty of integrated traditional and western medicine according to their professional characteristics. ⑤ Revise the relevant examination system. After completing the relevant TCM courses, the graduates of clinical medicine specialty of Western Hospital School can apply for the qualification examination of licensed doctors in all specialties in the clinical category (integrated traditional Chinese and western medicine). At the same time, the educational system of traditional Chinese medicine specialty will be gradually increased from five years to seven years. With reference to the dual major system of traditional Chinese medicine specialty in Taiwan's colleges and universities, that is, all the courses of both traditional Chinese medicine and western clinical medicine specialty will be completed. On this basis, graduates of traditional Chinese medicine specialty will be allowed to apply for the doctor qualification examination of western clinical medicine and oral medicine at the same time.
5.2 Revised practicing category and scope of medical practitioners
After revision, licensed doctors are still divided into four categories: clinical, oral, public health, and traditional Chinese medicine. Their scope of practice should be as follows:
5.2.1 Clinical category Physician's scope of practice: internal medicine, internal medicine (integrated traditional and western medicine), surgery, surgery (integrated traditional and western medicine), gynecology and obstetrics, gynecology and obstetrics (integrated traditional and western medicine), pediatrics, pediatrics (integrated traditional and western medicine), ophthalmology, otorhinolaryngology, ophthalmology, otorhinolaryngology (integrated traditional and western medicine), dermatology and venereal diseases, Dermatology and venereal diseases (integrated traditional and western medicine), mental health, mental health (integrated traditional and western medicine), occupational disease, occupational disease (integrated traditional and western medicine), emergency medicine, emergency medicine (integrated traditional and western medicine), rehabilitation medicine, rehabilitation medicine (integrated traditional and western medicine, including acupuncture and massage), prevention and health care, Specialty of special medicine and military medicine, specialty of family planning technical service, specialty of general medicine, specialty of medical imaging and radiotherapy, specialty of medical examination and pathology, and other specialties specified by the health administrative department at or above the provincial level.
5.2.2 The scope of practice of stomatologists is stomatology, stomatology (integrated traditional and western medicine), and other professions specified by the health administrative department at or above the provincial level.
5.2.3 The scope of practice of public health physicians is the public health category, and other professions specified by the health administrative department at or above the provincial level.
Part 2: Model article on the prospect of clinical medicine of traditional Chinese and western medicine
Abstract: Objective: To explore the advantages of integrated training mode education in clinical medicine undergraduate education by analyzing the employment rate, the first postgraduate entrance examination rate and the satisfaction of the clinical undergraduates who have been trained by different education modes. Methods: The situation of clinical medical undergraduates (research group) in Shaanxi University of Traditional Chinese Medicine in 2011 and 2012 who received the education of integrated training mode was analyzed by comparing the employment rate, first postgraduate entrance examination rate and satisfaction of half a year of employment of clinical medical undergraduates (control group) in 2009 and 2010 who received the education of traditional training mode at the same time point. Results: Compared with the control group, the employment rate, the first postgraduate entrance examination rate and the satisfaction with employment for half a year in the study group were significantly improved. Conclusion: The integrated training mode has a significant effect on the employment rate, the first postgraduate entrance examination rate and the satisfaction of the clinical undergraduates who have been employed for half a year.
Key words: integrated training mode; rate of employment; First postgraduate entrance examination rate; Satisfaction with employment for half a year
CLC No.: G642.0 Document Code: A Article No.: 1674-9324 (2017) 21-0094-02
In China, five-year undergraduate clinical medicine specialty is the main specialty of medical talent training. Under the background of improving the quality of higher education, it is an important and urgent task for medical education to vigorously promote the reform of medical education, explore and establish a new mode of clinical medical talent training that conforms to the laws of medical education reform and talent training in China. Through learning experience, reform and innovation, and bold exploration, on the basis of the traditional training model, our clinical specialty has explored and established a new integrated training model. This paper analyzes the employment rate, the first postgraduate entrance examination rate and the satisfaction after half a year of employment of students under the two training modes, to illustrate the impact of the integrated training mode on undergraduate clinical medical students.
1、 Data and methods
1. Research objects. Control group: 629 five-year clinical medical students of Shaanxi University of Traditional Chinese Medicine in 2009 and 2010 (249 in 2009 and 380 in 2001), receiving traditional training mode education; Research group: Shaanxi University of Traditional Chinese Medicine has 839 five-year clinical medical students of 2011 and 2012 (including 395 students of 2011 and 444 students of 2012), who have received integrated training mode education.
2. Cultivation methods. The control group: teaching and clinical practice, entrance education, medical guidance education were carried out in the traditional education mode and training mode, explaining the training mode, informing students of their responsibilities as a doctor, the knowledge and skills they must master in five years of medical learning, and the unfinished consequences; Basic knowledge module, basic course learning in the first and second academic years; The bridge course module, diagnostics and pharmacology in the third academic year have built a bridge between basic medicine and clinical medicine; Clinical course module, internships in the hospital based on learning theory in the fourth academic year; The clinical practice module enters the clinical practice stage in the fifth academic year.
Research group: add A assessment on the basis of the control group, and conduct a centralized assessment (i.e. A assessment) after the completion of basic courses and bridge courses in the third academic year. The assessment includes basic knowledge (including basic courses and bridge courses) assessment and basic skills assessment (the assessment conducted earlier is also part of the basic skills assessment in A assessment); Written examination is adopted for basic knowledge assessment; B assessment, at the end of the fourth academic year, includes clinical knowledge assessment (mainly clinical course knowledge, including some basic knowledge) and basic skills assessment (the assessment conducted in the earlier stage is also part of the basic skills assessment in B assessment); In the fifth academic year of the clinical practice module, before students formally leave the practice site, the teaching department will organize students to carry out pre internship pre job training, and provide the Pre internship Training Manual to standardize the medical behavior of all prospective doctors, and then M will enter the clinical practice stage. C assessment (OSCE), the assessment after the end of the fifth academic year's internship, including basic theory of basic and clinical courses+clinical practice skills, carries out multiple sites, various contents and forms, comprehensively evaluates the clinical ability of students, and closely links with the examination of licensed doctors. Teaching methods: In the course of teaching in the implementation of the integrated training model, teachers are required to reform teaching methods and apply PBL, CBL, situational cases, flipped classroom and other teaching methods.
3. Research indicators. This paper analyzes the situation of the 2011 and 2012 clinical medical undergraduates in Shaanxi University of Traditional Chinese Medicine receiving the integrated training mode education, and compares the employment rate of 2009 and 2010 clinical medical undergraduates receiving the traditional training mode education at the same time point, the first postgraduate entrance examination rate, and the satisfaction (including patients and employers) of the full half year of employment, To explore the advantages of holistic training mode education in clinical medicine undergraduate education.
2、 Results
It can be seen from Table 1 that the employment rate and the first postgraduate entrance examination rate of the two groups of students are increasing year by year, showing an upward trend, and the data analysis is statistically significant, indicating that compared with the traditional training mode, the integrated training mode can improve the employment rate and the first postgraduate entrance examination rate. It can be seen from Table 2 that the satisfaction of the two groups of students who have been employed for half a year is also on the rise year by year, and the data analysis is statistically significant, indicating that compared with the traditional training model, the integrated training model can improve employment satisfaction.
3、 Discussion
The traditional training mode is simple teaching+theoretical examination. This spoon feeding teaching mode not only has unsatisfactory teaching effect, but also cannot be close to clinical practice, and does not create a medical atmosphere for students. The innovative integrated training mode aims to mobilize students' awareness of independent learning and stimulate their enthusiasm for conscious learning. Use modern teaching methods to give lectures, including PBL, situational case teaching, CBL, flipped classroom and other teaching methods, so as to enhance students' learning enthusiasm and firmly grasp medical knowledge; On the basis of theoretical examination, clinical skill assessment (A, B, C three-step assessment) will be added, and this combined assessment mode will run through the entire undergraduate teaching stage, forming a set of interlocking assessment modes. The integrated training mode runs through the whole undergraduate teaching stage with "three early education" (early contact with clinical work, early contact with scientific research and early contact with social practice), which can not only strengthen students' learning and mastering of basic theoretical knowledge, but also effectively improve students' clinical practical operation ability, and also lay a solid foundation for graduate examination, licensed physician examination, etc, Promote students to develop self-learning, self-management, and self planning abilities. Students can have great flexibility in activities and large space for independent arrangement, and eventually cultivate a doctor who meets GMER (Global minimum essential requirements in medical education).
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Received on: November 23, 2016
Part 3: Model article on the prospect of clinical medicine of traditional Chinese and western medicine
The society needs applied medical talents with strong practical ability, and the cultivation of applied medical talents focuses on the cultivation of clinical practical ability; How to cultivate the application-oriented talents of integrated traditional Chinese and western medicine required by the society is an important issue for medical colleges and universities at present, and has been trying to explore a more systematic and complete training model for clinical professionals of traditional Chinese and western medicine. This paper analyzes the importance of clinical practice teaching, the existing problems and how to improve the measures taken, trying to provide a reference for the cultivation of talents of integrated traditional Chinese and western medicine.
key word:
Integrated traditional Chinese and western medicine; Application type; Practical teaching; reform
The society needs medical talents with strong practical ability, and talents of integrated traditional and western medicine with the background of integration of traditional medicine and modern medicine are the hot spots of social demand. We should change the traditional teaching concept in talent training, reform the curriculum system, teaching content, methods and evaluation system, build the training model of applied integrated traditional Chinese and western medicine talents, and train applied talents to meet the needs of local social development and economic construction. The author has been engaged in the teaching and management of integrated traditional and western medicine for many years, and has a little thought on how to cultivate the application-oriented talents of integrated traditional and western medicine needed by the society, which is described as follows.
