O papel do CAPS I na vida de seus usuários: um estudo a partir dos itinerários terapêuticos / The role of CAPS I in the lives of its users: a study based on therapeutic itineraries / El papel del CAPS I en la vida de sus usuarios: un estudio basado en itinerarios terapéuticos

Este artigo buscou compreender, a partir do itinerário terapêutico de pessoas em sofrimento psíquico e egressas de internação psiquiátrica, a inserção do centro de atenção psicossocial como equipamento de cuidado em suas trajetórias. Trata-se de estudo inspirado na Epistemologia Qualitativa de Gonzalez Rey no qual foram realizadas entrevistas com seis pessoas, de 27 a 52 anos, em tratamento em um Centro de Atenção Psicossocial tipo 1, e para análise do material transcrito foram adotados procedimentos inspirados no conceito de indicadores de González Rey e na análise temática de conteúdo. Neste artigo, foram discutidas duas categorias: (1) "O manicômio está presente" e (2) "CAPS: espaço de convivência e substituto da vida social?". Os indicadores apontaram que a internação psiquiátrica foi um recurso utilizado após inserção em CAPS, o qual é destacado mais como local de convívio do que de produção de autonomia e de desinstitucionalização. No percurso dos usuários, as internações ocorreram em hospitais gerais, hospitais especializados e comunidades terapêuticas. Os serviços de atenção primária não aparecem como ponto de cuidado à saúde mental, os serviços de urgência estão presentes na atenção às crises, dando ao CAPS contornos de um serviço para a convivência e não para o cuidado na crise. (AU)

Based on the therapeutic itinerary of individuals experiencing psychic distress and who have undergone psychiatric hospitalization, this study aimed to comprehend the integration of the Center of Psychosocial Attention as a care facility along their path. The study is inspired by Gonzalez Rey's Qualitative Epistemology, in which interviews were conducted with six individuals aged between 27 and 52, receiving treatment at a type 1 Center of Psychosocial Attention. Procedures inspired by González Rey's concept of indicators and thematic content analysis were employed to analyze the transcribed material. This paper will discuss two categories: (1) "The presence of the psychiatric hospital," and (2) "CAPS: A space for interaction and a substitute for social life?" The indicators reveal that psychiatric hospitalization was resorted to after involvement with CAPS, which is perceived more as a space for coexis-tence than for fostering autonomy and deinstitutionalization. As per the users' itineraries, hospitalizations occurred in general hospitals, specialized hospitals, and therapeutic communities. Primary care services do not emerge as a focal point for mental health care, whereas emergency services are present for crisis intervention, portraying CAPS as a service more geared towards coexistence rather than crisis management.

Este artículo buscó comprender, a partir del itinerario terapéutico de las personas en distrés psicológico y las dadas de alta de hospitalización psiqui-átrica, la inserción del centro de atención psicosocial como equipamiento de atención en sus trayectorias. Se trata de un estudio inspirado en la Epistemo-logía Cualitativa de González Rey, en el que se realizaron entrevistas a seis personas, de 27 a 52 años, en tratamiento en un Centro de Atención Psicosocial tipo 1 y para el análisis del material transcrito, procedimientos inspirados por el concepto de indicadores de González Rey y el análisis de contenido temático. En este artículo se discutirán dos categorías: (1) "Está presente el asilo" y (2) ¿"CAPS: espacio de convivencia y sustituto de la vida social?". Los indicadores señalaron que la hospitalización psiquiátrica fue un recurso utilizado después de la inserción en CAPS, que se destaca más como un lugar de socialización que para producir autonomía y desinstitucionalización. En el curso de los usuarios, los ingresos se realizaron en hospitales generales, hospitales especializados y comunidades terapéuticas. Los servicios de atención primaria no aparecen como un punto de atención en salud mental, los servicios de emergencia están presentes en la atención de crisis, dando al CAPS los contornos de un servicio de convivencia y no de atención en crisis. (AU)

"Louco sim, drogado não": o imaginário de profissionais da saúde mental / "Crazies over junkies": The collective imagination of mental health professionals

Considerando que as práticas clínicas se baseiam tanto em conhecimentos científicos como em crenças e valores nem sempre conscientes, este estudo objetiva investigar o imaginário coletivo de profissionais de saúde mental sobre o paciente psiquiátrico, na perspectiva da psicologia psicanalítica concreta. Justifica-se, portanto, desde o interesse em aperfeiçoar a qualidade do atendimento, tendo em vista tanto o benefício dos pacientes, como a melhoria das condições de exercício profissional. A partir de uma entrevista psicológica coletiva, articulada ao redor do uso do Procedimento de Desenhos-Estórias com Tema, abordamos sete profissionais de nível superior que trabalham em equipamento de saúde mental. A consideração do material permitiu a produção interpretativa de dois campos de sentido afetivo-emocional: "Sofredores psicóticos" e "Impostores dependentes". O quadro geral apresenta a coexistência de visões solidárias e éticas diante do psicótico com visões preconceituosas e hostis em relação ao dependente químico. Esse contraste se baseia sobretudo na dificuldade em perceber que a base motivacional do uso da droga seria o sofrimento emocional. Como um todo, esse cenário permite pensar que a reforma psiquiátrica gerou transformações que promovem acolhimento, mas que ainda permanecem estigmas a serem superados.

