我国全科医师教育培训与能力评估方法探讨

目前我国社区全科医师仍存在年龄偏大、知识结构老化、学历和职称偏低等情况,难以适应社区卫生服务发展的需要。当前的全科医师教育培训对象主要为两大类,社区卫生服务中心的在岗全科医师和毕业后专科医师培训中的全科专业医师。在开展教育培训工作时,应充分考虑学员的背景与需求,以美国毕业后医学教育认证委员会(ACGME)六项核心能力为目标,以学习金字塔和能力金字塔为两大理论支柱,科学运用各项教学、评估方法,建立和倡导整合式教学-评估体系,将医学理论知识学习、临床实践技能教学、临床能力考核评估三者有机结合,注重全科医师的能力培养,整合运用多种教学方法提升培训品质,同时对全科医师进行全方位、多面向的能力评估,明确培训效果。     

社区全科师资培训模式效果初探

目的 探索规范、系统的社区全科师资培训模式,提升师资教学能力与综合素质.方法 自2011年3月至2012年2月,在上海市枫林街道社区卫生服务中心内采用自荐法、推荐法选拔出16名社区全科师资人员,进行理论课程、教学演练、教学实践三阶段式培训.在培训前后分别对受训师资人员及其所带教的50名学员进行临床能力的测试与评估,采用白评调查问卷对受训师资人员培训前后的全科医疗工作能力、全科医学教学能力、个人综合素质进行评价.结果 培训前后师资人员在全科医学知识、体格检查、临床操作技能方面的测试结果比较,差异均无统计学意义（P值分别为0.794、0.674和0.326）.自我评价问卷调查发现,培训后师资人员的全科医疗工作能力（t=-2.840,P=0.015）、个人综合素质方面（t=-3.017,P=0.011）较培训前明显提升,差异有统计学意义.对师资人员带教学员的评估方面,带教后50名学员的全科医学理论知识（t=-9.200,P=0.000）、体格检查（t=-9.947,P=0.000）、临床操作技能（t=-14.828,P=0.000）与带教前相比均有明显提高,差异有统计学意义.结论 三阶段式、系统化的师资培训模式不同于以往的师资培训班,将教学理论与临床带教密切结合,强调师资实际教学能力的培养与提高,为规范开展社区全科师资培训、提升师资教学能力与综合素质提供了一定的实践经验.     

试析高等院校医学生团队合作能力的培养

医学生团队合作能力是卓越医师职业素养和综合素质培养的一个重要方面,医学生团队合作能力的强弱,直接影响他们在未来职业生涯中参与医疗工作的质量,与患者的健康和利益息息相关。本文分析了当前医学生团队合作能力培养的必要性,从教学管理的角度分析了医学生团队合作能力培养的路径,提出了医学生团队合作能力培养的具体措施。     

Clinical interdisciplinary health team care: an educational experiment.

With increasing concern for teamwork in clinical practice in health care settings, the need to identify the concepts, methods, and learning processes for improving interdisciplinary team skills is apparent. This paper describes patient-centered, clinical-research-demonstration programs for teams of students, preceptors, and faculty members from six disciplines who provided patient care in a long-term rehabilitation setting. The teams were involved in the theory and practice of team-building, including weekly sessions on leadership styles, communication, group decision-making, and team effectiveness assessment. Objective and subjective measurements were administered throughout the program. The results indicate that task-oriented patient care favors the learning of team skills, especially when all levels of administration support and participate in the processes. Question are raised concerning the effect of clinical teams on the quality of patient care, their cost-effectiveness, and the low priority given to teaching interdisciplinary team skills in professional education.     

临床技能培训中心工作开展中的困惑与管理对策

文章探讨了临床技能培训中心工作开展中遇到的问题和管理对策。在培训中发现对技能培训认知不够、技能培训与临床脱节及缺乏考核系统等问题比较突出,通过建立健全技能培训中心组织管理机构、改革培训方法和手段及建立健全的考核机制等改革措施,学员的临床技能和考核成绩明显提高,学员的自主学习能力增强。     

基于专业核心能力培养的文献检索课堂教学改革研究

分析当前中医专业文献检索课堂教学存在的问题,提出以德风责任与学习素养、临床思辨与临床技能、经典传承与科研创新为中医专业核心能力培养目标,阐述基于专业核心能力的文献检索课堂教学改革方案。     

