实习鉴定说明

Instructions for Evaluation on Practice

一、本实习手册必须实事求是，认真填写，不得随意涂改，否则所有记录和
鉴定结论视为无效。
I. This practice manual must be filled in seriously according to the facts and must not be arbitrarily altered.
Otherwise, all records and conclusions of the evaluation shall be deemed to be invalid.
二、评定内容、评定要求
II. Evaluation content, evaluation requirements
详见《右江民族医学院临床实习指南》。
See details in Clinical Practice Guidelines in Clinical Medicine of Youjiang Medical University for Nationalities
三、评定程序
III. Evaluation procedures
1、实习生每科实习结束前 3 天，在带教老师的监督下，当面填写《鉴定手册》
中的相关实习内容，然后交科室；
1. The student interns shall fill out the relevant practice contents in the Evaluation Manual under the
supervision of the clinical teacher and submit it to relevant departments 3 days prior to the end of each practice of
each department;
2、带教科室评定：
2. The evaluation of the teaching department:
学生出科前，由带教老师对实习生的职业道德与业务素质作出评分并核对学
生填写的其它实习记录→交科室负责人→ 科室负责人组织教师对实习生进行出
科理论考试及技能考核并作集体综合评价→ 科室负责人根据集体评价意见填写
鉴定结论并盖科室公章、签名→ 交由实习组长转下一科室；
Before the students completes the practice of each section, the clinical teacher shall evaluates and make a
score on the student interns' professional ethics and professional quality and check the other practice records filled
in by the students → hand it to Head of the department → Head of the department shall organize teachers to
implement Theoretical and Skill Examination on Completion and make a collective comprehensive evaluation →
Head of the department shall fill in the evaluation conclusion according to the collective evaluation opinion and
have it sealed with the official seal of the department, signed → hand it the practice leader to go to the next
department;
3、教学主管部门评定：
3. Evaluation of teaching administrative department:
结束实习前，实习大组组长到相关科室收集所有同学的《鉴定手册》→送到
医院主管实习的部门→ 医院主管实习的部门对实习同学逐一进行总体评价、签
名、盖章→以实习小组为单位封包→集中寄回或交由实习组长带回右江民族医学
院国际教育学院教学科研科，纳入学籍档案。
Before the end of the practice, practice leader shall go to the relevant departments to collect Evaluation
Manual of all the students → and send them to the hospital’s department in charge of practice → the
department shall implement overall evaluation, sign, seal to student interns one by one → package according
practice groups → have them centralized and returned back by post to or handed to the practice leader for being
brought back to Department of Teaching and Research of College of International Education of Youjiang Medical
University for Nationalities so as to be included into the records of school roll for student.
四、转院实习同学须进行两次总鉴定，分别由原实习单位和所转实习单位各
给予 1 次总评定。

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 IV. The students who are transferred to another hospital for practice shall be implemented with two summated
evaluations, which shall be evaluated once respectively by the original practice unit and transferred practice unit.
五、各种技能操作记录有关定义：
V. Relevant definition of various skill operation records:
操作是指学生在带教老师指导下亲自动手完成的基本技能操作；
Operation refers to the basic skill operations that are finished by the students under the guidance of the
clinical teacher;
示范是指学生观摩带教老师示范的基本技能操作；
Demonstration refers to the basic skill operations that are demonstrated by the clinical teacher and observed
by students;
主管是指学生在带教老师指导下亲自收治的病例；
In charging refers to the cases that are admitted by students personally under the guidance of the clinical
teacher;
见过是指学生实习期间未亲自收治，但曾参与诊治或病例讨论或教学查房所
熟识的病例。
Having seen refers to the cases that are not admitted by student personally during the internship of student,
but whose diagnosis or case discussion have been participated in by the student or that have been familiar with by
the student through ward inspection of teaching.

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 实习轮转计划安排表
Practice Rotation Schedule
实习科室 起止时间 职业道德与业务素质鉴定结论
Practice Department Beginning and Ending Time Evaluation Conclusion of Professional
Ethics and Professional Qualities
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to
年 月 日至 年 月 日
From to

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 右江民族医学院呼吸内科实习鉴定表
Evaluation Form for Practice in Respiratory Department of
Youjiang Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department

二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（一）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加教学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.

三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points

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鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，
中等 70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and
professional qualities and the comprehensive results is as follows: excellent means points 90-100; Good means
points 80-89; medium means points 70-79; basic pass means points 60-69; failed mean less than points 60 or
other reason of " One-vote veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序 示范 示范
项目名称 操作 序号 项目名称 操作
号 Demonstra Demonstra
Item name Operating tion
No. Item name Operating tion
No.
皮 试 次 次 洗胃 次 次
1 17
Skin test Times Times Gastric lavage Times Times
皮下注射
次 次 鼻饲 次 次
2 Hypodermic 18
Times Times Nasal feeding Times Times
injection
直肠指诊
肌肉注射
次 次 Digital 次 次
3 Intramuscular 19
Times Times examination of Times Times
injection
rectum
脉注射 次 次 心电图操作 次 次
4 20
Pulse injection Times Times ECG operation Times Times
鞘内注射
次 次 心电图分析 次 次
5 Intrathecal 21
Times Times ECG analysis Times Times
injection
X 线阅片
血透 次 次 次 次
6 22 X-ray film
Hemodialysis Times Times Times Times
reading
胸外心脏按压
次 次 插胃管 次 次
7 Closed cardiac 23
Times Times Stomach tube Times Times
massage
腰椎穿刺
次 次 次 次
8 Lumbar 24
Times Times Times Times
puncture
胸腔穿刺 次 次 次 次
9 25
Thoracocentesis Times Times Times Times
腹腔穿刺 次 次 次 次
10 26
Abdominocentesis Times Times Times Times

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 骨髓穿刺
次 次 次 次
11 Bone marrow 27
Times Times Times Times
aspiration
给氧 次 次 次 次
12 28
Oxygen supply Times Times Times Times
导尿
次 次 次 次
13 Urethral 29
Times Times Times Times
catheterization
灌肠 次 次 次 次
14 30
Clyster Times Times Times Times
物理降温
次 次 次 次
15 Physical cooling 31
Times Times Times Times
method
吸痰
次 次 次 次
16 Aspiration of 32
Times Times Times Times
sputum
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过 见过
主管 主管
(例) (例)
序号 病 名 (例) 序号 病 名 (例)
Have Have
No. Disease name In charge No. Disease name In charge
seen seen
(cases) (cases)
(cases) (cases)
上呼吸道感染
1 Upper respiratory 16
tract infection
细菌性肺炎
2 17
Bacterial pneumonia
慢性支气管炎
3 18
Chronic bronchitis
肺脓肿
4 20
Pulmonary abscess
肺原性心脏病
5 21
Corpulmonale
原发性支气管癌
6 Primary bronchogenic 22
carcinoma
支气管哮喘
7 23
Bronchial asthma
胸腔积液
8 24
Pleural effusion
支气管扩张症
9 25
Bronchiectasis
胸膜炎
10 26
Pleuritis
呼吸衰竭
11 27
Respiratory failure
自发性气胸
12 Spontaneous 28
pneumothorax
肺气肿
13 29
Emphysema

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 14 30
15
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]
带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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 右江民族医学院内分泌内科实习鉴定表
Evaluation Form for Practice in Endocrinology of
Youjiang Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department

二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（二）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加教学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.

三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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11
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
12
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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13
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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14
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序 示范 示范
项目名称 操作 序号 项目名称 操作
号 Demonstra Demonstra
Item name Operating tion
No. Item name Operating tion
No.
皮 试 次 次 洗胃 次 次
1 17
Skin test Times Times Gastric lavage Times Times
皮下注射
次 次 鼻饲 次 次
2 Hypodermic 18
Times Times Nasal feeding Times Times
injection
直肠指诊
肌肉注射
次 次 Digital 次 次
3 Intramuscular 19
Times Times examination of Times Times
injection
rectum
脉注射 次 次 心电图操作 次 次
4 20
Pulse injection Times Times ECG operation Times Times
鞘内注射
次 次 心电图分析 次 次
5 Intrathecal 21
Times Times ECG analysis Times Times
injection
X 线阅片
血透 次 次 次 次
6 22 X-ray film
Hemodialysis Times Times Times Times
reading
胸外心脏按压
次 次 插胃管 次 次
7 Closed cardiac 23
Times Times Stomach tube Times Times
massage
腰椎穿刺
次 次 次 次
8 Lumbar 24
Times Times Times Times
puncture
胸腔穿刺 次 次 次 次
9 25
Thoracocentesis Times Times Times Times
腹腔穿刺 次 次 次 次
10 26
Abdominocentesis Times Times Times Times
骨髓穿刺
次 次 次 次
11 Bone marrow 27
Times Times Times Times
aspiration
给氧 次 次 次 次
12 28
Oxygen supply Times Times Times Times
导尿
次 次 次 次
13 Urethral 29
Times Times Times Times
catheterization
灌肠 次 次 次 次
14 30
Clyster Times Times Times Times
物理降温
次 次 次 次
15 Physical cooling 31
Times Times Times Times
method
吸痰
次 次 次 次
16 Aspiration of 32
Times Times Times Times
sputum

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15
五、病种实习记录（学生填，教师核）
V. Diseases internship record (To be filled out by student, examined by teacher)
序
主管(例) 见过(例) 序 主管(例) 见过(例)
号 病 名 病 名
In charge Have seen 号 In charge Have seen
N Disease name Disease name
(cases) (cases) No. (cases) (cases)
o.
甲状腺机能亢进
1 16
Hyperthyroidism
甲状腺机能低下
2 17
Hypothyroidism
糖尿病
3 18
Diabetes mellitus
风湿性关节炎
4 20
Rheumatoid arthritis
肾上腺皮质功能减退
5 21
Hypoadrenocorticism
痛风
6 22
Uarthritis
7 23
8 24
9 25
10 26
11 27
12 28
13 29
14 30
15
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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16
 右江民族医学院神经内科实习鉴定表
Evaluation Form for Practice in Neurology of
Youjiang Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（三）考勤记录：迟到 次；早退 次； 病假 天； 事假 天； 旷
课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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17
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
18
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
19
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and shall be
marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
20
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序 示范 示范
项目名称 操作 序号 项目名称 操作
号 Demonstra Demonstra
Item name Operating tion
No. Item name Operating tion
No.
皮 试 次 次 洗胃 次 次
1 17
Skin test Times Times Gastric lavage Times Times
皮下注射
次 次 鼻饲 次 次
2 Hypodermic 18
Times Times Nasal feeding Times Times
injection
直肠指诊
肌肉注射
次 次 Digital 次 次
3 Intramuscular 19
Times Times examination of Times Times
injection
rectum
脉注射 次 次 心电图操作 次 次
4 20
Pulse injection Times Times ECG operation Times Times
鞘内注射
次 次 心电图分析 次 次
5 Intrathecal 21
Times Times ECG analysis Times Times
injection
X 线阅片
血透 次 次 次 次
6 22 X-ray film
Hemodialysis Times Times Times Times
reading
胸外心脏按压
次 次 插胃管 次 次
7 Closed cardiac 23
Times Times Stomach tube Times Times
massage
腰椎穿刺
次 次 次 次
8 Lumbar 24
Times Times Times Times
puncture
胸腔穿刺 次 次 次 次
9 25
Thoracocentesis Times Times Times Times
腹腔穿刺 次 次 次 次
10 26
Abdominocentesis Times Times Times Times
骨髓穿刺
次 次 次 次
11 Bone marrow 27
Times Times Times Times
aspiration
给氧 次 次 次 次
12 28
Oxygen supply Times Times Times Times
导尿
次 次 次 次
13 Urethral 29
Times Times Times Times
catheterization
灌肠 次 次 次 次
14 30
Clyster Times Times Times Times
物理降温
次 次 次 次
15 Physical cooling 31
Times Times Times Times
method
吸痰
次 次 次 次
16 Aspiration of 32
Times Times Times Times
sputum

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21
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过 见过
主管 主管
(例) (例)
序号 病 名 (例) 序号 病 名 (例)
Have Have
No. Disease name In charge No. Disease name In charge
seen seen
(cases) (cases)
(cases) (cases)
上呼吸道感染
1 Upper respiratory 16
tract infection
细菌性肺炎
2 17
Bacterial pneumonia
慢性支气管炎
3 18
Chronic bronchitis
肺脓肿
4 20
Pulmonary abscess
肺原性心脏病
5 21
Corpulmonale
原发性支气管癌
6 Primary bronchogenic 22
carcinoma
支气管哮喘
7 23
Bronchial asthma
胸腔积液
8 24
Pleural effusion
支气管扩张症
9 25
Bronchiectasis
胸膜炎
10 26
Pleuritis
呼吸衰竭
11 27
Respiratory failure
自发性气胸
12 Spontaneous 28
pneumothorax
肺气肿
13 29
Emphysema
14 30
15
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
22
 右江民族医学院血液内科实习鉴定表
Evaluation Form for Practice in Hematology of
Youjiang Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department

二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（四）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加教学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.

三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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23
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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24
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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25
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
26
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序 示范 示范
项目名称 操作 序号 项目名称 操作
号 Demonstra Demonstra
Item name Operating tion
No. Item name Operating tion
No.
皮 试 次 次 洗胃 次 次
1 17
Skin test Times Times Gastric lavage Times Times
皮下注射
次 次 鼻饲 次 次
2 Hypodermic 18
Times Times Nasal feeding Times Times
injection
直肠指诊
肌肉注射
次 次 Digital 次 次
3 Intramuscular 19
Times Times examination of Times Times
injection
rectum
脉注射 次 次 心电图操作 次 次
4 20
Pulse injection Times Times ECG operation Times Times
鞘内注射
次 次 心电图分析 次 次
5 Intrathecal 21
Times Times ECG analysis Times Times
injection
X 线阅片
血透 次 次 次 次
6 22 X-ray film
Hemodialysis Times Times Times Times
reading
胸外心脏按压
次 次 插胃管 次 次
7 Closed cardiac 23
Times Times Stomach tube Times Times
massage
腰椎穿刺
次 次 次 次
8 Lumbar 24
Times Times Times Times
puncture
胸腔穿刺 次 次 次 次
9 25
Thoracocentesis Times Times Times Times
腹腔穿刺 次 次 次 次
10 26
Abdominocentesis Times Times Times Times
骨髓穿刺
次 次 次 次
11 Bone marrow 27
Times Times Times Times
aspiration
给氧 次 次 次 次
12 28
Oxygen supply Times Times Times Times
导尿
次 次 次 次
13 Urethral 29
Times Times Times Times
catheterization
灌肠 次 次 次 次
14 30
Clyster Times Times Times Times
物理降温
次 次 次 次
15 Physical cooling 31
Times Times Times Times
method
吸痰
次 次 次 次
16 Aspiration of 32
Times Times Times Times
sputum

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
27
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过 见过
主管 主管
(例) (例)
序号 病 名 (例) 序号 病 名 (例)
Have Have
No. Disease name In charge No. Disease name In charge
seen seen
(cases) (cases)
(cases) (cases)
缺铁性贫血
1 Iron deficiency 16
anemia
白细胞减少
2 17
Leukopenia
白血病
3 18
leukemia
溶血性疾病
4 20
Hemolytic disease
过敏性紫癜
5 21
Allergic purpura
再生障碍性贫血
6 22
Aplastic anemia
淋巴瘤
7 23
Lymphoma
脾功能亢进
8 24
Hypersplenism
出血性疾病
9 25
Hemorrhagic disease
血小板减少性紫癜
10 Thrombocytopenic 26
purpura
骨髓增生异常综合征
11 Myelodysplastic 27
syndrome
12 28
13 29
14 30
15
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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28
 右江民族医学院消化内科实习鉴定表
Evaluation Form for Practice in Gastroenterology of
Youjiang Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department

二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（五）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加教学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.

