浅谈住院医师规范化培训

医学教育大体上可分为学校教育、毕业后教育和继续医学教育三部分，三者构成医学教育的全过程和有机的整体，在医学教育中占有同等重要的地位。毕业后医学教育主要指医学本科、硕士、博士研究生毕业后至成为专科医师之前的学习和培养过程，它又分为住院医师规范化培训和专科医师培训两大阶段。因此，毕业后医学教育作为医学教育的组成部分和今后医学院校及各教学医院教学工作的重要内容日益受到重视。住院医师规范化培训是毕业后医学教育的起步和开始阶段。     

“专培”如何达到预期成效?

近日,国家卫生计生委、中国医师协会在京启动专科医师规范化培训(以下简称专培)制度试点工作,首批选择神经外科、呼吸与危重症、心血管内科进行试点.按照初步规划,到2020年,我国将初步建立专科医师规范化培训制度,形成完整的毕业后医学教育体系.开展专科医师规范化培训试点,最终目的是要在住院医师规范化培训的基础上,培养一批能独立、规范地从事疾病专科诊疗工作的临床专科医师.     

建立我省专科医师培养制度——访省卫生厅科技教育与国际合作处副处长梁军

记者：您怎样看待专科医师培训？ 梁军：医学工作的特殊性决定了医学教育的特殊性和复杂性。医学教育体系由医学院校教育、毕业后医学教育和继续医学教育三阶段组成．其中以住院医师、专科医师培训为主要内容的毕业后教育是医学人才临床能力培养极为重要的阶段。通过住院医师、专科医师培训．     

神经内科住院医师规范化培训的探索

临床医学是实践性、技能性很强的学科,临床医师的成长不仅要有广博的知识,而且要有扎实熟练的临床技能。住院医师规范化培训是培养医药卫生人才的重要措施,也是完善毕业后继续医学教育的重要组成部分[1]。住院医师培训制度是指住院医师在上级医师的指导下进行临床实践,通过规范化的要求和严格的考核,从而学习到某一医学专科中的合格医师所需要的知识、技能和态度[2-4]。     

临床专业学位研究生与普通专科医师规范化培训模式并轨的探讨

近年来,教育部逐年增加临床专业学位研究生的招生规模,但是对于临床专业学位研究生的培养模式及考核方式等还存在许多问题,这些都直接影响到临床研究生的培养质量.通过临床专业学位研究生与普通专科医师规范化培训模式并轨,建立统一的且适合临床研究生的培养模式,提高培养质量,使得临床研究生毕业时既具备一定的科研能力,又能达到住院医师规范化培训一阶段的临床能力.     

首都医科大学传染(感染)病学专业学位博士研究生培养与专科医师规范化培训并轨培训模式的探索

摸索并建立起一套符合首都传染病专业学位博士研究生培养与专科医师规范化培训并轨的培训体系和管理制度;以培养具有丰富临床知识和熟练专业技能的合格医师为目的,为提高医师的医疗业务能力和水平夯实基础。     

“规培”的上海模式

<正>上海市于2010年在全国率先推出住院医师规范化培训,探索创立"5+3+X"人才培养模式,其首创的"3个结合"被列入教育部文件,住院医师规范化培训的"上海模式"受到国家卫生计生委充分肯定,已在全国推广。今年8月,上海市教育委员会、上海市卫生计生委联合制定下发《上海市临床医学博士专业学位教育与专科医师规范化培训衔接改革实施办法》。《办法》明确,凡是符合规定被招录的专科医师经3年规范化培训后,合格者将被授予临床博士学位。这份文件的出台,标志着上海市临     

专培如何才能"叫好又叫座"?

2016年开年,关于专科医师规范化培训(以下简称专培)试点的各种消息和评论刷爆了医学界人士的朋友圈.国家卫生计生委等8部门发布《关于开展专科医师规范化培训制度试点的指导意见》.自2016年起,我国将遴选有条件的专科启动试点工作,力争到2020年在全国范围内初步建立专培制度,形成较为完善可行的组织管理体系、培训体系和有效的政策支撑体系,形成完整的毕业后医学教育制度,培养一批高素质的合格临床专科医师.     