Considering that clinical practices are based both on scientific knowledge and on beliefs and values that are not always conscious, this study aims to investigate the collective imagination of mental health professionals about the psychiatric patient, from the perspective of psychoanalytic concrete psychology. The importance of this study lies on the interest in improving the quality of care, considering both the benefit of patients and the improvement of professional practice conditions. Based on a collective psychological interview, articulated around the use of the Thematic Story-Drawing Procedure, we approached seven higher education professionals who work in mental health service. Consideration of the material allowed the interpretative production of two affective-emotional fields of meaning: "Psychotic sufferers" and "Dependent impostors". The overall picture shows the coexistence of sympathetic and ethical views toward the mentally psychotic with prejudiced and hostile views toward the drug-dependent. This contrast is mainly based on the difficulty in realizing that the motivational basis for drug use would be emotional suffering. As a whole, this scenario allows us to conclude that the psychiatric reform has brought about transformations that promote acceptance, but that stigmas to be overcome still remain.

Participação social em saúde no Brasil: avanços e retrocessos do SUS 10 anos depois das Jornadas de Junho / Social participation in health in Brazil: advances and setbacks of SUS 10 years after the Jornadas de Junho / Participación social en salud en Brasil: avances y retrocesos del SUS 10 años después de las Jornadas de Junho

Com o objetivo de analisar a diretriz constitucional da participação social em saúde, considerando avanços e retrocessos do Sistema Único de Saúde, o presente artigo apoia-se numa breve revisão do estado da arte e em parte da produção do Observatório de Análise Política em Saúde. Discute, sucintamente, o conceito de participação social e suas conexões com as noções de democracia e de movimentos sociais. Descreve certos momentos da participação social nas origens da Reforma Sanitária Brasileira e do Sistema Único de Saúde e na conformação da Constituição de 1988, indicando avanços e retrocessos, especialmente após as Jornadas de Junho. Finaliza discutindo problemas da participação social no Sistema Único de Saúde e os desafios na constituição de sujeitos sociais.

Aiming to analyze the constitutional guideline of social participation in health, considering the advances and setbacks of the Unified Health System, this paper is based on a brief review of the state of the art and on part of the production of the Observatory for Political Analysis in Health. It briefly discusses the concept of social participation and its connections with the notions of democracy and social movements. It describes certain moments of social participation in the origins of the Brazilian Health Reform and the Unified Health System and in the shaping of the 1988 Constitution, indicating advances and setbacks, especially after the Jornadas de Junho(June Demonstrations). It ends by discussing problems of social participation in the Unified Health System and the challenges in the constitution of social subjects.

Con el objetivo de analizar la directriz constitucional de la participación social en salud, considerando los avances y retrocesos del Sistema Único de Salud, este artículo se basa en una breve revisión del estado del arte y en parte de la producción del Observatorio de Análisis Político en Salud. Discute, brevemente, el concepto de participación social y sus conexiones con las nociones de democracia y movimientos sociales. Describe ciertos momentos de participación social en los orígenes de la Reforma Sanitaria Brasileña y del Sistema Único de Salud y en la conformación de la Constitución de 1988, indicando avances y retrocesos, especialmente después de las Jornadas de Junho. Finaliza discutiendo los problemas de la participación social en el Sistema Único de Salud y los desafíos en la constitución de sujetos sociales.

Atenção Profissional a Familiares de Dependentes de Álcool no CAPs AD / Professional Care for Family Members of Alcohol Dependents in the CAPs AD / Atención Profesional a Familiares de Dependientes de Alcohol en el CAPs AD

Familiares de dependentes de álcool vivem intenso sofrimento emocional que os vulnerabiliza a ponto de necessitarem cuidado profissional. No Brasil, o Centro de Atenção Psicossocial Álcool e Drogas (CAPs AD) é o serviço público de referência no atendimento psicossocial a usuários de álcool e outras drogas. A partir da constatação da inexistência de artigos científicos sobre intervenções com familiares dos dependentes de álcool no CAPs AD, dada a profusão de trabalhos que tratam do dependente ou das políticas públicas que fundamentam o serviço, elaboramos três hipóteses sobre essa lacuna. A primeira propõe que na base dessa ausência de modalidades terapêuticas específicas esteja a concepção de que o cuidado aos familiares no CAPs AD é o mesmo e independe das peculiaridades de cada substância psicoativa. A segunda hipótese parte do fato de que a constante ameaça de aniquilamento dos próprios CAPs AD e a consequente luta para sua sobrevivência comprometeria pesquisas para o desenvolvimento de intervenções cada vez mais especializadas. E, finalmente, a hipótese de que a maior demanda de atendimento de usuários de mais de uma substância desarticularia a proposição de intervenções com familiares de dependentes de álcool. Esperamos que este estudo contribua para a elaboração de intervenções mais afinadas às necessidades desse público.

