In the process of surgery teaching, we should combine various teaching means and methods to improve students' interest in learning. Let's talk about scientific teaching means and methods.
Surgery is the main clinical discipline to study the etiology, pathology, clinical manifestations, diagnosis, treatment, prevention and surgical skills of surgical diseases. Its content is divided into two parts: general discussion and various discussions. Generally, it includes aseptic technique, fluid imbalance of surgical patients, blood transfusion, surgical shock, multiple organ dysfunction syndrome, anesthesia, intensive care and resuscitation, pain treatment, perioperative management, nutritional metabolism of surgical patients and surgical infection. These theories include various diseases of brain, neck, chest, chest, abdomen, spine and limbs. Surgical research is extensive, abstract and boring, so it is difficult to stimulate students' interest in learning. Therefore, surgery teachers must use a variety of teaching means and methods to mobilize the enthusiasm and initiative of students and improve the teaching quality of surgery.
1. Multimedia teaching.
Multimedia teaching takes computer technology as the core, and comprehensively uses various information carriers such as words, images, audio, video and animation in teaching, which fully stimulates the visual and auditory organs of the educated, arouses the interest and enthusiasm of the educated and improves the learning efficiency [1]. The use of multimedia in surgical teaching has the following advantages: (1) vividly displays the teaching content. The traditional classroom teaching method of surgery is that teachers use blackboard writing, teaching wall charts, slides, teaching molds and other means to teach. Because the concepts and clinical manifestations of many surgical diseases are abstract, it is difficult for students to understand them simply by relying on the above teaching methods. Multimedia courseware makes abstract content concrete and visual through the cooperation of pictures, words, sounds, videos and animations, which is convenient for students to understand. In addition, multimedia courseware can be played back and paused at any time, which is helpful for students to review after class and strengthen their memory; (2) Improve teaching efficiency. With the deepening of teaching reform, the teaching hours of each course are decreasing. How to teach students more teaching content in limited teaching time is a challenge for every teacher. Traditional classroom teaching requires teachers to write the knowledge points in lesson preparation notes on the blackboard for students to record, which will shorten the teacher's explanation time. Multimedia courseware can show a lot of knowledge points to students in limited classroom time, which saves teachers' time on the blackboard in class, helps to expand teaching content and enables students to learn more knowledge in class. At the same time, students only need to listen attentively in class, and do not need to take class notes, and copy the teacher's multimedia courseware after class; (3) Surgery includes surgery. Due to the limitation of operating room space and the aseptic requirement of operating room, it is impossible for all students in the class to enter the operating room to watch the operation. The operation area can be photographed by multimedia equipment, and then the operation process can be transmitted to the classroom in real time through TV image relay system for students to watch. Teachers explain while operating in the operating room, students watch and discuss in the classroom, and they can also ask questions to the teachers in the operating room at any time through multimedia equipment, which can achieve good teaching results; (4) Multimedia teaching has the advantage of illustrations, which can make the boring surgical teaching content lively and interesting, stimulate students' interest in learning, help students to listen carefully and think positively in class, and thus achieve better learning results.
2. Use the website of surgery for teaching.
In recent years, with the rapid development of network technology, many medical colleges have established their own surgical websites, which provide a good network platform for surgical teaching and are an important supplement to traditional classroom teaching. Network teaching spans the distance between teachers and students in time and space, breaks through the limitations of traditional face-to-face classroom teaching methods, extends the classroom from the classroom to any place covered by the network, and greatly enriches the teaching resources. Compared with the traditional teaching method, it has obvious advantages, as follows: (1) Surgery teachers are all clinicians in the hospital, and they have to undertake medical tasks and clinical research in addition to teaching work, which is quite busy. Moreover, a teacher is generally only responsible for teaching one chapter and goes to work in the hospital after class. If students encounter problems after class, they can't get the teacher's answer. There is usually a discussion area on the surgical website, where students can ask questions to their teachers, and teachers can also answer questions through the discussion area to strengthen communication between students and teachers. (2) There are many surgical teaching contents, but relatively few class hours. Therefore, teachers can only teach key content in class, and have no time to talk about other related content. After class, teachers can upload teaching courseware to the internet for students to learn, expand their knowledge and improve their autonomous learning ability. (3) With the rapid development of science and technology, surgical knowledge is constantly enriched and updated. In the classroom, the teacher's teaching content is textbook-centered, and the content is relatively old. Even the latest edition of textbooks generally takes 3 to 5 years, or even longer, from preparation to review and publication [3]. After such a long publishing cycle, the content of teaching materials obviously lags behind the development level of contemporary surgery. Students who only master book knowledge can't keep up with the development of surgery and can't meet the requirements of surgical education in the new era. Therefore, teachers can introduce the latest development of surgery to students through the website, broaden students' horizons, stimulate students' interest in learning, motivate them to study actively and acquire new knowledge, which is helpful to cultivate them into creative talents. (4) Some students are on-the-job students. They study while working. Sometimes I can't come to school because of work, so I can make up lessons through the network platform. (5) Establish a link between the school surgical website and famous foreign surgical websites, so that students can directly visit foreign websites to learn new knowledge and improve their English reading level; (6) Convenient and quick. According to the changes of surgical teaching syllabus, teachers can update or supplement the teaching content online at any time.