三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
29
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
30
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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31
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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32
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序 示范 示范
项目名称 操作 序号 项目名称 操作
号 Demonstra Demonstra
Item name Operating tion
No. Item name Operating tion
No.
皮 试 次 次 洗胃 次 次
1 17
Skin test Times Times Gastric lavage Times Times
皮下注射
次 次 鼻饲 次 次
2 Hypodermic 18
Times Times Nasal feeding Times Times
injection
直肠指诊
肌肉注射
次 次 Digital 次 次
3 Intramuscular 19
Times Times examination of Times Times
injection
rectum
脉注射 次 次 心电图操作 次 次
4 20
Pulse injection Times Times ECG operation Times Times
鞘内注射
次 次 心电图分析 次 次
5 Intrathecal 21
Times Times ECG analysis Times Times
injection
X 线阅片
血透 次 次 次 次
6 22 X-ray film
Hemodialysis Times Times Times Times
reading
胸外心脏按压
次 次 插胃管 次 次
7 Closed cardiac 23
Times Times Stomach tube Times Times
massage
腰椎穿刺
次 次 次 次
8 Lumbar 24
Times Times Times Times
puncture
胸腔穿刺 次 次 次 次
9 25
Thoracocentesis Times Times Times Times
腹腔穿刺 次 次 次 次
10 26
Abdominocentesis Times Times Times Times
骨髓穿刺
次 次 次 次
11 Bone marrow 27
Times Times Times Times
aspiration
给氧 次 次 次 次
12 28
Oxygen supply Times Times Times Times
导尿
次 次 次 次
13 Urethral 29
Times Times Times Times
catheterization
灌肠 次 次 次 次
14 30
Clyster Times Times Times Times
物理降温
次 次 次 次
15 Physical cooling 31
Times Times Times Times
method
吸痰
次 次 次 次
16 Aspiration of 32
Times Times Times Times
sputum

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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
33
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过 见过
主管 主管
(例) (例)
序号 病 名 (例) 序号 病 名 (例)
Have Have
No. Disease name In charge No. Disease name In charge
seen seen
(cases) (cases)
(cases) (cases)
胃炎
1 16
Gastritis
消化性溃疡
2 17
Peptic ulcer
肝硬化
3 18
Cirrhosis
胰腺炎
4 20
Pancreatitis
上消化道出血
Upper
5 21
gastrointestinal
bleeding
结肠炎
6 22
Colonitis
急性药物中毒
7 Acute drug 23
poisoning
肝昏迷
8 24
Hepatic coma
结肠癌
9 25
Carcinoma of colon
胆道感染
10 Infection of biliary 26
tract
骨髓增生异常综合征
11 Myelodysplastic 27
syndrome
12 28
13 29
14 30
15
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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34
 右江民族医学院心血管内科实习鉴定表
Evaluation Form for Internship in Cardiovcscular
Medicine Department of Youjiang Medical University
for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（六）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加教学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
35
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
36
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
37
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
38
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序 示范 示范
项目名称 操作 序号 项目名称 操作
号 Demonstra Demonstra
Item name Operating tion
No. Item name Operating tion
No.
皮 试 次 次 洗胃 次 次
1 17
Skin test Times Times Gastric lavage Times Times
皮下注射
次 次 鼻饲 次 次
2 Hypodermic 18
Times Times Nasal feeding Times Times
injection
直肠指诊
肌肉注射
次 次 Digital 次 次
3 Intramuscular 19
Times Times examination of Times Times
injection
rectum
脉注射 次 次 心电图操作 次 次
4 20
Pulse injection Times Times ECG operation Times Times
鞘内注射
次 次 心电图分析 次 次
5 Intrathecal 21
Times Times ECG analysis Times Times
injection
X 线阅片
血透 次 次 次 次
6 22 X-ray film
Hemodialysis Times Times Times Times
reading
胸外心脏按压
次 次 插胃管 次 次
7 Closed cardiac 23
Times Times Stomach tube Times Times
massage
腰椎穿刺
次 次 次 次
8 Lumbar 24
Times Times Times Times
puncture
胸腔穿刺 次 次 次 次
9 25
Thoracocentesis Times Times Times Times
腹腔穿刺 次 次 次 次
10 26
Abdominocentesis Times Times Times Times
骨髓穿刺
次 次 次 次
11 Bone marrow 27
Times Times Times Times
aspiration
给氧 次 次 次 次
12 28
Oxygen supply Times Times Times Times
导尿
次 次 次 次
13 Urethral 29
Times Times Times Times
catheterization
灌肠 次 次 次 次
14 30
Clyster Times Times Times Times
物理降温
次 次 次 次
15 Physical cooling 31
Times Times Times Times
method
吸痰
次 次 次 次
16 Aspiration of 32
Times Times Times Times
sputum

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39
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过 见过
主管 主管
(例) (例)
序号 病 名 (例) 序号 病 名 (例)
Have Have
No. Disease name In charge No. Disease name In charge
seen seen
(cases) (cases)
(cases) (cases)
心功能不全
1 16
Cardiac insufficiency
原发性高血压
2 Primary 17
hypertension
心律失常
3 18
Arrhythmia
冠心病
4 Coronary heart 20
disease
早搏
5 21
Premature beat
心肌疾病
6 22
Cardiac disease
房颤
7 23
Atrial fibrillation
肺心病
8 Pulmonary heart 24
disease
主动脉瓣疾病
9 25
Aortic valve disease
风湿性心脏病
10 Rheumatic heart 26
disease
原发性心肌病
11 Primary 27
cardiomyopathy
感染性心内膜炎
12 28
Infective endocarditis
心包炎
13 29
Pericarditis
特异性心脏病
14 30
Specific heart disease
风湿热
15
Rheumatic fever
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：

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40
 右江民族医学院肾内科实习鉴定表
Evaluation Form for Practice in Nephrology of
Youjiang Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department

二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（七）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加教学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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41
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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42
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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43
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
44
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序 示范 示范
项目名称 操作 序号 项目名称 操作
号 Demonstra Demonstra
Item name Operating tion
No. Item name Operating tion
No.
皮 试 次 次 洗胃 次 次
1 17
Skin test Times Times Gastric lavage Times Times
皮下注射
次 次 鼻饲 次 次
2 Hypodermic 18
Times Times Nasal feeding Times Times
injection
直肠指诊
肌肉注射
次 次 Digital 次 次
3 Intramuscular 19
Times Times examination of Times Times
injection
rectum
脉注射 次 次 心电图操作 次 次
4 20
Pulse injection Times Times ECG operation Times Times
鞘内注射
次 次 心电图分析 次 次
5 Intrathecal 21
Times Times ECG analysis Times Times
injection
X 线阅片
血透 次 次 次 次
6 22 X-ray film
Hemodialysis Times Times Times Times
reading
胸外心脏按压
次 次 插胃管 次 次
7 Closed cardiac 23
Times Times Stomach tube Times Times
massage
腰椎穿刺
次 次 次 次
8 Lumbar 24
Times Times Times Times
puncture
胸腔穿刺 次 次 次 次
9 25
Thoracocentesis Times Times Times Times
腹腔穿刺 次 次 次 次
10 26
Abdominocentesis Times Times Times Times
骨髓穿刺
次 次 次 次
11 Bone marrow 27
Times Times Times Times
aspiration
给氧 次 次 次 次
12 28
Oxygen supply Times Times Times Times
导尿
次 次 次 次
13 Urethral 29
Times Times Times Times
catheterization
灌肠 次 次 次 次
14 30
Clyster Times Times Times Times
物理降温
次 次 次 次
15 Physical cooling 31
Times Times Times Times
method
吸痰
次 次 次 次
16 Aspiration of 32
Times Times Times Times
sputum

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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45
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过 见过
主管 主管
(例) (例)
序号 病 名 (例) 序号 病 名 (例)
Have Have
No. Disease name In charge No. Disease name In charge
seen seen
(cases) (cases)
(cases) (cases)
类风湿性关节炎
1
Rheumatoid arthritis 16
慢性肾小球肾炎
2 Chronic
glomerulonephritis 17
间质性肾炎
3
Interstitial nephritis 18
肾小管疾病
4
Tubular disease 20
慢性肾功能不全
5 Chronic renal
insufficiency 21
糖尿病性肾病
6
Diabetic nephropathy 22
7 23
8 24
9 25
10 26
11 27
12 28
13 29
14 30
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]
带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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46
 右江民族医学院传染科实习鉴定表
Evaluation Form for Practice in Infectious Disease of
Youjiang Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department

二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（八）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加教学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
47
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
48
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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49
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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50
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序 示范 示范
项目名称 操作 序号 项目名称 操作
号 Demonstra Demonstra
Item name Operating tion
No. Item name Operating tion
No.
皮 试 次 次 洗胃 次 次
1 17
Skin test Times Times Gastric lavage Times Times
皮下注射
次 次 鼻饲 次 次
2 Hypodermic 18
Times Times Nasal feeding Times Times
injection
直肠指诊
肌肉注射
次 次 Digital 次 次
3 Intramuscular 19
Times Times examination of Times Times
injection
rectum
脉注射 次 次 心电图操作 次 次
4 20
Pulse injection Times Times ECG operation Times Times
鞘内注射
次 次 心电图分析 次 次
5 Intrathecal 21
Times Times ECG analysis Times Times
injection
X 线阅片
血透 次 次 次 次
6 22 X-ray film
Hemodialysis Times Times Times Times
reading
胸外心脏按压
次 次 插胃管 次 次
7 Closed cardiac 23
Times Times Stomach tube Times Times
massage
腰椎穿刺
次 次 次 次
8 Lumbar 24
Times Times Times Times
puncture
胸腔穿刺 次 次 次 次
9 25
Thoracocentesis Times Times Times Times
腹腔穿刺 次 次 次 次
10 26
Abdominocentesis Times Times Times Times
骨髓穿刺
次 次 次 次
11 Bone marrow 27
Times Times Times Times
aspiration
给氧 次 次 次 次
12 28
Oxygen supply Times Times Times Times
导尿
次 次 次 次
13 Urethral 29
Times Times Times Times
catheterization
灌肠 次 次 次 次
14 30
Clyster Times Times Times Times
物理降温
次 次 次 次
15 Physical cooling 31
Times Times Times Times
method
吸痰
次 次 次 次
16 Aspiration of 32
Times Times Times Times
sputum

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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
51
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过(例) 见过(例)
主管(例) 主管(例)
序号 病 名 Have 序号 病 名 Have
In charge In charge
No. Disease name seen No. Disease name seen
(cases) (cases)
(cases) (cases)
病毒性肝炎
1 16
Viral hepatitis
病毒性脑炎
2 17
Viral encephalitis
流脑
3 18
Meningitis
伤寒、副伤寒
4 20
Typhoid, paratyphoid
肺结核
5 21
Tuberculosis
流感
6 22
Influenza
细菌性食物中毒
7 Bacterial food 23
poisoning
细菌性痢疾
8 24
Bacterial dysentery
阿米巴痢疾
9 25
Amebic dysentery
阿米巴肝脓肿
10 26
Amebic liver abscess
疟疾
11 27
Malaria
钩体病
12 28
Leptospirosis
血吸虫病
13 29
Schistosomiasis
钩虫病
14 30
Hookworm disease
华枝睾吸虫病
15
Clonorchiasis
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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52
 右江民族医学院 内科实习鉴定表
Evaluation Form for Practice in of Youjiang
Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（九）考勤记录：迟到 次；早退 次； 病假 天； 事假 天； 旷
课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.

三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
53
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
54
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
55
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
56
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序 示范 示范
项目名称 操作 序号 项目名称 操作
号 Demonstra Demonstra
Item name Operating tion
No. Item name Operating tion
No.
皮 试 次 次 洗胃 次 次
1 17
Skin test Times Times Gastric lavage Times Times
皮下注射
次 次 鼻饲 次 次
2 Hypodermic 18
Times Times Nasal feeding Times Times
injection
直肠指诊
肌肉注射
次 次 Digital 次 次
3 Intramuscular 19
Times Times examination of Times Times
injection
rectum
脉注射 次 次 心电图操作 次 次
4 20
Pulse injection Times Times ECG operation Times Times
鞘内注射
次 次 心电图分析 次 次
5 Intrathecal 21
Times Times ECG analysis Times Times
injection
X 线阅片
血透 次 次 次 次
6 22 X-ray film
Hemodialysis Times Times Times Times
reading
胸外心脏按压
次 次 插胃管 次 次
7 Closed cardiac 23
Times Times Stomach tube Times Times
massage
腰椎穿刺
次 次 次 次
8 Lumbar 24
Times Times Times Times
puncture
胸腔穿刺 次 次 次 次
9 25
Thoracocentesis Times Times Times Times
腹腔穿刺 次 次 次 次
10 26
Abdominocentesis Times Times Times Times
骨髓穿刺
次 次 次 次
11 Bone marrow 27
Times Times Times Times
aspiration
给氧 次 次 次 次
12 28
Oxygen supply Times Times Times Times
导尿
次 次 次 次
13 Urethral 29
Times Times Times Times
catheterization
灌肠 次 次 次 次
14 30
Clyster Times Times Times Times
物理降温
次 次 次 次
15 Physical cooling 31
Times Times Times Times
method
吸痰
次 次 次 次
16 Aspiration of 32
Times Times Times Times
sputum

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
57
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过(例) 见过(例)
主管(例) 主管(例)
序号 病 名 Have 序号 病 名 Have
In charge In charge
No. Disease name seen No. Disease name seen
(cases) (cases)
(cases) (cases)
1 16
2 17
3 18
4 20
5 21
6 22
7 23
8 24
9 25
10 26
11 27
12 28
13 29
14 30
15
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
58
 右江民族医学院 内科实习鉴定表
Evaluation Form for Practice in of Youjiang
Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（十）考勤记录：迟到 次；早退 次； 病假 天； 事假 天； 旷
课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.

