无锡市麻醉科专业住院医师规范化培训结业临床技能考核分析

目的：分析麻醉科专业住院医师规范化培训结业临床技能考核结果,探讨麻醉科专业住院医师培训方式。方法：分析无锡市麻醉科专业住院医师结业临床技能考核结果。结果：2013~2016年临床技能考核通过率为91.45%,不同学历、不同级别医疗机构的麻醉科专业住院医师考核结果差异无统计学意义（P＞0.05）。临床技能考核成绩均比检查判读和检验报告分析高,差异有统计学意义（P＜0.05）。结论：麻醉科住院医师检查判读和检验报告分析能力不理想,综合能力待提高。     

妇产科住院医师第一阶段临床技能考核分析

自2004年北京地区开始推行住院医师第一阶段临床技能考核工作以来,每年由北京市卫生局科教处委托北京医学教育协会布置考核工作,由临床技能考核中心承担具体考核工作.考核目的是科学有效地评价住院医师的临床能力.我院自2004年开始,承担北京地区妇产科住院医师第一阶段临床技能考核任务.现对2006年至2010年妇产科临床技能考核资料进行分析总结,以寻求科学合理的考试、考核方法,比较被北京市卫生局认可为合格或基本合格的妇产科普通专科培训基地(以下简称基地)和未被北京市卫生局认可为妇产科普通专科培训基地(以下简称非基地)培训住院医师考核结果的差异性,探讨研究生毕业的住院医师纳入培训年限等问题.     

硕士研究生住院医师规范化培训的实践与成效分析

目的实施硕士研究生住院医师规范化的临床培训,提高住院医师的业务素质与临床技能。力弦探讨硕士研究生住院医师临床培训的运行机制与模式,利用统计描述法对培训成效进行分析。结果2006-2008年度,203位硕士研究生住院医师的阶段培训考核合格率高于80％：品德素质、理论知识、技能操作、病历质量、临床教学与科研能力等指标均达到培训要求。结论明确硕士研究生住院医师规范化培训的目标,探讨适宜的培训运行机制与模式,对实现住院医师规范化培训有积极意义。     

临床技能中心在住院医师临床能力培养中的应用

目的：探讨临床技能中心在住院医师临床能力培养中的作用,为临床教学医院临床技能中心建设提供经验总结。方法：采用便利抽样法,对68名2009届住院医师行临床基本技能操作培训考核工作,并对考核结果做统计分析。结果：考核合格率达77.9%（53/68）,本科组高于研究生组;不同工作时间者其考核得分有差别,经dunnettt检验组间比较：＂无工作经历＂组考核成绩高于＂工作1～3年＂组（P〈0.05）。结论：临床技能中心对于住院医师临床基本操作技能的培养和提高有重要作用,是提高住院医师临床能力的有效途径。     

住院医师体检技能缺陷分析与对策

体检技能是住院医师最重要的专业技能和临床基本功之一,体检技能水平的高低在一定程度上反映了住院医师的实际工作能力,成为医院考核住院医师“三基”水平的重要内容。近年来,国家、军队卫生行政部门相继制定了住院医师规范化培训方法,将体检技能培     

妇产科住院医师第二阶段临床技能考核分析

目的 探讨妇产科住院医师第二阶段考核方式的合理性、科学性,比较二级与三级医院、基地与非基地、不同学位层次考核结果的差异性,为科学地进行住院医师培训提供了一定的依据.方法 对参加妇产科第二阶段临床技能考核的人员及考核结果进行分析及统计学处理.结果 从考核通过率、妇科肿瘤和产科病历分析及辅助检查单项成绩比较可以看出,硕士、博士高于学士,基地高于非基地,三级医院高于二级医院.结论 妇产科住院医师第二阶段技能考核基本覆盖北京地区的医院.普通妇科、妇科肿瘤、产科病历分析及辅助检查的考核方式有效,能够反映住院医师的临床能力水平,针对住院医师培训的薄弱环节,非基地住院医师应有选择地进入基地进行培训.     

住院医师体检技能缺陷分析

体检技能是住院医师最重要的专业技能和临床基本功之一，体检技能水平高低一定程度上反映了住院医师实际工作能力，成为医院考核住院医师“三基”水平的重要内容。近年来，国家、军队卫生行政部门相继制定了住院医师规范化培训方法，将体检技能培训纳入了继续医学教育轨道...     

