Zimbabwe: a family planning profile

This brief article focuses on the history of family planning in Zimbabwe, available services, community-based distribution, contraceptive use, and program problems. Family planning services were first available in Zimbabwe in 1953. The Rhodesian Family Planning Association (RFPA) was established formally in 1965. RFPA distributed contraceptives in 1966 and trained for the first time "field educators" in 1967. The first community-based distributors were trained in 1972. The Ministry of Health integrated the RFPA into its department in 1981. In 1985, the family planning association became a parastatal and was renamed the Zimbabwe National Family Planning Council (ZNFPC). Services today are provided through 37 family planning clinics. The distribution of contraceptives includes IUDs, condoms, pills, and injectables. Harare and Bulawayo centers receive referrals and perform tubal ligation, vasectomy, and infertility counseling. 700 community-based distributors (CBDs) received a 6-week training course in order to educate about oral contraceptives, encourage their use, and screen clients for high blood pressure and side effects for oral contraceptives. CBDs use bicycles to make home visits and also have access to motorcycles. Each CBD averages 135 clients/month. Most visits are revisits. CBDs provided 25.3% of family planning in 1988. Local clinics provided 19.1% of family planning. Ministry of Health facilities provided 14.8% of services. ZNFPC clinics provided 13.7% of services. Private doctors or pharmacies provided 2.3% of services. 38% of women currently in a union used family planning in 1984, and 43% used it in 1988. 36% in 1988 used modern methods. The pill was the most common method, followed by withdrawal. Logistics of supplies and equipment remain problematic.     

全科医学培训需求分析

目的了解2000-2006年全科医学规范化培训学员的教育需求变化。方法采用自行设计的调查问卷调查2006年在我院参加上海市全科医师规范化培养的62名学员对全科医学规范化培养的认识及需求,并与2000年培训的53名学员的调查结果相比较。结果2000年培训的学员中,36％（19／53）认识全科医学（“六位一体”内容）、94％（51／53）愿意接受全科医学培训、57％（30／53）对社区工作不满意;2006年培训的学员对全科医学的认识、对培训的接受程度及对工作环境的满意程度均有提高,分别为100％（62／62）、100％（62／62）和98％（61／62）,但单位领导不重视仍是对社区工作不满意的主要原因。结论目前社区全科医生对全科医学教育需求有了很大提高,在有些方面还有待政策支持。     

北京市全科医生转岗培训学员状况及培训需求调查

目的了解北京市全科医生转岗培训学员状况、培训需求和影响培训的主要因素。方法采用问卷调查法和访谈法,对参加北京市第一批全科医生转岗培训的学员进行调查。结果 2010年参加北京市全科医生转岗培训在训学员共86人,发出问卷86份,回收80份,回收率为93.0%。城区、近郊区转岗培训学员学历和职称高于远郊区学员,注册全科医学范围人数仅占1.3%,最需要培训的技能为诊断与鉴别诊断,最需要培训的知识为常见病多发病的诊治。结论应进一步完善培训大纲,合理安排培训时间,结合全科医生工作特点开展培训。     

Impacts of Clinic-based Informed Choice Program on Quality of Individualized Counseling Service in China

Objective To evaluate the impacts of clinic-based informed choice program on quality of individualized service in family planning clinics in China。Methods During the program, family planning service staff in intervention clinics were trained on counseling skills and key points of individualized counseling service.Questionnaire surveys were conducted pre- and post-informed choice program to evaluate the impacts of the program.Results Informed choice program had significantly improved the quality of individualized counseling service. The multivariate regression analysis showed that clients of the clinic were more likely to give the better evaluation of the service, the OR of evaluation score of individualized service is 1. 712 (95% CI is 1. 146 to 2. 564) in Experiment Group of post-program in contrast with pre-program. The program also could satisfy individual needs of clients and increase the satisfaction degree of the service.Conclusions Informed choice program is helpful for the improvement of the quality of individualized counseling service. It is necessary and imperative to improve the skills of counseling service provided in family planning clinics.     

