Breathing life into bedside teaching in the era of COVID-19
Breathing life into bedside teaching in the era of COVID-19
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DOI：
10.1080/0142159x.2020.1798368
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发表时间：
2020-07-28
期刊：
影响因子：
4.7
通讯作者：
ten Cate, Olle
中科院分区：
文献类型：
--
作者：
van Dam, Marjel;Ramani, Subha;ten Cate, Olle
过去二十年来，床边技能一直在下降，多项研究报告称，在做出诊断决策时越来越依赖调查和技术。在新型冠状病毒肺炎（COVID-19，即2019冠状病毒病）危机期间，花在床边的时间甚至更少，体检似乎明显缩短或不存在。这是可能的，医疗保健的成本，医患关系，和临床推理技能可能会受到严重影响，在床边技能和这些技能的教学不断减少。仔细的病史采集和假设驱动的体格检查仍然是临床推理的支柱，并导致吝啬的调查。如果每个诊断都依赖于从头到脚的扫描，那么过度依赖调查可能会推高医疗保健成本。在本文中，我们描述了即使在大流行和物理距离时代也相关和适用的床边教学策略。这些策略分为：在床边与患者互动之前、期间和之后。这些策略可以适用于正常的临床教学情况，也可以适用于具有挑战性的情况，例如当前的大流行病，要求保持身体距离。
Bedside skills have been declining over the last two decades, with multiple studies reporting increasing reliance on investigations and technology in making diagnostic decisions. During the Covid-19 crisis, even less time is spent at the bedside, and physical examinations seem markedly truncated or non-existent. It is possible that cost of health care, doctor-patient relationships, and the clinical reasoning skills could be seriously impacted by ongoing decrease in bedside skills and the teaching of these skills. Careful history taking and hypothesis-driven physical examination still form the backbone of clinical reasoning and lead to parsimonious investigations. Overreliance on investigations could drive up costs of healthcare if every diagnosis depends on a head to toe scan. In this paper, we describe strategies for bedside teaching that are relevant and applicable even during the pandemic and an era of physical distancing. These strategies are categorised as: before, during and after patient interactions at the bedside. These strategies can be adapted to normal clinical teaching situations as well as challenging situations such as the current pandemic when physical distancing is mandated.