逐步完善我国外科住院医师规范化培训质量和进程的思考与展望

外科住院医师规范化培训是毕业后医学教育中极为重要的组成部分,是医学毕业生成长为一名具备独立、正确、规范地处理临床常见问题能力的外科医师的必由之路,是培养同质化临床医师、加强医学人才队伍建设、提高医疗卫生水平和质量的治本之策。自2013年底在全国范围内启动和实施以来,取得了较大的成绩,也暴露了一些问题,面临着新的挑战和考验。尤其在微创外科蓬勃发展的今天,积极推动青年外科医师学习腹腔镜技术的同时,更不能忽略传统外科基本技能的培训和严格训练的教学精髓,而将互联网带来的一系列变革和突破充分应用于住院医师的临床教学和规范化培训管理系统的构建,也将成为未来医学教育的创新模式。     

心血管外科住院医师规范化培训的探索与实践

［摘要］ 本文目的为进一步规范心血管外科住院医师规范化培训和提高规培质量提供借鉴。依据住院医师规培的总体要求，结合心血管外科专业性强，对规培医师实践能力要求高的特点，通过强化制度落实、优化师资配备、注重“三基”训练，改进带教方法、加强人文医学技能培训等方面着手，从实践中探索出一套优化的住院医师规范化培训策略。通过上述方法的改进和实施，调动了带教老师的积极性，取得了很好的教学效果，受到了规培医师的欢迎。从多层面着手，综合制定针对性的规培措施，可显著提高心血管外科的住院医师规范化培训质量。     

我院住院医师规范化培训实践与体会

住院医师培训工作是加快卫生人才队伍建设,提高临床医师队伍整体职业素质,促进医疗质量持续改进,保障患者安全的重大措施.住院医师培训工作不仅关系到一个医院的生存和发展,而且关系到整个医疗卫生服务行业的健康稳定发展.本文介绍了我院住院医师规范化培训工作的具体做法及体会,现总结如下:     

外科住院医师基本技能培训调查与分析

目的 调查外科住院医师规范化培训学员参与基本技能培训的现况。方法　2020年7月对在复旦大学附属中山医院接受外科住院医师规范化培训的学员参与外科基本技能培训的情况进行问卷调查。结果 共回收有效问卷87份，其中73名（83.9%）受访者参加过至少一项培训。非博士研究生学历以及接受第1年培训的受访者对培训表现出较高的参与度。非博士研究生学历的受访者参加外科吻合器械使用基础培训的比例显著高于博士研究生学历的受访者（P<0.05），而接受第1年培训的受访者参加外科缝合基础培训和腹腔镜手术基础培训的比例均显著高于接受第2、3年培训的受访者（P<0.05）。受访者评价最高的培训课程是外科能量器械使用基础培训。博士研究生学历受访者对外科缝合基础培训的评价明显高于非博士研究生学历受访者（P<0.05），接受第2、3年培训的受访者对外科能量器械使用基础培训的评价明显高于接受第1年培训的受访者（P<0.05）。92.0%（80/87）的受访者认为影响自己参加培训的最主要原因是“工作太忙，没有时间”，60.9%（53/87）的受访者希望培训课程安排在“工作日白天”。受访者普遍认为培训课程的实用性最为重要。博士研究生学历受访者比非博士研究生学历受访者更重视培训的先进性（P<0.05），而参加过培训的受访者比未参加过培训的受访者更重视培训的系统性（P<0.05）。结论 临床技能培训应充分考虑学员的不同资历背景和实际需求，差异化设计课程，合理安排培训时间；同时，课程内容应坚持实用性，将系统性贯穿始终。     

腹腔镜模拟培训在外科住院医师规范化培训中的应用

目的:探讨腹腔镜模拟训练在外科住院医师规范化培训中的应用效果。方法:选取2018年12月至2019年11月进行腹腔镜模拟培训的外科住培医师57人次,共举办三期培训班。培训内容包括在腹腔镜模拟器下缝合、打结、剪纸环、拾豆转移等项目,分别测试外科住培医师在三期腹腔镜培训后上述4项技能的完成效果。结果:三期腹腔镜模拟培训班均顺利完成,达到预定的培训目标。培训前后住院医师完成缝合、打结、剪纸环、拾豆转移4项技能的时间少于培训前,差异均有统计学意义(P<0.05)。结论:规范化的腹腔镜模拟培训符合腹腔镜手术的特点,可提高外科住培医师的腹腔镜培训效果,值得推广。     

重视外科住院医师规范化培训学员科研能力培养

随着现代外科的发展,要求外科住院医师成为临床与科研紧密结合的复合型人才。除了需要具备扎实的临床理论知识、熟练的临床手术技能外,还需要具有严谨的科研能力。调查外科住培医师的科研现状发现了一系列的问题,如外科住培医师自身对科研培训的意识度薄弱,缺少合适的平台和引领,科研氛围感缺失,使得住培医师的科研培训工作很难开展。针对上述问题制定相应解决方案,包括培养住培医师科研选题能力、重视高质量临床研究、依托培训基地所属院校研究所搭建合作平台、推行临床科研"双导师"制、采用多元化教学模式和完善住培医师的科研考核标准,力求提升外科住培医师科研能力和素养,为住培医师的个人全面发展和医院学科建设奠定一定的基础。     

