Delphi 法构建临床医学本科生《临床营养学》 课程内容 的研究

目的 着眼《国民营养计划(2017—2030 年)》加强营养能力建设要求,旨在培养具有岗位胜任力的当代临床医学本 科人才,构建符合新医科课程建设理念的《临床营养学》课程内容,全面提升《临床营养学》课程质量,为临床营养教学提供参 考,以期更好地提高综合医疗水平,解决公共卫生健康问题,推进临床医学本科临床营养教育改革。 方法 于 2020 年 12 月至 2021 年 3 月,运用 Delphi 法,遴选全国 11 省(直辖市)25 位专家(最终纳入 22 位),通过两轮问卷函询,计算专家积极系数和 权威系数,各项指标的满分率、重要性均数、变异系数和肯德尔协调系数(Kendall's W)。 结果 构建了适于临床医学本科生的 《临床营养学》课程内容,包括一级指标 4 个,二级指标 12 个,三级指标 27 个。 两轮问卷函询,专家的积极系数分别为 88%和 100%,权威系数均>0. 7,Kendall's W 值分别为 0. 082(χ 2 = 82. 947,P= 0. 001)、0. 277( χ 2 = 274. 585,P<0. 001)。 结论 本研究设 计构建的《临床营养学》课程内容可提升医学生的临床营养学知识水平和临床营养诊疗技能,突显价值营养治疗,具有临床实 用性,推动临床营养学科发展,推进我国临床营养学教育迈向新台阶。     

医患沟通技巧课程的满意度调查研究

[目的]分析临床医学硕士生对医患沟通培训课程的满意度,探索可提高培训效果的医患沟通课程改进措施.[方法]采取分层抽样的方法,抽取2013级不同专业临床硕士20人在临床训练阶段开展医患沟通技巧培训课程,问卷调查学生对培训课程的满意度.[结果]85％的学生认为讲授内容通俗易懂,提供了及时的信息;一致认为讲座内容切合临床需求.45％的学生认为该课程提供了新方法.[结论]学生对在临床训练阶段开设医患沟通技巧培训比较满意,但认为内容形式不够新颖.提示今后医患沟通培训可通过多阶段承接模式开展:课程设计增加岗前培训、进入临床训练阶段后3～6个月开展专家座谈、录制微课网络公开推送,在实践过程中结合临床实际进行及时沟通教育,最终改革沟通技巧授课模式和内容,进一步提高医学生沟通能力.     

肿瘤学研究生临床医学专业学位培养的实践与思考

[目的]探索和改进肿瘤学临床医学专业学位培养工作,培养符合社会需求的高素质临床应用型人才。[方法]查阅最新相关文献,结合研究生管理实践,立足于研究生临床专业学位人才培养毕业后社会需求进行分析。[结果]在临床医学专业学位培养中,重视开展岗前培训和实地教育相结合的医德医风和端正科研作风教育。建立完善临床实践教育工作体系,强调肿瘤综合治疗理念,在实践中反复强化三基培训,合理安排临床轮转,注重培养研究生观察能力、思维能力和表达能力,快速提升临床和科研能力。健全研究生培养质量监管体系,保证各培养环节的有效落实。[结论]良好的医德医风和端正的科研作风是成就合格社会人才的必备条件,完善临床实践教育工作体系和健全考核评估系统是保证培养质量的重要手段,培养具有肿瘤综合治疗理念、规范的医疗行为、善于发现和解决临床问题的科研思维能力的高素质人才是最终目的。     

质谱技术在肿瘤营养诊疗中的应用

肿瘤营养学是应用营养学的方法和理论进行肿瘤预防和治疗的一门新学科,恶性肿瘤患者是微量营养素异常的高 危人群,微量营养素异常会影响肿瘤患者的治疗、预后及生存时间等。因此,对于肿瘤患者入院时需要对其进行肿瘤与营养的 双诊断。质谱作为一种高灵敏、高特异性的检测手段,可以对人体的多种指标实现精准监测,从营养学角度为肿瘤患者提供准 确、丰富的诊疗信息。本文对质谱技术在肿瘤营养诊疗中的应用进行综述,通过总结液相色谱‐三重四极杆质谱、飞行时间质 谱、电感耦合等离子体质谱等技术在肿瘤营养诊断和治疗中的应用,对人体内维生素、微量元素、糖皮质激素、治疗性药物等指 标进行精准检测,为临床肿瘤患者营养支持提供更为准确的数据支撑。     

