摘要
医学科学的发展，有赖于医学自身认识能力的不断提高，更有赖富于创新能力的医学人才的不断成长。培养和造就富于创新能力的医学人才，是时代赋予医学教育的神圣使命，更是医学教育需要认真解析的深奥命题。基于对医学创新能力的核心要素及形成机制的认识，本文在医学教育学界首次提出“构建医学方法学课程群以促进医学生创新能力的培养”这一命题。
目的从实践层面了解医学生以其对科研与写作的把握程度为标志的医学创新能力的现状，了解医务人员和医学研究生对医学方法学知识的需求现状，以及医学院校对于医学方法学课程建设及其教学现状。从理论层面明确医学方法学、医学方法学课程群的概念，阐述医学方法学课程的学科渊源及学科特征，构建了医学方法学课程群，并揭示了医学方法学课程群与医学课程体系的内在关系，进而论证医学方法学课程教学模式的形态以及运行机制。
方法本文遵循系统性、实证性和思辨性的研究理念，综合运用文献法、调查法、比较法和演绎法等多种方法。
对象以3届新近入学本校的医学研究生和部分临床医学专家为调研对象，了解其对于医学方法学的需求；以3个不同时段的部分医学院校的课程计划为调研对象，了解其开设医学方法学课程的现状；以八年制和五年制规划教材为调研对象，抽取出对医学方法学学科性质的表述；以医学发展模式和医学创新能力的构成为研究对象，揭示出医学方法学知识对于创新能力形成的作用。
结果①了解到医学生以对科研与写作的认知状态为标志的创新能力有待提升，这种不佳状态源于大学期间相关课程（即本文所说的医学方法学课程）及其教学的薄弱，仅有16.91%的学生是通过课程学习获得的相关知识信息；②了解到医学院校开设医学方法学课程的现实状态，在被调查的22所开设七年制临床医学专业的院校中，有2/3的院校开设了“医学信息检索”和“医学统计学”两门课；仅有1/2的院校开设了“临床流行病学”和“医学科研方法”两门课；无论是课程门数、开课的普遍性，还是课程建设和教学管理的规范程度均有待提升。③了解到医学方法学课程已经初步形成。作为医学方法学课程之基础与前提的医学方法学，其各个学科，或以学科形式、或以领域的形式，已经初步形成，成为一种客观存在。医学方法学的各门课程，也已经以实实在在的课程形态，存在于部分医学院校的课程体系之中。④提出了构建医学方法学课程群之原则——以课程自然生态为基础、以课程集成功能为导引、以课程内容整合为手段和以课程效率提升为目的；提出了构建医学方法学课程群之三层蕴意——在观念上形成医学方法学及其课程群的概念、在医学课程体系整体层面确认医学方法学课程群的应有地位、在医学方法学课程的微观层面重新打造各门课程。⑤阐释了医学方法学课程的学科特征——学科渊源的多维性、价值体现的间接性、知识组织的程序性，以及与包括创新能力在内的医学认知能力的形成之内在关系，由此而揭示其对医学创新能力培养之意义。⑥阐释了医学方法学课程群的范畴、结构及与整个医学课程体系的内在逻辑联系，揭示了医学方法学课程群的整体功能作用——第一个层次为科学方法的熟知，第二个层次为科学思维的训练，第三个层次为科学精神的塑造。为医学方法学课程群及其构建奠定了学理依据；⑦阐释了医学方法学课程教学模式构建的依据——医学培养目标的导引、体现方法学课程特色、符合医学生成长规律和继承以往的传统规范。揭示了医学方法学课程教学模式构建的原则——授课目标上注重两个强化、授课内容上实现两个融合、授课原则上遵循两个同步和授课方式上采用两个并重。
结论医学方法学知识是医学创新能力形成不可或缺的构成要素；在目前的医学教育中，医学方法学课程建设及其教学并未达到其理想状态；通过构建医学方法学课程群及相应教学模式，可以实现其集成优势，以促进医学创新能力的培养；构建医学方法学课程群及相应教学模式，不仅有着理性的应然与必然，更有着充分的现实基础和客观条件，已经具备了现实操作层面的可能性。
The development of medical sciences depends on the continuous improvement of theknowledge ability for the medical sciences themselves and even relies on the growth of themedical talents who have abundant innovative capability. Cultivating and bringing up innovativemedical talents is a sacred mission of medical education entrusted by the times, further a moreesoteric proposition which requires medical education to perform careful analysis. Concerning thecore elements and formative mechanism of the medical innovative ability, this paper puts forwardthe proposition "constructing the medical methodology courses group to promote the cultivation ofthe medical students’ innovative ability” in the medical education circles for the first time.
