With the development of pharmaceutical education in the world and the reform of medical system in China, clinical pharmacy, as an organic combination of medicine and pharmacy, has attracted much attention in recent years and has become the backbone of clinical treatment. Clinical pharmacy takes "patient first" as the basic concept, biopharmaceutics and pharmacokinetics as the basic theoretical knowledge, and rational drug use as the core research content. Through pharmacists' in-depth participation in clinical practice, we can explore the law of drug use, ensure patients' rational drug use, improve the level of drug treatment, and achieve the goal of safe, effective and economical drug use. Based on this, clinical pharmacy occupies a core position in clinical drug treatment, which is an inevitable stage to adapt to the development of hospital pharmacy and the transformation of its working mode. As the executor of this work, clinical pharmacists should play an extremely important role, which is also a good opportunity for pharmaceutical professionals to reshape their professional image and enhance their professional value.
The "Regulations on Pharmaceutical Affairs Management of Medical Institutions" promulgated by the Ministry of Health on 20 1 1 clearly requires that medical institutions should establish a clinical treatment team composed of doctors, clinical pharmacists and nurses to carry out clinical rational drug use, and stipulate that there should be no less than 5 clinical pharmacists in tertiary hospitals and no less than 3 clinical pharmacists in secondary hospitals. Although the quantity of clinical pharmacists is strictly regulated, the current situation is not ideal, and the overall level of employees is not high, which can not meet the national requirements for the quantity and quality of clinical pharmacists in medical institutions. In order to better develop clinical pharmaceutical services, clinical pharmacists are eager to improve their academic level and knowledge level. To some extent, the cultivation of professional degree graduates makes up for the shortage of professional talents in China.
The traditional academic postgraduate degree is set according to disciplines, focusing on academic research, emphasizing theoretical research and cultivating research-oriented talents. Different from academic graduate students, the training goal of professional degree graduate students is to take professional practice as the guide, attach importance to practice and application, and cultivate high-level talents who have undergone formal and high-level training in specialty and specialized technology. It puts forward high requirements for graduates' practical work ability. Therefore, it is an urgent problem to make the graduate students of clinical pharmacy complete the prescribed courses and practical training within three years, and be basically competent as clinical pharmacists after graduation.
1 Training situation of clinical pharmacy postgraduates in China
1. 1 source of graduate students majoring in clinical pharmacy
Compared with developed countries, undergraduate clinical pharmacy education in China lags behind and starts late. As of 20 14, only 39 universities have the qualification to offer undergraduate clinical pharmacy, and the enrollment scale is small, most of them have only five-year academic system, so the quality and structure of clinical pharmacy knowledge need to be improved urgently; Pharmacy undergraduate has been running a school in China universities for many years, and the enrollment scale is relatively large. As the most mainstream pharmaceutical undergraduate education major, its graduates are mainly masters of clinical pharmacy, and the quality of students is generally poor.
1.2 professional background of clinical pharmacy postgraduates
The enrollment units of pharmaceutical undergraduate majors include medical colleges, comprehensive universities and even agricultural colleges. Judging from the current curriculum, most colleges and universities offer chemistry, pharmacy and functional courses, but the quality is uneven. Medical colleges offer pharmacy, and the courses of chemistry and pharmacy are relatively weak, but the functional courses may be relatively complete; However, comprehensive universities or pharmaceutical universities may prefer courses related to drug research and development, and pay insufficient attention to functional courses. The general feeling is that most pharmaceutical students in China receive general education in pharmacy, with many comprehensive courses, but the depth and accuracy are seriously insufficient, and the employment orientation is not clear; In the curriculum, more emphasis is placed on chemistry and pharmacy knowledge, and medical knowledge, especially clinical medical knowledge, is relatively lacking. To some extent, this has caused the complicated background of basic knowledge and many defects in the knowledge system of clinical pharmacy postgraduates.
1.3 Professional knowledge and existing problems of clinical pharmacy postgraduates.
Since China has not yet established a 6-8-year Pharm D training model represented by the United States, graduate students of pharmacy need to play a corresponding role when they graduate. Postgraduates of clinical pharmacy aim at cultivating practical working ability. Graduates should be able to "understand fine medicine" and play a great role in the field of drug therapy in the future, not just assisting doctors. Therefore, it is very important to do a good job in the courses and practical training for graduate students with professional degrees. Students should have knowledge of sociology, pharmacy and medicine, and need clinical practice for at least 2 years.