全科医学方庄社区培训基地教学模式探索

方庄社区卫生服务中心目前为全科医学教育培训基地,在近年针对不同类别学员的培训中,该基地充分结合自身条件,建立完整的社区教学网络,选取与培训全科医学专业教师;在具体教学实践中,确立基层实践专业培养目标,制定社区教学计划,合理安排培训进程,开展教师个人与集体备课、试讲与点评结合的授课前准备工作,并采用多种形式进行教学情况评价与学员学业评价。通过上述努力,该基地提高了社区教学水平,培养了一支适合社区的全科医学专业教师队伍,增强了受培学员的社区卫生服务能力,为社区培训基地教学模式探索提供了一定参考。     

Expanded services for intrauterine contraception in Sudan

Twenty nurse-midwives in government service in the Sudan (health visitors) were trained to provide intrauterine contraceptives in a research project designed to evaluate the safety of insertion of IUDs by medical personnel who are not physicians. After training, they inserted 763 IUDs. Independent evaluation of 520 clients was conducted by obstetrician-gynecologists who found that only six (1.2%) had been incorrectly inserted. Outcomes for clients of the health visitors with respect to perforations, infections, expulsions, and pregnancies compared well with those of eight physicians who participated in the study. The research strongly supports the concept of nurse-midwife training for IUD insertions which would greatly expand the availability of family planning services and would conserve physician time and skills for problem cases.     

How the Reproductive Health Needs of Unmarried Youth Be Concerned in Quality Services in Family Planning/ Reproductive Health？

Since the Cairo International Conference on Population and Development (ICPD) in 1994 and the Beijing World Women Conference in 1995, new thoughts and conceptions have been introduced to China’s family planning/ reproductive health (FP/RH). It is advocat…     

全科医师规范化培训教学法的实施与探讨

目的探寻在全科医师规范化培训中行之有效的临床教学方法。方法对学员进行培训前的基本理论知识和临床技能水平测试,设置一系列有针对性的培训项目,采用病例讨论、角色扮演法、模拟人操作实践等多种教学形式。通过对学员培训前后的基本理论知识和临床技能水平比较,评价教学方法的实施效果。结果根据学员培训前后的基本理论知识和临床技能水平的测试成绩进行比较,差异有显著性。结论以"因材施教"为原则的临床教学方法,使学员的整体水平在培训后有了显著提高,取得了较好的培训效果。     

Use of web based systems to support postgraduate medical education

BACKGROUND To meet the demands of delivering the Foundation programme across a geographically diverse country, two web based systems (ePortfolio and eLearning) were developed to promote accessibility to training material and assessment tools on standardised platforms. This study evaluated the use of both tools throughout an entire academic year. METHODS All Scottish Foundation trainees' online learning and assessment data in 2007/08 were analysed, providing a national breakdown of post specialty, completion rates of mandatory assessments (including summary analysis of anonymised scores), and trainees' use of non-mandatory learning tools. Independent verification of competence data was sought from Deaneries. RESULTS There were high levels of engagement with both the ePortfolio (75-97% assessment completion) and eLearning systems (89-98% induction course completion), and the majority of trainees completed all required elements. There was extensive use of ePortfolio beyond mandatory levels for recording of learning events, including almost 20?000 personal learning records submitted by second year trainees. There was evidence that ePortfolio was used to record achievement of clinical competence rather than to track improvements towards competence (median workplace based assessment scores were 'high' or 'very high'). Online learning modules received positive feedback and its flexible format suited the trainees' working environment. External verification of formal assessment data revealed good correlation with locally stored outcomes, both indicating approximately 99% programme completion rates. CONCLUSIONS Core components of the Foundation programme have been delivered successfully to thousands of trainees across Scotland using web based systems to deliver and support education and assessment. There is great potential for further exploration of this carefully managed, rich dataset at individual, regional, and national levels to inform the future of medical education.     