上海市普通外科专科医师规范化培训实践探索和经验总结

目的分析2013—2021年上海市普通外科专科医师规范化培训(简称专培)的开展情况。方法回顾性分析2013—2021年上海市各家医院普通外科专培基地的基本情况、床位数、带教师资情况、招录和结业人数以及结业考核通过率,对比上海市和全国普通外科试点专培的轮转培训时间和计划。结果截至2021年11月,上海市共有14家医院具备上海市或全国普通外科专培基地,均为三级甲等医院,平均床位数为283张,共有中国医师协会认定带教医师204名;完成9批专培医师的招录,共招录401名,轮转培训时间为3年,共结业297名,结业综合考核中第三阶段考核在2016、2017、2019年均未达到100%的通过率。同期,全国普通外科试点专培完成3批专培医师的招录,共招录190名。结论现阶段上海市普通外科专培基地所在医院均具备较好的培训保障和师资条件,并能顺利完成为期3年的轮转计划。采用"三段式"的考核模式能较好地反映经过培训后专培医师的5项核心能力,上海市普通外科专培的培训、管理和考核方式能为全国普通外科专培提供良好的模板和示范。     

妇产科住院医师规范化培训实行导师制的效果分析

目的探讨妇产科住院医师规范化培训中实施导师制是否可以增强临床教学效果。方法纳入2010年9月~2018年9月我科接受规范化培训住院医师84人,其中有导师组54人,无导师组30人。回顾性分析评估2014年后应用导师制的教学效果。结果有导师组轮转出科考核总成绩(93.5±3.0)分,显著高于无导师组(89.8±4.8)分(t=-5.922,P=0.000)。与无导师组比较,有导师组病史采集成绩[(4.4±0.6)分vs.(4.2±0.4)分,t=-2.561,P=0.011]、体格检查+病历书写成绩[(9.1±0.7)分vs.(8.4±0.9)分,t=-5.610,P=0.000]、临床思维考核成绩[(13.2±1.1)分vs.(12.0±2.2)分,t=-4.574,P=0.000]和临床技能操作成绩[(18.3±1.2)分vs.(16.4±2.1)分,t=-7.113,P=0.000]均有显著提高。北京市住院医师规范化培训一阶段通过率2015、2016年(无导师住院医师)分别为62.5%(5/8)和66.7%(8/12);2017、2018年(有导师住院医师)通过率均为100.0%(9/9)。导师制前非在读研究生住院医师发表科研文章数量为0,导师制后每年为1~2篇。结论妇产科住院医师规范化培训实行导师制教学模式明显改善临床教学效果,提高出科考试成绩、一阶段临床能力考核通过率,同时增强临床科研能力和科研产出。     

住院医师规范化培训中非临床知识技能科目设置的探讨

本文介绍了我院住院医师规范化培训的基本模式,对住院医师培训中非临床知识技能科目的设置进行了分析与思考.规范化培训不仅仅是对医师临床知识及技能的训练培养,一些非临床的内容如职业道德、医学相关法规、科研能力及教学带教能力的培养等对于一个合格的医师同样十分重要.     

The state of residency training in female pelvic medicine and reconstructive surgery

To evaluate the state of resident training in female pelvic medicine and reconstructive surgery, the American Urogynecology Society (AUGS) education committee surveyed obstetrics and gynecology program directors on resident training and competence in performing common urogynecologic surgical and office procedure skills. One hundred thirty-two programs (50%) responded. Programs averaged 9 weeks of pelvic floor rotations during residency training. Program directors reported that 77% of residents could independently do some type of anti-incontinence procedure, but only 58% could independently perform apical vaginal support procedures. In 85% of the programs, residents could perform without help only four out of ten urogynecological procedures identified as procedures that residents should be able to do independently by the Council for Resident Education in Obstetrics and Gynecology and AUGS’ guidelines.     

Impact of a surgical oncologist on general surgery residency training program

BACKGROUND: To assess the impact of adding a surgical oncologist to our faculty we examined the operative experience in our program before and after the addition. METHODS: Operative case numbers reported to the American Board of Surgery over a 10-year period were analyzed. This time period encompassed 5 years before and after the addition of a surgical oncologist to our faculty. All defined category case numbers were examined using t test analysis. Significance was defined as a P value of less than 0.05. RESULTS: The overall caseload increased in the time period after the faculty addition. There was a statistically significant increase in skin/soft tissue, breast, esophagus, small intestine, large intestine, live, spleen, and endocrine cases. No statistical significance was seen in head/neck, stomach, pancreas, and biliary cases. CONCLUSIONS: The addition of a surgical oncologist to our faculty coincides with a statistically significant increase in areas of skin/soft tissue, breast, esophagus, small intestine, large intestine, liver, spleen, and endocrine. Other areas not statistically significant may reflect referral patterns or this particular oncologist's preferences of practice.     

