The Research And The Education Of Clinical Competence Under The Bio-psycho-social Medical Model

Modern medicine has made brilliant achievements,but there are some serious problems.Firstly,there aredisparities and inequities in the health field.Secondly,there are excessive medical treatments caused by the tension in the doctor-patient relationship.Thirdly,the change of disease spectrum results in biomedical dilemma.Fourthly,environment and behavior risk is increasing.The medical system is becoming more and more complex.Unfortunately,modern medical education has failed to keep pace with the pace of modern medical development.There are obvious defects in the graduates trained in this field,and the post competency of medical students does not match the needs of the patients and the population.The other defects include the lack of teamwork ability,pure biomedical model diagnosis and treatment,and the lack of clinical thinking level.Pure biomedical model is not able to adapt to the rapid development of modern medicine.These are the new and severe challenges for the training of medical talents in the new century.In the field of human resources management,competency is one of the most important factors affecting physician performance.Therefore,a profound understanding of today's physicians' competency is helpful to enhance the physician competency,to build a harmonious relationship between doctors and patients,and to culture future excellent doctors.This study used literature,questionnaire,and interviews methods to construct the competency model of physicians.The results of the survey were analyzed.And then,the author develops a series of education experimentsof medical students' clinical competence,and puts forward transformation education is the direction of medical education.Research?.OBJECTIVE: Measure physician competency.We provide the necessary research tools for the development of the physician competency theory.We validate the competency model and find the problems and put up related suggestions.METHODS: Based on the literature analysis and the qualitative and quantitative research methods such as questionnaires and Delphi methods,we put forward the theoretical construction of the physician competency model.Item analysis,factor analysis,and latent variable structural equation model analysis were tested on a random sample of physicians.Through the self-designed questionnaire,the hospitals in Liaoning,Jinzhou,Jilin,Changchun places were investigated.By the results of descriptive analysis,t test,analysis of variance,and regression analysis,we understand the current status of clinical competency.RESULTS: A total of 58 items were included in the questionnaire,including professional values,personality characteristics,knowledge skills and decision-making ability.Through questionnaire investigation,we found that the clinical competency of doctors was inconsistent.Overall,clinical decision making competencies developed slowly,and professional values need to be strengthened.Educational level,title structure,age and working time had influence on clinical competence.The higher the degree,the higher the title and the qualifications of physicians,clinical competence was also stronger.There were significant correlations among any two variances in clinical competence scores,personality characteristics,decision-making ability,occupational values and knowledge and skills competence.Multiple linear regression analysis showed that the major factors affecting the total competency were age,job title and working time.Influencing factor of personality traits was the title.Factors affecting the decision-making ability were gender,age and educational degree.Factors influencing occupation values were age and administrative duties.Factors affecting knowledge and skills were the job time,the administrative duties and the hospital type.CONCLUSION: Physician clinical competence structure and actual investigation have strong guiding and practical significance to the improvement of physician clinical competency frame and the cultivation of clinical competency.Research II.OBJECTIVE: To make medical students form a multi-angle clinical thinking through the Balint case discussion groups.Furthermore,students realize the influence of their thoughts,emotions and personality on the patients,and promote own the medical humanities characters and clinical communication skills.METHODS: A total of 68 clinical medical students were conveniently sampling selected to carry out practical activities and conduct interview and questionnaire research.RESULTS: Participants can observe the difficult doctor-patient relationship from the psychological and social angle,have a new awareness of the relationship between doctors and patients,effectively deal with the relationship between doctors and patients,and ease the doctor-patient conflict.CONCLUSION: Balint case discussion groups have a positive impact on members' humanistic personality traits.Research III.OBJECTIVE: To verify the influence of feedback type and academic level on the acquisition of students' knowledge and skills.METHODS: A total of 252 medical undergraduates were selected by conveniently sampling,and they were random divided with excellent/bad academic level(2)×have/no feedback type(2)of 63 students respectively.RESULTS: Thetype of feedback of the formative evaluation had a significant effect on the final examination(F = 6.784,P< 0.05).Positive feedback was higher than non-feedback.(F = 6.729,P< 0.05),and the influence of feedback types on the students who study badly was higher than that of excellent students.CONCLUSION: Formative evaluation is carried out in the professional curriculum,and the type of feedback influences medical students' the clinical knowledge and skill competence to obtain.Research ?.OBJECTIVE: To explore the effect of formative learning evaluation in clinical practice stage of medical students.METHODS:By conveniently sampling,the clinical medical students grade fifth in internship as the research object,the experimental group and control group design,experimental group to carry out formative evaluation,the control group used the traditional method of practice,comparing the two groups of Mini-CEX structured questionnaire scores.RESULTS: Scores of an experimental class participating in formative assessment in the practicum process were significantly higher than those of the control group(P < 0.001).Conclusion: The formative evaluation in the clinical practice stage will help students to obtain the clinical competence,and the learners' professional values and clinical decision-making competencies are significantly improved.Research ?.OBJECTIVE: The current biomedical model is difficult to meet the clinical needs.The improvement of the medical environment depends on the change of the educational system.It is rigid on the traditional training mode of medical talants.We need to explore a transformative education pathway to cultivate medical students' competencies.RESULTS: Transformative learning is a process of effective change of reference frame,which is characterized by critical reflection.Competency-based transformational learning is a transformational learning process that integrates systematic and practical curriculum design,integrates medical technology and humanistic spirit,focuses on the needs of patients or people,closely aligns medical practice with students' competency development,and explore the clinical practice of adapting to the psychosocial medical model.CONCLUSION: Based on the effective development of competency-based learning,we must carry out: according to clinical practice needs to set the curriculum system,student-centered personalized teaching,the use of network information technology to support transformational learning,clinical thinking teaching based on biopsychosocial model,change in the concept of teaching.