三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
59
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
60
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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61
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
62
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序 示范 示范
项目名称 操作 序号 项目名称 操作
号 Demonstra Demonstra
Item name Operating tion
No. Item name Operating tion
No.
皮 试 次 次 洗胃 次 次
1 17
Skin test Times Times Gastric lavage Times Times
皮下注射
次 次 鼻饲 次 次
2 Hypodermic 18
Times Times Nasal feeding Times Times
injection
直肠指诊
肌肉注射
次 次 Digital 次 次
3 Intramuscular 19
Times Times examination of Times Times
injection
rectum
脉注射 次 次 心电图操作 次 次
4 20
Pulse injection Times Times ECG operation Times Times
鞘内注射
次 次 心电图分析 次 次
5 Intrathecal 21
Times Times ECG analysis Times Times
injection
X 线阅片
血透 次 次 次 次
6 22 X-ray film
Hemodialysis Times Times Times Times
reading
胸外心脏按压
次 次 插胃管 次 次
7 Closed cardiac 23
Times Times Stomach tube Times Times
massage
腰椎穿刺
次 次 次 次
8 Lumbar 24
Times Times Times Times
puncture
胸腔穿刺 次 次 次 次
9 25
Thoracocentesis Times Times Times Times
腹腔穿刺 次 次 次 次
10 26
Abdominocentesis Times Times Times Times
骨髓穿刺
次 次 次 次
11 Bone marrow 27
Times Times Times Times
aspiration
给氧 次 次 次 次
12 28
Oxygen supply Times Times Times Times
导尿
次 次 次 次
13 Urethral 29
Times Times Times Times
catheterization
灌肠 次 次 次 次
14 30
Clyster Times Times Times Times
物理降温
次 次 次 次
15 Physical cooling 31
Times Times Times Times
method
吸痰
次 次 次 次
16 Aspiration of 32
Times Times Times Times
sputum

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
63
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过(例) 见过(例)
主管(例) 主管(例)
序号 病 名 Have 序号 病 名 Have
In charge In charge
No. Disease name seen No. Disease name seen
(cases) (cases)
(cases) (cases)
1 16
2 17
3 18
4 20
5 21
6 22
7 23
8 24
9 25
10 26
11 27
12 28
13 29
14 30
15
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
64
 右江民族医学院外科实习鉴定表
Evaluation Form for Surgical Practice of Youjiang
Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（十一）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.

三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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66
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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67
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
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68
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

皮肤、骨牵引
消毒 次 次 次 次
1 21 Skin, skeletal
Disinfection Times Times Times Times
traction
脓肿切开引流
铺巾 次 次 Abscess 次 次
2 22
Drape Times Times incision Times Times
drainage
打石膏绷带
止血 次 次 次 次
3 23 Plaster
Hemostasis Times Times Times Times
bandaging
浅表肿瘤切除
缝合 次 次 Superficial 次 次
4 24
Suture Times Times tumor Times Times
resection
淋巴结活检术
灌肠 次 次 次 次
5 25 Lymph node
Enema Times Times Times Times
biopsy
拆线 护送搬运病人
次 次 次 次
6 Taking out 26 Escort and
Times Times Times Times
stitches carry patient
直肠指检
打结 次 次 次 次
7 27 Digital rectal
Tie Times Times Times Times
examination
软组织切开 肌肉注射
次 次 次 次
8 Soft tissue 28 Intramuscular
Times Times Times Times
incision injection
静脉注射
局部麻醉 次 次 次 次
9 29 Intravenous
Local anesthesia Times Times Times Times
injection
简单清创缝合 输液.输血
Simple 次 次 Blood 次 次
10 30
debridement Times Times transfusion, Times Times
and suture infusion
吸痰
换药术 次 次 次 次
11 31 Aspiration of
Dressing change Times Times Times Times
sputum
胃肠减压
次 次 给氧 次 次
12 gastrointestinal 32
Times Times Oxygen supply Times Times
decompression
胸腔穿剌术 次 次 次 次
13 33
Thoracocentesis Times Times Times Times
腹腔穿剌术 次 次 次 次
14 34
Abdominocentesie Times Times Times Times
导尿术
次 次 次 次
15 Urethral 35
Times Times Times Times
catheterization
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69
 序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

小夹板固定
次 次 次 次
16 Fixation with
Times Times Times Times
small splint
胸腔引流
次 次 次 次
17 thoracic 37
Times Times Times Times
drainage
胸外心脏按压
次 次 次 次
18 Closed cardiac 38
Times Times Times Times
massage
骨折复位固定
Fracture 次 次 次 次
19 39
reduction and Times Times Times Times
fixation
关节脱位复位
次 次 次 次
20 Joint dislocation 40
Times Times Times Times
reduction
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
教
主
主 一 二 三 师 一 二 三 教师
操
操 助 助 助 签 助 助 助 签名
作
作 名

Signature e of teacher
手术名称 手术名称
Signature of teacher

日期 日期
Second assistant

Second assistant
Operation Operation
Main operation
Third assistant

Third assistant
First assistant

First assistant
Date Date
Main operation

name name

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70
六、病种实习记录（学生填，教师核）
VI. Diseases practice record (filled out by student, examined by teacher)
主管 见过
主管(例) 见过(例) (例) (例)
序号 病 名 序号 病 名
In charge Have seen In Have
No. Disease name No. Disease name
(cases) (cases) charge seen
(cases) (cases)
单纯性甲状腺肿 肋骨骨折
1 31
Simple goiter Fracture of rib
损伤性气胸
Graves 病
2 32 Injury
Graves disease
pneumothorax
损伤性血胸
甲状腺癌
3 33 Injury
Thyroid cancer
hemothorax
急性乳腺炎 脓胸
4 34
Acute mastitis Pyothorax
食管癌
乳腺癌
5 35 Esophageal
Breast cancer
cancer
胃、十二指肠溃疡
肺癌
6 Gastric and 36
Lung cancer
duodenal ulcer
胃癌 四肢骨骨折
7 37
Gastric cancer Limb fractures
肠梗阻 关节脱位
8 Intestinal 38 Dislocation of
obstruction joint
骨化脓性感染
肠套叠 Osseous
9 39
Intussusception purulent
infection
结肠癌 关节化脓性感染
10 Carcinoma of 40 Joint purulent
colon infection
急性胰腺炎
直肠癌
11 41 Acute
Rectum cancer
pancreatitis
腰椎间盘突出症
Prolapse of
痔
12 42 lumbar
Hemorrhoid
intervertebral
disc
颈椎病
腹膜炎
13 43 Cervical
Peritonitis
spondylosis
急慢性阑尾炎 肾损伤
14 Acute and chronic 44
Kidney injury
appendicitis
门静脉高压症 尿道损伤
15 Portal 45
Urethral injury
hypertension
腹部创伤 泌尿系结石
16 Trauma of 46
Urinary stones
abdomen
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 17 腹部肿块 47 肾结核
Abdominal mass Nephrotuberculosis
腹外疝 肾肿瘤
18 Abdominal 48
Kidney tumor
external hernia
急性尿潴留
肝脓肿
19 49 Acute urinary
Hepatapostema
retention
颅内压增高
肝癌
20 50 Intracranial
Liver cancer
hypertension
颅脑损伤
胆石症
21 51 Craniocerebral
Cholelithiasis
injury
胆囊炎 颅骨骨折
22 52
Cholecystitis Fracture of skull
肛瘘、肛裂
脑损伤
23 Anal fistula, anal 53
Brain Injury
fissure
上消化道出血
急性腰扭伤
Upper
24 Acute lumbar 54
gastrointestinal
muscle sprain
bleeding
周围神经损伤 休克
25 Peripheral nerve 55 Shock
injury
骨盆骨折 脑疝
26 56
Pelvic fracture Cerebral hernia
颅内肿瘤
骨肿瘤
27 57 Intracranial
Bone tumor
tumor
半月板损伤
28 58
Meniscus injury
骨髓炎
29 59
Osteomyelitis
骨关节结核
30 Osteoarticular 60
tuberculosis
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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72
 右江民族医学院外科实习鉴定表
Evaluation Form for Surgical Practice of
Youjiang Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（十二）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.

三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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74
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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75
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
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76
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

皮肤、骨牵引
消毒 次 次 次 次
1 21 Skin, skeletal
Disinfection Times Times Times Times
traction
脓肿切开引流
铺巾 次 次 Abscess 次 次
2 22
Drape Times Times incision Times Times
drainage
打石膏绷带
止血 次 次 次 次
3 23 Plaster
Hemostasis Times Times Times Times
bandaging
浅表肿瘤切除
缝合 次 次 Superficial 次 次
4 24
Suture Times Times tumor Times Times
resection
淋巴结活检术
灌肠 次 次 次 次
5 25 Lymph node
Enema Times Times Times Times
biopsy
拆线 护送搬运病人
次 次 次 次
6 Taking out 26 Escort and
Times Times Times Times
stitches carry patient
直肠指检
打结 次 次 次 次
7 27 Digital rectal
Tie Times Times Times Times
examination
软组织切开 肌肉注射
次 次 次 次
8 Soft tissue 28 Intramuscular
Times Times Times Times
incision injection
静脉注射
局部麻醉 次 次 次 次
9 29 Intravenous
Local anesthesia Times Times Times Times
injection
简单清创缝合 输液.输血
Simple 次 次 Blood 次 次
10 30
debridement Times Times transfusion, Times Times
and suture infusion
吸痰
换药术 次 次 次 次
11 31 Aspiration of
Dressing change Times Times Times Times
sputum
胃肠减压
次 次 给氧 次 次
12 gastrointestinal 32
Times Times Oxygen supply Times Times
decompression
胸腔穿剌术 次 次 次 次
13 33
Thoracocentesis Times Times Times Times
腹腔穿剌术 次 次 次 次
14 34
Abdominocentesie Times Times Times Times
导尿术
次 次 次 次
15 Urethral 35
Times Times Times Times
catheterization
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77
 序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

小夹板固定
次 次 次 次
16 Fixation with 36
Times Times Times Times
small splint
五、参加手术操作记录（学生填，教师核）
V. Record of participating in surgical operation (filled out by student, examined by teacher)
教
主
主 一 二 三 师 一 二 三 教师
操
操 助 助 助 签 助 助 助 签名
作
作 名

Signature e of teacher
手术名称 手术名称

Signature of teacher
日期 Second assistant 日期

Second assistant
Operation Operation

Main operation
Third assistant

Third assistant
First assistant

First assistant
Date Date
Main operation

name name

六、病种实习记录（学生填，教师核）
VI. Diseases internship record (filled out by student, examined by teacher)
主管 见过
主管(例) 见过(例) (例) (例)
序号 病 名 序号 病 名
In charge Have seen In Have
No. Disease name No. Disease name
(cases) (cases) charge seen
(cases) (cases)
单纯性甲状腺肿 肋骨骨折
1 31
Simple goiter Fracture of rib
损伤性气胸
Graves 病
2 32 Injury
Graves disease
pneumothorax
损伤性血胸
甲状腺癌
3 33 Injury
Thyroid cancer
hemothorax
急性乳腺炎 脓胸
4 34
Acute mastitis Pyothorax
食管癌
乳腺癌
5 35 Esophageal
Breast cancer
cancer

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78
6 胃、十二指肠溃疡 肺癌
Gastric and 36 Lung cancer
duodenal ulcer
胃癌 四肢骨骨折
7 37
Gastric cancer Limb fractures
肠梗阻 关节脱位
8 Intestinal 38 Dislocation of
obstruction joint
骨化脓性感染
肠套叠 Osseous
9 39
Intussusception purulent
infection
结肠癌 关节化脓性感染
10 Carcinoma of 40 Joint purulent
colon infection
急性胰腺炎
直肠癌
11 41 Acute
Rectum cancer
pancreatitis
腰椎间盘突出症
Prolapse of
痔
12 42 lumbar
Hemorrhoid
intervertebral
disc
颈椎病
腹膜炎
13 43 Cervical
Peritonitis
spondylosis
急慢性阑尾炎
肾损伤
14 Acute and chronic 44
Kidney injury
appendicitis
门静脉高压症
尿道损伤
15 Portal 45
Urethral injury
hypertension
腹部创伤 泌尿系结石
16 Trauma of 46
Urinary stones
abdomen
腹部肿块 肾结核
17 47
Abdominal mass Nephrotuberculosis
腹外疝
肾肿瘤
18 Abdominal 48
Kidney tumor
external hernia
急性尿潴留
肝脓肿
19 49 Acute urinary
Hepatapostema
retention
颅内压增高
肝癌
20 50 Intracranial
Liver cancer
hypertension
颅脑损伤
胆石症
21 51 Craniocerebral
Cholelithiasis
injury
胆囊炎 颅骨骨折
22 52
Cholecystitis Fracture of skull
肛瘘、肛裂 脑损伤
23 Anal fistula, anal 53
Brain Injury
fissure

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79
 上消化道出血
急性腰扭伤 Upper
24 Acute lumbar 54
gastrointestinal
muscle sprain
bleeding
周围神经损伤 休克
25 Peripheral nerve 55 Shock
injury
骨盆骨折 脑疝
26 56
Pelvic fracture Cerebral hernia
颅内肿瘤
骨肿瘤
27 57 Intracranial
Bone tumor
tumor
半月板损伤
28 58
Meniscus injury
骨髓炎
29 59
Osteomyelitis
骨关节结核
30 Osteoarticular 60
tuberculosis
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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80
 右江民族医学院外科实习鉴定表
Evaluation Form for Surgical Internship of YouJiang
Medical University For Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（十三）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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81
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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82
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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83
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
84
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