《中国肿瘤临床》文章推荐:食管癌患者营养治疗指南

食管癌是营养不良发病率最高的恶性肿瘤。营养不良会降低食管癌细胞对放化疗的敏感性,增加治疗不良反应,延长住院时间,延缓身体康复,增加医疗费用,降低患者治疗疗效和生存质量。因此,开展规范化的营养治疗对食管癌患者具有重要的意义。迄今为止,国内外鲜见专门针对食管癌患者的营养治疗指南。为此,2020年第1期《中国肿瘤临床》特邀中国抗癌协会肿瘤营养专业委员会、中华医学会肠内肠外营养学分会和中国医师协会放射肿瘤医师分会营养与支持治疗学组的肿瘤营养专家,通过对食管癌营养治疗最新国内国外文献的全面检索与分析,撰写了《食管癌患者营养治疗指南》一文。该指南经过专家们反复讨论与修改,从食管癌患者的营养诊断、营养治疗适应证、治疗途径、治疗通路、营养素和疗效评价六个方面的内容分别进行了证据论述和意见推荐,以期对临床应用和研究能发挥一定的指导作用,改善患者生存质量。     

上海市医师对癌症疼痛的认识及治疗状况——2007年调查结果

目的:调查上海市医师对癌症疼痛的认识和治疗现状.方法:2007年1-3月对上海市106所二、三级医院1 982名医师进行癌痛治疗知识及治疗情况的问卷调查并进行统计学分析.结果:对"三阶梯止痛"治疗方案,52.3%的医师表示非常了解,比1999年上升了21.6个百分点,肿瘤科医师的了解程度明显好于非肿瘤科医师; 16.8%的医师对镇痛治疗剂量滴定的3个主要原则回答完全正确,肿瘤科医师回答的正确率高于非肿瘤科医师;强阿片类药物成为医师治疗重度癌痛的首选药物,应用杜冷丁治疗重度癌痛的比率下降;74.8%的患者通过治疗能使疼痛明显减轻,比1999年上升了25.4个百分点;81.1%的医师肯定疼痛治疗效果,肿瘤科医师对治疗效果更为乐观; 93.3%的医师认为有必要继续开展癌痛治疗知识的培训,其中非肿瘤科医师的需求更高.医院和政策法规限制过严是目前使用止痛药物的主要障碍.结论:医师对癌痛的认识和诊治水平较1999年有较大提高,但仍需进一步开展癌痛治疗知识的培训,推广规范性治疗并消除止痛药物的用药障碍.     

美国成立营养学肿瘤辅助治疗学会

人们相信营养在肿瘤学中已居于和止痛、生活质量同样重要的地位；美国有些学者遂发起成立了营养学肿瘤辅助治疗学会（NOAT）。目的是为了推动营养肿瘤学在支持疗法、辅助治疗和防癌等方面发挥作用。现任该学会主席为费城FoxChase癌中心的营养肿瘤学主任F.Offery博士。她宣称在营养肿瘤学领域需要严格的科学实验，以便提出标准的营养处理方式和干预计划，来为临床实验服务。因为多数医生营养学方面的培训很少，以全营养学还没有在肿瘤研究协作组中充分发挥作用。该学会期望开展一些营养肿瘤学的先驱研究项目，把他们的发现提供给临床实验…     

乳腺甲状腺外科进修医师培养的思考与探索

进修教育是目前国内最常见的临床医师培养方式之一。陆军军医大学第一附属医院乳腺甲状腺外科长期承担来自不同等级医院临床医师的进修学习和再教育培养工作。为更好地完成临床教学任务,提高教学质量,满足不同进修医师的学习要求,达到进修学习的预期目的,科室进行了不断的思考与探索,从进修人员把关、教学准备、针对不同级别进修医师的个性化培养、岗前培训、学术活动、考勤制度等多个方面进行规范。实践证明,全方位的要求和规范化培养能培养出优秀的临床进修医师,实现进修医师和带教科室的双赢。     