3. Actively carry out surgical experiment teaching [4].
Surgery is a major clinical subject with surgery as the main treatment. Surgical experiment is an important part of surgical teaching, aiming at cultivating students' surgical ability. The traditional surgical teaching mode pays more attention to the teaching of theoretical knowledge rather than the cultivation of surgical skills. Therefore, students' practical ability is poor after entering the clinic, and it is difficult to adapt to clinical work. How to improve the quality of surgical experiment teaching and enhance students' surgical skills is an important topic for teachers. Combined with the reality of our school, the surgical experiment teaching is divided into three steps by adopting the principle of step by step, and good results have been achieved. Step 1: Learn preoperative preparation and surgical operation skills, including how to correctly change clothes and shoes, wear masks and hats, wash hands during operation, enter a simulated operating room (laboratory), wear surgical gowns and sterile gloves, and other surgical operation skills, such as identification and use of surgical instruments, disinfection of operating area, towel laying, incision, hemostasis, ligation, separation, suture, dressing change and stitches removal. At this stage, through teachers' demonstration and explanation, combined with multimedia teaching courseware, students can learn and practice while learning, and initially learn these surgical operation skills. Step 2: Strengthen the training of surgical skills. An operation often requires repeated hard practice to achieve proficiency. Actual combat? Really use it. Some students think the exercises at this stage are boring and easy to get bored. Attention should be paid to mobilizing students' subjective initiative in teaching, such as holding some small competitions, organizing everyone to discuss with each other, learn from each other, help each other and improve their interest in learning. Teachers should let go without looking, encourage students to operate boldly and carefully, and correct their shortcomings and mistakes in time. Step 3: Conduct animal simulation surgery training. Using rabbits to simulate surgery, creating the same atmosphere as the operating room, emphasizing that simulating surgery on experimental animals, just like operating on patients in clinic, must strictly abide by aseptic operation procedures and basic principles of surgery, and at the same time train surgical skills more effectively. During the operation, each student takes turns to take different surgical roles, such as being the surgeon and assistant respectively, which not only enables students to gain different experiences and skills in different surgical positions, but also makes them understand that surgery is a highly cooperative labor and must have good team spirit.
4. Problem-based teaching.
Surgery is a very practical subject. The traditional surgical teaching mode is based on teaching, that is, teachers talk, students listen and students passively accept knowledge, but their ability to apply knowledge flexibly in practice is poor [5]. Specific performance in clinical practice: although students remember the theoretical knowledge of the etiology, pathology, clinical manifestations, diagnosis, differential diagnosis and treatment of surgical diseases, they are confused when facing patients, and cannot make a correct diagnosis and treatment of diseases [5]. 65438-0969 Barrows, an American professor of neurology, initiated a problem-based teaching model at McMaster University in Canada [6]. This teaching mode breaks the traditional lecture-based teaching mode, advocates taking patients' disease problems as the basis, taking students' self-study and discussion as the main body, and teachers' participation in guidance, thus mobilizing students' enthusiasm and initiative in learning and cultivating their ability to solve practical problems.