Importance of clinical practice teaching in clinical specialty of integrated traditional Chinese and western medicine
The training goal of clinical undergraduate talents of integrated traditional and western medicine is to "cultivate application-oriented undergraduate talents with solid foundation, practice, strong ability and high quality", and the curriculum setting focuses on "three bases and one innovation" (basic quality, basic knowledge, basic ability and innovative thinking). Cultivate the ability to systematically master the basic theories, basic knowledge and basic skills of traditional Chinese medicine and clinical medicine, master the basic diagnosis and treatment methods and practical skills of traditional Chinese and western medicine, have the concept of combining traditional Chinese and western medicine, be able to diagnose and treat frequently occurring and common diseases in clinical practice, and have the ability to conduct routine diagnosis and treatment for acute, difficult and severe diseases, Applied medical professionals who can engage in work related to the integration of traditional Chinese and western medicine. The cultivation of applied medical talents focuses on the cultivation of clinical practice ability, Solve common diagnosis and treatment problems in clinical medicine. In the training process, it is necessary to emphasize both the theoretical quality and practical ability of professionals of integrated traditional and western medicine, so attaching importance to clinical practice teaching has become an important link that cannot be ignored in the talent training process of medical colleges and universities at present [2].
Current situation of clinical practice teaching in clinical specialty of integrated western medicine
After 20 years of exploration and practice in the clinical specialty of integrated traditional and western medicine, our school has found out a relatively systematic and complete talent training model for the clinical specialty of integrated traditional and western medicine, and has constructed a talent training model and curriculum system of integrated traditional and western medicine of "two foundations, one clinic". After years of practice in our school, this training mode has been proved to be more suitable for five-year integrated traditional Chinese and western medicine professionals. Now this training mode has been applied in the training of professionals of integrated traditional and western medicine in more than ten medical colleges across the country, and has been recognized by educators engaged in integrated traditional and western medicine throughout the country. Undoubtedly, the training mode of "two foundations, one clinic" is currently more suitable for the training of five-year clinical talents of traditional Chinese and western medicine. However, after years of teaching practice, we also found that the following problems still exist in the training of clinical medicine of traditional Chinese medicine and western medicine.
2.1 At present, the academic system of clinical undergraduate of integrated traditional and western medicine is relatively short, only five years.
The short school system has led to the inability of teachers to systematically impart knowledge of Chinese and Western medicine in teaching, and the inability of students to comprehensively grasp the knowledge of Chinese and Western medicine. As a result, students failed to learn Chinese medicine and western medicine well. In limited time, it is difficult for medical colleges and universities to cultivate professionals who have high theoretical level and can meet the growing clinical medical work [3].
2.2 Some medical colleges have no fixed affiliated hospitals for practical teaching
The front-line teachers have been away from the clinic for a long time. The clinical teachers, especially the young teachers, lack clinical experience and the teaching quality is low.
2.3 In practical teaching
At present, there are not many real integrated traditional Chinese and western medicine hospitals in China. Although most of them adopt integrated traditional Chinese and western medicine, they still have a vague understanding of integrated traditional Chinese and western medicine and cannot teach students the idea of integrated traditional Chinese and western medicine. At the same time, in the clinical practice of students, most of them are interns in traditional Chinese medicine hospitals, so they can not fully receive the training of modern medicine and integrated traditional and western medicine, resulting in students' weak grasp of knowledge and skills of traditional Chinese medicine and western medicine, and weak practical ability.
2.4 Postgraduates seeking jobs and preparing for examinations have an impact on clinical practice.
At present, the employment situation of college students in China is grim, and many undergraduate graduates spend most of their energy and time on seeking jobs or preparing for graduate examinations in the clinical internship and internship stages. During the internship, students were busy attending various job fairs and pre exam tutoring classes for graduate students, and could not rest in clinical practice, which seriously affected the effect of clinical practice [4].
Thinking on clinical practice teaching of clinical specialty of integrated traditional and western medicine
In view of the above situation, we believe that in the training process of clinical medicine professionals in traditional Chinese medicine and western medicine, we should pay more attention to the training of students' clinical practice ability, and truly cultivate application-oriented advanced professionals in the integration of traditional Chinese medicine and western medicine who can learn both Chinese medicine and western medicine and have the concept of integration of traditional Chinese and western medicine for the society.
3.1 Increase the proportion of clinical courses
In the course system, strengthen the teaching of clinical courses of Chinese and Western medicine, especially increase the proportion of clinical courses of Chinese medicine. Strengthen the cultivation of the concept of integration of Chinese and Western medicine for students, so that students can systematically master the basic clinical skills of Chinese and Western medicine.
3.2 Enhance the training of clinical practice teaching teachers
It is suggested to register the teacher doctor certificate of each clinical teaching and research department in the practice teaching affiliated hospital. In a period of two years, according to the actual needs of teaching and training, young teachers from each teaching and research department enter the practice teaching affiliated hospital for rotational or specialized training, and the science and education department of the practice teaching affiliated hospital supervises and assists young teachers to complete the training. During the training period, the hospital will pay doctors with the same professional title and teachers. Young teachers who meet the assessment requirements for professional and technical titles of health can be evaluated and employed for professional and technical titles of health. Practice teaching teachers are familiar with the situation of hospitals, doctors and patients, which is conducive to the development of practice teaching work and the improvement of the quality of teaching practice.
3.3 Enhance the cultivation of students' practical ability
The teaching method is combined with other teaching methods [5], and the clinical case teaching, PBL teaching and bedside teaching of Chinese and western medicine are carried out in depth [6]. Increase the development of clinical practice bases and expand the subjects and scale of bedside clinical teaching.
3.4 Adjustment of internship plan
The suggested internship arrangement is as follows. Chinese medicine hospital and western hospital practice for half a year respectively. Six months' internship in Western Hospital, including two months' internship in Western Medicine Internal Medicine (in two different three-level disciplines) (one month's internship in each three-level discipline), one month's internship in Western Medicine Emergency Department, two months' internship in Western Medicine Surgery (in two different three-level disciplines) (one month's internship in each three-level discipline), and one month's internship in Functional Department (B-ultrasound, electrocardiogram, radiology). Internship in TCM hospital for 6 months, including 2 months in internal medicine of TCM (in two different three-level disciplines) (1 month in each three-level discipline), 1 month in surgery, obstetrics and gynecology, pediatrics, acupuncture and moxibustion respectively, and 1 month in the other, students can choose one month from the ophthalmology, otorhinolaryngology, orthopedics and traumatology departments according to their own interests.
In a word, in the training of clinical undergraduate talents of integrated traditional Chinese and western medicine, we should pay attention to the later clinical practice teaching, and take various measures to purposefully cultivate students' clinical thinking ability and ability to solve clinical problems, so as to make them become a qualified practical talents of integrated traditional Chinese and western medicine.
Author: Wang Guozuo, Yang Mei, Cheng Shaowu, Liao Jun, Liu Lin, Gong Shengqiang, Ge Jinwen Unit: School of Integrated Traditional Chinese and Western Medicine, Hunan University of Traditional Chinese Medicine, School of Medicine, Hunan University of Traditional Chinese Medicine
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[3] Tian Feng. The importance of strengthening professional theoretical learning in clinical practice teaching [J]. Journal of Clinical and Experimental Medicine, 2009, 8 (5): 145
[4] Han Jianhong, Sun Jue, Fan Zhongze. Discussion on clinical practice teaching mode of integrated traditional and western medicine [J]. Chinese Journal of Medical Education, 2008, 28 (5): 86-101
Chapter 4: Model article on the prospect of clinical medicine of traditional Chinese and western medicine
[Key words] TCM nursing mode; Dialectical nursing; Skill training
With the development of the whole natural science and the change of people's health concept, TCM nursing, as an independent discipline, is gradually moving towards science and standardization, and the characteristics and advantages of TCM nursing are increasingly respected by people. In order to give full play to its advantages and benefit the majority of patients, the author, starting from the actual situation of clinical TCM nursing, discussed with colleagues the current practical mode and working system of dialectical nursing.
1 Advantages and prospects of TCM nursing
1.1 Advanced health care concept Chinese medicine has put forward advanced theories such as "holistic concept" and "work to prevent disease" as early as ancient times, and gradually formed a dynamic and balanced holistic health concept, and an advanced nursing idea of biological social psychological environment integration [1]. It is believed that human is a unified whole, and the various parts constituting the whole coordinate with each other in function and influence each other in pathology.
1.2 The advantage of flexible and simple method is that nursing based on syndrome differentiation is the essence of traditional Chinese medicine nursing. In clinical practice, the nursing method of different care for the same disease, the same care for different diseases, and three factors (depending on people, time, and place) has won praise from nursing peers at home and abroad for its more humanistic advantages. With its advantages of convenience, safety, effectiveness and low price, TCM nursing technology plays an irreplaceable role in community nursing, elderly nursing, hospice care, home nursing and other fields.
1.3 With a strong cultural background, traditional Chinese medicine is the crystallization of the Chinese nation's experience in understanding life, disease and diagnosis and treatment. These experiences have risen to the theoretical level and effectively guided clinical practice for thousands of years [2]. It is a bright pearl in the treasure house of the traditional culture of the motherland. "Three points of treatment, seven points of care", as an important part of traditional Chinese medicine, The value of traditional Chinese medicine nursing has long been widely accepted and recognized by the people. Its unique inheritance background, strong humanistic characteristics, and deep into the hearts of the people, so traditional Chinese medicine nursing has a solid mass foundation in terms of thinking mode, values, and cultural customs.
1.4 The explicit development goal, the Outline of China's Nursing Development Plan (2005 － 2010), points out that "focusing on the role of TCM technology in nursing work, we should improve TCM nursing technology, give play to the characteristics and advantages of TCM nursing. According to the thought that prevention is more important than treatment and health preservation is more important in TCM nursing, we should give full play to the role of TCM nursing in the prevention and treatment of senile diseases and chronic diseases and health preservation and rehabilitation, highlight the holistic view of TCM and nursing based on syndrome differentiation, strengthen the organic combination of TCM and Western nursing techniques, and promote the sustainable development of TCM nursing. " It can be seen that in the era of rapid development of modern science and technology, traditional Chinese medicine nursing, like other professions, is full of both opportunities and challenges. As the pride of our nursing community, traditional Chinese medicine nursing has an immeasurable development prospect in the world.