Family members of alcohol dependents live intense emotional suffering that makes them vulnerable to the point of needing professional care. In Brazil, the Psychosocial Care Center for Alcohol and Drugs (CAPSad) is the public service of reference in psychosocial care for users of alcohol and other drugs. Based upon the lack of studies on interventions for family members of alcohol dependents in the CAPSad, contrasting with the profusion of works that deal with the dependent or the public policies that support the service, we elaborated three hypotheses about this gap. The first one proposes that at the center of this abscense of specific therapeutic modalities there is the idea that care for family members in the CAPSad is the same and does not depend on the peculiarities of each psychoactive substance. The second hypothesis derives from the fact that the constant threat of annihilation of the CAPSad themselves and the struggle for their survival would compromise the development of increasingly specialized interventions. At last, the hypothesis that the greater demand for assistance from multiple substance users would dismantle the proposal of interventions with family members of alcohol dependents. We expect that this study will contribute to the development of interventions in accord with the needs of this audience.

Familiares de dependientes de alcohol viven intenso sufrimiento emocional que los vulnera hasta que necesiten cuidado profesional. En Brasil, el Centro de Atención Psicosocial Alcohol y Drogas (CAPs AD) es el servicio público referencial a la atención psicosocial a usuarios de alcohol y drogas. Desde la constatación de la inexistencia de ensayos sobre intervenciones con familiares de dependientes de alcohol en CAPs AD, dada la profusión de trabajos que tratan del dependiente o de las políticas públicas que fundamentan el servicio, se elaboró tres hipótesis sobre esa brecha. La primera propone que en la base de esa ausencia de modalidades terapéuticas específicas esté una concepción de que el cuidado a los familiares en CAPs AD es lo mismo y no depende de las peculiaridades de cada material psicoactivo. La segunda hipótesis parte del hecho de que la constante amenaza de aniquilación de los CAPs AD y consecuente lucha para su sobrevivencia comprometería investigaciones al desarrollo de intervenciones todavía más especializadas. Finalmente, la hipótesis de que la mayor demanda de atención a usuarios de más de una sustancia desestructuraría la proposición de intervenciones con familiares de dependientes de alcohol. Se espera que este estudio contribuya a la elaboración de intervenciones específicas a las necesidades de ese público.

Historia de la enseñanza universitaria / History of university education

El vocablo "universidad" viene del latín universitas, término que hace referencia a "totalidad" o "reunido en un todo". Históricamente fue conformado por el grupo de "los que enseñan" y el de "los que aprenden". Una de las primeras universidades fue la Universidad de Bologna donde si bien predominaban los estudios jurídicos, también se dictaban filosofía, teología, farmacia, astronomía, matemáticas y medicina. Su contrapartida fue la Universidad de París, donde se enseñaba fundamentalmente teología. En esta última institución los pontífices se reservaron la vigilancia de su actuación y enseñanza. La universidad moderna surge del modelo de Guillermo Humboldt, en el que se restablece la coexistencia de la ciencia y la investigación, que constituyen el germen de nuestra relación docencia - investigación. En las universidades de América Latina se destaca la reforma universitaria de Córdoba, uno de cuyos puntos centrales fue la autonomía universitaria, definida como la facultad de los estudiantes de dirigir la Universidad sin la intromisión de los poderes del estado, en el ámbito propio de la deliberación y la decisión libre de los alumnos y maestros, despojados de toda autoridad diferente a su capacidad docente. (AU)

The word "university" comes from the Latin universitas, a term that refers to "totality" or "united as a whole". Historically it was formed by the group of "those who teach" and "those who learn". One of the first universities was the University of Bologna where, although legal studies predominated, philosophy, theology, pharmacy, astronomy, mathematics and medicine were also taught. Its counterpart was the University of Paris, where theology was the main subject. In the latter institution, the pontiffs reserved for themselves the supervision of their actions and teaching. The modern university arises from the model of William Humboldt, in which the conjunction of science and research is reestablished, which constitute the germ of our teaching-research relationship. In Latin American universities, the university reform of Córdoba stands out, one of the central points of which was university autonomy defined as the faculty of students to direct the University, without the interference of the powers of the state, in the proper scope of deliberation and free decision of students and teachers, stripped of any other authority different from their teaching capacity. (AU)

"O jogo é muito bruto, não é para amador": concepções de ex-ministros da saúde sobre a Reforma Sanitária brasileira / "The game is too rough, it's not for amateurs": conceptions of former ministers of health on the Brazilian Health Reform / "El juego es demasiado duro, no es para aficionados": concepciones de ex ministros de salud sobre la Reforma de Salud Brasileña

Este estudo histórico de abordagem qualitativa objetivou identificar e analisar as concepções acerca da Reforma Sanitária brasileira (RSB) de seis ex-ministros da saúde do Brasil que foram provavelmente acumuladas ao longo das suas trajetórias enquanto executivos federais da saúde (2002 a 2015). Foram extraídos excertos de entrevistas realizadas entre os anos de 2018 e 2020, sendo analisados e discutidos sob à luz do referencial teórico-filosófico de Jairnilson Paim. Foi possível identificar e contrastar os discursos dos ex-ministros com os principais conceitos desenvolvidos por Jairnilson Paim sobre a RSB, por exemplo, "revolução passiva", "transformismo", "retórica sanitária" e "fantasma da classe ausente". Conclui-se que o conhecimento e a análise de tais concepções são pistas úteis à compressão da política de saúde brasileira nas últimas décadas, sendo necessário que estudos nessa direção sejam construídos continuamente no intuito de não retrocedermos e colaborar, dentre outras coisas, para que se elimine a retórica detratora que posiciona a RSB como utopia e fetiche, enquadrando-a como uma possibilidade real e uma necessidade concreta.