营养与肿瘤治疗

<正>1肿瘤营养学的概念恶性肿瘤患者的营养不良发生率高,严重危害患者的生命及生活质量,因此针对肿瘤患者进行营养支持的研究及临床应用具有重要的现实意义。肿瘤营养学是应用营养学的方法和理论,进行肿瘤预防及治疗的一门新学科。营养不良会降低肿瘤治疗的有效性,增加化、放疗的毒副作用,降低患者     

肿瘤患者特殊医学用途配方食品使用指南

肿瘤患者因肿瘤本身及所接受治疗等因素影响,易出现摄入量下降及肿瘤特异性代谢异常,对营养素的需求与非 肿瘤人群存在差异。 此类特殊状态人群的营养需求需要通过特殊医学用途配方食品(简称特医食品)来满足,但尚无针对肿 瘤患者特医食品的指南。 由于人们对肿瘤患者营养需求的特殊性、代谢紊乱机制和营养治疗疗效等认识不足,导致特医食品 在临床实践中应用的局限性和不规范。 为规范特医食品的应用、指导临床营养治疗实践,国家市场监管重点实验室(肿瘤特 医食品)、中国营养保健食品协会特殊医学用途配方食品应用委员会及中国抗癌协会肿瘤营养专业委员会专家在循证医学的 指引下,对近年来发表的重要相关临床研究证据和权威指南进行收集整理、系统评估分析、讨论和总结,制订了本肿瘤患者特 医食品指南,以供临床医师、营养师、临床药师、医院管理人员以及患者及照护者参考。     

肿瘤医院高层次专业人才培养的

本文从高层次专业人才的类型、需求及医院发展三个层面分析培养高层次专业人才的必要性,阐述了通过继续教育和人才引进、院内行政科室轮转学习、建立拔尖人才库、设立人才培养基金多渠道培养及加强宣传,创新制度及搭建培养平台多项举措,培养和造就了一大批高层次专业人才,推动了医院可持续发展。     

The university and the needs of the society: what professional models?

An overview of the complex Italian situation and the consequences of the European integration, which puts an emphasis on the role of research and education involving the universities and the specific faculties, is given. Attention is then focused on the characteristics of the evolution of the medical activity and health services as for prevention, health education, more extensive knowledge and the need for continuing education. Different problems are tackled and pertinent suggestions are offered. The cultural and professional perspectives of the doctor should be considered within a new psychosocial approach to the illness, super- and hyper-specialization, collaboration and skills in non traditional fields. Medical education should be based on tutorial teaching and student-centered rather than on the traditional teacher centered-academic teaching. For better health care medical education and training should be updated with respect to the doctor-patient relationship as well as to the technological advances and team-work in medicine. The ethical aspects of the medical profession should be evidenced to be able to tackle the involved problems. The main features of the doctor of the future are the need and the difficulty of updating and life-long learning.     

Radiation oncology training in the United States: report from the Radiation Oncology Resident Training Working Group organized by the Society of Chairman of Academic Radiation Oncology Programs (SCAROP)

Purpose: In response to the major changes occurring in healthcare, medical education, and cancer research, SCAROP addressed issues related to post-graduate education that could enhance existing programs and complement the present system.Methods and Materials: SCAROP brought together a Working Group with a broad range of representatives organized in subcommittees to address: training, curriculum, and model building.Results: The Working Group emphasized the importance of training physicians with the necessary clinical, scientific, and analytical skills, and the need to provide expert radiation oncology services to patients throughout the United States. Opportunities currently exist for graduates in academic medicine, although there may be limited time and financial resources available to support academic pursuits.Conclusions: In the face of diminishing resources for training and education and the increased scope of knowledge required, a number of models for resident training are considered that can provide flexibility to complement the present system. This report is intended to initiate dialogue among the organizations responsible for radiation oncology resident education so that resident training can continually evolve to meet the needs of cancer patients and take advantage of opportunities for progress through innovative cancer care and research.     

