阶梯式–导师制在中医骨伤本科生临床 跟师培养中的构建与应用探析

Construction and Application of the Ladder Mentor System in Clinical Follow-Up Training for Undergraduate Students with Traditional Chinese Medicine Orthopedics

摘要: 随着中医药传承创新发展战略深入实施，中医骨伤专业人才的临床能力培养面临结构性挑战：传统“一刀切”带教模式难以兼顾学生认知发展阶段性特征与骨伤学科高度实践性、经验性、师承性特点。本综述系统梳理“阶梯式–导师制”这一新型培养范式的理论基础、结构逻辑与实践路径，聚焦其在中医骨伤本科生临床跟师培养中的适配性与可行性。研究发现，该模式通过将培养过程划分为“感知–模仿–协同–独立”四个递进阶段，并为各阶段匹配差异化导师角色(如导学型导师、技能型导师、思辨型导师、临床决策型导师)，有效回应了当前中医骨伤临床教学中存在的目标模糊、路径单一、评价粗放等问题。现有文献虽未直接命名“阶梯式–导师制”，但PBL教学法、PDCA循环理论、5D思维模式及多种导师制实践(如双导师制、组团式导师制、临床小班结合导师制)均从不同维度为其提供了方法论支撑与实证依据。未来需在制度设计上强化阶段转换标准、导师资质认证与动态评估机制，并依托中医骨伤临床技能实训课程体系与临床实践指南建设，推动该模式从经验性探索走向标准化、可复制的教育范式。

Abstract: With the deepening implementation of the strategy of inheriting, innovating and developing traditional Chinese medicine, the clinical ability cultivation of TCM bone injury professionals is facing structural challenges: the traditional “one size fits all” teaching model is difficult to balance the stage characteristics of students’ cognitive development with the highly practical, experiential and mentorship characteristics of bone injury discipline. This review systematically summarizes the theoretical basis, structural logic, and practical path of the new training paradigm of “ladder mentor system”, focusing on its adaptability and feasibility in clinical mentorship training for undergraduate students with traditional Chinese medicine bone injuries. Research has found that this model effectively addresses the problems of vague goals, single paths, and extensive evaluations in current clinical teaching of traditional Chinese medicine bone injuries by dividing the cultivation process into four progressive stages of “perception-imitation-collaboration-independence” and matching differentiated mentor roles (such as guidance mentor, skill mentor, critical thinking mentor, and clinical decision-making mentor) for each stage. Although the existing literature does not directly name the “hierarchical mentorship system”, PBL teaching method, PDCA cycle theory, 5D thinking mode, and various mentorship practices (such as dual mentorship system, group mentorship system, and clinical small class combined mentorship system) provide methodological support and empirical evidence from different dimensions. In the future, it is necessary to strengthen the stage transition standards, mentor qualification certification, and dynamic evaluation mechanism in institutional design, and rely on the construction of the TCM bone injury clinical skills training curriculum system and clinical practice guidelines to promote this model from empirical exploration to a standardized and replicable educational paradigm.