Статья
Технологические инновации в современном мире привели к смене парадигмы медицинского образования, обозначив новые задачи. Необходимость решения поставленных задач потребовала внедрения доказательной клинической практики, которая позволяет использовать имеющиеся доказательства наилучшего качества для обеспечения оптимальной помощи пациентам и повышения эффективности здравоохранения. Получение доказательств эффективности и безопасности лекарственных препаратов и медицинских технологий, диагностической точности вмешательств стало возможным благодаря внедрению методологии систематического обзора и метаанализа. Данная методология формирует клиническое мышления параллельно с развитием исследовательских и аналитических компетенций, что является одной из актуальных задач современного медицинского образования. В статье отражен опыт кафедры терапии Института профессионального образования Сеченовского Университета по внедрению практико-ориентированного исследовательского модуля, направленного на формирование критического мышления с использованием методов доказательной медицины у студентов и ординаторов. Включение исследовательских компетенций в образовательный процесс позволит качественно трансформировать медицинское образование и сформировать поколение конкурентоспособных грамотных специалистов, востребованных в мире постоянно развивающихся технологий.
1. Guyatt GH, Rennie D, Meade MO, Cook DJ. Users′ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. 2nd ed. Chicago, IL: AMA Press. 2002.
2. Haynes RB, Sackett DL, Gray JM, et al. Transferring evidence from research into practice: 1. The role of clinical care research evidence in clinical decisions. ACP journal club. 1996;125(3),A14-A16.
3. Lehane E, Leahy-Warren P, O’Riordan C, et al. Evidence-based practice education for healthcare professions: an expert view. BMJ evidence-based medicine. 2019;24(3):103-8. doi:10.1136/bmjebm-2018-111019.
4. Al-Ghimlas F. The philosophy of evidence-based clinical practice: Is evidence enough? Annals of thoracic medicine. 2013;8(3):131-2. doi:10.4103/1817-1737.114282.
5. Wagner CS, Zhang L, Leydesdorff L. A discussion of measuring the top-1% most-highly cited publications: quality and impact of Chinese papers. Scientometrics. 2022;127:1825-39. doi:10.1007/s11192-022-04291-z.
6. Лау Дж. У. Ф. Введение в критическое мышление и теорию креативности. М.: Эксмо. 2017. c. 368.
7. Павлов Ч. С., Ковалевская В. И., Киреева Н. В. и др. Образовательные приоритеты и программы развития исследовательских компетенций в науко-ориентированном медицинском образовании. Кардиоваскулярная терапия и профилактика. 2022;21(4S):3481. doi:10.15829/1728-8800-2022-3481.
8. Бэкон Ф. О достоинстве и приумножении наук. Бэкон Ф. Сочинения: в 2-х т. М.: Мысль. 1977.
9. Ennis RH. A concept of critical thinking: A proposed basis for research in the teaching and evaluation of critical thinking ability. Harvard Educational Review. 1962;32(1):81-111.
10. Ennis RH. Critical Thinking and Subject Specificity: Clarification and Needed Research. Educational Researcher. 2016;18(3):4-10. doi:10.3102/0013189X01800300.
11. Kaur S, Prakash S, Sharma R. Critical thinking in healthcare and education. BMJ. 2017;357. doi:10.1136/bmj.j2234. https://www.bmj.com/content/357/bmj.j2234/rr-1.
12. Huang GC, Newman LR, Schwartzstein RM. Critical Thinking in Health Professions Education: Summary and Consensus Statements of the Millennium Conference 2011. Teaching and Learning in Medicine an International Journal. 2014;26(1):95-102. doi:10.1080/10401334.2013.857335.
13. Abrami Ph, Bernard R, Borokhovski E. Strategies for Teaching Students to Think Critically: A Meta-Analysis. Review of Educational Research. 2015;85(2):275-314. doi:10.3102/0034654314551063.
14. Richards JB, Schwartzstein RM. Promoting Critical Thinking in Your Intensive Care Unit Team. Critical care clinics. 2022; 38(1):113-27. doi:10.1016/j.ccc.2021.08.002.
15. Reale М, Riche D, Witt B., Baker W, Peeter M. Development of critical thinking in health professions education: A meta-analysis of longitudinal studies. Currents in Pharmacy Teaching and Learning. 2018;10(7):826-833. doi:10.1016/j.cptl.2018.04.019.
16. Richards JB, Hayes MM, Schwartzstein RM. Teaching Clinical Reasoning and Critical Thinking: From Cognitive Theory to Practical Application. Chest. 2020;158(4):1617-28. doi:10.1016/j.chest.2020.05.525.
17. Papp KK, Huang GC, Lauzon Clabo LM, et al. Milestones of critical thinking: a developmental model for medicine and nursing. Academic medicine: journal of the Association of American Medical Colleges. 2014;89(5):715-20. doi:10.1097/ACM.0000000000000220.
18. Kahlke R, White J. Critical Thinking in Health Sciences Education: Considering "Three Waves". Creative Education. 2013;4:21-9. doi:10.4236/ce.2013.412A1004.
19. Sackett D. Bias in analytic research. Journal of Chronic Diseases. 1979;32(1-2):51-63. doi:10.1016/0021-9681(79)90012-2.