This historical study with a qualitative approach aimed to identify and understand the perceptions about the Brazilian Health Reform (RSB) of six former ministers of health in Brazil that probably accumulated throughout their trajectories as federal health executives (2002 to 2015). Excerpts from interviews carried out between 2018 and 2020 were extracted and were analyzed and discussed in the light of Jairnilson Paim's theoretical-philosophical framework. Identifying and contrasting the main concepts of the former ministers' discourses about RSB was possible with the main concepts developed by Jairnilson Paim, such as "passive revolution," "transformism," "sanitary rhetoric," and "ghost of the absent class." It is concluded that the understanding and the analisis of such conceptions are useful clues to understanding the Brazilian health politics in the last dates and studies that are being elaborated in this sense need to be constructed continuously with the intent of not going backwards and collaborating to, among other things, eliminate the detractor rhetoric that positions the RSB as a utopia and a fetish, framing it as a real and a concrete necessity.

Este estudio histórico, con enfoque cualitativo, tuvo por objetivo identificar y analizar las percepciones sobre la Reforma de Salud Brasileña (RSB) de seis ex ministros de salud en Brasil, que probablemente se acumuló a lo largo de sus trayectorias como ministros de salud (de 2002 a 2015). Se extrajeron extractos de entrevistas realizadas entre 2018 y 2020, los cuales se analizaron y se discutieron a la luz del marco teórico-filosófico de Jairnilson Paim. Se pudo identificar y contrastar los discursos de los exministros con los principales conceptos de la RSB desarrollados por Jairnilson, tales como "revolución pasiva", "transformismo", "retórica sanitaria" y "fantasma de la clase ausente". Se concluye que el conocimiento y el análisis de estas percepciones son indicios útiles para la comprensión de la política de salud brasileña en las últimas décadas, lo que apunta a la necesidad de realizar más estudios sobre el tema para seguir avanzando y colaborar, entre otras cosas, en la supresión de la retórica detractora que define la RSB como una utopía y un fetiche, enmarcándola como una posibilidad real y concreta.

Análise política da ação do Movimento da Reforma Sanitária Brasileira na pandemia da COVID-19: 2020-2021 / Political action analysis of the Brazilian Health Care Reform Movement in the COVID-19 pandemic: 2020- 2021

Resumo O objetivo deste trabalho é analisar a ação política do Movimento da Reforma Sanitária Brasileira (MRSB), notadamente Cebes e Abrasco, face à pandemia de COVID-19. As informações foram obtidas por meio de revisão documental de publicações das referidas entidades, que apresentam seus posicionamentos diante das ações governamentais implementadas entre janeiro de 2020 e junho de 2021. Os resultados evidenciam que a atuação dessas entidades incluiu ações diversas, em sua maioria reativas e críticas à atuação do governo federal na pandemia. Além disso, protagonizaram a criação da Frente pela Vida, organização que reuniu várias entidades científicas e organizações da sociedade civil, e cujo destaque foi a elaboração e difusão do "Plano Nacional de Enfrentamento à Pandemia de Covid-19", documento que contém uma análise abrangente da pandemia e suas determinações sociais, bem como um conjunto de proposições para o enfrentamento da pandemia e dos seus efeitos sobre as condições de vida e saúde da população. Conclui-se que a atuação das entidades do MRSB revela alinhamento com o projeto original da RSB, enfatizando as relações entre saúde e democracia, a defesa do direito universal à saúde e a expansão e fortalecimento do SUS.

Abstract The aim of this study is to analyze the political action of the Brazilian Health Care Reform Movement (MRSB, Movimento da Reforma Sanitária Brasileira), particularly Cebes and Abrasco, during the COVID-19 pandemic. The data were obtained through the documental review of publications from the abovementioned entities, which describe their positions on government actions implemented between January 2020 and June 2021. The results show that the performance of these entities included several actions, most of them reactive and critical of the Federal Government's role in the pandemic. Moreover, they led the creation of "Frente pela Vida", an organization that brought together several scientific entities and civil society organizations, whose highlight was the preparation and dissemination of the "Frente pela Vida Plan", a document that contains a comprehensive analysis of the pandemic and its social determinants, as well as a set of proposals to face the pandemic and its effects on the population's living and health conditions. It is concluded that the performance of the MRSB entities reveals alignment with the original project of the Brazilian Health Care Reform (RSB, Reforma Sanitária Brasileira), emphasizing the relationship between health and democracy, the defense of the universal right to health and the expansion and strengthening of the Brazilian Unified Health System - SUS (Sistema Único de Saúde).

Rogelio Bermejo Ortega y el desafío de la atención primaria de salud en el Perú

La publicación de este artículo historiográfico tiene dos objetivos: El primero, es el de rendir un homenaje a la trayectoria de vida del médico sanfernandino Rogelio Bermejo Ortega, uno de los pioneros peruanos de la sanidad rural, de la participación comunitaria y del trabajo intersectorial en el desarrollo del bienestar general. El segundo, efectuar a partir de su trayectoria de vida, un primer análisis crítico del proceso de implementación de la Atención Primaria de Salud (APS) en el Perú, a partir de las observaciones consignadas en su obra "La Atención Primaria de Salud en el Perú". Rescatamos algunos elementos para sustentar -en estos años de crisis general- una reforma del sistema de salud, orientada de manera auténtica al logro de la "salud para todos y por todos" en el Perú.