Operative experience in the Victorian general surgical training programme

Background: The Royal Australasian College of Surgeons recommends minimum operative and endoscopy training requirements for advanced trainees in general surgery. This study examines the influences of trainee seniority, geographical location of surgical rotation, and surgeons’ remuneration arrangements on the operative and endoscopy experiences of general surgical trainees in Victoria. Methods: Trainee log books covering two 6‐month training periods in the year 2001 were analysed for depth and breadth of reported operative and endoscopy experience. Results: A total of 81 trainee log books was reviewed. Senior trainees were significantly more likely to have a higher primary operator experience. Total operative caseload and primary operator experience, in terms of major operative cases, were greater in rural rotations. Endoscopy experience was significantly greater in rural rotations. Operative exposure to gynaecological, laparoscopic, orthopaedic, paediatric and plastic surgical procedures was significantly greater in rural rotations. Surgeons’ remuneration arrangements were not significantly related to trainee operative experience. Conclusions: Rural surgical rotations enhance the depth and breadth of operative experience of Victorian general surgical registrars, allowing greater exposure to subspecialty surgical procedures.     

Our experience with early integration of laparoscopic cholecystectomy in surgical residency training

Laparoscopic cholecystectomy is now a method of choice in treating symptomatic cholelithiasis. The aim of this study was to assess an early integration of surgical residents into performing laparoscopic cholecystectomies and the significance of the integration for their training.Since February 1992 laparoscopic cholecystectomy (LC) has been performed in our institutions. During the 1st year 253 LCs were done by 4 surgeons—2 residents (in postgraduate years 3 and 4) and 2 staff surgeons; the 2nd year the team was extended and 301 LCs were performed. The residents operated on 364 cases (66%); the overall conversion rate was 5.4%; in the group of patients operated by residents (R) it was 3.8%; in the group operated by staff surgeons (SS) it was 8.4%. The complication rates did not exceed literature reports. The overall complication rate was 3.4%, in the R group 3.0% and in the SS group 4.2%. It may be concluded that surgical residents can perform LC without additional complications after initial experience with the open technique and appropriate hands-on laboratory training period before starting LC. Continuous training in advanced open biliary procedures should be assured for senior surgical residents.Partially presented at the XCIV Annual Congress of Japan Surgical Society, Tokyo, Japan, 29–31 March 1994     

Early perioperative outcomes and pancreaticoduodenectomy in a general surgery residency training program

Current trends in national health care are triggering a reassessment of training in general surgery. Currently, 75% of general surgery residents seek postgraduate fellowship training, and significant debate has occurred regarding the best manner for surgeons to acquire competency in performing complex operations. Pancreaticoduodenectomy (PD) is a complex procedure performed infrequently by most surgical graduates. From 1990 through 1997, the average number of PD operations performed per general surgery graduate ranged from 1.5 to 2.5. We examine the surgical outcomes following PD performed by surgical resident staff in a university-based general surgery training program. Between January 2001 and October 2004, 164 patients underwent PD for periampullary disease. Data were prospectively entered into a computerized database, including resident participation. We analyzed 30-day mortality and morbidity rates. Perioperative outcomes were 30-day mortality (2.2%), pancreatic fistula (6.1%), reoperation (2.2%), average length of hospital stay (13.5 days), mean operating time (489 minutes), and median estimated blood loss (1274 ml per case). PD can be performed with an acceptable morbidity and mortality within the teaching structure of a general surgery training program. These outcomes are likely related to the performance of PD at a high-volume, tertiary center by a single surgeon and compare favorably to best-practice benchmark outcomes. Presented at The 2005 American Hepato-Pancreato-Biliary Association Congress, April 14–17, 2005, Fort Lauderdale, Florida     

Impact of a novel education curriculum on surgical training within an academic training program

BACKGROUND: The training of the 21st century surgeon has become increasingly complex with the Accreditation Council for Graduate Medical Education (ACGME) core competency requirements and work-hour restrictions. Herein we report the two-year results of a novel problem-based learning education module at a large academic surgery program. METHODS: All data were prospectively collected from 2004 to 2006 on all categorical residents in the department of surgery (n = 42). Analysis was performed to identify any correlation between class attendance and American Board of Surgery In-Service Training Exam (ABSITE) score performance (percentile change). All data were reported as a mean with a standard error of the mean. Categorical variables were analyzed using a paired Student's t-test. A bivariate correlation was calculated using Spearman's rho correlation. RESULTS: When comparing the 2004 scores (pre-program) to 2006 scores, there was significant score improvement (P 相似文献