皮肤、骨牵引
消毒 次 次 次 次
1 21 Skin, skeletal
Disinfection Times Times Times Times
traction
脓肿切开引流
铺巾 次 次 Abscess 次 次
2 22
Drape Times Times incision Times Times
drainage
打石膏绷带
止血 次 次 次 次
3 23 Plaster
Hemostasis Times Times Times Times
bandaging
浅表肿瘤切除
缝合 次 次 Superficial 次 次
4 24
Suture Times Times tumor Times Times
resection
淋巴结活检术
灌肠 次 次 次 次
5 25 Lymph node
Enema Times Times Times Times
biopsy
拆线 护送搬运病人
次 次 次 次
6 Taking out 26 Escort and
Times Times Times Times
stitches carry patient
直肠指检
打结 次 次 次 次
7 27 Digital rectal
Tie Times Times Times Times
examination
软组织切开 肌肉注射
次 次 次 次
8 Soft tissue 28 Intramuscular
Times Times Times Times
incision injection
静脉注射
局部麻醉 次 次 次 次
9 29 Intravenous
Local anesthesia Times Times Times Times
injection
简单清创缝合 输液.输血
Simple 次 次 Blood 次 次
10 30
debridement Times Times transfusion, Times Times
and suture infusion
吸痰
换药术 次 次 次 次
11 31 Aspiration of
Dressing change Times Times Times Times
sputum
胃肠减压
次 次 给氧 次 次
12 gastrointestinal 32
Times Times Oxygen supply Times Times
decompression
胸腔穿剌术 次 次 次 次
13 33
Thoracocentesis Times Times Times Times
腹腔穿剌术 次 次 次 次
14 34
Abdominocentesie Times Times Times Times
导尿术
次 次 次 次
15 Urethral 35
Times Times Times Times
catheterization
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85
 序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

小夹板固定
次 次 次 次
16 Fixation with 36
Times Times Times Times
small splint
五、参加手术操作记录（学生填，教师核）
V. Record of participating in surgical operation (filled out by student, examined by teacher)
教
主
主 一 二 三 师 一 二 三 教师
操
操 助 助 助 签 助 助 助 签名
作
作 名

Signature e of teacher
手术名称 手术名称

Signature of teacher
日期 Second assistant 日期

Second assistant
Operation Operation

Main operation
Third assistant

Third assistant
First assistant

First assistant
Date Date
Main operation

name name

六、病种实习记录（学生填，教师核）
VI. Diseases practice record (filled out by student, examined by teacher)
主管 见过
主管(例) 见过(例) (例) (例)
序号 病 名 序号 病 名
In charge Have seen In Have
No. Disease name No. Disease name
(cases) (cases) charge seen
(cases) (cases)
单纯性甲状腺肿 肋骨骨折
1 31
Simple goiter Fracture of rib
损伤性气胸
Graves 病
2 32 Injury
Graves disease
pneumothorax
损伤性血胸
甲状腺癌
3 33 Injury
Thyroid cancer
hemothorax
急性乳腺炎 脓胸
4 34
Acute mastitis Pyothorax
食管癌
乳腺癌
5 35 Esophageal
Breast cancer
cancer

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86
 胃、十二指肠溃疡
肺癌
6 Gastric and 36
Lung cancer
duodenal ulcer
胃癌 四肢骨骨折
7 37
Gastric cancer Limb fractures
肠梗阻 关节脱位
8 Intestinal 38 Dislocation of
obstruction joint
骨化脓性感染
肠套叠 Osseous
9 39
Intussusception purulent
infection
结肠癌 关节化脓性感染
10 Carcinoma of 40 Joint purulent
colon infection
急性胰腺炎
直肠癌
11 41 Acute
Rectum cancer
pancreatitis
腰椎间盘突出症
Prolapse of
痔
12 42 lumbar
Hemorrhoid
intervertebral
disc
颈椎病
腹膜炎
13 43 Cervical
Peritonitis
spondylosis
急慢性阑尾炎
肾损伤
14 Acute and chronic 44
Kidney injury
appendicitis
门静脉高压症
尿道损伤
15 Portal 45
Urethral injury
hypertension
腹部创伤 泌尿系结石
16 Trauma of 46
Urinary stones
abdomen
腹部肿块 肾结核
17 47
Abdominal mass Nephrotuberculosis
腹外疝
肾肿瘤
18 Abdominal 48
Kidney tumor
external hernia
急性尿潴留
肝脓肿
19 49 Acute urinary
Hepatapostema
retention
颅内压增高
肝癌
20 50 Intracranial
Liver cancer
hypertension
颅脑损伤
胆石症
21 51 Craniocerebral
Cholelithiasis
injury
胆囊炎 颅骨骨折
22 52
Cholecystitis Fracture of skull
肛瘘、肛裂 脑损伤
23 Anal fistula, anal 53
Brain Injury
fissure

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87
 上消化道出血
急性腰扭伤 Upper
24 Acute lumbar 54
gastrointestinal
muscle sprain
bleeding
周围神经损伤 休克
25 Peripheral nerve 55 Shock
injury
骨盆骨折 脑疝
26 56
Pelvic fracture Cerebral hernia
颅内肿瘤
骨肿瘤
27 57 Intracranial
Bone tumor
tumor
半月板损伤
28 58
Meniscus injury
骨髓炎
29 59
Osteomyelitis
骨关节结核
30 Osteoarticular 60
tuberculosis
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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88
 右江民族医学院外科实习鉴定表
Evaluation Form for Surgical Practice of Youjiang
Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（十四）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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89
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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90
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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91
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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92
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

皮肤、骨牵引
消毒 次 次 次 次
1 21 Skin, skeletal
Disinfection Times Times Times Times
traction
脓肿切开引流
铺巾 次 次 Abscess 次 次
2 22
Drape Times Times incision Times Times
drainage
打石膏绷带
止血 次 次 次 次
3 23 Plaster
Hemostasis Times Times Times Times
bandaging
浅表肿瘤切除
缝合 次 次 Superficial 次 次
4 24
Suture Times Times tumor Times Times
resection
淋巴结活检术
灌肠 次 次 次 次
5 25 Lymph node
Enema Times Times Times Times
biopsy
拆线 护送搬运病人
次 次 次 次
6 Taking out 26 Escort and
Times Times Times Times
stitches carry patient
直肠指检
打结 次 次 次 次
7 27 Digital rectal
Tie Times Times Times Times
examination
软组织切开 肌肉注射
次 次 次 次
8 Soft tissue 28 Intramuscular
Times Times Times Times
incision injection
静脉注射
局部麻醉 次 次 次 次
9 29 Intravenous
Local anesthesia Times Times Times Times
injection
简单清创缝合 输液.输血
Simple 次 次 Blood 次 次
10 30
debridement Times Times transfusion, Times Times
and suture infusion
吸痰
换药术 次 次 次 次
11 31 Aspiration of
Dressing change Times Times Times Times
sputum
胃肠减压
次 次 给氧 次 次
12 gastrointestinal 32
Times Times Oxygen supply Times Times
decompression
胸腔穿剌术 次 次 次 次
13 33
Thoracocentesis Times Times Times Times
腹腔穿剌术 次 次 次 次
14 34
Abdominocentesie Times Times Times Times
导尿术
次 次 次 次
15 Urethral 35
Times Times Times Times
catheterization
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93
 序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

小夹板固定
次 次 次 次
16 Fixation with 36
Times Times Times Times
small splint
五、参加手术操作记录（学生填，教师核）
V. Record of participating in surgical operation (filled out by student, examined by teacher)
教
主
主 一 二 三 师 一 二 三 教师
操
操 助 助 助 签 助 助 助 签名
作
作 名

Signature e of teacher
手术名称 手术名称

Signature of teacher
日期 Second assistant 日期

Second assistant
Operation Operation

Main operation
Third assistant

Third assistant
First assistant

First assistant
Date Date
Main operation

name name

六、病种实习记录（学生填，教师核）
VI. Diseases practice record (filled out by student, examined by teacher)
主管 见过
主管(例) 见过(例) (例) (例)
序号 病 名 序号 病 名
In charge Have seen In Have
No. Disease name No. Disease name
(cases) (cases) charge seen
(cases) (cases)
单纯性甲状腺肿 肋骨骨折
1 31
Simple goiter Fracture of rib
损伤性气胸
Graves 病
2 32 Injury
Graves disease
pneumothorax
损伤性血胸
甲状腺癌
3 33 Injury
Thyroid cancer
hemothorax
急性乳腺炎 脓胸
4 34
Acute mastitis Pyothorax
食管癌
乳腺癌
5 35 Esophageal
Breast cancer
cancer

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94
 胃、十二指肠溃疡
肺癌
6 Gastric and 36
Lung cancer
duodenal ulcer
胃癌 四肢骨骨折
7 37
Gastric cancer Limb fractures
肠梗阻 关节脱位
8 Intestinal 38 Dislocation of
obstruction joint
骨化脓性感染
肠套叠 Osseous
9 39
Intussusception purulent
infection
结肠癌 关节化脓性感染
10 Carcinoma of 40 Joint purulent
colon infection
急性胰腺炎
直肠癌
11 41 Acute
Rectum cancer
pancreatitis
腰椎间盘突出症
Prolapse of
痔
12 42 lumbar
Hemorrhoid
intervertebral
disc
颈椎病
腹膜炎
13 43 Cervical
Peritonitis
spondylosis
急慢性阑尾炎
肾损伤
14 Acute and chronic 44
Kidney injury
appendicitis
门静脉高压症
尿道损伤
15 Portal 45
Urethral injury
hypertension
腹部创伤 泌尿系结石
16 Trauma of 46
Urinary stones
abdomen
腹部肿块 肾结核
17 47
Abdominal mass Nephrotuberculosis
腹外疝
肾肿瘤
18 Abdominal 48
Kidney tumor
external hernia
急性尿潴留
肝脓肿
19 49 Acute urinary
Hepatapostema
retention
颅内压增高
肝癌
20 50 Intracranial
Liver cancer
hypertension
颅脑损伤
胆石症
21 51 Craniocerebral
Cholelithiasis
injury
胆囊炎 颅骨骨折
22 52
Cholecystitis Fracture of skull
肛瘘、肛裂 脑损伤
23 Anal fistula, anal 53
Brain Injury
fissure

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 上消化道出血
急性腰扭伤 Upper
24 Acute lumbar 54
gastrointestinal
muscle sprain
bleeding
周围神经损伤 休克
25 Peripheral nerve 55 Shock
injury
骨盆骨折 脑疝
26 56
Pelvic fracture Cerebral hernia
颅内肿瘤
骨肿瘤
27 57 Intracranial
Bone tumor
tumor
半月板损伤
28 58
Meniscus injury
骨髓炎
29 59
Osteomyelitis
骨关节结核
30 Osteoarticular 60
tuberculosis
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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96
 右江民族医学院外科实习鉴定表
Evaluation Form for Surgical Practice of Youjiang
Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（十五）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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97
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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98
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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99
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
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100
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

皮肤、骨牵引
消毒 次 次 次 次
1 21 Skin, skeletal
Disinfection Times Times Times Times
traction
脓肿切开引流
铺巾 次 次 Abscess 次 次
2 22
Drape Times Times incision Times Times
drainage
打石膏绷带
止血 次 次 次 次
3 23 Plaster
Hemostasis Times Times Times Times
bandaging
浅表肿瘤切除
缝合 次 次 Superficial 次 次
4 24
Suture Times Times tumor Times Times
resection
淋巴结活检术
灌肠 次 次 次 次
5 25 Lymph node
Enema Times Times Times Times
biopsy
拆线 护送搬运病人
次 次 次 次
6 Taking out 26 Escort and
Times Times Times Times
stitches carry patient
直肠指检
打结 次 次 次 次
7 27 Digital rectal
Tie Times Times Times Times
examination
软组织切开 肌肉注射
次 次 次 次
8 Soft tissue 28 Intramuscular
Times Times Times Times
incision injection
静脉注射
局部麻醉 次 次 次 次
9 29 Intravenous
Local anesthesia Times Times Times Times
injection
简单清创缝合 输液.输血
Simple 次 次 Blood 次 次
10 30
debridement Times Times transfusion, Times Times
and suture infusion
吸痰
换药术 次 次 次 次
11 31 Aspiration of
Dressing change Times Times Times Times
sputum
胃肠减压
次 次 给氧 次 次
12 gastrointestinal 32
Times Times Oxygen supply Times Times
decompression
胸腔穿剌术 次 次 次 次
13 33
Thoracocentesis Times Times Times Times
腹腔穿剌术 次 次 次 次
14 34
Abdominocentesie Times Times Times Times
导尿术
次 次 次 次
15 Urethral 35
Times Times Times Times
catheterization
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101
 序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

小夹板固定
次 次 次 次
16 Fixation with 36
Times Times Times Times
small splint
五、参加手术操作记录（学生填，教师核）
V. Record of participating in surgical operation (filled out by student, examined by teacher)
教
主
主 一 二 三 师 一 二 三 教师
操
操 助 助 助 签 助 助 助 签名
作
作 名

Signature e of teacher
手术名称 手术名称

Signature of teacher
日期 Second assistant 日期

Second assistant
Operation Operation

Main operation
Third assistant

Third assistant
First assistant

First assistant
Date Date
Main operation

name name

六、病种实习记录（学生填，教师核）
VI. Diseases practice record (filled out by student, examined by teacher)
主管 见过
主管(例) 见过(例) (例) (例)
序号 病 名 序号 病 名
In charge Have seen In Have
No. Disease name No. Disease name
(cases) (cases) charge seen
(cases) (cases)
单纯性甲状腺肿 肋骨骨折
1 31
Simple goiter Fracture of rib
损伤性气胸
Graves 病
2 32 Injury
Graves disease
pneumothorax
损伤性血胸
甲状腺癌
3 33 Injury
Thyroid cancer
hemothorax
急性乳腺炎 脓胸
4 34
Acute mastitis Pyothorax
食管癌
乳腺癌
5 35 Esophageal
Breast cancer
cancer

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102
 胃、十二指肠溃疡
肺癌
6 Gastric and 36
Lung cancer
duodenal ulcer
胃癌 四肢骨骨折
7 37
Gastric cancer Limb fractures
肠梗阻 关节脱位
8 Intestinal 38 Dislocation of
obstruction joint
骨化脓性感染
肠套叠 Osseous
9 39
Intussusception purulent
infection
结肠癌 关节化脓性感染
10 Carcinoma of 40 Joint purulent
colon infection
急性胰腺炎
直肠癌
11 41 Acute
Rectum cancer
pancreatitis
腰椎间盘突出症
Prolapse of
痔
12 42 lumbar
Hemorrhoid
intervertebral
disc
颈椎病
腹膜炎
13 43 Cervical
Peritonitis
spondylosis
急慢性阑尾炎
肾损伤
14 Acute and chronic 44
Kidney injury
appendicitis
门静脉高压症
尿道损伤
15 Portal 45
Urethral injury
hypertension
腹部创伤 泌尿系结石
16 Trauma of 46
Urinary stones
abdomen
腹部肿块 肾结核
17 47
Abdominal mass Nephrotuberculosis
腹外疝
肾肿瘤
18 Abdominal 48
Kidney tumor
external hernia
急性尿潴留
肝脓肿
19 49 Acute urinary
Hepatapostema
retention
颅内压增高
肝癌
20 50 Intracranial
Liver cancer
hypertension
颅脑损伤
胆石症
21 51 Craniocerebral
Cholelithiasis
injury
胆囊炎 颅骨骨折
22 52
Cholecystitis Fracture of skull
肛瘘、肛裂 脑损伤
23 Anal fistula, anal 53
Brain Injury
fissure