The publication of this historiographical article has two objectives: The first is to pay tribute to the life trajectory of the sanfernandino doctor Rogelio Bermejo Ortega, one of the Peruvian pioneers of rural health, of community participation and intersectoral work in the development of general welfare. The second, to carry out from his life trajectory a first critical analysis of the implementation process of Primary Health Care (PHC) in Peru, based on the observations stated in his work "Primary Health Care in Peru". Rescuing some elements to sustain -in these years of general crisis- a reform of the health system, oriented in an authentic way to the achievement of "health for all and per all" in Peru.

Application of flipped classroom teaching mode in community clinical pharmacist training / 中华医学教育探索杂志

Objective:To explore the application and effect of flipped classroom in community clinical pharmacist training.Methods:Seventeen pharmacists trained in 2017-2018 were used as the control group and received traditional teaching mode. Fourteen pharmacists trained in 2019-2020 were used as the experimental group and received the flipped classroom teaching mode. Finally, the teaching effect was evaluated through the trainees' graduation examination results and satisfaction degree. The SPSS 25.0 was used to conduct the t test and chi-square test. Results:The task performance, prescription audit scores, clinical practice scores, and total scores in the experimental group were significantly higher than those in the control group ( P<0.05). However, there was no significant difference in usual performance between the two groups ( P>0.05). For satisfaction survey, the total score of Likert scale in the experimental group was (20.1±3.4), which was significantly higher than that in the control group (16.9±3.4). However, there was no significant difference in the satisfaction of clinical practice and teachers' level between the two groups ( P>0.05). Conclusion:Flipped classroom can improve the enthusiasm of community clinical pharmacist trainees to participate in learning, increase the level of the trainees' theoretical knowledge and professional practice, and is conducive to the cultivation of high-quality community clinical pharmacists.

The application of improved team-based learning based on the training goal of excellent doctors in ophthalmology internship class / 中华医学教育探索杂志

Objective:To evaluate the effect of the improved team-based learning (TBL) teaching method in the undergraduate probation course of ophthalmology based on the goal of cultivating excellent doctors.Methods:The undergraduates of clinical medicine were randomly divided into experimental group and control group. The control group ( n=50) was given conventional ophthalmology probation teaching, while the experimental group ( n=50) was given ophthalmology probation teaching of improved TBL teaching method. The theoretical examination performance and skill assessment results of students in the two groups were compared, and the subjective evaluation of the students on the teaching was also compared. SPSS 23.0 was used to conduct t-test and Wilcoxon's rank sum test. Results:The theoretical examination performance of experimental group (29.68±4.52) was better than that of control group (27.84±4.33), with significant differences ( P<0.05); the skill assessment results of experimental group (32.88±5.05) were also better than those of the control group (30.88±6.99), with significant differences ( P<0.05); the subjective evaluation of teaching effect in each item of experimental group was better than that of control group ( P<0.05). Conclusion:The improved TBL teaching method can not only improve students' theoretical knowledge and experimental skills, but also improve students' self-study and teamwork ability, which will provide a feasible educational reform plan for achieving the goal of cultivating excellent doctors.

Reform of clinical medical talents cultivation model based on post competency: a case study of Guangxi Medical University / 中华医学教育探索杂志

Through the reform and practice of the "four-in-one" cultivation model of clinical medical talents, the training mode of applied high-quality medical and health talents with different orientations is established, and the curriculum teaching system suitable for the development of modern medical education is constructed to promote the reform of education and teaching. It solves the problems of single medical talents training mode, fragmentation of curriculum system, single teaching and training in teaching, and insufficient support for talent training. This reform established a set of curriculum system, teaching methods and evaluation methods to strengthen the cultivation of medical students' post competency, and achieved the goal of improving the quality of clinical medical personnel training in local medical colleges.

Reform and exploration of teaching methods for eight-year program medical students' early exposure to clinical practice / 中华医学教育探索杂志

Objective:To explore the effect of early clinical clerkship training in the early exposure to clinical practice of eight-year program medical students.Methods:Experimental control method was used in this study. A total of 120 eight-year program medical students in the third year of Batch 2014 to 2016 from the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were selected as the research objects. The students of each grade were randomly selected by computer and divided into experimental group and control group, with 20 students in each group. Before early clinical exposure, the experimental group received 16 class hours of early clinical clerkship training, while the control group did not receive early clinical clerkship training. After the early clinical exposure, the clinical diagnosis and treatment ability of the two groups of students was compared. SPSS 24.0 software was used for t test. Results:The scores of medical history inquiry of experimental group and control group were [(17.45±1.96) points and (15.95±1.93) points; (18.30±1.03) points and (16.75±1.86) points; (17.95±1.36) points and (16.40±1.60) points, respectively]. The physical examination scores were [(17.75±1.65) points and (16.05±1.64) points; (17.85±1.18) points and (16.80±1.47) points; (18.25±1.16) points and (16.85±1.63) points, respectively]. The clinical judgment scores were [(18.15±1.42) points and (16.35±2.41) points; (18.20±1.24) points and (16.65±1.53) points; (18.35±1.35) points and (16.25±1.83) points, respectively]. Diagnosis and treatment scheme scores were [(17.15±1.57) points and (14.55±2.56) points; (17.30±1.42) points and (15.90±1.48) points; (17.80±1.06) points and (16.35±1.87) points, respectively]. The scores of communication skills were [(17.95±1.15) points and (17.00±1.19) points; (18.55±0.83) points and (17.45±1.50) points; (18.45±1.00) points and (17.45±1.23) points, respectively], with statistically significant differences (all P<0.05). Conclusion:The application of early clinical clerkship training in the early exposure to clinical practice of eight-year program medical students can improve the quality of students' clerkship.