高温高湿环境下晕动病热习服消退后再建立所需时间的观察

目的 通过对已建立热习服但停止训练3个月达到退化状态的受试者再次进行高温高湿环境下系统训练,观察再次建立热习服的时间,探讨晕动病习服消退与再建立的规律。方法 29名已建立热习服的受试者,在经过停止高温高湿环境训练3个月后,再次在39℃与85%湿度的高温高湿环境下进行与建立期实验相同项目、相近强度的晕动病转椅吊转训练。结果 与建立期实验中受试者要经过30 d才能达到热习服相比,在同样的频次和强度下,27名(2人退出)受试者仅经过19 d即达到建立期实验训练后的热习服水平,晕动病热习服退化后再建立所需时间明显缩短。结论 受试人员热习服退化后再次建立热习服所需的训练时间比首次建立所需时间短。     

以工作场所为基础的干预对流动人口性与生殖健康咨询服务的影响

目的评估以工作场所为基础的干预对流动人口性与生殖健康咨询服务的影响。方法多阶段整群抽取上海市闵行区流动人口集中的工厂、建筑工地、服务娱乐场所,随机分为干预组和对照组。通过倡导、动员,管理,培训,计划生育宣传教育服务,性与生殖健康咨询服务,避孕节育技术服务,随访服务,转诊机制等干预活动对研究对象进行避孕节育、生殖健康综合服务干预。应用,及有序多分类Logistic回归分析等方法对其影响进行分析。结果本研究基线共调查2001人,评估调查时随访到有效样本1791人（失访率10．49％）。基线调查时,对照组和干预组对象接受过咨询服务的比例分别为16．65％、17．82％,两组比较差异无统计学意义（P〉0．05）;评估调查时,干预组对象接受过咨询服务的比例为36．77％,高于对照组的17．69％,差并有统计学意义（P〈0．05）。多因素Logistic回归分析结果显示干预促进了流动人口接受性与生殖健康咨询服务,近似值差异率（odd ratio,OR）为2．802,95％可信区间为（2．190,3．584）。基线调查时对照组和干预组有咨询服务需求的比例分别为63．87％、66．93％;评估调查时分别为65．27％、67．14％,两组相比较差异均无统计学意义（P〉0．05）,多因素分析也显示干预对研究对象的咨询服务需求没有显著性影响。结论干预项目取得一定成效,促进了流动人口接受性与生殖健康咨询服务的比例,但仍未满足需求。今后需要加强对流动人口性与生殖健康相关的咨询服务。     