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103
 上消化道出血
急性腰扭伤 Upper
24 Acute lumbar 54
gastrointestinal
muscle sprain
bleeding
周围神经损伤 休克
25 Peripheral nerve 55 Shock
injury
骨盆骨折 脑疝
26 56
Pelvic fracture Cerebral hernia
颅内肿瘤
骨肿瘤
27 57 Intracranial
Bone tumor
tumor
半月板损伤
28 58
Meniscus injury
骨髓炎
29 59
Osteomyelitis
骨关节结核
30 Osteoarticular 60
tuberculosis
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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104
 右江民族医学院外科实习鉴定表
Evaluation Form for Surgical Practice of Youjiang
Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（十六）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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105
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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106
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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107
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
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108
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

皮肤、骨牵引
消毒 次 次 次 次
1 21 Skin, skeletal
Disinfection Times Times Times Times
traction
脓肿切开引流
铺巾 次 次 Abscess 次 次
2 22
Drape Times Times incision Times Times
drainage
打石膏绷带
止血 次 次 次 次
3 23 Plaster
Hemostasis Times Times Times Times
bandaging
浅表肿瘤切除
缝合 次 次 Superficial 次 次
4 24
Suture Times Times tumor Times Times
resection
淋巴结活检术
灌肠 次 次 次 次
5 25 Lymph node
Enema Times Times Times Times
biopsy
拆线 护送搬运病人
次 次 次 次
6 Taking out 26 Escort and
Times Times Times Times
stitches carry patient
直肠指检
打结 次 次 次 次
7 27 Digital rectal
Tie Times Times Times Times
examination
软组织切开 肌肉注射
次 次 次 次
8 Soft tissue 28 Intramuscular
Times Times Times Times
incision injection
静脉注射
局部麻醉 次 次 次 次
9 29 Intravenous
Local anesthesia Times Times Times Times
injection
简单清创缝合 输液.输血
Simple 次 次 Blood 次 次
10 30
debridement Times Times transfusion, Times Times
and suture infusion
吸痰
换药术 次 次 次 次
11 31 Aspiration of
Dressing change Times Times Times Times
sputum
胃肠减压
次 次 给氧 次 次
12 gastrointestinal 32
Times Times Oxygen supply Times Times
decompression
胸腔穿剌术 次 次 次 次
13 33
Thoracocentesis Times Times Times Times
腹腔穿剌术 次 次 次 次
14 34
Abdominocentesie Times Times Times Times
导尿术
次 次 次 次
15 Urethral 35
Times Times Times Times
catheterization
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109
 序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

小夹板固定
次 次 次 次
16 Fixation with 36
Times Times Times Times
small splint
五、参加手术操作记录（学生填，教师核）
V. Record of participating in surgical operation (filled out by student, examined by teacher)
教
主
主 一 二 三 师 一 二 三 教师
操
操 助 助 助 签 助 助 助 签名
作
作 名

Signature e of teacher
手术名称 手术名称

Signature of teacher
日期 Second assistant 日期

Second assistant
Operation Operation

Main operation
Third assistant

Third assistant
First assistant

First assistant
Date Date
Main operation

name name

六、病种实习记录（学生填，教师核）
VI. Diseases practice record (filled out by student, examined by teacher)
主管 见过
主管(例) 见过(例) (例) (例)
序号 病 名 序号 病 名
In charge Have seen In Have
No. Disease name No. Disease name
(cases) (cases) charge seen
(cases) (cases)
单纯性甲状腺肿 肋骨骨折
1 31
Simple goiter Fracture of rib
损伤性气胸
Graves 病
2 32 Injury
Graves disease
pneumothorax
损伤性血胸
甲状腺癌
3 33 Injury
Thyroid cancer
hemothorax
急性乳腺炎 脓胸
4 34
Acute mastitis Pyothorax
食管癌
乳腺癌
5 35 Esophageal
Breast cancer
cancer

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110
 胃、十二指肠溃疡
肺癌
6 Gastric and 36
Lung cancer
duodenal ulcer
胃癌 四肢骨骨折
7 37
Gastric cancer Limb fractures
肠梗阻 关节脱位
8 Intestinal 38 Dislocation of
obstruction joint
骨化脓性感染
肠套叠 Osseous
9 39
Intussusception purulent
infection
结肠癌 关节化脓性感染
10 Carcinoma of 40 Joint purulent
colon infection
急性胰腺炎
直肠癌
11 41 Acute
Rectum cancer
pancreatitis
腰椎间盘突出症
Prolapse of
痔
12 42 lumbar
Hemorrhoid
intervertebral
disc
颈椎病
腹膜炎
13 43 Cervical
Peritonitis
spondylosis
急慢性阑尾炎
肾损伤
14 Acute and chronic 44
Kidney injury
appendicitis
门静脉高压症
尿道损伤
15 Portal 45
Urethral injury
hypertension
腹部创伤 泌尿系结石
16 Trauma of 46
Urinary stones
abdomen
腹部肿块 肾结核
17 47
Abdominal mass Nephrotuberculosis
腹外疝
肾肿瘤
18 Abdominal 48
Kidney tumor
external hernia
急性尿潴留
肝脓肿
19 49 Acute urinary
Hepatapostema
retention
颅内压增高
肝癌
20 50 Intracranial
Liver cancer
hypertension
颅脑损伤
胆石症
21 51 Craniocerebral
Cholelithiasis
injury
胆囊炎 颅骨骨折
22 52
Cholecystitis Fracture of skull
肛瘘、肛裂 脑损伤
23 Anal fistula, anal 53
Brain Injury
fissure

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111
 上消化道出血
急性腰扭伤 Upper
24 Acute lumbar 54
gastrointestinal
muscle sprain
bleeding
周围神经损伤 休克
25 Peripheral nerve 55 Shock
injury
骨盆骨折 脑疝
26 56
Pelvic fracture Cerebral hernia
颅内肿瘤
骨肿瘤
27 57 Intracranial
Bone tumor
tumor
半月板损伤
28 58
Meniscus injury
骨髓炎
29 59
Osteomyelitis
骨关节结核
30 Osteoarticular 60
tuberculosis
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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112
 右江民族医学院外科实习鉴定表
Evaluation Form for Surgical Practice of Youjiang
Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（十七）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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113
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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114
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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115
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
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116
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

皮肤、骨牵引
消毒 次 次 次 次
1 21 Skin, skeletal
Disinfection Times Times Times Times
traction
脓肿切开引流
铺巾 次 次 Abscess 次 次
2 22
Drape Times Times incision Times Times
drainage
打石膏绷带
止血 次 次 次 次
3 23 Plaster
Hemostasis Times Times Times Times
bandaging
浅表肿瘤切除
缝合 次 次 Superficial 次 次
4 24
Suture Times Times tumor Times Times
resection
淋巴结活检术
灌肠 次 次 次 次
5 25 Lymph node
Enema Times Times Times Times
biopsy
拆线 护送搬运病人
次 次 次 次
6 Taking out 26 Escort and
Times Times Times Times
stitches carry patient
直肠指检
打结 次 次 次 次
7 27 Digital rectal
Tie Times Times Times Times
examination
软组织切开 肌肉注射
次 次 次 次
8 Soft tissue 28 Intramuscular
Times Times Times Times
incision injection
静脉注射
局部麻醉 次 次 次 次
9 29 Intravenous
Local anesthesia Times Times Times Times
injection
简单清创缝合 输液.输血
Simple 次 次 Blood 次 次
10 30
debridement Times Times transfusion, Times Times
and suture infusion
吸痰
换药术 次 次 次 次
11 31 Aspiration of
Dressing change Times Times Times Times
sputum
胃肠减压
次 次 给氧 次 次
12 gastrointestinal 32
Times Times Oxygen supply Times Times
decompression
胸腔穿剌术 次 次 次 次
13 33
Thoracocentesis Times Times Times Times
腹腔穿剌术 次 次 次 次
14 34
Abdominocentesie Times Times Times Times
导尿术
次 次 次 次
15 Urethral 35
Times Times Times Times
catheterization
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117
 序号 项目名称 操作 示范 序号 项目名称 操作 示范
No. Item name Operating Demonstration No. Item name Operating Demonstration

小夹板固定
次 次 次 次
16 Fixation with 36
Times Times Times Times
small splint
五、参加手术操作记录（学生填，教师核）
V. Record of participating in surgical operation (filled out by student, examined by teacher)
教
主
主 一 二 三 师 一 二 三 教师
操
操 助 助 助 签 助 助 助 签名
作
作 名

Signature e of teacher
手术名称 手术名称

Signature of teacher
日期 Second assistant 日期

Second assistant
Operation Operation

Main operation
Third assistant

Third assistant
First assistant

First assistant
Date Date
Main operation

name name

六、病种实习记录（学生填，教师核）
VI. Diseases practice record (filled out by student, examined by teacher)
主管 见过
主管(例) 见过(例) (例) (例)
序号 病 名 序号 病 名
In charge Have seen In Have
No. Disease name No. Disease name
(cases) (cases) charge seen
(cases) (cases)
单纯性甲状腺肿 肋骨骨折
1 31
Simple goiter Fracture of rib
损伤性气胸
Graves 病
2 32 Injury
Graves disease
pneumothorax
损伤性血胸
甲状腺癌
3 33 Injury
Thyroid cancer
hemothorax
急性乳腺炎 脓胸
4 34
Acute mastitis Pyothorax
食管癌
乳腺癌
5 35 Esophageal
Breast cancer
cancer

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118
 胃、十二指肠溃疡
肺癌
6 Gastric and 36
Lung cancer
duodenal ulcer
胃癌 四肢骨骨折
7 37
Gastric cancer Limb fractures
肠梗阻 关节脱位
8 Intestinal 38 Dislocation of
obstruction joint
骨化脓性感染
肠套叠 Osseous
9 39
Intussusception purulent
infection
结肠癌 关节化脓性感染
10 Carcinoma of 40 Joint purulent
colon infection
急性胰腺炎
直肠癌
11 41 Acute
Rectum cancer
pancreatitis
腰椎间盘突出症
Prolapse of
痔
12 42 lumbar
Hemorrhoid
intervertebral
disc
颈椎病
腹膜炎
13 43 Cervical
Peritonitis
spondylosis
急慢性阑尾炎
肾损伤
14 Acute and chronic 44
Kidney injury
appendicitis
门静脉高压症
尿道损伤
15 Portal 45
Urethral injury
hypertension
腹部创伤 泌尿系结石
16 Trauma of 46
Urinary stones
abdomen
腹部肿块 肾结核
17 47
Abdominal mass Nephrotuberculosis
腹外疝
肾肿瘤
18 Abdominal 48
Kidney tumor
external hernia
急性尿潴留
肝脓肿
19 49 Acute urinary
Hepatapostema
retention
颅内压增高
肝癌
20 50 Intracranial
Liver cancer
hypertension
颅脑损伤
胆石症
21 51 Craniocerebral
Cholelithiasis
injury
胆囊炎 颅骨骨折
22 52
Cholecystitis Fracture of skull
肛瘘、肛裂 脑损伤
23 Anal fistula, anal 53
Brain Injury
fissure

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119
 上消化道出血
急性腰扭伤 Upper
24 Acute lumbar 54
gastrointestinal
muscle sprain
bleeding
周围神经损伤 休克
25 Peripheral nerve 55 Shock
injury
骨盆骨折 脑疝
26 56
Pelvic fracture Cerebral hernia
颅内肿瘤
骨肿瘤
27 57 Intracranial
Bone tumor
tumor
半月板损伤
28 58
Meniscus injury
骨髓炎
29 59
Osteomyelitis
骨关节结核
30 Osteoarticular 60
tuberculosis
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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120
 右江民族医学院妇产科实习鉴定表
Evaluation Form for Practice in Gynecology and
Obstetrics of Youjiang Medical University for
Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（十八）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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121
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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122
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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123
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
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124
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、妇产科诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation of gynecology and obstetrics (filled out by student,
examined by teacher)
序 序
项目名称 操作 示范 项目名称 操作 示范
号 号
Item name Operating Demonstration Item name Operating Demonstration
No. No.
骨盆外测量 次 次 诊刮 次 次
1 15
External pelvimetry Times Times Curettage Times Times
宫颈涂片检查
四步触诊 次 次 次 次
2 16 Cervical smear
Four-step palpation Times Times Times Times
test
胎心音的观察
次 次 阴道冲洗 次 次
3 Fetal heart sound 17
Times Times Vaginal douche Times Times
observation
清宫术 宫颈电烙
次 次 次 次
4 Complete curettage 18 Electrocauteriza
Times Times Times Times
of uterine cavity tion of cervix
阴窥器检查 人流术
次 次 次 次
5 Vaginal speculum 19 Artificial
Times Times Times Times
examination abortion
双合诊 次 次 输卵管通水 次 次
6 20
Bimanual examination Times Times Hydrotubation Times Times
宫外孕手术
三合诊
次 次 Extrauterine 次 次
7 Vagino-recto-abdomin 21
Times Times pregnancy Times Times
al examination
operation
肛检 次 次 剖宫产手术 次 次
8 22
Anal examination Times Times Cesarean Times Times
正常接生 次 次 坐盆 次 次
9 23
Normal deliver Times Times Sitting basin Times Times
放、取环
次 次 助产术 次 次
10 Insertion, taking out 24
Times Times Midwifery Times Times
of intra-uterine device
引产 次 次 次 次
11 25
Odinopoeia Times Times Times Times
输卵管结扎 次 次 次 次
12 26
Tubal ligation Times Times Times Times
宫颈上药 次 次 次 次
13 27
Cervical medicine Times Times Times Times
会阴侧切术 次 次 次 次
14 28
Lateral episiotomy Times Times Times Times