Construction and application of bilingual test question database of digitalized systematic anatomy for international students in China / 中华医学教育探索杂志

Objective:To explore the teaching resources innovation and the teaching quality improvement for international students in clinical medicine based on the bilingual test question database of digitalized systematic anatomy.Methods:The test question database was set up and applied to Batch 2018 international students of clinical medicine (experiment group). The results of the usual test, final theory, and experimental examination of Batch 2017 international students (control group) were compared to verify the application value of the test question database. Questionnaires were used to get feedback from international students, and the feasibility of developing the test question database and the driving effect of teaching reform were further evaluated. SPSS 20.0 was used for data analysis, and the examination achievements of the two groups were compared with independent-samples t test and the measurement data were expressed by (mean ± standard deviation). Results:There was no significant difference between the two groups in the usual test results ( P>0.05), and in the experimental group, the results of final theory and experimental examination were significantly higher than those in the control group ( P<0.05). According to the questionnaire, more than 89.55%(155) of the international students highly appraised the test question database in terms of learning resources, quality of questions, examination mode and experience evaluation, while only 52.02%(90) of them recognized the bilingual form of the test questions. Conclusion:The bilingual test question database of digital systematic anatomy has effectively expanded the teaching resources and promoted the teaching reform of international students.

Analysis and evaluation of Hematology online open course based on SPOC platform / 中华医学教育探索杂志

Objective:To explore the teaching evaluation of online open course of hematology based on small private online course (SPOC) platform by means of quantitative method.Methods:The fourth-year undergraduates of clinical medicine major were selected to receive online course learning of hematology, including video viewing, rich text browsing, in-class quizzes, and seminars. The teaching contents covered the basis of hematological diseases, anemic diseases, hematological tumors, bleeding and coagulation disorders. Teaching evaluation was conducted through teaching behavior assessment, unit test, course examination and SPOC scoring. Linear regression analysis was used to analyze the correlation between the duration of the teaching video and student learning behavior. The correlation between video learning quantity and viewing time and course test scores and SPOC scores was analyzed. Kruskal-Wallis test was used to compare the differences in curriculum learning behavior (participation rate). T-test was used to compare the differences between the two results of two unit tests and to calculate the alternative-form reliability. Chi-square test was used to compare the differences in scores of different sub-specialty questions in hematology, and the differences of participation rate of different examination points of hematological tumors. Results:The teaching video viewing rate was significantly higher than the participation rate of rich text browsing and in-class quizzes ( P < 0.001; P < 0.001). There was no obvious correlation between video duration and video viewing, rich text browsing, in-class quizzes ( R = 0.168, F = 0.81, P = 0.376; R = 0.057, F = 0.07, P=0.802; R=0.124, F=0.37, P=0.546). There was a significant positive correlation between the participation rate of video viewing and rich text browsing and in-class quizzes ( R =0.890, F=76.41, P<0.001; R=0.934, F=163.67, P < 0.001). The participation rate of anemic disease unit test was significantly higher than that of hematological tumors ( χ2 = 49.08, P<0.001), bleeding and coagulation disorders ( χ2= 25.97, P< 0.001), and the second results were significantly improved ( t=-2.09, P=0.040), and the alternative-form reliability was 0.750. There was no significant difference in the participation rate of different sub-specialty courses ( χ2=5.20, P=0.074); the number of video watching was significantly positively correlated with SPOC scores ( R=0.523, F=196.22, P<0.001); the participation rate of molecular genetics and molecular biology tests of blood tumor was significantly lower than that of general clinical information questions ( P < 0.05). Conclusion:Teaching videos are the foundation of online courses. Increasing the number of video viewing and improving video viewing rate can effectively mobilize the enthusiasm of extensive learning, such as rich text browsing and in-class quizzes, and improve learning participation. It is conducive to the improvement of students' academic performance. Simple behavior factors such as video viewing time are not recommended as performance evaluation indicators. Unit test takes two times to get the highest score, which is conducive to improving professional learning level through learning behavior, without affecting the reliability of the performance evaluation. The online open course based on the SPOC platform is conducive to the balanced development of the course teaching of Hematology.