北京市某社区卫生服务中心医务人员进修现状分析

背景　进修学习是医务人员提高医疗质量的途径，在基层进修学习有助于对社区卫生服务中心医务人员进行有针对性的培训和指导，且进修机构通过统计分析进修人员的学习情况，有助于总结经验、设计更好的进修课程。目的　统计2016-2019年首都医科大学附属复兴医院月坛社区卫生服务中心医务人员总体进修情况，为今后合理设计进修程序、提高进修医师专业水平、更好地因材施教提高进修效果提供借鉴。方法　收集2016年3月-2019年7月于首都医科大学附属复兴医院月坛社区卫生服务中心进修的人员资料（n=67），主要包括进修情况（包括每批次进修人员数目及进修时间、来源地区、单位、费用情况）、进修人员信息（包括进修人员的性别、年龄、职称、所在科室、职务）、进修安排（包括进修人员拟进修科室、实际进修科室、实际进修科室数量）。采用小组访谈法，对2019年7月在首都医科大学附属复兴医院月坛社区卫生服务中心进修学习的7名进修人员进行访谈，访谈内容主要包括此次进修课程安排必要性、课程内容等方面。结果　2016年3月-2019年7月首都医科大学附属复兴医院月坛社区卫生服务中心共接收进修时间≥5 d的进修人员33批次，批次进修人数为1人共21批次，占63.6%；进修时间以<30 d为主，共计15批次（45.4%）；20批次（60.6%）为非北京地区进修人员；进修人员单位以社区卫生服务中心（站）为主〔16批次（48.5%）〕；免费进修24批次（72.7%）。进修人员以女性为主〔39人（56.5%）〕、年龄集中在30~40岁〔37人（53.6%）〕；职称以中级职称〔31人（44.9%）〕为主，所在科室以全科和管理为主，分别为21人（30.4%）和16人（23.2%）；职务以无职务〔43人（62.3%）〕为主。进修人员拟进修科室排在前3位的依次为全科〔30人（46.4%）〕、管理〔14人（20.3%）〕、护理和康复（分别为9人，分别占13.0%），实际进修科室排在前3位的分别为全科〔41人（59.4%）〕、保健〔27人（39.1%）〕和管理〔25人（36.2%）〕。在实际进修科室数量方面，每人进修科室为1~4个，进修1个科室者最多〔32人（46.4%）〕，进修2个科室者次之〔17人（24.6%）〕。在课程安排必要性上，6人持“很需要”态度、1人持“需要”态度，7人对讲课教师满意度评价为“很满意”。7人均对课程内容感兴趣。结论　首都医科大学附属复兴医院月坛社区卫生服务中心进修批次多、进修需求大，进修人员以中级职称和无职务为主，在实际进修科室数量方面，每人进修科室为1~4个，进修1个科室者最多；进修人员对进修满意度高。但也存在进修流程更新滞后等问题，需进一步优化流程以保证科学的培训、规范化的管理、高质量的教学。     

百色市医务人员的遗传咨询态度与地中海贫血预防

目的　评价百色市医务人员对地中海贫血(简称地贫) ,基本知识和遗传咨询水平和地贫预防情况以及培训后的效果。方法　对5 60名医务人员进行地贫基本知识讲座、提供地贫筛查的基本方法并建立地贫控制基层网点、制定控制地贫的基本流程、给全体临床一线医护人员发放地贫科普小册子、设立地贫专家组咨询电话随时回答基层医务人员的问题,在培训前后进行地贫问卷调查。观察培训前后医务人员地贫基本知识及态度的基线答对率、医务人员咨询作用促进的产前诊断及其效果等。结果　培训前地贫基本知识及其态度的基线答对率为5 8%±10 % ;培训后答对率为88%±8% ,χ2 =5 .41,P <0 .0 5。培训后医务人员遗传咨询作用促进的产前诊断例数比培训前提高了3 7% ,年均增加了4例(P =0 .0 43 )。每2 .7例产前诊断就有1例是由于培训后的医务人员咨询作用促成,避免了4例重型地贫儿的出生。结论　通过对各级医务人员的培训,提高医务人员地贫基本知识和遗传咨询水平,以及对高危地贫胎儿的产前诊断,避免重型地贫儿的出生。     

全科住院医师规范化培训考核体系的应用与评价研究

背景　近年来我国全科住院医师规范化培训的开展初见成效，黑龙江省全科住院医师规范化培训历经4年时间，逐步建立了较为系统的考核评价体系，通过分析问题、总结经验，使其更加适应黑龙江省全科医生的人才培养需求具有重要意义。目的　对2014年以来全科住院医师规范化培训考核评价体系工作进行回顾性分析，发现问题并制定措施，逐步完善全科住院医师规范化培训考核评价标准和办法，使其更加适应规范化培训的需要。方法　选取2014年9月-2019年5月，参加哈尔滨医科大学附属第二医院全科住院医师规范化培训的100例住院医师为调查对象。对3年来学员参加的各项考核成绩进行统计，并采用“全科住院医师规范化培训考核评价管理办法满意度调查问卷”对现行考核评价体系进行评价。结果　共95例参与全科住院医师规范化培训的学员被纳入调查，其中2015级41例，2016级30例，2017级24例。2015、2016级学员在连续3年的年度考核中第1次不通过者，参加2次补考，最终通过率均为100.0%。2015级学员结业考试通过率为88.6%（31/35），2016级学员结业考试通过率为100.0%（30/30）。调查问卷13个条目平均得分2.5~4.0分。满意度最高的2个条目为“有助于对临床基本技能与实践操作的考查”（4.0分）和“对促进全科医学临床思维有帮助”（4.0分），满意度最低的2个条目为“有助于对科研能力的考查”（2.5分）和“能够客观地评估住院医师的综合能力”（2.9分）。结论　现行的考核体系可行性好、学员接受度高。未来还需重视科研能力和住院医师的综合能力评价，进一步完善考核评价标准体系。     

