ISSN (печатный вариант): 2073-0071
clinical games, functional diagnosis, communicative ability, mentality, diagnosis, experiment, patient, doctor, video recorders, urinalysis, X-ray, electrocardiogram. Ключевые слова: клинические игры, функциональная диагностика, коммуникативные навыки, психика, диагноз, эксперимент, больной, доктор, видео материал, уриноанализ, рентген, электрокардиограмма
В данной статье рассматриваются описание различных форм клинических игр на занятиях в медицинских коллежах, как клинические игры в медицине направлены на формирование клинического мышления в работе с больным.
Most close to reality simulation of professional activity is seen in the clinical games. In the literature there is a description of various forms of clinical games: "Doctor - patient", "consultation", "pain in the heart," "wounded on the battlefield" and other games in the clinical medicine focused on the formation of clinical thinking in dealing with patients. First of all diagnostic and therapeutic games. Unlike games that are called "Clinic", "Hospital". The need for their inclusion in the educational process is seen in the fact that the student is in possession of the game communication skills with staff registry, offices of functional diagnostics, consultants of various specialties and ranks, develops the organizational principles of the treatment process. Modeling professional teamwork therapeutic and prophylactic institutions (MPI) with the help of educational games helps prepare graduates to interact with colleagues form his communication skills. Clinical games are applicable to all clinical departments. In the future, when modeling professional activity doctor recommended games equipment means of training (simulators, video recorders). The simulation of clinical works the most suitable clinical games, the essence of which is to create the most realistic model of professional activity of the doctor. Do I need a model of the patient, when there is the patient himself? Entrenched many decades of clinical forms of training in high school, when the cornerstone put students to work with real patients, have a number of psychological, ethical and didactic problems. Sick of the physician and medical student waits sensitivity and compassion. In fact, the student learning experience on the patient turns the latter, as it were in a textbook. It definitely hurts the patient's psyche and moral seduces students. When training on patients with endless talk about the subject of ethics and ethics disagree with the practice while parsing the patient in a group in front of him. Starting from the 3rd year students get used to that, even percussion and palpation technique, they work out every day on the sick. In such an atmosphere in everyday student can build a sense of compassion, and personal responsibility for the patient. On the other hand there are cases of absence in the clinic, "the theme of the patient", as a result of the student finishes high school without having an idea of the way of patients with this disease. Clinical games solve all of these problems. Working with patients is more effective after preliminary training on models. On what course it is advisable to conduct clinical games? Cover whether all topics of the course? The most acceptable imitation of professional activity can be provided on the second course, the student has to varying degrees of knowledge about all the diseases included in the educational program. In addition, he was initiated into the differential diagnosis, one of the main conditions for the success of clinical games. What is the criterion in the selection of the theme of the game sessions? The game should be practiced those sections of the course that are a real part of the professional activity of the doctor. The most acceptable acute situations, bearing the patient a threat of death or disability. Such a situation as much as possible to mobilize the intellectual and moral powers playing students. Clinical games should be based on syndrome, rather than ontological principle. For example, not a "chronic bronchitis" and "cough syndrome". The syndrome diagnosis of principle - a recognition and delineation of diseases that manifest one leading syndrome, regardless of their belonging to different disease entities. At the same time thinking overcomes a number of stages: collection of symptomatic information, highlighting among them the leading symptom or syndrome, which is carried out on the basis of inside sindromatic differential diagnostics, and further diagnosis, phase of the disease, outcomes and complications. The next stage - the appointment of treatment. Example clinical game. 1. First of all, the teacher defines the purpose of the game: - Demonstrate communication skills in communication with the patient, his family and colleagues, involved in the action; - Demonstrate proficiency manual skills of the patient survey, the ability of clinical interpretation identified physical signs of disease; - Reasonably assign additional methods of research to interpret their results; - Based on the differential diagnosis with similar on the main syndrome disease diagnosis; - Demonstrate the ability to prescribe adequate treatment. 2. The place of the game (in our example) is determined by the patient's apartment, but there may be a clinic, and a first aid station, and the street. 3. Set a set of roles. In our example: the patient, his wife, an ambulance doctor, hospital reception department, head of the therapeutic department of the hospital, an expert group of 2-3 people. 4. Expanding the procedure reclaim the medical records: complete blood count, urinalysis, X-ray, electrocardiogram, and others. 5. Action: - Carried out the distribution of roles, which are involved and students. This allows you to see the friendship and business preferences, the balance of social roles in the team; - Expert Group allocates responsibilities and proceeds to play a critical evaluation of activities. The game begins with a phone call "wife" of the patient to call home emergency doctor. It argues swap challenge the dire state of the patient, due to the high temperature and shortness of breath. Challenge accepted. After 15 minutes of arriving "emergency doctor" with a nurse. Wash hands and sits next to the patient. Conducts questioning, and then proceeds to the fixed examination (general inspection, percussion, auscultation). Cyanosis, the number of breaths -23 per minute. Measures body temperature - 39, 8 C captures the presence of a fever. Measures of blood pressure 100/70 mm Hg. Art., the pulse 108 beats per min., the rhythm is correct. He asks the nurse to remove the ECG. Conclusion - sinus tachycardia, heart rate - 108 in 1 min. "Doctor," informs the patient that he has pneumonia. It explains the essence of his state, involves him in further discussion of tactics (management). Believes that hospitalization is necessary because at the end of the day, ahead of the night, and the patient's condition is closer to hard. "Sick" categorically refuses hospitalization. "Doctor," draws the conversation "spouse." "Spouse" is afraid to leave her husband's house, because it does not have the experience of care, sick man. "Doctor," assures the feasibility of patient hospitalization, argues the possibility of two-way process, severe intoxication, the need to remove the X-ray, blood count, oxygen therapy, injection administration of antibacterial agents. As an additional argument "doctor" refers to the cold in the apartment. "Sick" agrees, and it brought to the hospital. In the waiting room of the patient visits the "physician receptionist", sends it to the X-rays. On the X-ray focal shadows are not found, there is increased pulmonary pattern on both sides. On this basis, it has doubts regarding the pneumonia, considers it necessary to rule out an infectious disease. A consultation invited "the senior doctor on duty," the head of a therapeutically department reviewing the history, examining the patient, it is urgently appointing a common blood test results -... Leukocytosis confirms the diagnosis of the guide 37 mm / hr "senior doctor is report" - - pneumonia and directs the patient in office, appointing a treatment with a shift to the left S'OE... Analysis of the game. Experts analyzed the actions of all participants in the game; each student group can express their views on the actions of all the players. When an expert evaluation is taken into account: - The quality of anamnesis; - Interaction doctor - patient (respectful to the patient during the collection of anamnesis, inspection, discussing the tactics of management); - Respectful to the patient's spouse; - Inspection of the effectiveness of the patient's physician; - Overcoming the difficulties in case of failure of the patient to be hospitalized; - Respectful of ambulance doctor relationship, the doctor's receptionist and the doctor on duty, validity of their views on the management of patients. A detailed analysis of the actions of all participants in the game, admitted at each stage of omissions, allows students to improve clinical skills. Clinical game lasts 15-20 min., During which the teacher manages to assess the knowledge and skills of a group of students. The advantage of modeling professional activity before the boring survey of students on employment is evident. After the completion of the clinical activity of the game may be continued in the House. At the same time, students should switch roles: the "experts" examining the patient, those who have been in the game - are the experts. After the examination of the patient in the classroom analysis of the results of the activities carried out.
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