Construction and evaluation of clinical-thinking patterned curriculum for parallel graduate students with "running through clinical diagnosis and treatment process" / 中华医学教育探索杂志

Objective:To explore the construction and implementation effect of clinical-thinking patterned curriculum for parallel graduate students with "running through clinical diagnosis and treatment process."Methods:In this study, 94 Batch 2016-2017 graduate students with clinical medical professional degree in Shanxi Provincial People's Hospital were selected as the research subjects. Among them, 48 Batch 2017 parallel graduate students were selected as the experimental group. The curriculum of clinical-thinking patterned training of "running through the clinical diagnosis and treatment process" was used. In addition to participating in the degree courses and residency courses, a series of training to improve the clinical-thinking ability were introduced. And 46 Batch 2016 parallel graduate students were divided in the control group, using a traditional curriculum and only participating in degree courses and residency courses. The differences among mini-clinical evaluation exercise (Mini-CEX) scores, direct observation of procedural skills (DOPS) scores, objective structured clinical examination (OSCE) scores and students' satisfaction were compared by t test, chi-square test and repeated measures analysis of variance. Results:The Mini-CEX scores showed the average scores of other aspects except humanistic care were higher than those of the control group, and the score of communication skills was significantly higher than that of the control group [(6.55±0.98) vs. (5.77 ±1.12)], with significant differences ( t=3.62, P<0.001). In the DOPS scores, except for the skills of communication with patients, ability to consider patient's feelings and practice of occupational literacy, the average scores of other aspects of the experimental group were higher than those of the control group, and the real operation-ability score of clinical skills was significantly higher than that of the control group [(6.38 ± 1.38) vs. (5.53±1.23)], with a significant difference ( t=3.12, P=0.002). In terms of the outpatient receiving station, the emergency treatment station, the clinical thinking station①, the clinical thinking station②, the specialist skill station, the auxiliary examination station and the case writing station, their OSCE scores at different stages in the experimental group were higher than those in the control group, and in terms of clinical thinking station①, the score of the experimental group was significantly higher than that of the control group, with a significant difference ( F=6.51, P=0.012). The satisfaction rate of the experimental group in terms of curriculum was higher than that in the control group except for the future career development, and in improving logical-thinking ability, the score of the experimental group was significantly higher than that of the control group, with a significant difference ( χ2=19.18, P<0.001). Conclusion:The curriculum of clinical-thinking ability with "running through the clinical diagnosis and treatment process" can enhance the clinical practical ability of parallel graduate students, making them meet the residential academic standards as soon as possible and effectively promoting the training quality of the students.

Evaluation on the application effect of "flipped classroom" in general surgery practice teaching / 中华医学教育探索杂志

Objective:To explore the application and practice of "flipped classroom" in the teaching of general surgery interns.Methods:A total of 20 internship groups (3 to 5 people in each group) were randomly selected from the general surgery practice group in the Department of General Surgery of the Second Clinical Medical College of North Sichuan Medical College. They were randomly divided into the flipped group (45 people) and the traditional group (40 people), with 10 subgroups in each group. The flipped group adopted the flipped classroom teaching mode (students' self-study by handing out materials before class, students and teachers' discussion in class, and students and teachers' evaluation after class), while the control group adopted the current conventional teaching mode (students' preview before class, teachers' explanation in class, and teachers' question answering after class). At the end of the teaching, a questionnaire was used to evaluate the participation and completion of each student. The teaching effect was evaluated by medical history collection and case analysis. The participation, completion, and teaching effect between the two groups were compared and analyzed. SPSS 23.0 software was used for t-test and Chi-square test. Results:The participation of the flipped group was better than that of the traditional group [(17.45±1.83) vs. (15.57±1.52)], and the difference was statistically significant ( P < 0.05). There was no statistically significant difference between the flipped group and the traditional group. There was no significant difference in medical history collection scores between the two groups. The case analysis of the flipped group was better than that of the traditional group [(87.30±6.06) vs. (81.50±5.88), P < 0.05]. The questionnaire shows that about 90% of the students think that flipped classroom can improve their interest in learning [96% (43/45)], improve their autonomous learning ability [89% (40/45)], and have better learning effect. At the same time, 78% (35/45) of students think that learning time is too long. Conclusion:The flipped classroom teaching model can improve the teaching participation of general surgery students, improve students' interest in learning, improve their self-learning ability, and improve students' thinking ability of medical record analysis.

Analysis of the effects of the teaching reform to strengthen the integration of basic medicine and clinical medicine through the National Medical Licensing Examination scores / 中华医学教育探索杂志

Objective:To investigate the effects of teaching reform to strengthen the integration of basic medicine and clinical medicine by analyzing the scores of the National Medical Licensing Examination from 2014 to 2018.Methods:Through the improvement of the training program, the establishment of subject integration courses, the standardization of case teaching mode and the establishment of comprehensive medical experiment courses, the teaching reform of the combination of basic medicine and clinical medicine was carried out. The differences in the scores of the National Medical Licensing Examination between the students from Dalian University and those from the whole country were compared, including the average total scores, the passing rates, the average mastery rates of the basic medicine, and the average mastery rates of the cognitive level of the basic medicine.Results:In 2014, 2015 and 2016, the average total scores of the students from Dalian University were 384.70±53.62, 395.45±50.49, and 401.43±50.88, respectively, which were lower than those from the whole country (396.15±58.85, 400.78±56.88, and 405.15±58.06). The average mastery rates of the basic medicine of the students from Dalian University were 56.28%, 62.45%, and 64.92%, respectively, lower than those from the whole country (58.41%, 62.46%, and 65.36%). The average mastery rates of the basic medicine of the students form Dalian University from 2014 to 2016 were lower than those from the whole country, and those were higher in 2017 to 2018 than the whole country. The average total scores of the students form Dalian University in 2017 and 2018 were 397.11 and 400.26 ± 61.15, respectively, higher than those from the whole country (388.91 and 397.01±58.35). The average mastery rates of the basic medicine of the students form Dalian University were 61.53% and 59.85%, respectively, higher than those from the whole country (58.64% and 58.38%). The total passing rates of the students from Dalian University in 2014 and 2016 were 91.11% and 72.73%, respectively, lower than those from the whole country (91.18% and 73.75%), while in 2015, 2017 and 2018 those were 76.47%, 77.78%, and 77.59%, respectively, all higher than those from the whole country (73.59%, 74.29%, and 76.89%). All the data showed a trend of increase with the teaching reform process.Conclusion:Strengthening the teaching reform of the combination of basic medicine and clinical medicine during the learning stage of basic medicine could improve students' learning interest and attention to the basic medical knowledge, strengthen the understanding of the relevance of basic medicine to clinical medicine, and play a positive role in the cultivation of medical students' post competency and the achievement of the goal of training applied medical talents.