2 Current situation of clinical TCM nursing
2.1 Nursing based on syndrome differentiation has become a form. Since the 1980s, the nursing discipline in China has developed by leaps and bounds. From the functional system, the responsibility system, to the modern holistic nursing model, the level of nursing technology has advanced by leaps and bounds, but the convenient and effective traditional Chinese medicine nursing has not been rapidly developed in clinical application. Luo Kunhua [3] survey showed that 60.2% of ward nurses and nursing students in TCM hospitals did not carry out syndrome differentiation nursing. At present, the rate of syndrome differentiation nursing in clinical practice is generally low. Even when carrying out syndrome differentiation nursing, it is often difficult to distinguish the syndrome, the result of syndrome differentiation is different from the doctor's diagnosis, and the doctor must obey the doctor, the nurse must obey the result of syndrome differentiation is the same, the use of traditional Chinese medicine in nursing measures is beyond the scope of the nurse's power, and so on. The characteristics of TCM nursing records also mostly stay in the records of solar terms, tongue coating, pulse conditions and syndrome types, and there are few substantive records of the content of syndrome differentiation nursing and the implementation of traditional TCM nursing technology interventions.
2.2 Nursing staff lack of traditional Chinese medicine nursing skills, such as massage, massage, traditional Chinese medicine atomization, traditional Chinese medicine foot treatment, which are widely loved in various health care places, but their clinical application is not satisfactory. Admittedly, there are institutional and economic factors, but the concept of nursing staff and the level of TCM operation skills are also important reasons. At present, although the major Chinese medicine colleges and universities across the country have set up the specialty of Chinese medicine nursing, which has provided a certain number of Chinese medicine nursing talents for Chinese medicine hospitals at all levels, the number is far from meeting the clinical needs. Most of the nurses in TCM hospitals graduated from western medical schools, while only 3% to 10% of them graduated from basic TCM hospitals. There are also some nurses graduated from TCM colleges and universities who are unfamiliar with the operation skills and can not use them correctly because they seldom carry out the operation of TCM nursing technology in clinical practice.
Posted on 3 to create a practical nursing model
3.1 Background of the construction of practical TCM nursing mode The advantages and prospects of TCM nursing are universally recognized, but how to effectively promote the development of dialectical nursing, improve the participation rate of clinical TCM technology and the quality of dialectical nursing has always been a problem for TCM nursing staff at all levels. In recent years, some experts have made a scientific conception of the framework of TCM nursing mode, and made pioneering thinking on how to apply TCM nursing technology in the new situation. A standardized and highly operational mode has not yet been formed to guide clinical TCM nursing work. According to the requirements of nursing services under the new situation and the actual clinical situation in China, our hospital has set up a special scientific research team based on the principle of simplicity, practicality, strong operability, and adaptation to the requirements of the current medical laws and regulations, to study and explore a practical TCM nursing model that conforms to the current status of nursing work and the requirements of the current laws and regulations, and to promote the systematic, modern and scientific development of TCM nursing.
3.2 The skill training of clinical nurses is the basic condition for the practical TCM nursing model. Our hospital is a national three-level first-class TCM hospital. Although several TCM training courses were held in the early stage, and all clinical nurses have obtained the certificate of completion of TCM training, only 10% of the survey population can comprehensively carry out dialectical nursing in clinical nursing work, The development rate of TCM nursing technology in clinical patients is less than 30%. For this reason, our hospital, in combination with the actual situation of the current nursing staff, changed the previous training mode of emphasizing theory over skills, started with simple TCM nursing operation techniques for insomnia, constipation and other common symptoms, carried out short-term, phased and batch standardized intensive training of TCM nursing techniques, focused on the standardized operation of cupping, medicine bath, ear point seed embedding, and repeated practice, After everyone passes the examination, all departments are encouraged to carry out the implementation in clinical practice and achieve good results. After effective training and assessment, nursing staff can correctly and skillfully use traditional Chinese medicine nursing methods and provide patients with simple, easy to understand and reliable Chinese medicine nursing techniques, which not only highlights the characteristics of Chinese medicine, but also has been recognized by patients. The development rate of Chinese medicine nursing techniques has reached more than 70%. Extensive clinical practice has enabled nurses to accumulate certain experience. On the basis of practice, they regularly conduct experience summary and theoretical learning, deepen their understanding and application ability of TCM knowledge, and significantly improve the development rate of clinical nursing based on syndrome differentiation and clinical nurses' TCM operating skills. It can be regarded as one of the current economic and effective TCM nursing training methods for in-service personnel.
3.3 The core of the practical TCM nursing model is the implementation of dialectical nursing. With the change of the medical model, the traditional "dialectical nursing" as a methodology is not comprehensive, because today's medical care services have to face "people" rather than "syndrome". If it is directly used for the practice of TCM nursing, there may be incomplete and incomplete data collection, so it is necessary to "dialectical nursing" Carry out innovative inheritance. In view of how to combine the nursing based on syndrome differentiation with the actual clinical nursing work, and give better play to the advantages of traditional Chinese medicine, Chen Ying proposed to combine the international common nursing diagnosis with the actual situation of traditional Chinese medicine nursing, "traditional Chinese medicine" nursing procedures, and implement the traditional Chinese medicine featured nursing procedures of "four diagnosis - syndrome differentiation - nursing - evaluation" [5]. However, it is difficult to carry out clinical work due to various factors. From the perspective of operability, the practical TCM nursing model studied by our hospital proposed that nurses should collect nursing related data according to the results of doctors' syndrome differentiation, use the eight principles of TCM syndrome differentiation, disease nature syndrome differentiation, disease location syndrome differentiation and other methods for syndrome differentiation, and then formulate nursing measures led by unique nursing techniques of TCM, The nursing procedure of timely and effective implementation in the form of nursing path and scientific evaluation of nursing effect endows the content of traditional Chinese medicine syndrome differentiation nursing with modern connotation, and constantly amends and improves it based on clinical practice, so as to establish a complete set of syndrome differentiation nursing work system and make the new model a practical model that can truly guide clinical practice.
3.4 The focus of practical Chinese medicine nursing mode is the management idea of nursing based on syndrome differentiation. Looking at the current situation of Chinese medicine nursing in China, a nursing management system guided by Chinese medicine theory has not yet been formed, and there is a lack of scientific and objective measurement standards in quality management. The current nursing management standards of Chinese medicine hospitals are basically based on the management of Western hospitals. Due to the different theoretical systems of Chinese medicine and Western medicine, In clinical nursing, there are often inconsistencies in thinking, pace and cooperation between doctors and nurses, which restrict the development of the characteristics of traditional Chinese medicine to varying degrees. The management objective of practical TCM nursing mode is based on practicality and professional promotion, focusing on increasing the coverage of dialectical nursing, strengthening the control of each link, improving the relevant rules and regulations, quality control standards, and forming a management mode with Chinese medical characteristics through the path of quality and benefit management. On the one hand, the management idea of the new model is based on the construction and development of the connotation of traditional Chinese medicine. It uses multidisciplinary knowledge and multi-channel methods to carry out evidence-based nursing of traditional Chinese medicine, develop scientific evaluation methods that not only conform to the laws of traditional Chinese medicine nursing, but also can be understood and recognized by people from different industries and cultural backgrounds, and establish unified and standardized objective quantitative indicators for common syndrome types, Form a clinical nursing effect evaluation system. On the other hand, the quality control management was strengthened. The Nursing Department counted the development of TCM nursing technology in each nursing unit every month through the head nurse manual, included the participation rate of TCM nursing technology in the quality inspection and assessment of the Nursing Department, coordinated the non nursing factors that affect the development of TCM nursing technology, summarized the effect regularly, and fed back information to the hospital's leading group with strengthened TCM characteristics. At the same time, nurses were organized to hold an operation exchange meeting of TCM nursing technology every three months to introduce the experience of clinical application of TCM nursing technology, explore the application skills, and further improve the quality of nursing care based on syndrome differentiation.
4 Summary
To sum up, although there is a gap between the current situation of nursing in China and that in developed countries, TCM nursing, with its unique advantages, has an immeasurable prospect in the current trend of "returning to nature" of human health care. The urgent task is to recognize the advancement of the new model, and on the premise of humanism, based on carrying forward the nursing technology that has been considered effective and widely accepted in the long-term practice of traditional Chinese medicine nursing, create a Chinese medicine nursing model that integrates science and practicality. "Change without losing its integrity, and keep the spirit in mind while maintaining the form". It is believed that through the joint efforts of TCM nursing colleagues, TCM nursing, which gradually forms an independent discipline, will show its unique style and charm in the near future.
reference
［ 1 ］ Wang Min. Thoughts on the development prospect of TCM nursing ［ J ］. China Nursing Management, 2007, 7 (5): 19
[2] Zhang Hua, Wei Hong. Thoughts on how to develop the theory of traditional Chinese medicine [J]. Liaoning Journal of Traditional Chinese Medicine, 2005, 32 (2): 105
[3] Luo Kunhua. Investigation and analysis of the status quo of syndrome differentiation nursing in the hospital and management ideas [J]. Journal of Traditional Chinese Medicine, 2006, 12 (8): 68
Chapter 5: Model article on the prospect of clinical medicine of traditional Chinese and western medicine
[Abstract]: In view of the current situation of TCM disease names, from the perspective of history and clinical practice, this paper demonstrates that the combination of disease and syndrome is the essence of TCM diagnostics, compares the similarities and differences between Chinese and Western medicine disease names from epistemology and methodology, and expounds that it is necessary to adhere to TCM disease names, inherit and develop TCM theory, standardize the academic system of TCM disease names, and promote TCM to go global.
[Key words]: TCM disease name; diagnosis; Standards; Combination of disease and syndrome
[CLC No.] R2-03 [Document Identification Code] A [Article No.] 1007-8517 (2009) 03 (top) - 0141-02
The name of a disease is an important concept generated and developed in the long-term clinical practice of Chinese medicine. It is an important part of the academic system of Chinese medicine, and disease differentiation is an indispensable part of clinical Chinese medicine [1]. Any disease has its cause, pathogenesis, law, syndrome, treatment and prognosis. The goal of clinical treatment is mainly to target the disease. However, at present, TCM disease names are almost in the state of being canceled. Most of the clinical diagnosis, papers and works, scientific research topics, etc., use western medicine disease names, and TCM disease names are abandoned, or just belong to the "×× category" of TCM. Therefore, it is necessary to formulate standard disease names of traditional Chinese medicine and issue them as national standards to protect the intellectual property rights of traditional Chinese medicine and maintain the integrity of the knowledge system of traditional Chinese medicine.
