The clinical puncture skills are the elementary technical skills for every medical student.In recent years,reforms have been carried out on teaching method of the training of clinical puncture skills in our hospital and we have achieved satisfactory teaching effect.These reform measures include reforming of operating flow,repeated training from simulative training to clinical practice,educating the medics'consiousness of medical safety and cultivating their competence of communication with patients.

Taking the assessment of undergraduate teaching as a turning point,this article discussed how to enhance the clinical teaching quality in all directions and put forward some measures such as improving the quality of classroom teaching,standardizing the teaching rounds,stressing the practice skills,consolidating the theoretical knowledge,strengthening the managements and constructions of the teaching documents,creating the excellent course of internal medicine,and expanding the network teaching resources.

Based on the present status of administration models in clinical staff rooms of affiliated hospitals in colleges and universities,reform on the administration model is required for adaptation to the modern medical teaching situation.Through the development of the standard staff room,establishment of the teaching performance appraisal system to standardize teachers' teaching responsibility,increasing clinical teachers’enthusiasm to participate in teaching activity, reforming the management model and process in teaching,the creation of teaching teams,im-prove the quality control of teaching,we have further improved the scientific management of our clinical staff room.

Methods:188 students majorting in clinical medicine were randomly divided into two groups:the experimental group with evidence based medicine(EBM)teaching method and the control group with traditional teaching method.Results:The experimental group was better than the control group in results of theory examination and skill test,writing medical record,analyzing condition of patients and the level of student's satisfaction.Conclusions:EBM thinking training is practicable in clinical teaching.

Based on the understanding of the present situations of bilingual teaching in clinical medical courses together with the analysis of the students' characteristics,the different methods in improving bilingual teaching were explored and the experience was discussed.The problems encountered in bilingual teaching were also discussed.

This paper concluded and analyzed the application of objectivc structured clinical examination (OSCE) in clinical bilingual education.It explored the promotion and inhibition effects of OSCE on bilingual teaching by discussing its implementation process,introduction pattern,advantages,disadvantages and feedback from teachers and students.

Objective To investigate the correlations of serum total bilirubin level with infarct volume,severity and etiological typing in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to hospital from January 2012 to January 2014 were used as subjects of study.Their clinical and imaging data were collected,and serum total bilirubin levels were detected.The correlations of the serum total bilirubin levels with the infarct volume,severity and etiological typing were analyzed.Results A total of 290 patients with acute ischemic stroke were enrolled in the study.The patients were divided into either a large infarction group (≥1.8 cm3,n =145) or a small infarction group (＜ 1.8 cm3;n =145)according to the median cerebral infarction volume.The total bilirubin level of the large infarction group was significantly higher than that of the small infarction group (16.896± 7.761 μmol/L vs.13.039±4.477 μmol/L;t =5.185,P ＜ 0.001).Multivariate logistic regression analysis showed that the bilirubin highest quantile group (＞ 17.893 μmol/L) was an independent risk factor for large infarction (odds ratio [OR] 2.754,95％ confidence interval [CI] 1.028-7.375;P =0.044).According to the National Institutes of Health Stroke Scale (NIHSS) score,the patients were divided into a mild stroke group (NIHSS score ＜8;n =210) and a moderate to severe stroke group (NIHSS score≥ 8,n =80).The total bilirubin level of the moderate to severe stroke group was significantly higher than that of the mild stroke group (16.861 ±7.689)μmol/L vs.14.246 ± 6.019 μmol/L;t =3.052,P =0.002).Multivariate logistic regression analysis showed that the total bilirubin level was not an independent risk factor for moderate to severe stroke.Small artery occlusive stroke,large artery atherosclerotic stroke,and other definite causes of stroke were combined into non-cardioembolic stroke group (n =244).The total bilirubin level in the cardioembolic stroke group (n=46) was significantly higher than that in the non-cardioembolic stroke group (19.639±8.409 μmol/L vs.14.087 ±5.831 μmol/L;t =5.479,P＜0.001).Multivariate logistic regression analysis showed that the bilirubin highest quartile group (＞ 17.893 μmol/L) was an independent risk factor for cardioembolic stroke (OR 8.405,95％ CI 1.719-41.106,P =0.009).Conclusions The increased serum total bilirubin level is an independent risk factor for larger infarction and cardioembolic stroke.As an oxidative stress index,serum total bilirubin in acute stage can provide help for early identification of infarct volume and etiological subtype in patients with ischemic stroke.

The standard administration and the management of the teaching files have been built firstly in the teaching and research apartment of medicine.A variety of databases to achieve files informatics and a series of teaching resources have been reinforced for recent years.Informatics technology,curriculum construction and teaching methods have been conformed to take full advantage of the teaching files.

Based on the present standardized training model for medicine residents,we analyzed the problems we met in the performance and discussed how to innovate the standardized management.

The department of Internal Medicine at our hospital has enhanced students' clinical skills training,strengthened the system of clinical teaching rounds,established an effective clinical practice teaching supervision mechanism,and established a scientific and effective clinical evaluation system for basic skills. These clinical teaching practice reforms have achieved satisfactory teaching results.