整合医学教学模式在急诊医学住院医师规范化培训中的应用

目的探讨整合医学教学模式在急诊医学住院医师规范化培训中的教学效果。方法选取蚌埠医学院第一附属医院急诊医学住院医师规范化培训基地学员50名,随机分为观察组和对照组,各25名。对照组采用传统教学法,观察组采用整合教学法。采用问卷调查和实践技能考核相结合的方法进行综合评价。比较2组学员临床技能考核结果和教学效果满意度评价。结果观察组学员清创缝合术、洗胃术、气管插管术、留置鼻胃管术、心肺脑复苏术、病例分析能力得分均明显高于对照组(P < 0.01)。观察组学员健康意识、急救技能、科研创新能力、沟通能力、问题解决与分析能力、知识掌握程度、激发学习兴趣、提高临床思维能力方面教学效果满意度评分均明显高于对照组(P < 0.01)。结论在急诊医学住院医师规范化培训中采用整合医学教学模式有助于提高学员的科研创新能力、急救技能、知识掌握程度、沟通能力和临床思维能力,教学效果明显提升。     

标准化病人在全科住院医师接诊技能培训中的应用

目的评价标准化病人（standardized patients,SP）在全科住院医师接诊技能培训中的作用。方法采用sP对2008年5月至7月上海市全科医师规范化培训的52名全科住院医师的接诊技能进行评价,其中SP评估内容为临床技能（包括病史采集、体格检查）;教师评估内容包括临床技能（病史采集和体格检查）、临床思维（诊断、鉴别诊断和治疗计划）、健康教育、门诊病史书写和接诊时间控制5个方面。随后SP对住院医师接诊技能反馈指导,教师针对住院医师在接诊中的问题进行授课、小组讨论等形式的培训。2个月后再次采用SP进行接诊技能的评价,比较2次接诊评分和合格率。结果培训后SP对住院医师接诊临床技能评分的合格率高于培训前（88．5％比46．2％,P〈0．01）。教师对其评分的合格率也高于培训前（86．5％比51．9％,P〈0．01）,其中培训后临床技能和健康教育合格率均高于培训前（分别为80．8％比46．2％,88．5％比67．3％,均P〈0．01）;临床思维、病史书写和接诊时间控制合格率培训前后差异无统计学意义（分别为71．2％比51．9％,100．0％比100．0％,100．0％比100．0％,均P〉0．05）。结论采用SP能较好地提高全科住院医师临床接诊技能能力,尤其是在病史采集、体检方面,但在临床思维方面尚有待提高。     

住院医师基础生命支持课程的探索

目的通过对住院医师开展基础生命支持课程的总结,探讨心肺复苏术的规范化培训途径。方法对参加基础生命支持课程规范化培训的住院医师59人进行笔试和操作考核,培训结束后填写满意度问卷调查。结果 100%的住院医师认为开展该课程很有意义。住院医师心肺复苏基础知识和技能考核的合格率均超过90%。结论制定并实施规范化培训课程,将可以提高心肺复苏培训的效果。     