According to the current work content and actual situation of clinical pharmacists in domestic hospitals, courses such as clinical pharmacotherapy, clinical pharmacokinetics, drug use for special groups, clinical evaluation and rational drug use, therapeutic drug monitoring and individualized drug administration, drug information and literature evaluation, drug epidemiology and adverse reaction monitoring, pharmacometrics, pharmaceutical service skills, etc. are offered as compulsory courses in the postgraduate training program of clinical pharmacy, with clinical drug treatment as the core. To master drug therapy, students must have good basic and clinical medical knowledge.
It is worth noting that basic medical courses such as pathophysiology, pathology and diagnostics, and clinical medical courses such as internal medicine, surgery, obstetrics and gynecology and pediatrics are set up in the school-running standards of clinical pharmacy undergraduate majors in China. This aspect is rarely involved in the cultivation of pharmaceutical undergraduate majors, and the study time of theoretical courses in postgraduate stage is very limited, so it is impossible to set up simple clinical medical subjects alone. For the graduate students of clinical pharmacy who graduated from the four-year undergraduate course of pharmacy, the foundation is very weak. How to cultivate clinical thinking in the study of core theory courses and pharmacy service's practice, and analyze and solve problems by using clinical medical knowledge and pharmaceutical knowledge will be a great challenge; From the teaching point of view, how to guide students to learn and complete teaching tasks is also a great challenge for teachers. Postgraduates should pay attention to the cultivation of autonomous learning and lifelong learning ability. Problem-based learning (PBL) is an alternative teaching method.
Advantages of 2 2PBL teaching
From 65438 to 0969, American neurologist Barros initiated the PBL teaching method at McMaster University in Canada, which has become a popular teaching method in the world. It is a complete educational method, based on the real world and student-centered learning situation design. Different from the traditional subject-based teaching method, PBL teaching mode designs real tasks, sets learning in complex and meaningful problem scenes, emphasizes students' autonomous learning as the core, solves problems through learners' independent inquiry and cooperation, and constantly promotes learning in the process of solving problems, actively cultivating problem-solving skills and autonomous learning ability.
The essence of PBL teaching method is to play a problem-oriented role in the learning process, mobilize students' initiative and enthusiasm, and let students learn independently on the premise of mastering certain basic knowledge. At present, in China's clinical medical education, PBL teaching is mainly based on clinical cases and clinical problems, with medical students as the main body, teachers as the guide, heuristic education, case analysis and discussion, and training medical students' clinical analysis and diagnosis ability. There are differences and similarities between clinical pharmacy teaching and clinical medicine teaching, and there are also many clinical cases in clinical pharmacy that can be analyzed and discussed. Therefore, the mature PBL teaching method in clinical medicine teaching can be introduced into clinical pharmacy education.
The advantages of PBL teaching are: first, it breaks through the limitations of classroom teaching and creates a relaxed and independent learning atmosphere for students to speak freely and fully express their views; At the same time, all students are encouraged to participate in the project research, which fully mobilizes everyone's learning autonomy. Secondly, we can train students' literature retrieval ability, inductive and summary ability, logical reasoning and oral expression ability, so that students can draw conclusions through their own investigation and research. Thirdly, it not only emphasizes the interaction between teachers and students, but also strengthens the communication and cooperation between students, thus overcoming the passivity of unilaterally imparting knowledge and the one-sidedness of completely independent learning, enabling students to build their own comprehensive learning system and lay a good foundation for future clinical work.
Although PBL has obvious advantages, it also has its limitations. Taking clinical problems as the leading factor and canceling the teaching of basic subjects will make it difficult for some students with poor clinical reasoning ability and self-study ability to adapt. At the same time, small class teaching also needs a large number of teachers. However, because there are fewer professional master students, it is more suitable for small class teaching and has little influence on graduate education; At the same time, as a graduate student who has studied in the university for four years, he should have the ability of self-study and mastery. These favorable conditions have laid a good foundation for introducing PBL into the core courses of clinical pharmacy.