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125
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过 见过
主管 主管
(例) (例)
序号 病 名 (例) 序号 病 名 (例)
Have Have
No. Disease name In charge No. Disease name In charge
seen seen
(cases) (cases)
(cases) (cases)
产力异常
正常分娩
1 21 Abnormal uterine
Normal delivery
action
孕期常见症状 产褥感染
2 Common symptoms 22 Puerperal
during pregnancy infection
流产 阴道炎
3 23
Abortion Colpitis
子宫颈癌
早产
4 24 Carcinoma of
Premature delivery
uterine cervix
异位妊娠 子宫肌瘤
5 25
Ectopic pregnancy Hysteromyoma
妊娠高血压综合症 子宫内膜癌
6 Pregnancy-hypertensi 26 Carcinoma of
on syndrome endometrium
前置胎盘 卵巢肿瘤
7 27
Placenta previa Ovarian tumor
葡萄胎
胎盘早剥
8 28 Hydatidiform
Placental abruption
mole
过期妊娠 绒毛膜癌
9 29
Prolonged pregnancy Choriocarcinoma
妊娠合并心脏病
Pregnancy 子宫内膜异位症
10 30
complicated with Endometriosis
heart disease
闭经、月经不调
产前出血
Amenorrhea,
11 Ante partum 31
irregular
hemorrhage
menstruation
功能性子宫出血
高危妊娠
12 32 Dysfunctional
High risk pregnancy
uterine bleeding
妇产科急腹症
子宫低张性宫缩乏力
Acute abdomen of
13 Hypotonic uterine 33
gynecology and
inertia
obstetrics
子宫收缩不协调 生殖器结核
14 uterine contraction 34 Genital
disharmony tubercolosis
盆腔炎
子宫破裂
15 35 Pelvic
Hysterorrhexis
inflammation
产后出血
不孕症
16 Postpartum 36
Apogeny
hemorrhage
新生儿窒息
17 37
Asphyxia neonatorum
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126
 胎儿宫内窘迫
18 Fetal distress in 38
uterus
宫颈炎
19 39
Cervicitis
滴虫、霉菌性阴道炎
20 Trichomonal vaginitis, 40
colpomycosis
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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127
 右江民族医学院妇产科实习鉴定表
Evaluation Form for Practice in Gynecology and
Obstetrics of Youjiang Medical University for
Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（十九）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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128
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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129
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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130
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
131
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、妇产科诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation of gynecology and obstetrics (filled out by student,
examined by teacher)
序 序
项目名称 操作 示范 项目名称 操作 示范
号 号
Item name Operating Demonstration Item name Operating Demonstration
No. No.
骨盆外测量 次 次 诊刮 次 次
1 15
External pelvimetry Times Times Curettage Times Times
宫颈涂片检查
四步触诊 次 次 次 次
2 16 Cervical smear
Four-step palpation Times Times Times Times
test
胎心音的观察
次 次 阴道冲洗 次 次
3 Fetal heart sound 17
Times Times Vaginal douche Times Times
observation
清宫术 宫颈电烙
次 次 次 次
4 Complete curettage 18 Electrocauteriza
Times Times Times Times
of uterine cavity tion of cervix
阴窥器检查 人流术
次 次 次 次
5 Vaginal speculum 19 Artificial
Times Times Times Times
examination abortion
双合诊 次 次 输卵管通水 次 次
6 20
Bimanual examination Times Times Hydrotubation Times Times
宫外孕手术
三合诊
次 次 Extrauterine 次 次
7 Vagino-recto-abdomin 21
Times Times pregnancy Times Times
al examination
operation
肛检 次 次 剖宫产手术 次 次
8 22
Anal examination Times Times Cesarean Times Times
正常接生 次 次 坐盆 次 次
9 23
Normal deliver Times Times Sitting basin Times Times
放、取环
次 次 助产术 次 次
10 Insertion, taking out 24
Times Times Midwifery Times Times
of intra-uterine device
引产 次 次 次 次
11 25
Odinopoeia Times Times Times Times
输卵管结扎 次 次 次 次
12 26
Tubal ligation Times Times Times Times
宫颈上药 次 次 次 次
13 27
Cervical medicine Times Times Times Times
会阴侧切术 次 次 次 次
14 28
Lateral episiotomy Times Times Times Times

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132
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过 见过
主管 主管
(例) (例)
序号 病 名 (例) 序号 病 名 (例)
Have Have
No. Disease name In charge No. Disease name In charge
seen seen
(cases) (cases)
(cases) (cases)
产力异常
正常分娩
1 21 Abnormal uterine
Normal delivery
action
孕期常见症状 产褥感染
2 Common symptoms 22 Puerperal
during pregnancy infection
流产 阴道炎
3 23
Abortion Colpitis
子宫颈癌
早产
4 24 Carcinoma of
Premature delivery
uterine cervix
异位妊娠 子宫肌瘤
5 25
Ectopic pregnancy Hysteromyoma
妊娠高血压综合症 子宫内膜癌
6 Pregnancy-hypertensi 26 Carcinoma of
on syndrome endometrium
前置胎盘 卵巢肿瘤
7 27
Placenta previa Ovarian tumor
葡萄胎
胎盘早剥
8 28 Hydatidiform
Placental abruption
mole
过期妊娠 绒毛膜癌
9 29
Prolonged pregnancy Choriocarcinoma
妊娠合并心脏病
Pregnancy 子宫内膜异位症
10 30
complicated with Endometriosis
heart disease
闭经、月经不调
产前出血
Amenorrhea,
11 Ante partum 31
irregular
hemorrhage
menstruation
功能性子宫出血
高危妊娠
12 32 Dysfunctional
High risk pregnancy
uterine bleeding
妇产科急腹症
子宫低张性宫缩乏力
Acute abdomen of
13 Hypotonic uterine 33
gynecology and
inertia
obstetrics
子宫收缩不协调 生殖器结核
14 uterine contraction 34 Genital
disharmony tubercolosis
盆腔炎
子宫破裂
15 35 Pelvic
Hysterorrhexis
inflammation
产后出血
不孕症
16 Postpartum 36
Apogeny
hemorrhage
新生儿窒息
17 37
Asphyxia neonatorum
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 胎儿宫内窘迫
18 Fetal distress in 38
uterus
宫颈炎
19 39
Cervicitis
滴虫、霉菌性阴道炎
20 Trichomonal vaginitis, 40
colpomycosis

带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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134
 右江民族医学院妇产科实习鉴定表
Evaluation Form for Practice in Gynecology and
Obstetrics of Youjiang Medical University for
Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（二十）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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135
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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136
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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137
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
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138
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、妇产科诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation of gynecology and obstetrics (filled out by student,
examined by teacher)
序 序
项目名称 操作 示范 项目名称 操作 示范
号 号
Item name Operating Demonstration Item name Operating Demonstration
No. No.
骨盆外测量 次 次 诊刮 次 次
1 15
External pelvimetry Times Times Curettage Times Times
宫颈涂片检查
四步触诊 次 次 次 次
2 16 Cervical smear
Four-step palpation Times Times Times Times
test
胎心音的观察
次 次 阴道冲洗 次 次
3 Fetal heart sound 17
Times Times Vaginal douche Times Times
observation
清宫术 宫颈电烙
次 次 次 次
4 Complete curettage 18 Electrocauteriza
Times Times Times Times
of uterine cavity tion of cervix
阴窥器检查 人流术
次 次 次 次
5 Vaginal speculum 19 Artificial
Times Times Times Times
examination abortion
双合诊 次 次 输卵管通水 次 次
6 20
Bimanual examination Times Times Hydrotubation Times Times
宫外孕手术
三合诊
次 次 Extrauterine 次 次
7 Vagino-recto-abdomin 21
Times Times pregnancy Times Times
al examination
operation
肛检 次 次 剖宫产手术 次 次
8 22
Anal examination Times Times Cesarean Times Times
正常接生 次 次 坐盆 次 次
9 23
Normal deliver Times Times Sitting basin Times Times
放、取环
次 次 助产术 次 次
10 Insertion, taking out 24
Times Times Midwifery Times Times
of intra-uterine device
引产 次 次 次 次
11 25
Odinopoeia Times Times Times Times
输卵管结扎 次 次 次 次
12 26
Tubal ligation Times Times Times Times
宫颈上药 次 次 次 次
13 27
Cervical medicine Times Times Times Times
会阴侧切术 次 次 次 次
14 28
Lateral episiotomy Times Times Times Times

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139
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过 见过
主管 主管
(例) (例)
序号 病 名 (例) 序号 病 名 (例)
Have Have
No. Disease name In charge No. Disease name In charge
seen seen
(cases) (cases)
(cases) (cases)
产力异常
正常分娩
1 21 Abnormal uterine
Normal delivery
action
孕期常见症状 产褥感染
2 Common symptoms 22 Puerperal
during pregnancy infection
流产 阴道炎
3 23
Abortion Colpitis
子宫颈癌
早产
4 24 Carcinoma of
Premature delivery
uterine cervix
异位妊娠 子宫肌瘤
5 25
Ectopic pregnancy Hysteromyoma
妊娠高血压综合症 子宫内膜癌
6 Pregnancy-hypertensi 26 Carcinoma of
on syndrome endometrium
前置胎盘 卵巢肿瘤
7 27
Placenta previa Ovarian tumor
葡萄胎
胎盘早剥
8 28 Hydatidiform
Placental abruption
mole
过期妊娠 绒毛膜癌
9 29
Prolonged pregnancy Choriocarcinoma
妊娠合并心脏病
Pregnancy 子宫内膜异位症
10 30
complicated with Endometriosis
heart disease
闭经、月经不调
产前出血
Amenorrhea,
11 Ante partum 31
irregular
hemorrhage
menstruation
功能性子宫出血
高危妊娠
12 32 Dysfunctional
High risk pregnancy
uterine bleeding
妇产科急腹症
子宫低张性宫缩乏力
Acute abdomen of
13 Hypotonic uterine 33
gynecology and
inertia
obstetrics
子宫收缩不协调 生殖器结核
14 uterine contraction 34 Genital
disharmony tubercolosis
盆腔炎
子宫破裂
15 35 Pelvic
Hysterorrhexis
inflammation
产后出血
不孕症
16 Postpartum 36
Apogeny
hemorrhage
新生儿窒息
17 37
Asphyxia neonatorum
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140
 胎儿宫内窘迫
18 Fetal distress in 38
uterus
宫颈炎
19 39
Cervicitis
滴虫、霉菌性阴道炎
20 Trichomonal vaginitis, 40
colpomycosis
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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141
 右江民族医学院儿科实习鉴定表
Evaluation Form for Practice in Pediatrics of Youjiang
Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（二十一）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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142
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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143
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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144
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
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145
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、儿科诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation of pediatrics (filled out by student, examined by
teacher)
序
项目名称 操作 示范 序号 项目名称 操作 示范
号
Item name Operating Demonstration No. Item name Operating Demonstration
No.
静脉注射
胸腔穿剌术 次 次 次 次
1 12 Intravenous
Thoracocentesis Times Times Times Times
injection
皮下注射
腰椎穿剌术 次 次 次 次
2 13 Hypodermic
Lumbar puncture Times Times Times Times
injection
呼吸机的应用
骨髓穿剌术 次 次 次 次
3 14 Application of
Marrow puncture Times Times Times Times
ventilator
心电图机操作 次 次 给氧 次 次
4 15
Operating of ECG Times Times Oxygen supply Times Times
吸痰
保温箱使用 次 次 次 次
5 16 Aspiration of
Use of incubator Times Times Times Times
sputum
护搬送运病人
光疗箱使用
次 次 Nursing and 次 次
6 Use of 17
Times Times transporting Times Times
phototherapy box
patients
结核菌素试验 次 次 次 次
7 18
Tuberculination Times Times Times Times
输血、输液
Blood 次 次 次 次
8 19
transfusion, Times Times Times Times
infusion
胸外心脏按压
次 次 次 次
9 External chest 20
Times Times Times Times
compression
物理降温 次 次 次 次
10 21
Physical cooling Times Times Times Times
肌肉注射
次 次 次 次
11 Intramuscular 22
Times Times Times Times
injection

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146
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过 见过
主管 主管
(例) (例)
序号 病 名 (例) 序号 病 名 (例)
Have Have
No. Disease name In charge No. Disease name In charge
seen seen
(cases) (cases)
(cases) (cases)
吸入性肺炎 喘息性支气管炎
1 Aspiration 22 Asthmatic
pneumonia bronchitis
肺炎合并心衰
新生儿窒息
2 23 Pneumonia with
Asphyxia neonatorum
heart failure
新生儿败血症 风湿热
3 24
neonatal septicemia Rheumatic fever
新生儿黄疸 中毒性休克
4 25
Pedicterus Toxic shock
缺氧缺血性脑病
心肌炎
5 Anoxic ischemic 26
Myocarditis
encephalopathy;
小儿惊厥
小儿肺炎
6 27 Pediatric
Infantile pneumonia
convulsion
上呼吸道感染
水痘
7 Upper respiratory 28
Varicella
tract infection
小儿支气管炎 中毒性痢疾
8 29
Infantile bronchitis Toxic dysentery
佝偻病 流行性腮腺炎
9 30
Rickets Mumps
急性出血性肠炎
胸膜炎 Acute
10 31
Pleuritis hemorrhagic
enteritis
先天性心脏病
麻疹
11 Congenital heart 32
Measles
disease
肾病综合征 呆小病
12 33
Nephrotic syndrome Fexism
小儿心力衰竭
早产儿
13 Infantile cardiac 34
Premature infant
failure
风心病
先天性愚型
14 Rheumatic heart 35
Down’s syndrome
disease
肾病综合征 猩红热
15 36
Nephrotic syndrome Scarlet fever
急性肾炎 苯丙酮尿症
16 37
Acute nephritis Phenylketonuria
病毒性脑炎 脊髓灰质炎
17 38
Viral encephalitis Poliomyelitis
腹泻脱水 小儿结核病
18 Diarrhoeal 39 Tuberculosis in
dehydration children

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147
 小儿常见贫血
结核性脑膜炎
19 40 Common anemia
Tubercular meningitis
in children
原发性免疫缺陷症
20 Primary 41
immumodefficiency
化脓性脑膜炎
21 42
Purulent meningitis
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]
带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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148
 右江民族医学院儿科实习鉴定表
Evaluation Form for Practice in Pediatrics of
Youjiang Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（二十二）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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149
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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150
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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151
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
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152
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、儿科诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation of pediatrics (filled out by student,
examined by teacher)
序
项目名称 操作 示范 序号 项目名称 操作 示范
号
Item name Operating Demonstration No. Item name Operating Demonstration
No.
静脉注射
胸腔穿剌术 次 次 次 次
1 12 Intravenous
Thoracocentesis Times Times Times Times
injection
皮下注射
腰椎穿剌术 次 次 次 次
2 13 Hypodermic
Lumbar puncture Times Times Times Times
injection
呼吸机的应用
骨髓穿剌术 次 次 次 次
3 14 Application of
Marrow puncture Times Times Times Times
ventilator
心电图机操作 次 次 给氧 次 次
4 15
Operating of ECG Times Times Oxygen supply Times Times
吸痰
保温箱使用 次 次 次 次
5 16 Aspiration of
Use of incubator Times Times Times Times
sputum
护搬送运病人
光疗箱使用
次 次 Nursing and 次 次
6 Use of 17
Times Times transporting Times Times
phototherapy box
patients
结核菌素试验 次 次 次 次
7 18
Tuberculination Times Times Times Times
输血、输液
Blood 次 次 次 次
8 19
transfusion, Times Times Times Times
infusion
胸外心脏按压
次 次 次 次
9 External chest 20
Times Times Times Times
compression
物理降温 次 次 次 次
10 21
Physical cooling Times Times Times Times
肌肉注射
次 次 次 次
11 Intramuscular 22
Times Times Times Times
injection