临床住院医师规范化培训的实践

住院医师规范化培训是完善毕业后医学教育制度阶段的重要组成部分,是培养合格医师的有效途径,是专科医师培训的必要前提和基础,对提高医师队伍素质和临床诊断治疗水平具有重要和深远意义,对我国医疗卫生事业发展起着重要的推动和促进作用。     

住院医师规范化培训保障体系的构建

住院医师规范化培训是医学生毕业后为其职业生涯打下重要基础的关键阶段,是毕业后医学教育的重要组成部分,是培养优秀医师的有效途径,是医学生从在校教育过渡到专科医师培养的必经阶段.住院医师规范化培训的有序、健康、良性发展离不开科学的培训大纲、严格的考核、人事保障、思想保障、文化氛围保障、后勤保障、信息保障等方面.本文就住院医师培训的多元保障体系谈谈体会.     

A survey of clinical teaching fellowships in UK medical schools

CONTEXT: Undergraduate medical education in the UK has changed considerably over the last decade. One development has involved the creation of teaching-specific posts for junior doctors by medical schools. These posts are generally termed 'clinical teaching fellowships', but it is not known how many of them exist, or whether they are similar in terms of educational activities, professional development, and research and clinical experience opportunities. METHODS: Teaching deans in all UK medical schools were sent a questionnaire relating to clinical teaching fellowships, and were asked to distribute a second set of different questionnaires to their clinical teaching fellows, which were to be returned to the authors separately. RESULTS: A total of 28 deans and 46 fellows responded. Fifteen medical schools had clinical teaching fellows and there appeared to be a total of 77 such posts in the UK. There was little uniformity in the activities undertaken within the posts. Deans who employed clinical teaching fellows were unanimously positive regarding the posts. Fellows were generally positive but expressed reservations relating to approval for postgraduate training, career development, deterioration in clinical skills, financial disincentives, credibility within one's own specialty, and provision of training and support. CONCLUSIONS: Clinical teaching fellow posts are generally enjoyed by fellows and valued by deans. Fellows carry out differing duties and their training in medical education is variable. The posts can be unstructured and may lack credibility to doctors outside medical education. Providing specific structured training in medical education, recognised at a national level, would help deal with these concerns.     

Training for medical teachers: a UK survey, 1993†

Summary: Opportunities and resources for training of medical teachers have been criticized in recent UK reports. A survey of undergraduate and postgraduate medical deans showed that training courses were available at most institutions, though only a few were specifically designed for medical teachers. Many new and specific courses are being planned and many new appointments are being made in medical education at both medical school and postgraduate levels. While the outcome of greater resources for training of medical education cannot yet be determined, we conclude that criticisms are being speedily addressed.     

Reforming higher specialist training in the United Kingdom--a step along the continuum of medical education

OBJECTIVES: The requirement to align the arrangements for postgraduate training in the United Kingdom with those elsewhere in the European Community provided the opportunity to review and reform our arrangements for higher specialist training. This paper describes the case for change--the strengths and deficiencies of the traditional pattern of postgraduate medical training, demographic influences in the medical workforce and the need for a more structural or planned approach to training. CONCLUSIONS: Over the past 5 years substantial progress has been made: the introduction of new regulatory arrangements and a new higher specialist training grade; the development of a managed and flexible system for delivering training to standards set by the Royal Colleges and which can accommodate the needs of those pursuing academic and research medicine; and the opportunity for trainees' progress to be measured against published curricula. The significant programme of change has been underpinned by careful workforce planning and the publication of comprehensive guidance. Significant reform of higher specialist training has been achieved. This paper also makes the case for a more strategic approach to planning and developing medical education across the continuum, from entry to medical school until retirement, which can guide medical education and improve patient care into the next millennium.     

Medical specialization in Europe: the way forward Promotion of educational quality

Summary. The medical specialties are being intensively reconsidered in the countries of Europe. The important need is for promoting improvement of educational training programmes. Evaluation and improvement of specialist training programmes is the priority and not the setting up of qualifying examinations. The first necessity is to safeguard 20 years of evolution in postgraduate training. Support for the educational process is essential, to a much greater extent than occurs at present, if standards are to be improved and the confidence of the public is to be retained. The EC medical education system is the only existing international structure in medical education which is controlled by law, and is on that basis alone of the greatest interest.     