持续质量改进应用于住院医师临床能力考评

目的探讨持续质量改进对提高住院医师临床能力考评效能的具体应用与收效。方法采用计划-实施-检查-处理（PDCA）循环应用的持续质量改进方法,改进住院医师临床能力考评效能。结果通过调查问卷、教学联席会等发现影响临床能力考评的主要问题包括临床实践机会少、考核形式较单一、评分标准不一致、人文观念欠缺等;通过开放临床技能中心、细化考评标准、多元化考评模式的应用、强化人文医学等方法,提高临床能力考评的效度与信度;一系列改进措施实施后再通过问卷调查评估质量改进效果,总结并提出质量改进方案。结论持续质量改进能有效提高住院医师临床能力考评效能,是一种实用、有效的方法,值得推广应用。     

上海市住院医师规范化培训十年评估

搜集了上海市住院医师规范化培训的有关文件与资料,并对该项培训的市级管理者进行了访谈,在此基础上对上海市16所二级医院与16所三级医院住院医师和管理人员进行了问卷式调查,对上海市住院医师规范化培训进行了十年评估。上海市十年间住院医师规范化培训重在规范、重在能力培训、重在实效、重在低成本高效果,取得了一定的成效。但上海市住院医师规范化培训还需进一步加强临床能力的培训和考核;进一步研究二级医院二级学科住院医师赴三级医院培训的合理性;政策仍需配套,以全力推进育人工程;并应开展对临床研究生进行临床技能规范化培训的研究。     

绩效考核在住院医师规范化培训中的作用

目的：探讨绩效考核在住院医师规范化培训中的作用。方法：以我院在培住院医师规范化培训学员66人为研究对象,比较绩效考核革新前后的学员绩效收入满意度、临床理论知识和技能操作考核评分、住院病历评分等。结果：绩效考核革新后,住培学员对学员收入满意度、临床理论知识和技能操作考核评分、住院病历评分显著高于绩效考核方案革新前,差异均具有统计学意义（p＜0.05）。结论：绩效考核有助于提高住院医师规范化培训学员工作积极性,提高住院医师规范化培训的质量,具有一定的推广价值。     

Evaluation of interns by senior residents and faculty: is there any difference?

INTRODUCTION: Both senior residents and faculty members evaluate family practice interns (PGY-1) on the inpatient family medicine service at the University of Missouri-Columbia. The purpose of this study was to investigate the content and nature of narrative comments on a clinical evaluation sheet. METHODS: Objective 1. The authors placed the subjective comments made by faculty and senior residents in their evaluations of PGY-1 residents into 12 distinctive categories. Objective 2. Comments were coded with a positive or negative valence. Objective 3. The genders of the evaluator and learner were recorded. RESULTS: All evaluations made between 1996 and 1999 were analysed. A total of 1341 individual comments were reviewed. Objective 1. Categories used most often were generic comments (20.2%), personal attributes (18%), and clinical competence (14.1%). There was no difference in category use based on the experience level of the evaluator (P = 0.17). Objective 2. The majority of the comments (81.9%) were positive in nature. Senior faculty members were significantly less likely to make negative comments than were junior faculty members or senior residents (P = 0.004). Objective 3. There were no differences in category use based on the gender of the evaluator (P = 0.13). CONCLUSIONS: Objective 1. Narrative evaluation comments may be placed into 12 distinctive categories. Most comments are generic and do not help to inform learning. Objective 2. A total of 82% of comments were positive. Residents were more likely to make negative comments than senior faculty members. Objective 3. There was no demonstrable gender bias in writing negative comments.     

Characteristics of ratings of physician competence by professional associates.

Although the evaluation of medical students and residents frequently includes the use of global ratings scales as measures of clinical competence, few studies have investigated the use of global ratings in evaluating the performance of practicing physicians, or the psychometric properties of these ratings. In this article, the characteristics of ratings of physician competence by professional associates are described, using practicing internists as the subjects for the study. Ratings of nine aspects of clinical competence for 210 internists were obtained from four physician associates with whom patient care had been shared. The results suggest that ratings of physicians' clinical competence by professional associates are both reliable and potentially useful in identifying physicians with low performance. Studies are needed to clarify further the psychometric properties of peer ratings, and to determine factors that affect these ratings.     

Facing the challenges of competency-based assessment of postgraduate dental training: Longitudinal Evaluation of Performance (LEP)

CONTEXT: The evaluation of competence in the health professions is of great importance to the public and professionals alike. Recent efforts to design dependable and accurate systems of assessment for demanding clinical roles are increasingly attempting to focus on all-round competence of practitioners. Many challenges are faced in this field as a balance between robust assessment methodology and feasibility in practice is crucial to implementation and adoption. OBJECTIVES: The authors discuss some of the challenges faced by educators and clinicians involved in the development of systems of assessment for the health professions, and describe a method which aims to address these issues in the assessment of postgraduate dental training in Scotland. DISCUSSION: Three of the major challenges facing educators and clinicians involved in the design of competency-based systems of assessment are considered: the requirement for evaluation in different areas of competence; the importance of association of assessment with the training objectives, and the types and focus of the assessment introduced. Issues around the use of formative and summative assessment, and the perception that these must always remain completely separate, are discussed in detail. SOLUTIONS: A proposal is made for the introduction of a method of assessment which has been designed keeping these challenges in mind. The rationale behind this assessment method is described.     