Combination of disease and syndrome is the essence of TCM diagnostics
TCM's understanding of the nature of disease is to determine the disease type and give it a name at the earliest. There are more than 200 kinds of diseases described in the Yellow Emperor's Internal Classic. Zhang Zhongjing wrote Treatise on Febrile Diseases and Miscellaneous Diseases. Both Treatise on Febrile Diseases and Treatise on Exogenous Diseases in Treatise on Febrile Diseases and Treatise on Internal Injuries and Miscellaneous Diseases in Synopsis of the Golden Chamber take diseases as the key link and pay equal attention to disease, pulse, syndrome and treatment. Since then, medical books of all dynasties, such as "On the Origin of Diseases", "Jing Yue Quan Shu", "Yi Zong Jin Jian", "Criterion of Syndrome and Treatment", etc., as well as modern clinical teaching materials of TCM, have basically treated diseases (symptoms) based on syndrome differentiation. Therefore, it is necessary to inherit the disease name and diagnosis of traditional Chinese medicine.
The combination of disease and syndrome is the basic method for TCM to understand the essence of disease. Diagnosis of disease can effectively grasp the fundamental contradictions in the whole process of disease, while syndrome differentiation can accurately grasp the main contradictions such as disease location and disease nature at a certain stage of disease. The layered understanding of disease and syndrome is highly complementary. The relationship between the two is like the crisscross of longitude and latitude, which makes the understanding of the essence of disease in TCM reach a three-dimensional unity in the three aspects of the disease location, the upper and lower parts of the exterior, the viscera and meridians, the cold and heat deficiency and excess of the disease, and the depth of the disease. The name of TCM disease is integrated into the theoretical system of TCM, which can correctly guide clinical syndrome differentiation and treatment. Like syndrome diagnosis, disease name diagnosis is an indispensable part of clinical diagnosis and treatment of traditional Chinese medicine.
2 TCM disease name must be used in TCM clinic
As far as the goal of clinical diagnosis and treatment is concerned, both Chinese medicine and Western medicine are aimed at diseases. In this regard, the names of diseases in Chinese medicine and Western medicine are interrelated. However, due to the difference in epistemology and methodology, the disease name system derived is necessarily different. The names of diseases in both Chinese and Western medicine generally consist of the combination of etiology, disease nature (pathology), disease location and symptoms. Because Chinese and Western medicine have different understandings of the physiology, pathology and interrelationship of various tissues and organs, the name of the disease is clearly defined. Western medicine has different forms of etiological diagnosis, pathological anatomical diagnosis, pathophysiological diagnosis, functional diagnosis, clinical syndrome diagnosis and other forms, and pays attention to the combination of several aspects to make a complete diagnosis, But it is lengthy and complex. In contrast, the names of diseases in traditional Chinese medicine are extremely refined and concise. The actual words of each disease name are generally only 2-4 words. It is not necessarily necessary to summarize the essential attributes of each disease, such as the cause, nature, and location of disease, but can be supplemented through diagnosis based on syndrome differentiation. It is precisely because of the complementarity between the diagnosis of disease name and the diagnosis of syndrome differentiation that the diagnosis of disease and syndrome of traditional Chinese medicine is integrated into the theoretical system of traditional Chinese medicine and has the characteristics of traditional Chinese medicine. It can be seen that the disease names of traditional Chinese medicine and western medicine are related but not equal.
The clinical practice of traditional Chinese medicine must be guided by the theory of traditional Chinese medicine and use accurate and standardized disease names of traditional Chinese medicine. The disease names of Chinese medicine and Western medicine can only coexist and contrast with each other, and cannot be used together, let alone replace the disease names of Chinese medicine with those of Western medicine. Only by standardizing the names of diseases in Chinese medicine and insisting on and strengthening the diagnosis of the names of diseases in Chinese medicine can we benefit the development of Chinese medicine and give full play to the advantages of Chinese medicine.
3 Necessity of TCM disease name diagnosis
Many disease names in traditional Chinese medicine, such as tetanus, tray furuncle, pterygium climbing eyes, thrush, tongue fungus, mumps, Yin blowing, etc., are concise and easy to master. There are many good names of diseases in traditional Chinese medicine, such as calendar wind, tetanus, cold, red silk furuncle, wrapped waist fire pill, snake head furuncle, milk rock, sky red, crab eye, bone trough wind, and nose pit. Their names are scientific and accurate, and they match the name with the reality, just as in Song Zhang Gao's "Medical Treatise on Diseases", it is said that "in ancient times, diseases are discussed by taking more images than categories, so that people can easily understand". Therefore, these TCM disease names have been used up to now and are known by all, showing strong vitality. Some diseases, such as dysentery, cholera, typhoid, tetanus, rheumatic fever, cold, measles, epilepsy, eclampsia, diphtheria, hemorrhoids, carbuncle, gout, rubella, cloud, beriberi, psoriasis, syphilis, were cited by Western medicine when it was introduced into China.
Traditional Chinese medicine emphasizes syndrome differentiation, and mostly takes symptoms as diseases. But after all, syndrome differentiation only reflects the condition of a certain stage of the disease, and the disease is only the external manifestation of the essence of the disease. The disease name determined through diagnosis represents the understanding of the essence of the disease. The diagnosis of disease name is of great significance in the medical practice of traditional Chinese medicine. It is conducive to grasping the overall situation of the disease and the general law of the whole process, and is conducive to clinical treatment. This is an important part of the academic development of traditional Chinese medicine.
4. Standardize TCM disease name system
All disciplines are developed on the basis of inheriting the academic ideas of predecessors, and the academic study of TCM disease names is no exception. The primary and fundamental principle of the research on the standardization of TCM disease names must also be the principle of inheritance. It is necessary to sort out and excavate TCM disease names from the medical books of the past dynasties that contain the rich experience and theory of predecessors, and use them when they are suitable for clinical practice, and transform them when they are not in line with clinical practice. On this basis, in line with the principles of characteristics, practicality, innovation and accuracy, we will comprehensively and systematically carry out the research on the system of disease names, and form a complete and standardized academic system of TCM disease names. The disease part of the National Standard of the People's Republic of China "Terminology of Clinical Diagnosis and Treatment of Traditional Chinese Medicine" [3], issued in recent years, is based on the purpose of inheriting and developing the theory of traditional Chinese medicine, and uses inheritance, mining, extension, innovation, introduction and other methods to differentiate and define disease names, so that the academic system of TCM disease names can be formed in a relatively complete sense.
When the leaves fall, the cancellation of disease names is a precursor to the demise of TCM learning. In the face of traditional Chinese medicine, which is increasingly far away from traditional culture, how to restore the close relationship between traditional Chinese medicine and traditional culture in the past, and how to make Chinese medicine develop healthily according to its own development laws, may be a problem that people who are interested in revitalizing the cause of Chinese medicine today should urgently think about and solve [4, 5].
Modern medicine has established international standards such as the International Classification of Diseases (1CD) and the domestic Classification and Code of Diseases. However, traditional Chinese medicine is a traditional medicine with unique theories and rich experience. Traditional Chinese medicine is a valuable cultural heritage of our country, which is very different from western medicine. Therefore, it is impossible to standardize the names of diseases in traditional Chinese medicine with foreign terms such as ICD. Now the disease names of traditional Chinese medicine are abandoned in clinical practice, and there is no system of disease names of traditional Chinese medicine. Therefore, it is necessary to step up the standardization and standardization research of disease names of traditional Chinese medicine. The national health administration department should organize traditional Chinese medicine scholars to carry out research on standard disease names of traditional Chinese medicine, establish a system of standard disease names of traditional Chinese medicine, and fully absorb and reflect the reasonable contents of previous research on one hand, On the other hand, it makes up for the lack of standardization research in the previous paragraph. The study of standard disease names of TCM should strictly distinguish the concepts of diseases, syndromes and symptoms according to the theoretical system of TCM. On the basis of inheriting the original disease names, the study should refer to the disease names of Western medicine and innovate, differentiate and expand the disease names of TCM according to the theory of TCM. This research can provide a comprehensive standard "original" for the academic research of traditional Chinese medicine, constantly improve the disease system of traditional Chinese medicine, guide clinical diagnosis and differential diagnosis, and protect the intellectual property rights of traditional Chinese medicine.
reference
[1] Zhu Wenfeng, He Zelong. On the necessity of adhering to the diagnosis of TCM disease names [J]. Liaoning Journal of Traditional Chinese Medicine, 2000, 27 (2): 50-52
[2] Su Yulin. The name of traditional Chinese medicine should be reformed [J]. China Journal of Traditional Chinese Medicine, 2000, 5:31
[3] Zhu Wenfeng, Wang Yongyan, Wang Pei, et al. Terminology of clinical diagnosis and treatment of traditional Chinese medicine diseases [S]. Beijing: National Standards Press, 1997
[4] Liu Ideal, Zhang Qicheng. The impact of modern cultural initiatives on traditional Chinese medicine [J]. China Journal of Traditional Chinese Medicine, 2006, 10 (13):
Chapter 6: Model Essay on the Prospect of Clinical Medicine of Traditional Chinese and Western Medicine
Medical colleges in the college entrance examination enrollment specialty directory (undergraduate) of ordinary colleges and universities, log on each college website to get the required data; If it is not available on the website, contact the graduate school of the university or consult the experts related to the specialty of the university. At the same time during the investigation
Refer to the Yearbook of Chinese Pharmacy (2007-2011), the website of the Ministry of Education, the website of the Ministry of Health, the website of the Pharmaceutical Affairs Management Research Department of the Hospital Management Institute of the Ministry of Health/the website of the Pharmaceutical Affairs Management Professional Committee of the China Hospital Management Association, and summarize the colleges and universities that have approved the establishment of clinical pharmacy specialty and independently set clinical pharmacy direction in China as of May 2013, Log on the university website one by one to inquire and interview relevant experts to collect data and data, and then conduct statistical analysis. After investigation, As of May 2013, there are 35 full-time colleges and universities in China that have set up clinical pharmacy or undergraduate education in clinical pharmacy (The clinical pharmacy specialty of Peking University and Shandong University is a long-term system, and the undergraduate training of students is basically similar to that of other pharmaceutical majors. The training of clinical pharmacy specialty did not start until they entered the graduate stage, so the two universities were included in the research of clinical pharmacy graduate training), accounting for about 22% of the total number of undergraduate universities offering pharmacy specialty in China. Compared with the United States, where the current Pharm. D training accounts for more than 90% of the total scale of pharmaceutical education, there is a big gap. See Table 1 for the details of its clinical pharmacy specialty/direction setting (the approval time in the table is the time announced after the filing and approval of the Ministry of Education. "-" refers to the clinical pharmacy direction independently set up by colleges without the approval and filing of the Ministry of Education).