3. Design of core curriculum system for clinical pharmacy postgraduates based on PBL teaching.
As a future drug therapy expert, its core competence lies in rational drug use. The knowledge system of clinical pharmacy postgraduates can be divided into four levels, namely, basic courses, pharmacy courses, basic and clinical courses, clinical drug therapy and advanced pharmaceutical practice. The periphery is basic courses, including chemistry courses (inorganic chemistry, organic chemistry, analytical chemistry, etc. ) and functional courses (anatomy, physiology, pathophysiology, biochemistry, etc. ); The second level is pharmaceutical courses, including pharmacology, medicinal chemistry, pharmacy, biopharmaceutics and pharmacokinetics. The third level is mostly a bridge course between foundation and clinic, which aims to cultivate students' pharmaceutical service ability and is divided into social science and clinical science. Social science includes courses such as pharmaceutical administration, pharmacoeconomics, interpersonal communication and ethics, while clinical science includes clinical pharmacology, drug use for special groups, clinical evaluation and rational drug use, therapeutic drug monitoring and individualized drug administration, drug information and literature evaluation, drug epidemiology and adverse reaction monitoring, pharmacometrics and clinical science. The fourth level is the most important core course-clinical drug therapy and advanced pharmaceutical practice, taking systemic diseases as the main line to learn drug therapy of diseases, and carrying out internship related to pharmaceutical services in hospitals.
The clinical knowledge of graduate students majoring in clinical pharmacy in China is generally weak. How to complete the course and practical training in a short period of three years, fill the gap as soon as possible, and basically be competent for clinical pharmacists is an urgent problem to be solved. The author chooses the core clinical drug therapy as the starting point, and the students' learning effect is good, so they can consider extending it to other sub-core courses. The specific implementation routes are as follows: ① Taking drug therapy based on human body system as the main line, the course content is divided into several topics around the eight systems of human body, and each topic has a teacher group composed of pharmacology teachers, clinical pharmacists and clinicians, who is responsible for selecting appropriate cases; Students' learning is not limited to the classroom, and they should finish reading, thinking and discussing after class. (2) Two weeks before each special class, the teacher throws out cases, asks questions, guides students to think, and provides a bibliography to facilitate students to learn basic knowledge systematically and independently. ③ In order to improve each student's learning enthusiasm and prevent some students from "following the crowd" and not actively participating in the learning process, one week before the second class, the group was decided by drawing lots (7 groups of 3-4 people), and one of them was designated by the tutor to prepare PPT. ④ In the third class, assign a group to explain anatomy, physiology, pathophysiology, pharmacology, internal medicine, surgery, clinical pharmacotherapy and other related contents to others. After the explanation, the team members accept questions from other students and teachers. The teacher evaluates the performance of the group and summarizes and supplements the relevant knowledge. Furthermore, the teacher provides some new cases of clinical medication for group discussion, which further deepens the impression and promotes learning. ⑤ The fourth class is the summary of this topic, which is led by students and guided by teachers.
4 conclusion
Drug therapy is an important part of clinical treatment, and the effect of pharmacists participating in clinical treatment is obvious. High-quality and efficient clinical pharmacy education is an important guarantee for clinical pharmacy work. With the development of China's economy and society, the demand for high-level and applied professionals is more urgent in scale and quality. Starting from the development trend of postgraduate education in the world and the reality of postgraduate education in China, China is gradually transforming postgraduate education from cultivating academic talents to cultivating applied talents. Master of Pharmacy is an important measure to reform the training system of pharmacy specialty in China. However, due to the unreasonable training scheme and curriculum of undergraduate pharmacy, the clinical knowledge of clinical pharmacy postgraduates is generally weak, which has a certain impact on the training quality.
PBL teaching method is very popular in medical education and has achieved remarkable results, but its application in pharmaceutical education is rare. Clinical pharmacotherapy is an interdisciplinary subject, which belongs to pharmacy and has the characteristics and contents of clinical medicine. Therefore, the introduction of PBL teaching method into the curriculum system of clinical pharmacy postgraduates, with systemic diseases as the main line, problem-oriented, integrating the knowledge of multiple courses, breaking the boundaries between disciplines and letting students master it, can not only improve students' ability of autonomous learning and lifelong learning, but also improve students' ability.
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