Evaluation of teaching effect of opening experiments on occupational health and occupational medicine / 中华医学教育探索杂志

Objective:To carry out opening experiments on occupational health and occupational medicine for students majoring in preventive medicine, reform the experimental teaching mode, and explore the teaching methods to improve students' professional quality and scientific research ability.Methods:Opening experiments were carried out in the experimental course of occupational health and occupational medicine for students of preventive medicine major. A total of 147 students majoring in preventive medicine of Batch 2016 were classified as the control group, and the routine confirmatory experiment was carried out in the group; 176 students majoring in preventive medicine of Batch 2017 were classified as the experimental group, and this group carried out opening experiment. The evaluation was made from three aspects: comprehensive evaluation results, teacher self-evaluation and student satisfaction survey. SPSS 22.0 software was used for analysis and comparison by independent-samples t-test and Chi-square test. Results:The theoretical scores of the experimental group and the control group students were (84.37±10.45) vs. (81.44±9.22) ( t=2.68, P=0.008), and the experimental skills scores were (93.66±3.89) vs. (88.41±5.67) ( t=9.51, P<0.001). Questionnaire investigation showed that the students in the opening experimental group were more satisfied with the courses arrangement ( χ2=8.31, P=0.004), group cooperation ( χ2=21.10, P<0.001), assessment form ( χ2 =7.92, P=0.005), improvement of the writing ability of scientific research papers ( χ2 =17.56, P<0.001), improvement of practical skills ( χ2=11.70, P=0.001), logical thinking, language organization and expression ability ( χ2=10.33, P=0.001). They considered the opening experiment was helpful to cultivate innovative thinking and ability, but it had limited effect on the cultivation of employment advantages. And the students considered the opening experiments of setting up professional courses was sufficient and necessary. Conclusion:Carrying out opening experiments for students majoring in preventive medicine is helpful to improve students' professional quality and cultivate their practical ability and scientific research ability.

Case-based learning method combined with mind mapping in pathophysiology teaching / 中华医学教育探索杂志

Objective:To explore the effect of case-based learning (CBL) combined with mind mapping on pathophysiology teaching.Methods:Totally 124 undergraduate students from Batch 2017 of Yanjing Medical College of Capital Medical University were selected as research subjects, and they were divided into experimental group ( n=60) and control group ( n=64). The traditional teaching method was used in the control group, while the experimental group adopted CBL combined with mind mapping teaching method. At the end of the course, the teaching effectiveness was evaluated by the usual grades from Mosoteach online teaching platform and test performances. SPSS 17.0 was used to perform Wilcoxon rank sum test and the Welch's correction t test. Results:The initiative of students in the experimental group was significantly improved than that in the control group ( P<0.001), and the understanding ability was also better in the experimental group than the control group ( P=0.020). The average theoretical scores of the experimental group were significantly better than those of the control group ( P=0.036), with the main manifestations that the scores of objective questions were higher than those of the control group ( P<0.001), and the scores of short answer and discussion questions were higher than those of the control group ( P=0.006). There was no significant difference in noun interpretation scores between the two groups ( P=0.302). Conclusion:The CBL combined with mind mapping can significantly improve the teaching quality of pathophysiology.

Teaching reform and practice of 'Production Internship' course for biotechnology specialty from the perspective of training application-oriented talents / 生物工程学报

Production internship is an important teaching tache for undergraduate students to carry out engineering training by using professional skills, and it is a key starting point for fostering application-oriented talents in biotechnology. The Course Group of 'production internship of biotechnology majors' of Binzhou University is investigating application-oriented transformation for local regular colleges and universities, as well as fostering high-level application-oriented talents. By taking green fluorescent protein (GFP) polyclonal antibody as an example, the reform and practice on teaching content, teaching mode, assessment method, continuous improvement of curriculum were carried out. Moreover, the characteristics of the Yellow River Delta-Binzhou Biotechnology & Pharmaceutical Industrial Cluster were taken into account to intensify academic-enterprise cooperation. On one hand, this Course Group designed and rearranged the course contents, carried out essential training through online resources and platforms such as virtual simulation, and recorded, tracked and monitored the progress of production internship through practical testing and software platforms like 'Alumni State'. On the other hand, this Course Group established a practice-and application-oriented assessment method in the process of production internship and a dual evaluation model for continuous improvement. These reform and practices have promoted the training of application-oriented talents in biotechnology, and may serve as a reference for similar courses.