1.1 Among colleges and universities that enroll undergraduate clinical pharmacy majors or directions, there are 24 medical colleges, 6 comprehensive universities, 3 pharmaceutical colleges and 2 TCM colleges and universities. This is related to the need for close integration of clinical pharmacy education with medicine and clinical practice; At the same time, it also reflects its characteristics as a comprehensive discipline. The establishment of TCM colleges and universities also means that clinical pharmacy has begun to step into the field of TCM.
1.2 The time of approving specialty setting is based on the adjustment of undergraduate specialty setting in China by the Ministry of Education in 2012. Clinical pharmacy has become a special specialty with special needs of national talent cultivation in recent years, and is also one of the 62 specialties controlled by the state [1]. Among the above colleges and universities, 24 colleges and universities have clinical pharmacy majors set up after the filing or approval of the Ministry of Education, the remaining 11 colleges and universities are pharmacy majors (clinical pharmacy direction), and 2 colleges and universities are clinical medicine majors (clinical pharmacy direction). The number of colleges and universities offering clinical pharmacy specialty/direction has increased from one to six every year since the Ministry of Education resumed the establishment of clinical pharmacy specialty in 2006. This is not only related to the promotion of clinical pharmacy discipline in China and the development of clinical pharmacy discipline abroad in the past 40 years, but also closely related to the Interim Provisions on Pharmaceutical Affairs Management in Medical Institutions issued by the Ministry of Health in January 2002, Article 10 of the Interim Provisions stipulates that "pharmaceutical departments should establish a patient-centered pharmaceutical work model, carry out clinical pharmaceutical work with rational drug use as the core, participate in clinical disease diagnosis and treatment, provide pharmaceutical technical services, and improve medical quality." Article 17 first proposes to "gradually establish a clinical pharmacist system", and stipulates seven responsibilities of clinical pharmacists. In order to implement the above provisions, the Ministry of Health has held a series of expert seminars since 2003 to actively prepare the thinking and organization for the construction of the clinical pharmacist system. On this basis, the Ministry of Health issued a document to carry out the pilot work of clinical pharmacist training in 2005, and in 2007 issued a document to start the pilot work of clinical pharmacist system. The implementation of the construction of the clinical pharmacist system in medical institutions has promoted the overall transformation of the focus of pharmaceutical education, and this transformation and development trend has also been recognized by most medical professionals.
1.3 Regional distribution The 31 universities are distributed in 19 provinces and cities in China. Anhui 2, Beijing 2, Fujian 1, Guangdong 1, Guangxi 1, Hebei 1, Heilongjiang 2, Hubei 1, Jilin 2, Jiangsu 5, Jiangxi 1, Liaoning 3, Shandong 2, Shaanxi 1, Sichuan 2, Tianjin 1, Yunnan 1, Zhejiang 1, Inner Mongolia 1, Guizhou 1, and Chongqing 1. In terms of distribution, more than half of the provinces and municipalities in China have universities with clinical pharmacy majors/directions, but there are still great differences in regional distribution and development, especially that only one university in the five northwestern provinces has clinical pharmacy directions.
1.4 Length of schooling and degrees According to the professional introductions on the websites of colleges and universities as of May 2013, the length of schooling of clinical pharmacy can be divided into two categories: general length of schooling (5 years and below) and long-term length of schooling (6 years and above). However, since the early stage of the long term clinical pharmacy education is basically the same as the general pharmacy education curriculum, the specialty division is not carried out until the later stage, so the long term clinical pharmacy education is included in the discussion of graduate education. It can be seen from Table 1 that the undergraduate education of clinical pharmacy in China is mostly 4-5 years. This is different from the comprehensive implementation of Pharma. D long schooling professional education in the United States, Japan and other countries. At present, China still focuses on the clinical pharmacy training mode of ordinary schooling. In terms of degree awarding, the degree of Master of Medicine or Master of Science can be awarded after completing the long-term education; After completing the general education system, a bachelor of medicine or a bachelor of science degree can be awarded, of which a bachelor of science is the absolute majority.
1.5 In terms of enrollment and employment, enrollment and employment of clinical pharmacy specialty has generally increased in recent years. According to literature reports, about 1370 students are planned to be enrolled in clinical pharmacy from 2006 to 2010. See Table 2 for the specific number of students. However, there are still regional defects in the enrollment of clinical pharmacy majors: taking Xinjiang Autonomous Region as an example, from 2006 to 2011, no school provided Xinjiang examinees with clinical pharmacy undergraduate professional quotas. According to the statistics of the 2007 – 2010 edition of the Chinese Pharmacology Yearbook, the employment situation of clinical pharmacy students is good, reaching 100%, and the employment destination is mainly medical units. According to the requirements for the number of clinical pharmacists in hospitals in the 2011 Provisions on the Administration of Pharmaceutical Affairs in Medical Institutions [6]: there shall be no less than 5 in Grade III hospitals, and no less than 3 in Grade II hospitals, with an average of 4; By the end of July 2012, there are 8059 secondary and tertiary public hospitals in China, and it is roughly estimated that at least 32236 clinical pharmacists are needed nationwide. Obviously, the number of clinical pharmacists trained is far from meeting the practical needs.
1.6 Training program For the undergraduate training program of clinical pharmacy, there are some common courses in various colleges and universities. Although there are different opinions on the classification of courses, such as public basic courses, basic core courses of disciplines, professional courses, main courses, practical courses, graduation practice, etc., in general, there are two categories of theoretical and practical courses, see Table 3 for details. From the perspective of teaching hours, each college has shortened the teaching of chemistry courses compared with the previous pharmaceutical courses, of which the proportion of China Medical University is the lightest, accounting for 1/10 of the total teaching hours, less than all courses; The proportion of basic chemistry courses in most other colleges is about 1/4 of all courses [8]. According to the survey, some medical courses have been gradually added to the clinical pharmacy specialty in all colleges and universities. In fact, the clinical pharmacy specialty is not a simple addition of medicine and pharmacy. The original pharmacy curriculum and some medical courses for clinical medicine cannot be simply combined into the connotation and teaching content of clinical pharmacy education, The West China College of Pharmacy of Sichuan University has set up professional courses that can better reflect the patient-centered pharmaceutical services according to the characteristics of clinical pharmacy (see the bolded part in Table 3 for details). Clinical practice is mostly carried out in the penultimate year of the teaching academic year, that is, the four-year system is in the fifth and sixth semesters, and the five-year system is in the seventh and eighth semesters. The average total class hours are more than 30, and a small number of colleges and universities only carry out clinical practice courses of less than 10 class hours [8].
2. Postgraduate education of clinical pharmacy
In this part of the survey, all medical colleges and universities under the enrollment brochure column are searched by querying the China Postgraduate Information Network (the designated website for graduate enrollment and adjustment); Log in to each college website to get the required data; If it is not available on the website, contact the graduate school of the university or consult the experts related to the specialty of the university.
2.1 Postgraduate education of clinical pharmacy As of May 2013, a total of 35 colleges and universities in China have enrolled clinical pharmacy majors/direction masters, which are distributed in 23 provinces, cities and autonomous regions across the country. Among them, 6 enrollment units have clinical pharmacy master programs approved by the Ministry of Education, and the other 24 have clinical pharmacy directions under other majors. See Table 4 for specific enrollment information ("-" means data is temporarily unavailable due to research conditions). It can be seen from Table 4 that the enrollment units for clinical pharmacy majors/directions are mainly medical colleges, but also comprehensive universities and universities of traditional Chinese medicine. Among them, the proportion of setting clinical pharmacy specialty/direction in the pharmacy of the enrollment unit is similar to that in the medical school and department, and there is also one enrollment unit setting clinical pharmacy direction in its basic medical school, which is not unrelated to the characteristics of clinical pharmacy as a comprehensive applied discipline. 20 All the enrollment units of clinical pharmacy mostly set them under the majors of pharmacology, pharmacy, pharmaceutical master and pharmaceutical analysis, as well as under the majors of traditional Chinese medicine and geriatrics. At present, there are about 140 tutors nationwide who have the qualification to enroll master's degree in clinical pharmacy (the situation that one tutor enrolls students in several universities has been excluded), and the proportion of teachers and students is basically estimated to be 1:1. See Figure 1 for details of the research direction of the enrollment catalog logo of each school. In terms of degrees, after completing the clinical pharmacy master's degree, three kinds of degrees can be granted, namely, Master of Medicine, Master of Science and Master of Pharmacy. Among them, Master of Medicine and Master of Science are scientific degrees. As we all know, the acquisition of a science degree requires graduate students to carry out theoretical and innovative research projects, and pass the strict defense of master's thesis. In clinical pharmacy, students are required to have considerable knowledge and skills in clinical medication, and have more requirements on clinical practice. Too many research projects will inevitably occupy the time of clinical practice. Therefore, the cultivation of clinical pharmacy master to meet the needs of clinical practice is a problem that needs serious consideration in the cultivation of clinical pharmacy master students.
