新医科背景下康复治疗学实践教学体系建设的思考

Reflections on the Development of a Practice-Based Teaching System for Rehabilitation Therapy under the “New Medical Education” Initiative

摘要: 实践教学是康复治疗学本科人才培养质量的关键环节。国内研究已在课程建设、校内实训、临床见习和评价工具等方面积累经验，但培养目标、真实岗位任务、能力进阶与评价证据之间仍缺少稳定对应。国际康复及医学教育研究以能力导向教育(competency-based medical education, CBME)、里程碑评价和职前跨专业教育(interprofessional education, IPE)为重要路径，强调以毕业结果反向设计课程、依托工作场景连续观察，并在团队任务中形成协作能力；其局限则在于抽象能力难以转化为可观察行为、短期课程偏重态度自评、评价者校准不足。基于此，本文在比较国内外研究的基础上，结合西藏民族大学与中山大学附属第三医院协同实习的过程观察，提出“毕业能力标准–阶段里程碑–真实任务–校院共评–质量改进”的实践教学框架，并以脑卒中偏瘫综合病例展示评定、目标设定、方案制定、沟通协作和再评价的任务链，附列毕业实习岗位胜任力清单草案。文章认为，改革成效取决于能否把能力框架落实为可完成的岗位任务和可追踪的成长证据，而非教学方法或实习基地的简单叠加。

Abstract: Practical education is a critical component in ensuring the quality of undergraduate training in rehabilitation therapy. In China, considerable experience has been accumulated in curriculum development, campus-based practical training, clinical observation, and assessment tools. However, stable alignment remains insufficient among training objectives, authentic workplace tasks, progressive competency development, and assessment evidence. International research in rehabilitation and medical education has increasingly adopted competency-based medical education (CBME), milestone-based assessment, and pre-licensure interprofessional education (IPE) as major approaches. These approaches emphasize backward curriculum design based on expected graduate outcomes, longitudinal observation in workplace settings, and the development of collaborative competence through team-based tasks. Nevertheless, several limitations remain, including difficulties in translating abstract competencies into observable behaviors, an overreliance on self-reported attitudes in short-term courses, and inadequate calibration among assessors. Against this background, this article compares relevant research conducted in China and abroad and draws on process observations from a collaborative clinical placement program jointly implemented by Xizang Minzu University and the Third Affiliated Hospital of Sun Yat-sen University. It proposes a practical education framework consisting of “graduate competency standards-stage-specific milestones-authentic tasks-joint university-hospital assessment-quality improvement.” A comprehensive case of post-stroke hemiplegia is used to illustrate a task chain encompassing clinical assessment, goal setting, intervention planning, communication and collaboration, and reassessment. A preliminary checklist of workplace competencies for graduation internships is also provided. This article argues that the effectiveness of practical education reform depends on whether competency frameworks can be translated into achievable workplace tasks and traceable evidence of learner development, rather than on the simple addition of teaching methods or clinical training sites.