Medical Continuing Education: Reform of Teaching Methods about High Altitude Disease in China

Introduction

In China, high altitude is considered 3000 m above sea level. The Chinese plateau area includes all of Tibet and parts of Qinghai, Xinjiang, Yunnan, and Sichuan provinces. Studies report that China's plateau area is approximately 257.2×10⁴ km², which accounts for approximately 26.8% of China's area (Zhang et al., 2002). Until 2006, approximately 12 million people lived permanently at altitudes between 2200 and 5200 m on the Qinghai-Tibetan Plateau (Wu and Kayser, 2006). The purpose of high altitude continuing medical education is to adapt knowledge and skills for practical application on the plateau (Luo and others 2012b). The students in high altitude continuing medical education include physicians, nurses, and paramedics on the plateau. Most trainees have experience with academic education and grassroots work experience on the plateau, so they want knowledge about new advances in the pathogenesis, diagnosis, and treatment of high altitude disease. Based on the trainees' special needs, traditional classroom teaching methods are not useful to them. Training objects, content, and methods should attempt to implement a variety of teaching practices. Through continuing military medical education on high altitude disease, the authors seek to change the traditional teaching model away from a single classroom and traditional written examinations to expand trainees' abilities.

Traditional Classroom Teaching

In continuing medical education, traditional classroom teaching remains indispensable. It has been used to present new knowledge, disseminate new theories, and learn new technologies. Teaching subjects should include scientific and rational information to meet trainees' needs. In our practice, we attempt to teach about progress in pathogenesis and the prevention and treatment of acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), high altitude cerebral edema (HACE), and chronic mountain sickness (CMS). During the teaching course, a heuristic discussion style is used to improve dynamic interactions and to fully mobilize students' learning initiatives.

Case Study Approach and Simulation Drills

In continuing medical education, a case study approach has been used to teach about high altitude disease. The selection of cases is meant to be representative, and some students simulate high altitude disease themselves. These cases are generally concerned with common problems for trainees, such as how to diagnose and treat AMS, HAPE, and HACE cases in the remote region with little medicine. For example, to simulate AMS, students show a headache and one of the following symptoms: gastrointestinal distress, fatigue/weakness, dizziness/lightheadedness, or difficulty sleeping (Hackett and Roach, 2001). To simulate HAPE, the trainees show difficulty in breathing, severe coughing, and white or pink bloody and frothy sputum (Hackett and Roach, 2001). To simulate HACE, the trainees show severe head pain and frequent vomiting or a change in mental status (Hackett and Roach, 2001). Some students simulate high altitude disease for doctors to show how to diagnose and treat patients while other students observe carefully. These simulation exercises are designed to be similar to real-life situations to ensure that teaching is effective. In practice, trainees are taught to prevent and treat AMS, HAPE, and HACE in their own units on the plateau. This method can validate and amend the theory of high altitude disease.

Experiential Teaching Approach

In continuing medical education, trainees attend on-site teaching or high altitude simulation training in an altitude chamber. Through these methods, students come to understand the effect of hypoxia on the body through controlled experiments, and they deepen their theoretical knowledge. Personal experience of cognitive function with hypoxia, intracranial pressure, exercise capacity, and ECG changes produce in-depth knowledge of high altitude hypoxia on the human nervous system and circulatory system and help trainees to master theoretical knowledge about high altitude disease to improve their high altitude skills on the plateau. On-site teaching can improve skill in the treatment of AMS, HAPE, and HACE cases on the plateau. An experiential teaching approach can help students to deepen their thinking and creativity and to strengthen their skills (Luo et al., 2012a). This knowledge can broaden students' horizons and inspire intellectual curiosity and ambition.

Reform of Examination Methods

The traditional written examination method (closed-book exam) is the most popular type of assessment in academic education. The advantage of written examinations is that they are easy to quantify. The disadvantage is that these examinations restrict trainees. Continuing medical education uses oral assessment methods and practical job assessment methods. On-site, face-to-face responses can be given by students and evaluated by the instructor. In this way, the instructor can improve students' analytical and problem-solving skills and can identify problems with language skills and trainees' abilities. Thus, assessments of quality can truly reflect students' comprehensive abilities. Practical job assessments with clear targets can allow students to innovate and to use their potential to prevent and treat AMS, HAPE, HACE, and CMS. Thus, students' practical abilities can be developed through a combination of assessment and simulation training.

In short, the teaching process attempts to teach in a “non-fixed” way. In continuing medical education, the teaching content and objectives should be flexibly selected, based on various teaching and assessment methods or a combination of teaching methods to the greatest extent possible to improve the quality of teaching and students' ability to prevent and treat AMS, HAPE, HACE, and CMS while increasing the quality of high altitude medical care.