2.2 Clinical pharmacy doctoral education In China, clinical pharmacy doctoral education began at the beginning of the 21st century. The former West China Medical University, the former Shanghai Medical University, the Second Military Medical University and other universities have become the earliest clinical pharmacy doctoral degree awarding points in China, which means the establishment of a complete system of clinical pharmacy education from the scholar, master and doctor levels. Since 2008, China has maintained 5 clinical pharmacy doctoral programs, which are respectively set up in Sichuan University, Fudan University, China Pharmaceutical University, Shenyang Pharmaceutical University and the Second Military Medical University. There are 14 doctoral supervisors in total, with an average annual cumulative enrollment of 6. These five universities all follow the unified doctoral enrollment model in China, and regard obtaining a master's degree as the admission condition for doctoral enrollment. Except for the requirements for publishing articles for master candidates with the same academic qualifications, none of them has clear requirements for master's stage achievements and relevant work experience. As of 2012, the average age of clinical pharmacy doctoral tutors who are still enrolling students in China is 52 years old, of which 13.3% are young tutors aged 45 and below, 73.3% are 45 to 59 years old, and 13.3% are tutors aged over 60 years old. It can be seen that the advantages of clinical pharmacy doctoral tutors in youth are obvious. Among the clinical pharmacy doctoral tutors, the vast majority (about 66.7%) have doctoral degrees, which meets the demand for high-level and high-quality doctoral education teachers while clinical pharmacy education continues to mature and develop. The professional background of the tutor team will have a certain impact on the connotation and extension of the discipline to a certain extent, especially in clinical pharmacy, a comprehensive discipline integrating pharmacy, medicine, social science and other knowledge, which needs to learn from a diversified knowledge system to guide clinical practice, and also affect the students' comprehensive ability and divergent thinking. From the professional background of supervisors, clinical pharmacy doctoral supervisors belong to two fields, pharmacy and medicine, and the supervisors with medical professional background are part-time. Compared with the requirements of clinical pharmaceutical services for high-level talents, such professional background still has some deviation. At the same time, the single supervisor responsibility system is adopted for the cultivation of clinical pharmacy doctors in China, which is different from the collective responsibility system adopted by the U.S. Pharm. D cultivation. This makes the professional field of the individual supervisor have a great impact on whether clinical pharmacy doctors can really conduct research in the professional field of clinical pharmacy. The doctoral training direction of clinical pharmacy in China mainly involves four aspects: clinical application of drugs, pharmacokinetic research, pharmaceutical foundation, and drug policy and supervision. These directions basically cover the contents involved in clinical pharmacy, especially the research direction in the clinical application of drugs, which is specific to the evaluation of drug treatment of diseases. They are not only closely integrated with clinical specialty, but also show the characteristics and irreplaceable of clinical pharmacy. Development is also an issue for relevant personnel to consider.
3 Conclusions and suggestions
1. Establish the concept of clinical pharmacy. Clinical pharmacy is one of the most dynamic pharmaceutical fields. The emergence and development of clinical pharmacy have improved the pharmaceutical discipline system, expanded the scope of pharmacy, and promoted the overall development of pharmaceutical discipline. As a comprehensive applied technology discipline to research and practice the rational use of drugs, clinical pharmacy needs health administrators, education and teaching managers, teaching staff and students involved in clinical pharmacy education to establish a mature concept of clinical pharmacy discipline From the perspective of tool system (such as teaching content and teaching methods) and application system (such as students' career development), think about their responsibilities and obligations in the construction of clinical pharmacy education system.
2 Optimize the teaching content of clinical pharmacy With the development of medicine, changes in diseases, and changes in people's understanding of clinical pharmacy, the construction of clinical pharmacy discipline needs to constantly explore the professional characteristics of clinical pharmacists' work and explore the professional characteristics of clinical pharmacy education. Clinical pharmacy should have significant professional characteristics, not the simple addition of clinical medicine and pharmacy. We should aim at the ultimate goal of pharmaceutical care and build a patient centered clinical pharmacy curriculum system. This patient-centered approach is not just about the patient's disease status. At the same time, we should take into account the specific circumstances of patients as social people, such as their cognitive level, economic ability, family background, and provide an individualized and easily accepted clinical pharmaceutical service.
In the school education of clinical pharmacy, the practice link teaching of pharmaceutical service is one of the weakest links at present, and strengthening the practice link teaching has become a major issue to be solved urgently in the training of clinical pharmaceutical talents. At present, some progress has been made in strengthening the combination of schools and clinical practice institutions, building clinical practice bases, providing clinical pharmacy students with teaching conditions for internships, internships and graduation internships of clinical related courses, cultivating teachers, and downplaying the requirements of academic research in graduation theses. However, how to measure the effectiveness of these progress specifically and make this practical teaching measure become a mere formality; In other words, how to evaluate the effect of clinical pharmacy practice teaching, and to promote the future.
4 Pay attention to the role transformation from students to clinical drug practitioners, and attach importance to post graduation education. In fact, no matter in terms of knowledge level or qualification, clinical pharmacy school education can not directly participate in clinical practice, and post graduation education is an indispensable link to realize the role transformation from students to clinical drug practitioners. Therefore, clinical pharmacy education cannot only be regarded as school education, and relevant people should pay more attention to the post graduation education of clinical pharmacy, take the training of clinical pharmacists as the goal, adhere to the clinical approach, and transform the knowledge acquired from education into clinical drug application skills through clinical practice.
5 Focusing on the cultivation of discipline leaders The cultivation of discipline leaders with solid theoretical knowledge of clinical pharmacy system and practical skills of clinical drug treatment is an important part of the discipline construction. The education of clinical pharmacy graduate students is an effective way to cultivate high-level talents and discipline leaders in clinical pharmacy and ensure the construction of clinical pharmacy discipline echelon. The training of clinical pharmacy graduate students should be based on the professional degree training mode, and the path and idea of clinical pharmacy professional degree training should be detailed from the aspects of training objectives, curriculum settings, tutor guidance methods, and thesis evaluation standards, so as to train the clinical pharmacy discipline leaders in a targeted manner.
6. To build a reasonable clinical pharmacy education system, the elements of various levels and types of clinical pharmacy education should form an orderly combination to build a reasonable clinical pharmacy education system. Although this study focuses on the school education of clinical pharmacy, the post graduation education of clinical pharmacy cannot be ignored. Undergraduate education in clinical pharmacy lays a solid foundation for talent cultivation; On the basis of this, postgraduate education has trained more innovative and leading clinical pharmaceutical discipline leaders; Post graduation education is an indispensable part of school education for graduates to grow into professional clinical pharmacists. Continuing education provides clinical pharmacists with opportunities to improve and participate in organized learning throughout their lives. Only a complete, comprehensive and open education system can fully develop and utilize the potential educational resources, and constantly improve the quality and level of clinical pharmacists to meet the needs of social development.
Chapter 7: Model Essay on the Prospect of Clinical Medicine of Traditional Chinese and Western Medicine
[Key words] Integrated traditional and western medicine; Specialty construction; personnel training
In order to vigorously and rapidly promote the cause of integrated Chinese and Western medicine in China, it is a suitable choice to launch the specialty of integrated Chinese and Western medicine in national higher education. At present, many colleges and universities have set up the specialty of integrated traditional and western medicine, but there are still some disputes about the development prospect of the specialty and the talent training mode, which need to be explored and improved continuously [1, 2]. Therefore, we have conducted an investigation on the problems related to the establishment of integrated traditional and western medicine in colleges and universities that have opened integrated traditional and western medicine earlier and had a greater impact in China. Now we report the results of the investigation as follows.
1、 Methods
The survey focused on four influential universities in China, including Tianjin University of Traditional Chinese Medicine, Hebei Medical University, Hunan University of Traditional Chinese Medicine and Guangzhou University of Traditional Chinese Medicine, and used the method of questionnaire survey to send 146 questionnaires to 26 medical universities and colleges of traditional Chinese medicine, experts in traditional Chinese medicine and teaching management, and school leaders, with 132 returned, Expert consultation was conducted on issues related to the talent training program of traditional Chinese medicine and western medicine, and experts from inside and outside the school were organized to demonstrate.
2、 Results
1. Prospects of Integrated Traditional and Western Medicine
When investigating the necessity of setting up the specialty of integrated traditional and western medicine, 48 cases (36.4%) thought it was necessary; 73 copies were necessary, accounting for 55.3%; Eleven were unnecessary, accounting for 8.3%. 66 (50%) were very positive about whether the specialty of integrated traditional Chinese and western medicine was one of the development directions of higher medical education; 45 positive, accounting for 34.1%; 21 were uncertain, accounting for 15.9%. The employment prospects of graduates majoring in integrated traditional Chinese and western medicine were very good in 63 cases, accounting for 47.7; 38, accounting for 28.8%; 19 were considered as average, accounting for 14.4%; 12 were not optimistic, accounting for 9.1%.
2. Current development of integrated traditional and western medicine
At present, there are nearly 30 Chinese medicine colleges and universities and comprehensive medical universities across the country that offer undergraduate education in the specialty of integrated traditional and western medicine, and have established departments or colleges of integrated traditional and western medicine. For example, in 1993, Hunan College of Traditional Chinese Medicine, Guiyang College of Traditional Chinese Medicine, and Zhejiang College of Traditional Chinese Medicine established departments of integrated traditional and western medicine and began to enroll five-year undergraduate students, and in 2000, they enrolled 7-year undergraduate and postgraduate students. Hebei Medical University started to enroll three-year junior college students majoring in integrated traditional and western medicine in 1992, established the Department of Integrated Traditional and Western Medicine in 1993, changed to the College of Integrated Traditional and Western Medicine in 2001, enrolled five-year undergraduate students in 2001, and enrolled seven-year undergraduate and postgraduate students in 2002. The Department of Integrated Traditional Chinese and Western Medicine of Shanghai Medical College of Fudan University was officially established in March 2002, and it enrolls 7-year continuous undergraduate and postgraduate students majoring in integrated traditional Chinese and Western medicine. In recent years, Guangzhou University of Traditional Chinese Medicine has annually enrolled nearly 100 7-year continuous undergraduate and postgraduate students majoring in traditional Chinese medicine (7-year integrated Chinese and Western medicine). In 2000, Nanjing University of Traditional Chinese Medicine and Nanjing Medical University jointly started to enroll 7-year undergraduate and postgraduate courses in integrated traditional and western medicine. The Department of Integrated Traditional Chinese and Western Medicine of Anhui University of Traditional Chinese Medicine was established in 2000, and in 2001, it officially enrolled five-year undergraduate students majoring in integrated traditional Chinese and Western medicine. Liaoning College of Traditional Chinese Medicine began to enroll 7-year undergraduate and postgraduate courses in the specialty of integrated traditional and western medicine in 2002. Shandong University of Integrated Traditional Chinese and Western Medicine is the first private institution of higher learning in China, which mainly focuses on integrated traditional Chinese and Western medicine. It enrolls five years of students majoring in integrated traditional Chinese and Western medicine, and has 6000 undergraduate and junior college students.