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153
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
见过 见过
主管 主管
(例) (例)
序号 病 名 (例) 序号 病 名 (例)
Have Have
No. Disease name In charge No. Disease name In charge
seen seen
(cases) (cases)
(cases) (cases)
吸入性肺炎 喘息性支气管炎
1 Aspiration 22 Asthmatic
pneumonia bronchitis
肺炎合并心衰
新生儿窒息
2 23 Pneumonia with
Asphyxia neonatorum
heart failure
新生儿败血症 风湿热
3 24
neonatal septicemia Rheumatic fever
新生儿黄疸 中毒性休克
4 25
Pedicterus Toxic shock
缺氧缺血性脑病
心肌炎
5 Anoxic ischemic 26
Myocarditis
encephalopathy;
小儿惊厥
小儿肺炎
6 27 Pediatric
Infantile pneumonia
convulsion
上呼吸道感染
水痘
7 Upper respiratory 28
Varicella
tract infection
小儿支气管炎 中毒性痢疾
8 29
Infantile bronchitis Toxic dysentery
佝偻病 流行性腮腺炎
9 30
Rickets Mumps
急性出血性肠炎
胸膜炎 Acute
10 31
Pleuritis hemorrhagic
enteritis
先天性心脏病
麻疹
11 Congenital heart 32
Measles
disease
肾病综合征 呆小病
12 33
Nephrotic syndrome Fexism
小儿心力衰竭
早产儿
13 Infantile cardiac 34
Premature infant
failure
风心病
先天性愚型
14 Rheumatic heart 35
Down’s syndrome
disease
肾病综合征 猩红热
15 36
Nephrotic syndrome Scarlet fever
急性肾炎 苯丙酮尿症
16 37
Acute nephritis Phenylketonuria
病毒性脑炎 脊髓灰质炎
17 38
Viral encephalitis Poliomyelitis
腹泻脱水 小儿结核病
18 Diarrhoeal 39 Tuberculosis in
dehydration children

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154
 小儿常见贫血
结核性脑膜炎
19 40 Common anemia
Tubercular meningitis
in children
原发性免疫缺陷症
20 Primary 41
immumodefficiency
化脓性脑膜炎
21 42
Purulent meningitis
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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155
 右江民族医学院社区卫生服务中心实习鉴定表
Evaluation Form for Practice in Community Medical
Service Center of Youjiang Medical University for
Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（二十三）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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156
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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157
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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158
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
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159
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序号 项目名称 操作 示范 序号 项目名称 操作
Demonstrati
示范
No. Item name Operating on
No. Item name Operating Demonstration

次 次 次 次
1 Times Times 21 Times Times
次 次 次 次
2 Times Times 22 Times Times
次 次 次 次
3 Times Times 23 Times Times
次 次 次 次
4 Times Times 24 Times Times
次 次 次 次
5 Times Times 25 Times Times
次 次 次 次
6 Times Times 26 Times Times
次 次 次 次
7 Times Times 27 Times Times
次 次 次 次
8 Times Times 28 Times Times
次 次 次 次
9 Times Times 29 Times Times
次 次 次 次
10 Times Times 30 Times Times
次 次 次 次
31
11 Times Times Times Times
次 次 次 次
12 Times Times 32 Times Times
次 次 次 次
13 Times Times 33 Times Times
次 次 次 次
14 Times Times 34 Times Times
次 次 次 次
15 Times Times 35 Times Times
次 次 次 次
16 Times Times 36 Times Times
次 次 次 次
17 Times Times 37 Times Times
次 次 次 次
18 Times Times 38 Times Times
次 次 次 次
19 Times Times 39 Times Times
次 次 次 次
20 Times Times 40 Times Times

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160
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
主管(例) 见过(例) 主管(例) 见过(例)
序号 病 名 序号 病 名
In charge Have seen In charge Have seen
No. Disease name No. Disease name
(cases) (cases) (cases) (cases)
1 11
2 12
3 13
4 14
5 15
6 16
7 17
8 18
9 19
10 20
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
161
 右江民族医学院 科实习鉴定表
Evaluation Form for Practice in of Youjiang
Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（二十四）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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162
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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163
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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164
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
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165
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序号 项目名称 操作 示范 序号 项目名称 操作
Demonstrati
示范
No. Item name Operating on
No. Item name Operating Demonstration

次 次 次 次
1 Times Times 21 Times Times
次 次 次 次
2 Times Times 22 Times Times
次 次 次 次
3 Times Times 23 Times Times
次 次 次 次
4 Times Times 24 Times Times
次 次 次 次
5 Times Times 25 Times Times
次 次 次 次
6 Times Times 26 Times Times
次 次 次 次
7 Times Times 27 Times Times
次 次 次 次
8 Times Times 28 Times Times
次 次 次 次
9 Times Times 29 Times Times
次 次 次 次
10 Times Times 30 Times Times
次 次 次 次
31
11 Times Times Times Times
次 次 次 次
12 Times Times 32 Times Times
次 次 次 次
13 Times Times 33 Times Times
次 次 次 次
14 Times Times 34 Times Times
次 次 次 次
15 Times Times 35 Times Times
次 次 次 次
16 Times Times 36 Times Times
次 次 次 次
17 Times Times 37 Times Times
次 次 次 次
18 Times Times 38 Times Times
次 次 次 次
19 Times Times 39 Times Times
次 次 次 次
20 Times Times 40 Times Times

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166
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
主管(例) 见过(例) 主管(例) 见过(例)
序号 病 名 序号 病 名
In charge Have seen In charge Have seen
No. Disease name No. Disease name
(cases) (cases) (cases) (cases)
1 11
2 12
3 13
4 14
5 15
6 16
7 17
8 18
9 19
10 20
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
167
 右江民族医学院 科实习鉴定表
Evaluation Form for Practice in of Youjiang
Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（二十五）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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168
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
169
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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170
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
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171
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序号 项目名称 操作 示范 序号 项目名称 操作
Demonstrati
示范
No. Item name Operating on
No. Item name Operating Demonstration

次 次 次 次
1 Times Times 21 Times Times
次 次 次 次
2 Times Times 22 Times Times
次 次 次 次
3 Times Times 23 Times Times
次 次 次 次
4 Times Times 24 Times Times
次 次 次 次
5 Times Times 25 Times Times
次 次 次 次
6 Times Times 26 Times Times
次 次 次 次
7 Times Times 27 Times Times
次 次 次 次
8 Times Times 28 Times Times
次 次 次 次
9 Times Times 29 Times Times
次 次 次 次
10 Times Times 30 Times Times
次 次 次 次
31
11 Times Times Times Times
次 次 次 次
12 Times Times 32 Times Times
次 次 次 次
13 Times Times 33 Times Times
次 次 次 次
14 Times Times 34 Times Times
次 次 次 次
15 Times Times 35 Times Times
次 次 次 次
16 Times Times 36 Times Times
次 次 次 次
17 Times Times 37 Times Times
次 次 次 次
18 Times Times 38 Times Times
次 次 次 次
19 Times Times 39 Times Times
次 次 次 次
20 Times Times 40 Times Times

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172
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
主管(例) 见过(例) 主管(例) 见过(例)
序号 病 名 序号 病 名
In charge Have seen In charge Have seen
No. Disease name No. Disease name
(cases) (cases) (cases) (cases)
1 11
2 12
3 13
4 14
5 15
6 16
7 17
8 18
9 19
10 20
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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173
 右江民族医学院 科实习鉴定表
Evaluation Form for Practice in of
Youjiang Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、基本要求记录（本栏（一）、（二）由学生填写，教师核；（三）由教师填写。）
II. The records for basic requirement (In this column, (I) and (II) shall be filled out by students,
checked by teachers; (III) shall be filled out by the teachers.)
（二十六）考勤记录：迟到 次；早退 次； 病假 天； 事假 天；
旷课 天。
(I) Attendance record: Late arrival for times; early leave for times; sick leave for
days; private affair leave for days; absent for days.

（二）基本要求记录：分管病床 张；病历书写 份； 参加学查房 次；

(II) The records for basic requirement: In charge of sickbeds; have written medical
records; have attended times of ward inspection of teaching;
参加学术(全院/病区)讲座、专题报告 次； 参加病例讨论__ __次。
Have participated in times of academic (hospital / ward) lectures, special reports; have
participated in times of case discussion.

（三）出科成绩记录：理论考试 分；技能考核 分。
(III) Records for completion of the practice in this Department: points in theory examination;
points in skill assessment.
三、职业道德与业务素质鉴定（本栏由带教老师填写）
III. Evaluation of professional ethics and professional quality (this column shall be filled out by
clinical teacher)
鉴定依据 基本分 得分
Evaluation basis Basic points Score
较 一
好 差
好 般
一级指标 二级指标
Excellent

Ordinary

Primary index Secondary index

Good

Poor

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174
 ①遵守医德规范，关心病人，科学诊疗，具良好医
德医风
① Comply with ethical standards, concern the patients,
diagnose and treat scientifically and have good medical
ethics
②不损害集体和病人的利益，尊重病人及其家庭之
间的相互理解和关系
1、职业道德
②Without prejudice to the interests of the collectivity 10 8 6 4
行为
and the patients; respect the patients and the mutual
Ethical behavior
understanding and relationship between the patients
and their families
③注意病人文件、保密性等的伦理和医学问题，处
理好与医护人员、同事之间的关系
③ Pay attention to ethical and medical issues such as
patient documents, confidentiality, etc.; handle the
relationship with medical staff and colleagues
①服从实习轮转科室及带教老师的工作安排，严格
贯彻“三严”，具良好工作作风
① Obey the work arrangements of practice rotation
department and clinical teacher; strictly implement the
"Three Strict", having a good working style
2、工作态度 ②积极主动，责任心强，不怕脏累，任劳任怨
表现 ② Work actively with responsibility, not afraid of dirty,
9 7 5 3
Work attitude tired, hard work
performance ③严格请假，不迟到、不早退，无旷课现象
③ Strict with the leave system. Do not come late, do
not leave early and do not skip.
④积极参加实习医院和实习组的各种集体活动
④ Actively participate in the various group activities of
the practice hospital and the practice group.
①学习态度端正，刻苦钻研，积极参加学术活动和
3、学习态度 讲座
表现 ① Have correct learning attitude, study hard, and
Performance of actively participate in academic activities and lectures 8 6 4 2
Learning ②虚心好学，求知欲上进心强
Attitude ②Modest and eager to learn, thirst for knowledge and
motivation
①尊重病人，态度和蔼，注意倾听、收集和综合同
疾病诊断问题有关的信息
①Respect patients with affable attitude, listen
attentively, collect and synthesize information related
4、沟通技能 to disease diagnosis
表现 ②运用沟通技巧促进病人及其家庭间理解，避免信
Performance 息不对称
8 6 4 2
of ② Use communication skills to promote the
communication understanding of patients and their families and avoid
skills information asymmetry
③有效地进行语言和书面沟通，建立和保管好医疗
档案
③Communicate effectively in verbal and written form,
establish and preserve sound medical records.

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175
 ①严格贯彻“三基”，基础扎实、牢固
①Enforce strictly the principle of three basics with
solid and firm foundation.
②掌握和运用人体正常结构和功能的知识，正确运
用机体结构和功能的异常变化的知识解释疾病发
生机制
②Master and apply the knowledge of normal structure
and function of human body; correctly apply the
knowledge of anomalous changes on body’s structure
5、基础知识与 and function to explain the pathogenesis of disease.
基本理论 ③掌握病人正常和异常行为表现的知识，影响健康
Basic 14 12 10 8
和疾病的重要因子和危险因素
knowledge and
basic theory ③ Master the knowledge of patients’ normal and
abnormal behaviors, important and dangerous factors
affecting health and diseases
④掌握维持机体动态平衡分子、细胞、生化和生理
机制知识
④ Master the knowledge of molecular, cells,
biochemical and physiological mechanism that
maintain the dynamic balance of human body.
⑤掌握疾病流行病学知识
⑤ Master disease epidemiology knowledge
病史采集
能力 问诊思路广阔，正确，系统，
Medical 逻辑性强
history broad, systematic and logical view on
collection inquiring
ability
体格检查
技能
操作规范、熟练
6、临床思维与 Physical
Standard, skilled operating
诊断能力 examination
Clinical thinking skills 14 12 10 8
and diagnostic ①遵循疾病诊断规律，不随意扩大
ability 辅助检查项目
① Follow the law of disease
辅助检查
diagnosis, do not arbitrarily expand
选择
the auxiliary inspection items
Auxiliary
②熟悉辅助检查项目正常参考值及
inspection
其临床意义
options
② Familiar with the normal reference
value of auxiliary examination items
and its clinical significance
7、诊疗操作技能 操作规范、熟练
12 10 8 6
Diagnosis and treatment skills Standard, skilled operating

