The clinical reasoning of general practitioners is the key to providing quality medical services to patients, but it is not suitable for traditional methods to evaluate this ability because it is an abstract ability that cannot be directly observed.

This paper aims to improve the efficiency of general practitioners' clinical reasoning training and enrich the evaluation of medical education by optimizing the evaluation method of curriculum teaching.

From September to December 2022, 38 master's degree students of the Medical School of Tongji University were divided into the in-service group (16) and residential training group (22). The course consists of three modules, namely core, case and result, and adopts blended teaching method to carry out teaching. The content of quantitative evaluation is different kinds of rating scale, while the content of subjective evaluation comes from multi-source feedback.

The final course scores for the core and case modules were statistically significant for both groups (P<0.05), but the first course scores were not (P>0.05). The quantitative evaluation scores of the whole class and the two groups of students in the first and last courses of the above two modules were compared, and there was statistical significance (P<0.001). Subjective evaluation can be divided into positive evaluation and improvement evaluation. The positive evaluation of the courses on consultation skills, physical examination, auxiliary examination, health management, and chronic disease management is relatively low, while the improvement evaluation is relatively high; the positive evaluation of the courses on doctor-patient communication, SOAP, multiple diseases coexirelatively high, while the improvement evaluation is relatively low.

Programmatic assessment can enrich the evaluation system of general clinical reasoning, promote students' construction of general clinical reasoning in order, and also found that "flipped classroom" is a form of procedural evaluation.

全科临床诊疗思维是全科医生为患者提供高质量诊疗服务的关键，但因其属于无法被直接观察的抽象能力，所以并不适合用传统的方法进行评价。

本文旨在通过优化课程教学评价方法提高全科医生临床诊疗思维培训效率，丰富医学教育评价。

于2022年9—12月，以同济大学医学院38名全科方向硕士研究生为对象，根据学习与工作经历分为在职组16名与住培组22名。培训课程包含核心、案例、结果3个模块，采取混合式教学方法开展实践。定量评价的内容为技能评分表、PBL评分表与案例评分表，主观评价的内容来自多源反馈。

两组学员核心和案例模块首次课程评分比较，差异无统计学意义（P>0.05）；两个模块末次课程得分比较，差异有统计学意义（P<0.05）。将总体学员以及两组学员核心和案例模块首、末次课程的定量评价得分比较，差异均有统计学意义（P<0.001）。主观评价性质分为肯定性评价与改进性评价，问诊能力、体格检查、辅助检查、健康管理、慢病管理课程的肯定性评价占比较低，而改进性评价占比较高；医患沟通、病历书写、多病共存、心身疾病、未分化疾病课程的肯定性评价占比较高，而改进性评价占比较低。

程序性评价能够丰富全科思维评价体系、促进学员循序建构全科思维，同时也发现了"翻转课堂"是程序性评价的呈现形式。