3. Training mode of integrated traditional and western medicine
In terms of educational system, 75 students, accounting for 56.8%, thought that it was better to set up a long educational system (7-year system) for integrated traditional Chinese and western medicine; 57, accounting for 43.2%, believed that a short term education system (five-year system) was set up. Among the types of personnel training of integrated traditional Chinese and western medicine, 23 (17.4%) believed that they were scientific research type; 44 cases considered as clinical type, 33.3%; 65 (49.2%) believed clinical research type. The proportion of traditional Chinese medicine and western medicine in the curriculum of integrated traditional and western medicine was 6 ∶ 4, 12, accounting for 9.1%; 56 cases (42.4%) with a ratio of 5 ∶ 5; 64 at 4:6, accounting for 48.5%. As for the teaching materials of integrated traditional Chinese and western medicine, 39 of the existing teaching materials of traditional Chinese medicine and western medicine were used, accounting for 29.5%; It is believed that 93 textbooks of integrated traditional and western medicine have been rewritten, accounting for 70.5%. The survey also found that the most important factor to run the specialty of integrated traditional Chinese and western medicine well is the teachers. At present, the teachers of the specialty of integrated traditional Chinese and western medicine are generally considered to be lacking, so it is necessary to strengthen the training.
3、 Discussion
The direction of integration of traditional Chinese medicine and western medicine has received considerable attention and development as a major force with traditional Chinese medicine and western medicine since liberation. Although the rapid development of undergraduate education has been a matter of more than 10 years, the Ministry of Education of the People's Republic of China agreed to set up a "specialty of integration of traditional Chinese medicine and western medicine" outside the specialty directory in 2001, but the undergraduate education of integration of traditional Chinese medicine and western medicine has mushroomed and developed rapidly. At present, most people believe that it is necessary to start the specialty of integrated traditional and western medicine, and they are optimistic about the employment and development prospects of the specialty. In some colleges and universities, the number of students enrolled in the specialty of integrated traditional Chinese and western medicine is more than that in the specialty of traditional Chinese medicine. From the above data, we can see that the development speed of integrated traditional and western medicine in recent years can be described as "rapid development". It can also be inferred that the market has a huge demand for talents of integrated traditional and western medicine. Due to the large demand gap for talents of integrated traditional Chinese and western medicine at the grass-roots level in China, the vast majority of experts in our survey believe that graduates of integrated traditional Chinese and western medicine will not have employment pressure in the past 10 years, and that the undergraduate education of integrated traditional Chinese and western medicine will be a golden period of rapid development in the next 10 years. We also found an interesting phenomenon in the survey. At present, when college graduates of traditional Chinese medicine colleges apply for jobs, they would rather fill in the form of "integrated Chinese and western medicine" than "traditional Chinese medicine". In undergraduate enrollment, the specialty of integrated traditional Chinese and western medicine is the most popular specialty, which is often dozens of points higher than other majors at the same time. This shows that the social demand for integrated traditional Chinese and western medicine is really great, and the development prospect is promising. As a new discipline, the transfer of posts to integrated traditional Chinese and western medicine is not mature enough. At present, the training mode of integrated traditional and western medicine professionals in China is still in the exploratory stage. Due to the rapid development of the specialty of integrated traditional Chinese and western medicine, there are some noticeable problems in the undergraduate teaching of integrated traditional Chinese and western medicine, mainly as follows.
1. Talent training mode. The combination of traditional Chinese medicine and western medicine requires both Chinese and western medicine, and a solid foundation of traditional Chinese medicine and western medicine. The cultivation of talents in the combination of traditional Chinese medicine and western medicine should strictly avoid the addition of two levels of technical secondary schools. At the same time, the integration of traditional Chinese medicine and western medicine in the field of basic theory and epistemology also needs further in-depth exploration. Based on the current situation of the development of integrated traditional Chinese and western medicine, what kind of training mode is the most appropriate for undergraduate education, how long is the school system of integrated traditional Chinese and western medicine, and the specific curriculum arrangement, many other problems still need to be solved in the development.
2. Teachers. The lack of teachers reflects the most common problem and is the bottleneck restricting the development of integrated traditional Chinese and western medicine professional education. The specialty of integrated traditional Chinese and western medicine has high requirements for teachers. Teachers must have a good grasp of the two sets of medical theoretical systems, and have rich clinical practice of integrated traditional Chinese and western medicine, so that they can integrate the two and make the curriculum well and lively. Due to the lack of teachers who understand both traditional Chinese medicine and western medicine, there is a lack of understanding of western medicine and traditional Chinese medicine, especially in the later clinical teaching.
3. Teaching materials. A set of scientific, systematic and comprehensive teaching materials is one of the necessary conditions to ensure the quality of professional education and teaching in colleges and universities. With the rapid development of the specialty of integrated traditional Chinese and western medicine, several sets of integrated traditional Chinese and western medicine textbooks have been edited and published at the undergraduate and junior college levels. Various versions of textbooks have their own characteristics. Competition is good for discipline construction, but there is indeed a phenomenon of mixed good and bad. At present, there are 16 textbooks for the national unified planning, which are not complete and systematic in terms of subjects alone. Moreover, the textbooks for basic courses are not different from the current textbooks for basic courses of traditional Chinese medicine and lack obvious characteristics of their own.
4. Teaching mode. At present, the basic teaching mode of each college is: two foundations and one clinic. That is, the basis of western medicine, the basis of traditional Chinese medicine; Clinical practice of integrated traditional Chinese and western medicine. The basic teaching of traditional Chinese medicine and western medicine is followed in the basic teaching of traditional Chinese medicine and western medicine; Multiple experiments. In clinical teaching, the method of combining western medicine with traditional Chinese medicine is adopted.
Through the above investigation and research, we believe that the current establishment of integrated traditional and western medicine is to keep pace with the times and grasp the direction of the development of higher education in the 21st century. The necessity and prospect of setting up the specialty of traditional Chinese medicine and western medicine are generally recognized. At present, the development momentum of the specialty of integrated traditional Chinese and western medicine is good, and the enrollment scale, source quality and employment prospects are generally reflected well. However, there are still some problems in the personnel training mode, teachers and teaching materials of integrated traditional and western medicine. Therefore, everyone's opinions on whether to set up the specialty of integrated traditional and western medicine have been relatively unified, that is, it is necessary to set it up. At present, the focus is how to build up the specialty of integrated traditional and western medicine. In particular, it is necessary to strengthen the training of teachers of integrated traditional and western medicine, gradually compile more adaptable teaching materials of integrated traditional and western medicine, strengthen the teaching discussion of integrated traditional and western medicine among colleges and universities, conduct extensive demonstration and communication on the training model and teaching model of integrated traditional and western medicine, and highlight the characteristics of integrated traditional and western medicine, Provide high-quality talents for the construction of integrated traditional Chinese and western medicine and social and economic development.
[References]
Chapter 8: Model Essay on the Prospect of Clinical Medicine of Traditional Chinese and Western Medicine
Key words: foreign students; Medical Chinese; Curriculum; present situation
CLC No.: G642.0 Document Code: A Article No.: 1674-9324 (2016) 44-0084-02
In recent years, with the increasing international status and comprehensive national strength of China, the education of studying abroad in China has been booming. In 2011, nearly 300000 foreign students from 194 countries and regions studied and advanced in 660 higher education institutions in China, including 1553 non academic medical students and 33725 academic medical students. ■ The Ministry of Education's Interim Provisions on the Quality Control Standards of Medical Undergraduate Education for Foreign Students in China pointed out that the overall goal of medical undergraduate education for foreign students in China is to train medical graduates with solid basic medical knowledge, standardized clinical skills and good professional quality. It can be seen that the importance of medical Chinese teaching for foreign students is self-evident. Now the author will talk about the current situation of medical Chinese courses in Guangxi Medical University based on the situation of foreign students in Guangxi Medical University.
1、 Distribution and school situation of foreign students in Guangxi Medical University
Guangxi Medical University has enrolled international students since 1958. At present, the source countries of students cover more than 60 countries and regions on five continents, including Vietnam, India, Yemen, Mauritius, France, the United States, Ecuador, Tonga and other countries. In recent years, our school has gradually expanded the enrollment scale and improved the level of enrollment, and the number of international students on campus has increased significantly. As of June 2015, there were 851 international students on campus, including doctors, masters, undergraduates, language learning, etc., of which 515 were all English students. Since 2000, our self funded Chinese students have mainly come from India and Vietnam. There are about 500 Indian students, accounting for 64% of the international students in our school; Vietnam now has about 120 students, accounting for 15.4% of the international students in the university.
As of September 2008, our school has six years of clinical medicine teaching in English, five years of clinical medicine (hereinafter referred to as clinical medicine), five years of preventive medicine, five years of stomatology (hereinafter referred to as stomatology), five years of medical laboratory, four years of pharmacy (hereinafter referred to as pharmacy), four years of nursing, four years of information management and information system (medicine) There are nine undergraduate majors in English major and four-year English major. Among them, foreign students are concentrated in English teaching of six-year clinical medicine, five-year clinical medicine, five-year stomatology and four-year pharmacy. Therefore, our school has set up basic medical Chinese courses for foreign students in these four majors. Especially for six-year clinical medical English teaching students, since the professional teaching language is English, but when entering the clinical practice stage, foreign students are required to have certain Chinese ability to communicate with teachers, students, doctors and patients, and can read Chinese cases. Medical Chinese is listed as a required course of the specialty. The reality is that the students of this major treat it as an elective course.