构建“以健康为中心”的医疗卫生人才培养模式

随着医学模式的演变，我国的医疗卫生人才培养模式必须从“以治疗疾病为中心”转变为“以健康为中心”。文章阐述了“以健康为中心”的医疗卫生人才培养模式产生的背景，提出以“治未病与健康管理”博士项目为抓手，推进医学教育模式改革，加快医疗卫生人才培养机制的变革，以适应新时期我国医疗卫生事业发展的需要。     

Learning to doctor: tinkering with visibility in residency training

Medical doctors in teaching hospitals aim to serve the two central goals of patient care and medical training. Whereas patient care asks for experience, expertise and close supervision, medical training requires space to practise and the ‘invisibility’ of medical residents. Yet current reforms in postgraduate medical training point to an increasing emphasis on the measurable visibility of residents. Drawing on an ethnographic study of gynaecology training in The Netherlands, this article demonstrates that in daily clinical routines multiple practices of residents’ visibility (visibilities) coexist. The article lists four visibilities: staging residents, negotiating supervision, playing the invisibility game and filming surgical operations. The article shows how attending physicians and medical residents tinker with these visibilities in daily clinical work to provide good care while enacting learning space, highlighting the increasing importance of visualising technologies in clinical work. Moreover, the article contributes to traditional sociological accounts on medical education, shifting the focus from medical education as a social institution to the practices of medical training itself. Such a focus on practice helps to gain an understanding of how the current reform challenges clinicians’ educational activities.     

Expectation and experience: dissonances between novice and expert perceptions in medical education research

Context  There is both qualitative and quantitative variation in the research methods training provided for Masters and doctoral students on medical education programmes across the UK. Unlike other higher-degree programmes, there are no requirements for higher-degree medical education students to have studied the subject at degree level or for their supervisors to have training in social science research methods. This study explores the ways in which a panel of experts responded to novices' presentations of their research in progress.
Methods  This qualitative, case-based study of a 1-day education research consortium generated data in two phases. The author collected detailed field notes as a non-participant observer and subsequently analysed the data they contained. A second set of data was generated from written reflexive accounts of the day e-mailed to the author by all participants 1 month after the event and was subsequently analysed.
Results  Thematic coding revealed wide degrees of variance between the research experiences and abilities of the novices and the expectations of the experts. These levels of dissonance are ascribed to the limited amounts of research training undertaken by students and the variable guidance provided by research supervisors, some of whom were themselves novices in this area.
Conclusions  If medical education research is to thrive, it requires a properly developed infrastructure with training and support for research supervisors and students alike. Communities of practice need to be fostered to enable researchers to collaborate and disseminate good practice. This will ensure that medical education research practitioners can produce theoretically sound, rigorously designed and executed studies that can contribute to the evidence base for medical education.     

The content of the medical curriculum at McMaster University: graduates'' evaluation of their preparation for postgraduate training

This paper describes McMaster University medical graduates' perceptions of how well their medical curriculum prepared them for postgraduate training. The graduates view their overall preparation for postgraduate work as sound. These perceptions were compared with independent assessments by internship supervisors for one graduated class. The graduates suggest their preparation for postgraduate work differs somewhat from fellow interns. Graduates reported feeling very well prepared compared to fellow postgraduate trainees in independent learning, self-evaluation and problem solving skills. They also judge their preparation in data gathering skills, behavioural science knowledge, ability to deal with social and emotional problems of patients, medical record keeping skills, preventive, follow-up and in-patient care as very good compared to peers. They identified two content areas, pharmacology and the basic medical sciences, as requiring more attention in the curriculum. These findings are discussed and related to the approach to medical education at McMaster University.     

A regional medical manpower and training information system

Summary MEDICS (Medical Education Information and Career System) is a computerized information system relating to hospital doctors employed in the South West Thames Regional Health Authority which is administered through the Regional Postgraduate Dean's Office at the British Postgraduate Medical Federation (BPMF). The system, which was initially set up to analyse postgraduate training, has been expanded to encompass medical manpower planning and career strategy to enable this Region to deal with its own requirements and contribute to the national picture. The basis of the system is a comprehensive, dynamic and reactive master file of medical manpower which is utilized for manpower and service planning, the provision of essential information for training, service and individual specialty committees and the planning and monitoring of postgraduate medical education. Confidentiality is strictly observed and access to data carefully controlled by in-built system security, data only being accessible by supplying appropriate passwords.     

实习医师平息人际冲突能力的调查分析

目的在推进住院医师规范化培训的背景下,了解现行高等医学教育培养的不同性别和不同学历的实习医师的平息人际冲突能力。方法对179名实习医师采用问卷调查并进行分析。结果男实习医师整体平息人际冲突能力较女实习医师整体强(P<0.05),研究生实习医师平息人际冲突能力较本科生实习医师弱(P<0.01)。结论研究生实习医师(尤其是女性)平息人际冲突能力不佳,医学研究生教育及住院医师规范化培训应予以重视和改善。