核心能力训练在手术室护士培训中的实施与效果

目的:探讨手术室护士核心能力在手术室护士培训中的方法与效果。方法:对手术室18名护士从专科基础知识和技能、专科专业知识和技能、临床思维能力、教育和培训能力、管理与应急能力7个模块制订各层级训练计划,根据手术室专业特点,对各级护理人员分层次进行业务培训,用岗位培训、专科轮转、临床实践、一对一的老师负责制进行训练,并通过专业知识和技能考核、综合能力考评和手术医生满意度调查,对训练效果进行评价。结果:训练后护士专业知识、专业技能考核成绩及综合能力、医生满意90%。结论:实施手术室护士核心能力训练计划,有助于护士临床思维和解决临床护理问题能力的提高,为护士提供了职业生涯的进步阶梯,提高了患者和手术医生对手术室的满意度,提高了工作质量。     

全国高等医学院校大学生临床技能竞赛的教学思考

回顾连续3年参加全国高等医学院校大学生临床技能竞赛培训工作的实践,思考临床技能竞赛的实质.提出将技能培训与医师职业素质培养有机结合起来,注重培养学生的自信力、同情心、人文关怀、认真细致的特性及团队合作能力.重点探讨了临床实践能力培训的具体方法与技巧,教师需要制订技能操作指南、操作考核评分标准,再依此制订循序渐进的单项训练计划,其后进行团队训练,提高学生综合能力.     

台湾地区的全科(家庭)医学教育培训

台湾医学界及当局于20世纪70年代开始引入家庭医学的概念,1986年成立"台湾家庭医学医学会",并于2000年起推动家庭医师制度和整合性照护系统。为响应现代民众与社会之需求,台湾家庭医学教育更是讲究全人照护及解决问题的能力,故问题或任务导向式学习模式、临床技能训练与测验、行为科学与沟通技巧及小区医学实务训练已普遍地运用于医学生及住院医师的教育培训当中,以确保实践家庭医学之全人、全家、全社区、全队、全程的理念。家庭医学之所以能成为一种专科医学,是因为它拥有自己的学术领域及其照顾患者的独特地位,不能够被其他专科所取代。是故,家庭医学的特色并不在于知识及技能的宽广,更是在于它照顾民众时所秉持之哲学、态度及方法。家庭医学教育培训无疑为医学教育成功的基石之一。     

Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?

CONTEXT: Although physicians report spending a considerable amount of time in continuing medical education (CME) activities, studies have shown a sizable difference between real and ideal performance, suggesting a lack of effect of formal CME. OBJECTIVE: To review, collate, and interpret the effect of formal CME interventions on physician performance and health care outcomes. DATA SOURCES: Sources included searches of the complete Research and Development Resource Base in Continuing Medical Education and the Specialised Register of the Cochrane Effective Practice and Organisation of Care Group, supplemented by searches of MEDLINE from 1993 to January 1999. STUDY SELECTION: Studies were included in the analyses if they were randomized controlled trials of formal didactic and/or interactive CME interventions (conferences, courses, rounds, meetings, symposia, lectures, and other formats) in which at least 50% of the participants were practicing physicians. Fourteen of 64 studies identified met these criteria and were included in the analyses. Articles were reviewed independently by 3 of the authors. DATA EXTRACTION: Determinations were made about the nature of the CME intervention (didactic, interactive, or mixed), its occurrence as a 1-time or sequenced event, and other information about its educational content and format. Two of 3 reviewers independently applied all inclusion/exclusion criteria. Data were then subjected to meta-analytic techniques. DATA SYNTHESIS: The 14 studies generated 17 interventions fitting our criteria. Nine generated positive changes in professional practice, and 3 of 4 interventions altered health care outcomes in 1 or more measures. In 7 studies, sufficient data were available for effect sizes to be calculated; overall, no significant effect of these educational methods was detected (standardized effect size, 0.34; 95% confidence interval [CI], -0.22 to 0.97). However, interactive and mixed educational sessions were associated with a significant effect on practice (standardized effect size, 0.67; 95% CI, 0.01-1.45). CONCLUSIONS: Our data show some evidence that interactive CME sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice and, on occasion, health care outcomes. Based on a small number of well-conducted trials, didactic sessions do not appear to be effective in changing physician performance.