Critical performance analysis of rotating resident doctors in Iraq

The present study was undertaken to evaluate the competence of rotating residents in handling clinical problems, falling under the purview of the major clinical disciplines, which they come across during their routine work. Three hundred and one rotating residents (55% of the total) who graduated in June 1981 from the four universities of Iraq, namely, Mustansiryia, Basrah, Mosul and Baghdad, and were currently undergoing their residency posting in the various hospitals of Iraq were selected for the study. Two approaches were used to assess the level of competence: first, on the basis of the resident's responses to fifty simulated patient-management problems and, secondly, their critical performance in patient care adjudged by their respective supervisors. A minimum passing level (MPL) was fixed for patient management problems (PMP). The score for the consultant's observations could range from -70 to +100 to represent the very poor and the very good performance. Only 2% of the residents were found to have reached the minimum pass level of competence taking their overall performance in the various disciplines. No significant variation in performance was observed in relation to the university of graduation. None of the residents could reach the MPL in the case of obstetrics and gynaecology. In the case of medicine and medical emergency the findings were almost similar. The residents put up a much better performance in orthopaedics and paediatrics (45.0% and 27.5% respectively). According to the supervisors' assessment nearly two-thirds of the residents secured at least 50% of the maximum score. The study underscores the need to redefine our educational objectives specifically, with aim of developing competences at a defined level in the learner befitting the needs of the health system through a competency-based curriculum.     

Impact of formal family planning residency training on clinical competence in uterine evacuation techniques

BACKGROUND: The goal of this study was to assess the impact of formal opt-out family planning training on clinical competence in uterine evacuation. STUDY DESIGN: Residents who participated in newly established, routine opt-out family planning training completed surveys before and after their rotations. The surveys asked residents to report clinical experience and competence in family planning. RESULTS: One hundred ninety-six pre- and postrotation questionnaires were collected for a total response rate of 63%. After completing the rotation, residents reported higher competence in medical abortion, manual uterine aspiration, electric uterine aspiration and dilation and evacuation (p<.001). Residents also reported increased clinical experience with methods of termination, postabortion contraception, including intrauterine contraception, ultrasound and perioperative pain management. CONCLUSIONS: Participation in a formal opt-out family planning rotation results in increased clinical exposure to family planning and in reported competence in pregnancy termination.     

Home making and community building: Notes on empowerment and place

The authors warn that some supportive housing development is creating a new generation of quasi-institutional settings, and they believe that developing units of housing is not as important as enabling each person to create a personalized home. A variety of processes for cocreating environments and social settings are proposed that will result in empowerment-oriented supportive housing programs. Such efforts require new staff roles and innovative techniques. Anticipated outcomes include improved self-identity and self-esteem, increased social status and a sense of security, increased residential stability due to improved person/environment fit, and improved personal competence among residents.     

基于疾病诊断相关组的医院内专科评价指标探讨

目的通常疾病诊断相关组(DRGs)指标用于评价综合医院的能力,当用于医院内部评价时,因专科差异较大,现有指标不宜直接用于临床专科比较。本文拟探讨DRGs指标体系应用于医院内评价的问题,并提出专科能力指数及其计算方法。方法以某院2018年DRGs分组结果及该院所在省份DRGs数据,论证现有DRGs指标体系应用于医院内专科评价存在的问题,并提出新评价指标——专科能力指数以对临床科室进行比较与评价。结果新指标能有效地弥补DRGs指标体系在医院内评价临床科室时存在“不可比”的问题,能在一定程度上反映临床科室的专科能力。结论基于DRGs的专科能力指数不仅使得各临床科室具有可比性,且能在一定程度上反映临床科室的医疗服务综合能力。     

Nurse assistant mental models, sensemaking, care actions, and consequences for nursing home residents

In a nursing home case study using observation and interview data, the authors described two mental models that guided certified nurse assistants (CNAs) in resident care. The Golden Rule guided CNAs to respond to residents as they would want someone to do for them. Mother wit guided CNAs to treat residents as they would treat their own children. These mental models engendered self-control and affection but also led to actions such as infantilization and misinterpretations about potentially undiagnosed conditions such as depression or pain. Furthermore, the authors found that CNAs were isolated from clinicians; little resident information was exchanged. They suggest ways to alter CNA mental models to give them a better basis for action and strategies for connecting CNAs and clinical professionals to improve information flow about residents. Study results highlight a critical need for registered nurses (RNs) to be involved in frontline care.     

清远市医院临床科主任胜任力模型研究

目的 构建清远市医院临床科主任胜任力模型。方法 通过对清远市20名医院临床科主任的行为事件访谈获得效标样本的胜任特征数据,并评价编码效果。通过对绩优组和绩平组的差异性检验,获得鉴别胜任特征。通过“胜任特征核检表”获得共有胜任特征。结果 绩优组和绩平组在访谈时间和访谈文稿长度比较,不存在显著差异;行为事件访谈文稿的编码信度较高,编码得到的胜任特征信度较好;确立了鉴别性胜任特征,包括成就取向、关注质量与秩序、主动性13项;确立了基准胜任特征,包括竞争意识、诚信正直、纪律意识等11项。结论 建立清远市医院临床科主任胜任力模型,为清远市医院临床科主任的能力评价提供了客观标准。