上海市全科医师师资培训中心学员反馈调查

目的 通过对上海市全科医师师资培训中心学员的反馈意见的调查,为完善全科师资培训工作提供依据.方法 采用自行设计的调查问卷,整群抽取2012年4月17-20日第23期全科师资培训班的171名学员进行调查,分析培训课程及内容设置的合理性.结果 共回收170份有效问卷,其中86人（51％）认为培训课程安排非常恰当,76人（9％）认为安排恰当;97人（57％）认为培训形式非常生动,65人（38％）认为较生动;学员对教师的总体评价分为4.64分;170人中93人（55％）表示很愿意参加培训,70人（41％）表示愿意;156人（92％）最希望学习医学新进展,111人（65％）最希望学习教学技能和全科理论知识;32人（19％）认为培训内容与学员的需要完全符合,129人（76％）认为大部分符合;82人（48％）认为收获很大,80人（47％）认为收获较大;147人（86％）认为培训开阔了思路,104人（61％）认为提高了临床诊治能力;53人（31％）认为提高了理论水平;87人（51％）对本次培训的总体评价很满意,75人（44％）较满意.结论 海市全科医师师资培训中心的培训计划及课程设置基本合理,经过培训学员收获较大.     

Job-sharing in paediatric training in Australia: availability and trainee perceptions

OBJECTIVE: To examine the current availability of job-sharing in paediatric training hospitals in Australia and to evaluate job-sharing from the trainees' perspective. DESIGN: National survey with structured telephone interviews and postal questionnai res. SETTING: The eight major paediatric training hospitals in Australia. PARTICIPANTS: Directors of Paediatric Physician Training (DPPTs) at each hospital (or a staff member nominated by them) provided information by phone interview regarding job-sharing. All paediatric trainees who job-shared in 1998 (n=34) were sent written questionnaires, of which 25 were returned. RESULTS: Hospitals differed in terms of whether a trainee was required to give a reason for wishing to job-share, and what reasons were acceptable. One hospital stated that two specialty units (Intensive Care and Neonatal Intensive Care) were excluded from job-sharing, and another stated that certain units were unlikely to be allocated job-sharers. The remaining six hospitals said that all units were available for job-sharing, but the majority of their trainees disagreed. Only one hospital had a cap on the number of job-share positions available yearly. Trainees perceived benefits of job-sharing to include decreased tiredness, increased enthusiasm for work, and the ability to strike a balance between training and other aspects of life. Trainees believed job-sharing did not adversely affect the quality of service provided to patients, and that part-time training was not of lower quality than full-time training. CONCLUSIONS: Job-sharing in Australian paediatric training hospitals varies in terms of the number of positions available, eligibility criteria, and which units are available for job-sharing. In our survey, trainees' experience of job-sharing was overwhelmingly positive.     

全科医师规范化培训的回顾分析

目的对我院全科医师规范化培训的实践工作进行回顾,分析培训计划的实施效果和学员反馈意见,提出培训中存在的突出问题和可行的改进措施。方法依照《上海市全科专科医师规范化培养细则》标准,制定和实施培训计划,对学员成绩和反馈意见进行分析。结果新华医院9名2006级学员经过3年培训,全部通过国家执业医师资格考试和上海市卫生局统一组织的毕业考核,合格率为100%。28名2006、2007级学员中,认为在临床基地实践中能接触到更多病种26人（92.9%）、获得更多临床操作机会21人（75.0%）、培养良好诊疗思路20人（71.4%）;认为在社区实习基地实践中有利于医患沟通能力的培养19人（67.9%）、更贴近全科医师的实际工作17人（60.7%）。认为对社区工作帮助最大的理论学习内容是：社区常见病多发病的诊断与鉴别诊断23人（82.1%）、急诊医学及双向转诊23人（82.1%）、社区合理用药21人（75.0%）。20人（71.4%）认同临床基地带教老师有必要在带教前接受全科师资培训或短期下社区熟悉工作。78.6%的学员愿意向他人推荐全科医师规范化培训。结论制定和实施适合全科医学教育特点的培训计划是行之有效的。随着受训学员的逐年增加,加快师资队伍建设尤为重要,特别是在社区实习基地显得更加迫切。