20. Sackett D. How to read clinical journals: I. why to read them and how to start reading them critically. Canadian Medical Association journal. 1981;124(5):555-8.
21. Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problem-solving. BMJ (Clinical research ed.). 1995; 310(6987):1122-6. doi:10.1136/bmj.310.6987.1122.
22. Jenicek M. Towards evidence-based critical thinking medicine? Uses of best evidence in flawless argumentations. Med Sci Monit. 2006;12(8).
23. Jenicek M, Croskerry P, Hitchcock DL. Evidence and its uses in health care and research: the role of critical thinking. Medical science monitor: international medical journal of experimental and clinical research. 2011;17(1):RA12-RA17. doi:10.12659/msm.881321.
24. Royce CS, Hayes MM, Schwartzstein RM. Teaching Critical Thinking: A Case for Instruction in Cognitive Biases to Reduce Diagnostic Errors and Improve Patient Safety. Academic medicine: journal of the Association of American Medical Colleges. 2019;94(2):187-94. doi:10.1097/ACM.0000000000002518.
25. Kassirer JP. Teaching clinical reasoning: case-based and coached. Academic medicine: journal of the Association of American Medical Colleges. 2010;85(7):1118-24. doi:10.1097/acm.0b013e3181d5dd0d.
26. Norman GR, Monteiro SD, Sherbino J, et al. The Causes of Errors in Clinical Reasoning: Cognitive Biases, Knowledge Deficits, and Dual Process Thinking. Academic medicine: journal of the Association of American Medical Colleges. 2017;92(1):23-30. doi:10.1097/ACM.0000000000001421.
27. Croskerry P. A universal model of diagnostic reasoning. Academic medicine: journal of the Association of American Medical Colleges. 2009;84(8):1022-8. doi:10.1097/ACM.0b013e3181ace703.
28. Roberts D, Leung J, Gluud C, et al. Comparison of recommendations from cirrhosis Clinical Practice Guidelines and from Cochrane systematic reviews. Research Square. 2023. doi:10.21203/rs.3.rs-2194398/v1.
29. Wang J, Wang D, Chen Y, et al. The effect of an evidence-based medicine course on medical student critical thinking. Journal of evidence-based medicine. 2017;10(4):287-92. doi:10.1111/jebm.12254.
30. Romero M. Digital Game Design as a Complex Learning Activity for Developing the 4Cs Skills: Communication, Collaboration, Creativity and Critical Thinking. GaLA Conference, Rome. 2015. doi:10.1007/978-3-319-40216-1_10.
31. Fischer K, Sullivan AM, Krupat E, Schwartzstein RM. Assessing the Effectiveness of Using Mechanistic Concept Maps in Case-Based Collaborative Learning. Academic medicine: journal of the Association of American Medical Colleges. 2019;94(2):208-12. doi:10.1097/ACM.0000000000002445.
32. Mamede S, van Gog T, van den Berge K, et al. Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA. 2010;304(11):1198-203. doi:10.1001/jama.2010.1276.
33. Krupat E, Richards JB, Sullivan AM, et al. Assessing the Effectiveness of Case-Based Collaborative Learning via Randomized Controlled Trial. Academic medicine: journal of the Association of American Medical Colleges. 2016;91(5):723-9. doi:10.1097/ACM.0000000000001004.
34. Pavlov ChS, Kovalevskaja VI, Litvinova TM, Volel’ BA. Models of medical education: historical aspects, current state, problems. Medical ethics. 2022;3:44-50. (In Russ.) Павлов Ч. С., Ковалевская В. И., Литвинова Т. М., Волель Б. А. (2022). Модели медицинского образования: исторические аспекты, современное состояние, проблемы. Медицинская этика. 2022;3:44-50. doi:10.24075/medet.2022.051.
35. Guyatt GH, Sackett DL, Cook DJ. Users’ guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group. JAMA. 1994;271(1):59-63. doi:10.1001/jama.271.1.59.
36. Jaeschke R, Guyatt G, Sackett DL. Users’ guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 1994;271(5):389-91. doi:10.1001/jama.271.5.389.
37. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn’t. BMJ (Clinical research ed.). 1996;312(7023):71-2. doi:10.1136/bmj.312.7023.71.
38. Balsarkar G. Art of Reading an Article in the Journal. J Obstet Gynecol India. 2022;72:1-5. doi:10.1007/s13224-021-01613-8.
39. Kolars JC, Halvorsen AJ, McDonald FS. Internal Medicine Residency Directors Perspectives on Global Health Experiences. Review. The American Journal of Medicine. 2011;124(9):806-12. doi:10.1016/j.amjmed.2011.03.007.
40. Horwitz RI, Hayes-Conroy A, Caricchio R, Singer BH. Evidence Based Medicine to Medicine Based Evidence. Review. The American Journal of Medicine. 2017;130(11):1246-50. doi:10.1016/j.amjmed.2017.06.012.
41. Colbert-Getz JM, Bierer SB, Berry A, et al. What Is an Innovation Article? A Systematic Overview of Innovation in Health Professions Education Journals. Academic Medicine. 2021;96(11S):S39-S47. doi:10.1097/ACM.0000000000004293.