Question-based teaching model to follow? The teacher asked questions about the case? Students teach themselves? Class discussion? Teacher's summary? These four steps to achieve [7]. Step 1: The teacher gives a case and asks questions. Like studying surgical diseases? Acute perforation of gastroduodenal ulcer? At that time, the teacher provided the following cases to the students before class: Wang, male, 45 years old, farmer. Chief complaint: abdominal pain, abdominal distension with intermittent vomiting for three months, severe pain 12 hours. For three months, patients often felt dull pain and fullness in the upper abdomen, and vomited sour food residues every 1 ~ 3 days/time. The stool is yellow every day 1 time. Vomiting has become more and more serious recently, and the food eaten separately from rice is sour. On the morning of admission, I suddenly felt persistent pain in my upper abdomen, which did not radiate to my shoulders and back. At first, I could bear it. Abdominal pain worsened at night and he was admitted to the hospital urgently. In the past, patients were in good health. In recent 10 years, due to improper diet, I often feel dull pain and discomfort in my upper abdomen. He has a history of pantothenic acid and hiccups, but he has never vomited blood or black stool. Physical examination: temperature 38.0OC, pulse 140 beats/min, breathing 2 1 beat/min, blood pressure 80/50mmHg. Acute severe disease, dehydrated appearance, no yellow staining of sclera, no abnormality of heart and lung. Abdominal muscles are obviously tense, abdominal breathing is weakened, and the whole abdomen, especially the upper abdomen, has tenderness and rebound pain. Blood test: white blood cell count 13? 109/L, neutrophils accounted for 94%, and red blood cell count was 5? 1 012/L. According to the teaching objectives, the teacher asked the following questions: (1) Preliminary diagnosis, listing the diagnosis basis; (2) What diseases need to be identified; (3) What necessary tests are needed for further diagnosis? (4) If confirmed, what is the treatment plan? Step 2: Students teach themselves. In view of the problems in the case, students go to the library or surf the Internet to consult books and reference materials and seek knowledge to solve the problems. Step 3: Class discussion. In class, students discuss in groups first, and each student can express his own views around the problem or ask his own confused questions. Then, each group sends a representative to summarize the results of the group discussion and make a speech in class. During the students' discussion, the teacher recorded various opinions and questions. Step 4: The teacher summarizes. After the discussion, the teacher commented on the students' speeches, answered the questions raised and gave the correct answers to the questions. The problem-based teaching mode leads to problems through surgical cases, and students learn independently around the problems. By consulting books, periodicals and other materials, we can obtain the knowledge hidden behind the problem and apply the knowledge to solve practical clinical problems. This teaching mode is closest to the method of dealing with surgical problems in clinic, and can improve students' ability to solve problems in clinical practice.
5. Standardize patient teaching.
The last year of medical students' study is to leave school and enter the hospital for clinical practice. Clinical practice is a bridge between basic theory and clinical practice, which lays the foundation for medical students to become qualified doctors after graduation [8, 9]. Therefore, clinical practice is an important stage to train medical talents. When medical students begin their clinical practice, they will feel more or less inconvenient and even more painful because of their lack of physical examination experience. Therefore, many patients are unwilling to accept their consultation and physical examination, which will greatly reduce the learning opportunities of medical students and affect the quality of clinical practice. In order to make up for the shortage of students' clinical practice opportunities, medical colleges can recruit some high-quality personnel to face the society and train them, so that they can become standardized patients, accurately imitate the clinical symptoms and signs of patients, and use them for the training of students' basic clinical skills. This is a new way to train clinical practice skills in line with international standards [10]. Through standardized patient teaching, students not only improve their clinical skills, but also learn to respect patients and enhance their ability to communicate with patients, laying a solid foundation for future clinical work.
6. Establish a comprehensive evaluation system.
Traditional surgical examination is mainly theoretical examination, and students often get high scores by rote, which is not conducive to cultivating students' operational skills and problem-solving ability. Therefore, we should reform the assessment methods and evaluate students' learning situation from many aspects. The comprehensive evaluation includes written examination of surgical theoretical knowledge, examination of surgical skill operation and examination of problem-solving ability. The assessment of the ability to analyze and solve problems includes: the performance of group discussion in the process of problem-based teaching, the learning records during clinical practice, and the achievements of students in scientific and technological innovation activities. Through the above comprehensive evaluation, students' theoretical knowledge, operational skills and ability to analyze and solve problems are comprehensively evaluated, so as to promote students' all-round development and improve their comprehensive quality.
In short, in the process of surgical teaching, the comprehensive use of multimedia, surgical experiment teaching, problem-based teaching, standardized patient teaching, comprehensive evaluation and other teaching means and methods can not only enhance students' interest in learning, improve their theoretical knowledge, but also strengthen their practical ability and lay a foundation for future clinical work.
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