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    針灸臨床帶教中的幾點體會和思考

    出處:論文網
    時間:2019-09-12

    針灸臨床帶教中的幾點體會和思考

      臨床帶教是將理論與實踐相結合的重要環節,也是培養對中醫針灸感性認識及臨床思維的重要階段。講授法和自學是醫院普遍采取的教學方法,但有一定的局限性,容易造成學習者的依賴,知識掌握不牢固。[1]針灸作為一門實踐性較強的臨床課程,其專業性強,穴位精準,臨床操作精巧細膩,本人通過幾年的臨床帶教,對針灸臨床帶教有一些體會,簡單總結如下:

      一、要讓學生對針灸感興趣,對病人感興趣

      很多教師都對學生說過這句話——“興趣是最好的教師”,在針灸臨床帶教中也是一樣,確實要先讓學生對針灸感興趣,才能激發他們學習針灸的積極性。那么,如何做才能讓學生有興趣呢?我認為,應該讓他們看到針灸的神奇療效,那么他們就會喜歡上針灸。在這里我舉兩個真實的臨床案例:沈xx,男,34歲,本科室同事,爬樓梯時因用力不當突然出現左膝內側疼痛,當時以此為病例提問規培生應該如何處理,有說冷敷的,有說扎內膝眼的。我繼續問你們的處理方法有信心立竿見影嗎?無人出聲。我隨即在他右肘關節揉按1分鐘后,疼痛減輕大半,學生們都覺得不可思議,這個時候興趣就來了,開始主動問我問題了,然后我就仔細講解按壓的部位是心門穴,最后刺一針,囑其爬樓梯,15分鐘后回診室,疼痛消失。連續回訪3天,未出現疼痛。第二個病例:沈XX,男,47歲,就診號A2088247X,主訴:吸氣時出現背部疼痛1周。予查胸部CT:右肺小結節影,考慮炎性增殖灶。因患者怕針刺,予膻中穴及對應背部痛點按壓15秒,癥狀緩解。3天后電話回訪,自按壓后未再出現疼痛。當學生看到針灸有如此好的療效,只需要一針或簡單的按壓就能馬上緩解疼痛的時候,都開始對這個技術感興趣。我想以后即便他們走上工作崗位,不是從事針灸專業,那么碰到這樣的病人,一定會用這種辦法。而后跟我學習的規培生,對針灸的學習興趣大大提高,會主動看書,主動和我交流很多專業問題。

      二、學習與考核相結合

      考試對于學生并不陌生,從小學到大學,再到工作崗位,醫學生和臨床醫生每年都經歷大小考試若干場。但是通過近兩年的臨床帶教我發現,現在的學生相當一部分臨床學習態度不端正,能偷懶則偷懶,能聊天則聊天,并且和其他行業一樣玩手機成為他們的一大頑疾。所以,考核非常必要,這是督促和監督學生的一個必要手段,也是帶教質量的重要保證。當然,僅僅通過一次出科考試是遠遠不夠的,我認為考核應該滲透到臨床帶教中,比如帶學生針刺治療腰痛病人,提問膀胱經的循行,或者腰陽關、腎俞這些穴位的具體定位,這是一種考核,如果這次學生回答不上來,或者回答不是很準確,我們可以給出正確定位,或者讓他回去看書。但不管哪種方式,一定要告訴他下次具體時間,我還會再問這個問題。通過一對一的提問,讓不愿意回答問題、懼怕回答問題這一普遍現象得到改善。再比如臨床帶教中,對于經絡、穴位掌握比較好的學生,在我的陪同下針刺某個比較安全的穴位,如足三里、合谷等。讓其慢慢感受在真實病人身上針刺的感覺,練習手法,去除恐懼心理。這也是一種考核,并且是相對全面的考核。第一考核理論,第二考核針刺手法,第三考核心理素質。這種考核的好處在于,讓學生有主動復習針灸理論。因為現在多數學生眼高手低,只想跟著教師針灸,但是不愿意看書,你這個穴位回答對了,定位準了,那么就給你上手的機會去針,你回答得越多獲得針刺的機會越多,等手法熟練了,就可以單獨做臨床。能達到這個程度,就是皆大歡喜——學生獲得大量的實踐機會,教師減少了工作量,能更細心地看病和帶新同學。

      三、重視學生“學與思”的培養

      論語中有一句名言“學而不思則罔、思而不學則殆”,這句話指的是一味讀書而不思考,就會因為不能深刻理解書本的意義,而不能合理有效地利用書本的知識,甚至會陷入迷茫。而如果一味空想而不去進行實實在在的學習和鉆研,則終究一無所得。這句話告訴我們,一定要把學習和思考結合起來,才能取得較好的效果。臨床帶教中有一部分同學學習非常認真,手里有個小冊子,每天都在背穴位的定位和主治作用,但是很多時候把這些東西應用于臨床,感覺療效并不是非常令人滿意。這類同學不懂得思考,只是一味地死記硬背。還有一部分同學每天都在想著這個病我用什么方法治療,這個方法效果不好,再換另外一種方法。這類同學只在思考方法,而不去學習理論知識,不知道應該用什么理論指導和支持他的治療措施,也得不到好的療效。所以,應該掌握一定的基礎理論,然后在理論的指導下去臨床,而在臨床中又要多學習新的知識。所以,我要求針灸專業的學生,必須重視靈樞經的學習,用經典指導臨床,用療效驗證經典。

      四、要重視知識的回顧

      “溫故而知新,可以為師矣”。在帶教過程中,要對所講的知識反復提問和回顧,再簡單不過的東西,可能有的同學還是會記不住,要避免帶教中只講一次的情況出現。更要避免因為學生回答不出教師認為非常簡單的知識而發脾氣。針灸科多數的病人都是頸肩腰腿痛,所以治療中要經常反復以前講過的內容,讓學生增強記憶,然后在溫故的基礎上,獲得新的知識,如果他們知識掌握熟練了,可以指導低一屆的學生,這樣可以得到更好的效果。

      五、要善于發現學生的優點

      現在經常聽到不少教師在帶教會中吐槽:現在的學生一屆不如一屆,不愿意學習,天天玩手機。但如果有這樣的情緒,很可能作出對學生不管不問,任其發展的反應;蛘咛焯靾蠼虒W辦,導致和學生的關系惡劣。其實我們可以換一個思路去解決問題,一個學生喜歡玩手機,那么可以經常讓他在手機上找一些知識點,如穴位的定位,中藥的性味歸經等。這種處理辦法,遠比直接嚴厲批評不讓玩手機會更好。同時也能讓學生學到一些東西,形成習慣以后,你再讓他去查找穴位,那么他會很不好意思地知道自己玩手機不對了。我們還應該看到學生中有的很尊重教師,有的很勤快,有的能吃苦,這些都是他們的優點。如果我們能發現他們的優點并指出,那么師生關系會處理得很好,并且學生的實習效果也會大大提高。

      臨床帶教應該是一件很快樂的事,在90后、00后的群體里,可以使自己心態年輕,接觸到更多的新事物,有病人時他們多看看,我們多講講;有空的時候多聊聊,增進互相的了解。

    針灸臨床帶教中的幾點體會和思考

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