Objectives From the practical level, the students’ medical cognitive abilities which take theextents of the scientific research and writing as symbols, the needs for medical methodologyknowledge of the medical personnel and medical graduate, the status of medical methodologycourse construction and teaching in some medical schools were acknowledged. From thetheoretical level, the concepts of the medical methodology and the medical methodology coursesgroup were defined, the academic origins and subject characteristics of the medical methodologycourses were expounded, the medical methodology courses group was constructed, the innerrelation between the medical methodology courses group and the medical courses system wasclarified, further to demonstrate the teaching mode pattern and the operation mechanism of themedical methodology courses.
Methods The systematic, empirical and critical research conceptions were followed and theliterature method, investigation method, comparative method and deductive method wereemployed synthetically in this paper.
Objects The three sessions of the medical graduates newly enrolled in the school and a part of theclinical experts were taken as the research objects, their needs for the medical methodology wereacknowledged; the courses programs in some medical colleges in three different periods weretaken as the research objects, the status of its offering medical methodology courses wereacknowledged; the teaching materials in eight years and five years planning were taken as theresearch objects, the expression for the natures of the medical methodology disciplines werebextracted; the medical developing model and the composition of the medical innovative abilitieswere taken as the research objects, the effects of the medical methodology knowledge on theformation of innovative abilities were revealed.
Results①The medical students’ innovative abilities which take the extents of the scientificresearch and writing as symbols were acknowledged and should be improved. The poor state is aresult of the weakness of related university courses (i.e. medical methodology courses mentionedin this paper) and their teachings, only16.91%of the students learned the relevant knowledge and information through the curriculum.②The realistic states of the medical methodology coursescommencements in the medical schools were acknowledged, in the22medical colleges in whichthe clinical seven years planning students are enrolled in this survey,2/3of the collegescommence the programs of "medical information retrieval" and "medical statistics", only1/2ofthe colleges commence the programs of "clinical epidemiology" and "scientific researchmethodology";no matter the number of the courses, the commencement of the courses or theconstruction and teaching management regularity of the courses should be improved. This kind ofstate provides the evidence for the inference of the above survey results on the medical graduatestudents and proposes the theory and realistic problem of how to reform.③The realistic state thatthe medical methodology courses are initially formed was acknowledged. As the basis andpremise of medical methodology courses, the subjects of the medical methodology, in the form ofsubjects or fields, has been initially formed and become objective existence. The courses ofmedical methodology also have been in real course form, existing in the curriculum system ofsome medical college.④The principles in constructing courses group were proposed--taking thenatural ecology of the course as the basis, taking its integrated function as the guidance, taking itscontent integration as the methods and taking the improvement of the efficiency as aims; putforward three layers of the meanings to construct the medical methodology courses—forming theconcept of the medical methodology and its courses group in the view of ideas, confirming therightful position of the medical methodology courses group at an overall level of the medicalcourses system, rebuild the various courses at a microcosmic level of the medical methodologycourses.⑤The subject characteristics of the medical methodology courses were expounded.—themulti-dimension of the subject origin, the indirection in reflecting the value, the procedure of theknowledge organization, and the inner relations with the formation of the medical cognitiveabilities including the medical innovative abilities, and reveal their significance in the cultivationof the medical innovative abilities.⑥The scope, structure of the medical methodology coursesgroup and its logical relation with the whole medical courses system were expounded and thewhole functions and effects of the medical methodology course group were revealed--the firstlevel is being accustomed to the scientific methods, the second level is the training of scientificthinking, the third level is shaping the spirit of science. This has laid a theoretical basis for themedical methodology courses group and its construction.⑦The basis for the construction of theteaching mode of the medical methodology was expounded—taking the medical training goal asguidance, reflecting the characteristics of the methodology courses, according with the rule ofmedical students growth and inheriting the previous traditional regularity. The principles inconstructing the teaching mode of the medical methodology courses were revealed—attachingimportance to “the two strengthening” in the teaching objectives, realizing “the two fusion” in theteaching contents, following “the two synchrones” in teaching principles and employ “the twoequal attention” in teaching pattern.
Conclusions The medical methodology knowledge is the essential constructive element in the formation of the medical innovative abilities; however, in the current medical education, themedical methodology course construction and teaching did not reach the ideal state; through theconstruction of medical methodology courses group and the corresponding teaching mode, theintegrated advantages can be achieved to promote the cultivation of the medical innovative ability;there are not only the necessity and rationality but also the realistic basis and objective conditionsin the construction of medical methodology courses group and the corresponding teaching mode,the possibility in the practical operating level has its existence.
引文
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