2、 Foreign Students' Chinese in Guangxi Medical University
Undergraduate foreign students who teach in Chinese (we call them "Chinese students" in the school) are required to have a Chinese language level of three or more levels of HSK (Chinese Proficiency Test) when they enter the school (the new HSK requires to have a level of four or more). This kind of foreign students have a certain Chinese foundation when they enter the school. According to the concept of convergence management, Arrange classes for international students and Chinese students to create more opportunities for international students to contact with Chinese students and exchange culture, customs, concepts and other aspects. The two sides can interact and influence each other in learning, behavioral norms and other aspects. Five years of medical learning are all in Chinese. When such international students enter the clinical practice stage, Chinese problems will not be prominent, I can integrate quickly. In addition to paying more attention to medical procedures, I heard that there is generally no problem. However, there is no HSK requirement for English teaching undergraduate students (in the campus, we call them all English students) when they enter the university. Chinese is the starting point, and their mother tongue or official language is English. Although the school has arranged medical Chinese courses according to the situation, because the medical professional courses are all in English for five years, the study and life do not intersect with that of Chinese students. There are only 4-6 class hours of Chinese courses a week. The sixth year of clinical practice, the problems caused by Chinese are extremely prominent, and students are difficult to quickly integrate into clinical practice, listening and speaking, Not to mention the problem of case study, which makes most students tired of and afraid of learning.
3、 Current situation of time coordination between basic medical Chinese courses and medical courses
The Chinese course of basic medicine is a language course for foreign students majoring in clinical medicine, pharmacy and stomatology who are five-year students (taught in Chinese). This course has a total of two semesters. It mainly introduces some basic definitions and professional vocabulary of basic medical courses. At the same time, it carries out comprehensive training of listening, speaking, reading and writing in the medical background. The purpose is to lay a good language foundation for foreign students to learn medical professional courses.
According to the undergraduate talent training program of Guangxi Medical University, English is a required course for Chinese undergraduate students, but it is not a required course for foreign students, but an exempted course. Instead, it is a medical Chinese course. Clinical, oral and pharmaceutical courses all have 280 class hours and 14 credits for English courses, and 130 class hours and 7 credits for medical Chinese courses. In contrast, the author believes that the class hours of medical Chinese should be increased, and if conditions permit, the author believes that medical Chinese practice should be increased.
According to the MBBS training program of Guangxi Medical University, the medical Chinese course totals 216 class hours and 12 credits. Taking Chinese students as an example, Chinese students began to learn English from middle school, and most of them could not use English for doctor-patient communication and case reading and writing after 280 class hours of professional language learning in college. In the same way, for foreign students with English background, although they have 576 class hours of basic Chinese learning, it is very difficult for them to enter the full Chinese clinical practice environment at once with only 216 class hours of medical Chinese courses, and reach the level of Chinese students with the same degree.
The author believes that medical Chinese practice course should be added, that is, pre practice stage. Taking the 2007 five year clinical medical Chinese teaching international students of our university as an example, before entering the formal practice, we arranged an 8-week pre practice in the First People's Hospital of our city. The students of this project are full of praise for this, and the survey result is that 100% think it is very necessary to add this course, which is very helpful to quickly enter the practice, so that foreign students can understand the practice mode and structure in advance, adapt to the practice environment, and combine the theory and practice in medical Chinese class. Previous international students were confused and at a loss when they entered the internship, but the students who had undergone the pre internship were basically familiar with the "framework structure" of the internship at the pre internship stage. They could understand the instructions of the leaders, and most of them could quickly find their own "position" and "role", instead of waiting for the arrangement of the leaders. Therefore, the author believes that the practice part of medical Chinese courses can be added if conditions permit.
4、 Problems in medical Chinese textbooks
At present, Chinese textbooks for medical students are extremely scarce in the market. First, the demand is not large due to the strong professionalism. Second, teaching Chinese as a foreign language itself is a new discipline, let alone medical Chinese. Our school has used the series of practical medical Chinese published by FLTRP and the Medical Chinese Course published by Higher Education Press, with less selectivity.
As far as the textbooks used in our school are concerned, no textbook can be perfect at present, and it is even more difficult to compile it. Due to the lack of medical Chinese teaching materials and the characteristics of strong professionalism, it requires teachers to have both language teaching ability and rich medical background. Because in the teaching process, in addition to teaching guidance for students according to the content of the textbook, teachers need to be able to supplement certain medical knowledge to enrich the classroom. The teachers who serve as medical Chinese courses for foreign students are almost non-medical background, and it is very difficult to write them. However, teachers with medical background generally do not understand the characteristics of language teaching, tend to be medical thinking, and have a general effect on foreign students' learning.
When compiling medical Chinese textbooks, we should pay attention to the diversity of practice forms, which can fully mobilize the enthusiasm of foreign students. The design exercises give full play to the role of images as far as possible, and have a good impact on sensory memory. Grammar practice must be combined with medical vocabulary, so that foreign students can draw inferences from one instance and learn and use flexibly. The functional exercise must estimate the situation. In the scenario design, do not imagine it out of thin air. It should be based on reality. The closer it is to life, the more practical it will be. It can also avoid ridicule.
5、 The weight of "medicine" and "Chinese" in medical Chinese classroom teaching
The weight of "medicine" and "Chinese" in medical Chinese classroom teaching is often a headache for teachers and foreign students. In the teaching evaluation activities carried out in 2011, some foreign students thought that the course was very useful and could help them, some thought it was useless and wasted time, and some foreign students thought that the teacher should change the teaching method and need more vivid language. The author believes that in medical Chinese classroom teaching, first of all, we should fully consider the learning characteristics and needs of medical overseas students, and guide and emphasize the practicality; Secondly, the medical Chinese class should not focus on teaching, but on communication scenes, emphasizing the training of "listening and speaking" ability; Finally, we should pay attention to the transition and connection between language knowledge and professional knowledge. Because medical Chinese, after all, is a Chinese course, which cannot replace medical professional courses. When teaching the medical profession, the author believes that teachers should grasp the scale point to the end, try to explain from the perspective of language, and cultivate the reading skills of scientific and technological articles and the expression ability of medical terms.
notes:
(1) Brief Statistics of Foreign Students in China in 2011, Department of International Cooperation and Exchange, Ministry of Education, internal data.
reference:
[1] Academic Affairs Office of Guangxi Medical University. Undergraduate Talent Training Program of Guangxi Medical University [Z]
Chapter 9: Model Essay on the Prospect of Clinical Medicine of Traditional Chinese and Western Medicine
1.1 Evaluation index After the end of teaching (June 2013), students were assessed for clinical skill operation. The operation assessment scale used the clinical skill operation assessment scale developed by the clinical skill teaching team of our hospital to compare the differences between the two groups of students' skill operation mastery. Clinical ability mainly includes five dimensions, including clinical disposal ability (checking system, hand washing principle, cleaning and sorting of operating materials), communication ability (language organization ability, attitude, communication skills, ability to obtain support from patients and their families), operation skills, humanistic knowledge, and legal knowledge, with a total of 18 items. A fixed instructor will evaluate the students' operation ability, and check the correct items.
1.2 Statistical method The data of the questionnaire were entered in Excel and statistically analyzed in SPSS16.0 software package. The measurement data were expressed as mean ± standard deviation, and the two groups were compared by independent sample t test. χ 2 test was used for counting data. Inspection level α=0.05.
2 Results
The operation ability of the two groups of students was compared (taking gastrointestinal decompression as an example). The students in the scenario simulation medical dispute group were significantly better than those in the traditional teaching group in terms of their clinical handling ability, operating skills, communication ability, humanistic knowledge, legal knowledge and other related knowledge points, with a statistically significant difference (P<0.05), as shown in Table 1.
3 Discussion
Clinical skills is a new clinical basic discipline, which is the key to knowledge transformation skills, and also the key stage of clinical basic theoretical knowledge, basic skills, communication skills, and scientific thinking ability training. In order to ensure the integrity and systematicness of knowledge, the integration of scenario simulation medical dispute teaching mode is the priority of clinical skills courses. The concept of integrating knowledge points and paying attention to skill training is reflected in the curriculum setting and arrangement of scenario simulation medical disputes. The teaching goal has changed from simple knowledge teaching to focusing on students' ability to use theoretical knowledge and clinical skills, think independently, solve and seek solutions to problems. The traditional medical teaching model, to varying degrees, has many disadvantages, such as emphasizing theory over practice, emphasizing knowledge over skills, more infusion than inspiration, and insufficient students' learning initiative. In the process of problem solving and case analysis, the teaching mode of scenario simulation medical disputes skillfully combines theory and practice, mobilizes students' information management ability, uses critical thinking to identify and absorb massive information, flexibly integrates various resources and multiple ways to acquire knowledge, solve problems, expand ideas, and arouse curiosity, Stimulating the ability of independent thinking, analysis and decision-making, and cultivating a scientific clinical thinking mode meet the core competence requirements of the most basic requirements of global medical education.
The results of this study suggest that in the process of clinical skills teaching, the mastery of clinical handling ability, operating skills, communication skills, humanistic knowledge, legal skills and other clinical operating abilities of students in the medical dispute group who use scenarios to simulate medical disputes are significantly better than those in the traditional teaching group, with a statistically significant difference (P<0.001). This shows that creating scenarios and role drills for students through scenario simulation medical dispute teaching can make students truly understand that the clinical medical environment and atmosphere are very complex and changeable, and can improve clinical handling ability, operating skills and communication ability, self-protection awareness and medical dispute prevention awareness in a high pressure working environment, so as to achieve the real purpose of skill training, Enhance the role adaptability of students. The application of scenario simulation in medical dispute teaching in clinical skills teaching creates a clinical atmosphere for students to change from students to doctors, so that they can become familiar with the "real" medical environment as soon as possible, which is conducive to improving their ability to analyze and solve clinical problems and doctor-patient communication skills, and cultivating their enthusiasm and interest in learning clinical skills. Scenario simulation medical dispute teaching requires all students to exert their subjective initiative to collect data, consult literature, analyze cases, participate in discussions, summarize, and play roles according to medical dispute cases, put students in the actual clinical work process, and cooperate and accumulate experience in the learning process. This enables students to have a new understanding of the theoretical knowledge of skills. Through a series of learning practice models, such as learning thinking operating relearning verifying rethinking, they truly understand the role of different roles in clinical skills practice and the significance of theoretical knowledge in practice.
