住院医师规范化培训中临床带教信息传递偏差的分析

Analysis of Information Transmission Bias in Clinical Teaching during Standardized Residency Training

摘要: 临床带教中常见的这种困境是教学活动已完成流程，住院医师的理解内化与迁移运用却未同步跟进。本文将这一现象称为“教学信息传递偏差”，并引入传播学编码–解码模型，将偏差系统解构为编码噪声、解码语境差异与反馈回路缺失三个环节。文章分析了TITD的三维表征，重结论轻推理、重操作轻策略、重留痕轻实效及各环节的成因，在此基础上提出包含思维显化、分层带教、结构化互动、形成性评价、人文嵌入和师资督导的系统改进策略，以及不同层级医院的差异化建议和分类实施建议。

Abstract: A common dilemma in clinical teaching is that the instructional process is often completed, but the residents’ internalization and transfer of understanding do not keep pace. We refer to this phenomenon as “teaching information transmission deviation” (TITD) and introduce the encoding-decoding model from communication studies to systematically deconstruct it into three components: encoding noise, decoding context discrepancy, and the absence of feedback loops. The article analyzes TITD from three dimensions, namely an emphasis on conclusions over reasoning, on procedures over strategies, and on documentation over actual outcomes, along with the contributing factors for each. Based on this analysis, we propose a set of systematic improvement strategies, including making thinking explicit, stratified teaching, structured interaction, formative assessment, embedding humanistic elements, and faculty supervision. We also offer differentiated recommendations for hospitals at different levels and suggestions for phased implementation.