肿瘤学教学中应加强转化医学教育

转化医学源于上世纪90年代,强调基础研究与临床应用之间的相互转化和相辅相成,已成为医学领域关注的热点,为当代医学的发展带来了新的启示和机遇。结合当前我国肿瘤学教育现状,适时引入转化医学的理念、思维和方法,逐步应用到肿瘤学教育实践中去,既是当代医学教育发展的需要,更是新世纪肿瘤学人才培养的需要。     

构建完善的《临床肿瘤学》教学体系的探索与建议

恶性肿瘤基础与临床的相关研究成果正日新月异地推动着临床肿瘤学的发展与进步。因此,在现有基础上,有必要对高等医学院校临床医学生进行更为系统、全面、优化的《临床肿瘤学》理论与实践相关内容的教学。全文就如何构建完善的《临床肿瘤学》教学体系,包括国内外教学研究趋势、教学内容、教学方法等提出一点建议。     

Nutrition education curriculum at the University of Nevada School of Medicine

This article describes a developing nutrition education curriculum for the University of Nevada School of Medicine, a small and progressive, community-based medical school. The curriculum has been planned to reflect the longitudinal, interdisciplinary, and comprehensive integration of nutrition into new required and existing courses so that timely delivery of knowledge and development of skills will occur in the basic science years followed by direct application in the clinical clerkships. The availability of the "Nutrition and Cancer Education Objectives" is timely and provides overall direction and curricular goals for the simultaneous development of nutrition-cancer education. The coordination of the four-year curriculum of the entire medical school can be specifically targeted for the incorporation of this needed information synergistically at a most opportune time.     

美国放射治疗师培养和认证模式启示与借鉴

美国放射治疗师培训项目成立较早,培养模式、资格认证和继续教育较为完善。查阅美国劳工部、放射技师注册资格认证协会、放射技师协会、放射技术教育联合审查委员会网站以及中国内地外相关文献资料,分析了美国放射治疗师的培养模式、资格认证、工作内容、继续教育、就业情况,为建立适合中国内地国情的放射治疗师专业人才培养的新模式提供一些借鉴和启示。     

Design, implementation, and evaluation of a longitudinal cancer curriculum

The University of Massachusetts Medical School's two year preclinical curriculum is organized by organ system and controlled by the basic science departments. It is followed by two years of required and elective clinical clerkships. An evaluation of cancer teaching in the preclinical curriculum using criteria derived from the Cancer Education Objectives for Medical Schools was conducted. Deficiencies in cancer teaching were documented and the need for an organized cancer education program established. The administration then allotted 18 hours for cancer teaching spread over the two years of the preclinical curriculum. Supported by an R25 Cancer Education Grant, the Longitudinal Cancer course (LCC), was developed in an attempt to effectively utilize the scattered class time to meet a significant number of American Association for Cancer Education Objectives. In addition, interdisciplinary teaching of the more common cancers was facilitated and faculty were supported in their use of cancer related examples to illustrate relevant materials in the basic sciences. Evaluation of the LCC after a three-year trial has shown that, without strong administrative support, it is a very inefficient method of cancer teaching. While students appreciated class content and met a significant number of course objectives, they found the longitudinal format of the course unsatisfactory and recommended that the course be consolidated into a block. R25 grant support was being sought to implement a proposal to consolidate cancer teaching when the R25 program was suspended. Without external support, implementation will be difficult because it will require serious disruption of an established course. Such a change will require resources that are not readily available in this era of fiscal constraint.     

Undergraduate oncology education in Scandinavia

An overview of undergraduate education in general oncology in 18 medical schools in Scandinavia demonstrated that insufficient resources were allocated to this activity, and that there was a lack of integrated multidisciplinary educational activities. Further, there was a lack of clear consensus about the contents of a curriculum in oncology. To remedy this situation a minimal list of recommendations is suggested for the undergraduate education in oncology in Scandinavia. The main points are: (1) a better coordination of the curriculum in general oncology with the curricula of other specialty disciplines, (2) a two-week period of clinical clerkship in the department of general oncology early in the study, (3) a two-week concentrated course in general oncology late in the study, (4) a final knowledge test, and (5) adequate funding of cancer educators.     

放射肿瘤学专业住院医师规范化培训初步实践与思考

放射肿瘤学专业具有本科教学无相关课程、学习内容难、覆盖病种多、与内外科明显不同的特点。放射肿瘤学专业2014年被国家纳入住院医师规范化培训的科目。如何做好放射肿瘤学专业住院医师规范化培训是一个全新命题。依据自身特点,除了采用带教老师负责制,还创新使用指导导师负责制。从临床实践能力、临床思维能力、科研能力和教学能力等多方面对住院医师进行全方位、系统化、规范化的培训,并通过各项规范化的考核制度,保证住院医师的培训效果。本文同时对放射肿瘤学专业住院医师规范化培训中存在的问题及相应对策进行初步探讨。