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176
 治疗原则的 熟悉常见病的治疗原则，对疑难病例
运用 能提出意见
Application of Acquainted with treatment principles 10 8 6 4
treatment of common diseases and give advice
principles on intractable disease cases.
①遵循疾病治疗原则及其疾病病情
发展的需要
治疗措施、
① Follow the principles of disease
手术方案
treatment and the need of the
制定
disease’s progress
Development
②恰当地采取生化的、药物的、心理
of treatment
measures, 的、社会等措施干预临终者
surgery ② Carry out measures of
program biochemistry, pharmacy, surgery,
psychology and sociology etc. to
intervene the dying properly
①遵循疾病治疗原则及其疾病病情
8、治疗决策
发展的需要
Treatment
① Follow the principles of disease
decisions
treatment and the need of the
disease’s progress
②能用价格便宜又能达到治疗效果
的，拒绝价格昂贵的药物
② Refuse expensive medicine when
治疗用药
there is one of medicine with suitable
选择
price and sound therapeutic effect
Selection of
③遵守治疗价值与经济价值相一致
treatment
原则
medication
③ Follow the principle of treatment
value equaling to economic value
④掌握药物作用的原理和使用原则，
不同治疗方法的功效
④ Master theories and application
principles of drug reaction and
efficacy of different therapeutic
treatments.
符合医疗文件书写的规范要求、整洁
9、医疗文件书写能力
Be in line with writing standards of medical
Medical document writing 15 12 9 6
documents and do the writing normatively
ability
and neatly
总得分
Total Points
鉴定结论（本栏由科室负责人填写，在[ ]打“√”）
Evaluation conclusion (This column shall be completed by responsible person of department, and
shall be marked with "√" in [ ])
经科室合议，该生在本科室实习期间职业道德与业务素质综合评定为：
Through the joint discussion of the department, the comprehensive professional ethics and professional qualities of
the students in this Department during the practice is evaluated as:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]
科室（章） 负责人签名： 日期： 年 月 日
Department (seal) Signature of responsible person Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:
科室（章） 负责人签名： 日期：20 年 月 日
Department (seal) Signature of responsible person: Date:
有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
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177
说明：职业道德与业务素质综合评定结果与综合成绩的换算关系为：优秀 90—100 分，良好 80-89 分，中等
70-79 分，基本合格 60-69 分，不合格低于 60 分或其他“一票否决”原因。
Note: the conversion between the comprehensive evaluation results of professional ethics and professional qualities
and the comprehensive results is as follows: excellent means points 90-100; Good means points 80-89; medium
means points 70-79; basic pass means points 60-69; failed mean less than points 60 or other reason of " One-vote
veto ".
四、诊疗技术操作记录（学生填，教师核）
IV. Record of medical technology operation (filled out by student, examined by teacher)
序号 项目名称 操作 示范 序号 项目名称 操作
Demonstrati
示范
No. Item name Operating on
No. Item name Operating Demonstration

次 次 次 次
1 Times Times 21 Times Times
次 次 次 次
2 Times Times 22 Times Times
次 次 次 次
3 Times Times 23 Times Times
次 次 次 次
4 Times Times 24 Times Times
次 次 次 次
5 Times Times 25 Times Times
次 次 次 次
6 Times Times 26 Times Times
次 次 次 次
7 Times Times 27 Times Times
次 次 次 次
8 Times Times 28 Times Times
次 次 次 次
9 Times Times 29 Times Times
次 次 次 次
10 Times Times 30 Times Times
次 次 次 次
31
11 Times Times Times Times
次 次 次 次
12 Times Times 32 Times Times
次 次 次 次
13 Times Times 33 Times Times
次 次 次 次
14 Times Times 34 Times Times
次 次 次 次
15 Times Times 35 Times Times
次 次 次 次
16 Times Times 36 Times Times
次 次 次 次
17 Times Times 37 Times Times
次 次 次 次
18 Times Times 38 Times Times
次 次 次 次
19 Times Times 39 Times Times
次 次 次 次
20 Times Times 40 Times Times

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178
五、病种实习记录（学生填，教师核）
V. Diseases practice record (filled out by student, examined by teacher)
主管(例) 见过(例) 主管(例) 见过(例)
序号 病 名 序号 病 名
In charge Have seen In charge Have seen
No. Disease name No. Disease name
(cases) (cases) (cases) (cases)
1 11
2 12
3 13
4 14
5 15
6 16
7 17
8 18
9 19
10 20
带教老师意见：属实[ ]，不属实[ ]
Comment of clinical teacher: true [ ], not true [ ]

带教老师签名：
Signature of clinical teacher:
联系电话：
Telephone number:
Email：
年 月 日
Year Month Date:

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179
 右江民族医学院实习生职业道德与业务素质总鉴定表（转院实习用）
Overall Evaluation Form for Professional Ethics and Professional Qualities of Student
Intern of Youjang Medical University for Nationalities (for practice of hospital
transfer)
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department

二、职业道德与业务素质总鉴定
II. Overal evaluation of professional ethics and professional qualifications
A 栏：学生自我鉴定（本栏由学生本人填写，填写不够可另加附页）
Column A: self-evaluation of students (The column shall be filled by the students, if the space is not
enough, more pages can be attached)
（自我鉴定指个人在政治思想表现、职业道德行为、工作态度表现、学习态度表现、沟通技能表现、基
础知识与基本理论、临床思维与诊断能力、诊疗操作技能、治疗决策和医疗文件书写等 10 个方面的综合表现。
详见《实习工作指南》）
(Self-evaluation refers to the comprehensive performance of individual in 10 aspects such as political and
ideological performance, ethical behavior, work attitude, learning attitude, communication skills, basic knowledge
and basic theory, clinical thinking and diagnostic skills, diagnosis and treatment skills, treatment decisions and
writing of medical documents, etc. See details in Practice Guide)

签名： 日期：20 年 月
日
Signature: Date:

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180
B 栏：实习小组意见（本栏由实习小组组长填写）（如实习小组仅有一人，则此栏不需填写）
Column B: Comments of practice group (This column shall be filled out by the leader of practice group) (If there is only
one student in the practice group, this column is not required to be filled out.)
该生的自我鉴定反映其在实习期期间的综合表现：真实[ ]；基本真实[ ]；不真实[ ]
The self-evaluation of the student reflects his or her overall performance during the practice
period: True [ ]; Basicly true [ ]; Not ture [ ]
总评价：优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Overall evaluation: Excellent [ ]; Good [ ]; Medium [ ]; Basic pass [ ]; Failed [ ]

小组名称 组长签名： 日期：20 年 月

日
Group name Signature of group leader: Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:

小组名称 组长签名： 日期：20 年 月 日

Group name Signature of group leader: Date:
C 栏：实习医院鉴定（本栏由实习医院教学管理部门填写）
Column C: Evaluation of practice hospital (this column shall be filled out by the
teaching administrative department of the practice hospital)
实 习 医 院 意 见
Comments of Practice Hospital

总体评价：
Overall evaluation:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Bassic pass [ ]; Failed [ ]

实习医院（章） 负责人签名： 日期：20 年 月 日

Practice hospital (seal) Signature of responsible person: Date:

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
181
 右江民族医学院实习生职业道德与业务素质总鉴定表
Overall Evaluation Form for Professional Ethics and Professional Qualities of Student
Intern of Youjiang Medical University for Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department

二、职业道德与业务素质总鉴定
II. Overal evaluation of professional ethics and professional qualities
A 栏：学生自我鉴定（本栏由学生本人填写，填写不够可另加附页）
Column A: self-evaluation of students (The column shall be filled by the students themselves, if the
space is not enough, more pages can be attached)
（自我鉴定指个人在政治思想表现、职业道德行为、工作态度表现、学习态度表现、沟通技能表现、基
础知识与基本理论、临床思维与诊断能力、诊疗操作技能、治疗决策和医疗文件书写等 10 个方面的综合表现。
详见《实习工作指南》）
(Self-evaluation refers to the comprehensive performance of individual in 10 aspects such as political and
ideological performance, ethical behavior, work attitude, learning attitude, communication skills, basic knowledge
and basic theory, clinical thinking and diagnostic skills, diagnosis and treatment skills, treatment decisions and
writing of medical documents , etc. See details in Practice Guide)

签名： 日期：20 年 月 日
Signature: Date:

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
182
B 栏：实习小组意见（本栏由实习小组组长填写）（如实习小组仅有一人，则此栏不需填写）
Column B: Comments of practice group (This column shall be filled out by the leader
of practice group) (If there is only one student in the practice group, this column is not required to be filled
out.)
该生的自我鉴定反映其在实习期期间的综合表现：真实[ ]；基本真实[ ]；不真实[ ]
The self-evaluation of the student reflects his or her overall performance during the internship
period: True [ ]; Basic true [ ]; Not ture [ ]
总评价：优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Overall evaluation: Excellent [ ]; Good [ ]; Medium [ ]; Bassic pass [ ]; Failed [ ]

小组名称 组长签名： 日期：20 年 月 日

Group name Signature of group leader: Date:
评议结论为“不合格”的理由：
Reasons for being evaluated to be “Failed”:

小组名称 组长签名： 日期：20 年 月 日

Group name Signature of group leader: Date:
C 栏：实习医院鉴定（本栏由实习医院教学管理部门填写）
Column C: Evaluation of practice hospital identification (this column shall be filled
out by the teaching administrative department of the practice hospital)
实 习 医 院 意 见
Comments of Practice Hospital

总体评价：
Overall evaluation:
优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Excellent [ ]; Good [ ]; Medium [ ]; Bassic pass [ ]; Failed [ ]

实习医院（章） 负责人签名： 日期：20 年 月 日

Practice hospital (seal) Signature of responsible persone: Date:

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
183
 右江民族医学院实习生职业道德与业务素质总鉴定表
Overall Evaluation Form for Professional Ethics and Professional Qualities of Student
Intern of YouJiang Medical University For Nationalities
一、实习生基本信息（本栏由学生本人填写）
I. Basic Information of Student Intern (This column shall be filled by the student himself or herself)
实习生姓名 学号 专业年级层次
Student intern Student Major, Grade,
name No. Level
实习医院名称 实习科目
Name of practice Practice subjects
hospital
本科室实习期限 年 月 日—— 年 月 日（共 天）
Duration of From to ( days in total)
practice in the
Department
二、鉴定表使用范围、鉴定程序、记录方法、鉴定依据与结论
II. Scope of use of the evaluation form, evaluation procedures, methods of recording, evaluation
basis and conclusion
（一）本鉴定表供各专业学生在实习期间职业道德与业务素质总的评价使用。
(I) The evaluation form is used for the overall evaluation of professional ethics and professional qualities of students of
various majors during the period of practice.
（二）鉴定程序
(II) Evaluation procedures
实习结束前 1 周，每位同学填写好自我鉴定（A 栏）后送实习小组组长，实习小组组长根据学生自我鉴定内容作出评价（B
栏），最后将本表交给实习医院教学管理部门进行总鉴定（C 栏）并统一保管、寄回学院实践教学管理科。
In one week prior to the end of the practice, each student shall fill out a self-evaluation (Column A) and then send it to practice
group leader. The practice group leader shall make an evaluation based on the self-evaluation of the student (Column B) and finally
submit the form to the Teaching Administrative Department for overall evaluaiton (Column C) and then the forms shall be under unified
custody and sent to the Practice Teaching Management Section of the University.
（三）记录方法、鉴定依据与结论
(III) Recording method, evaluation basis and conclusion
1、记录方法：凡需在表中的[ ]内打标记的，均使用“√”标记。
1. Recording method: where you need to mark in the table [ ], please mark "√".
2、职业道德与业务素质总鉴定结论实行“一票否决制”，学生在本科室实习期间，只要符合以下情况之一，鉴定结论为
不合格：
2. The conclusion of the overall evaluation of profession ethics and professional qualties shall implement "one-vote veto system",
as long as the student has any one of the following conditions during the undergraduate practice, the evaluation conclusion shall be
fail:
（1）任何必修科目或选修科目职业道德与业务素质不合格。
(1) The professional ethics and professional qualities of any compulsory subjects or elective subjects are failed.
（2）出现医疗事故。
(2) Occurrence of a medical incident.
（3）冒名顶替带教老师或科室主任鉴定（签字）。
(3) Be a faitour for the evaluaiton of clinical teacher or department director (signature).
（4）实习单位认为评定为不合格的其它情况。
(4) Other circumstances that are considers as faied by the practice unit.
3、鉴定结果分为优秀、良好、一般、基本合格及不合格五个等级。如出现不合格情况，实习小组组长或医院教学管理部
门应将评价理由填写在出现不合格情况栏目内。
3. The evaluation results are divided into five levels: excellent, good, medium, bassic pass and failed. In case of failed, the practice
group leader or the teaching administrative department of the hospital should fill out the reason into the column of fail situation.

三、职业道德与业务素质总鉴定
III. Overal evaluation of professional ethics and professional quality
A 栏：学生自我鉴定（本栏由学生本人填写，填写不够可另加附页）
Column A: self-evaluation of students (The column shall be filled by the students, if the space is not
enough, more pages can be attached)

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
184
 （自我鉴定指实习一年来在政治思想表现、职业道德行为、工作态度表现、学习态度表现、沟通技能表现、基础知识与基
本理论、临床思维与诊断能力、诊疗操作技能、治疗决策和医疗文件书写等 10 个方面的综合表现。详见《实习工作指南》）
(Self-evaluation refers to the comprehensive performance of individual in 10 aspects such as political and
ideological performance, ethical behavior, work attitude, learning attitude, communication skills, basic knowledge
and basic theory, clinical thinking and diagnostic skills, diagnosis and treatment skills, treatment decisions and
writing of medical documents , etc. See details in Practice Guide)

签名： 日期：20 年 月 日
Signature: Date:
B 栏：实习小组意见（本栏由实习小组组长填写）（如实习小组仅有一人，则此栏不需填写）
Column B: Comments of practice group (This column shall be filled out by the leader
of practice group) (If there is only one student in the practice group, this column is not required to be filled
out.)
该生的自我鉴定反映其在实习期期间的综合表现：真实[ ]、基本真实[ ]、不真实[ ]。
The self-evaluation of the student reflects his or her overall performance during the practice
period: True [ ]; Basic true [ ]; Not ture [ ]
总的评价为：优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]
Overall evaluation: Excellent [ ]; Good [ ]; Medium [ ]; Bassic pass [ ]; Failed [ ]

小组名称 组长签名： 日期：20 年 月 日

Group name Signature of group leader: Date:
评议结论为“不合格”的理由：
Reasons for being evaluated as “Failed”:

小组名称 组长签名： 日期：20 年 月 日

Group name Signature of group leader: Date:
C 栏：实习医院鉴定（本栏由实习医院教学管理部门填写）
Column C: Evaluation of training hospital identification (this column shall be filled
out by the teaching administrative department of the practice hospital)
实 习 医 院 意 见
Comments of Training Hospital

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
185
总体评价：优秀[ ]；良好[ ]；中等[ ]；基本合格[ ]；不合格[ ]。
Overall evaluation: Excellent [ ]; Good [ ]; Medium [ ]; Bassic pass [ ]; Failed [ ]
实习医院（章） 负责人签名： 日期：20 年 月 日
Training hospital (seal) Signature of responsible person: Date:

D 栏：学院意见（本栏由实践教学管理科负责审核填写）
Column D: Comments of the University (This column shall be filled out and examined by the
Department of Practical Teaching Management)
学 院 审 核 意 见
Examination Comments of University

负责人签名： 日期：20 年 月 日
Signature of responsible person: Date:

有疑问请咨询右江民族医学院国际教育学院留学生科邮箱：yygjlxsk@163.com 电话：+86-776-2853821
If you have any question, please contact International Student Department of International Education College of
Youjiang Medical University for Nationalities E-mail: yygjlxsk@163.c Phone:+86-776-2853821
186