CBL结合循证医学理念在儿科住院医师培训中的作用

目的探讨以病例为基础的学习（ease—basedlearning,CBL）结合循证医学方法在儿科住院医师培训中的实施效果。方法将52名住院医师随机分为实验组（CBL结合循证医学理念教学组26人）和对照组（灌输式教学组26人）,教学均围绕病房患儿病例展开。实验组住院医师以2人为小组,由带组教师提出问题,住院医师下班后查阅文献;在每周固定的全科教学查房时间结合该病例进行循证医学证据总结汇报;全科室人员参与病例讨论和学习,带组教师进行总结。对照组采用传统的灌输式教学,以带教教师的临床经验指导住院医师作病例分析;住院医师有问题提出时,带教教师直接给予回答。轮转时问为4个月。教学效果评价分为问卷调查、理论试卷考试、临床技能考核三部分。用SPSS16．0软件对考核成绩进行统计学分析,试卷考试和技能考核成绩用均数±标准差（面±s）表示,行t检验,以P〈0．05为差异具有统计学意义。结果实验组住院医师认为,自身所接受的培养方式在提高自学能力、文献检索查阅能力、医师间团队合作精神、临床思维、幻灯片制作技术和语言表达能力方面更有优势。理论考试成绩显示,实验组平均成绩（75．460±6．646）分高于对照组（71．380±4．758）分,差异有统计学意义（P=0．014）;尤其表现在主观题部分。临床技能考核显示,实验组病例书写及临床思维成绩优于对照组。结论CBL结合循证医学教学在提高自学能力、培养临床思维能力及文献检索和语言表达等方面明显优于传统的灌输式教学,适用于儿科住院医师培训。     

美国以能力为基础的住院医师培训探析

美国毕业后医学教育认证委员会(Accreditation Council for Graduate Medical Education,ACGME)倡导以能力为基础的住院医师培训,其主要目标是培养职业医师所必须具备的能力,不断提高住院医师对患者的诊疗质量;其具体实施围绕6项核心能力的培养进行,贯穿于理论、临床和科研等各个方面.     

非重症医学专业住院医师临床重症监护教学内容与方法的探讨

重症医学是一门新兴学科,其临床教学研究尚处于起步阶段.非重症医学专业住院医师在重症医学科的临床培训工作与提高其综合技能密切相关.安徽医科大学第二附属医院重症医学科结合本专业的研究内容及学科特点,将非重症医学专业住院医师的培训重点放在加强基本技能、思维方式及人文修养等方面的训练上,在临床教学实践中取得了良好的效果.     

Evaluación de competencias en residentes de pediatría en el primer nivel de atención mediante la utilización del Mini-CEX

BackgroundA residency is a professional training system based on supervised clinical practice. The Mini Clinical Evaluation Exercise (Mini-CEX) is a method of assessment through direct observation that enables the design of strategies to improve professional performance.The purpose of this study is to analyze the results of implementing the Mini-CEX to assess pediatric residents during their rotation at the first level of care while exploring differences according to the training site to which they belong.MethodsWe conducted an analytical cross-sectional study that included 2nd-year pediatric residents on rotation at the first level of care in pediatric and general hospitals. Each resident underwent two Mini-CEX encounters for the assessment of 8 domains: history taking, communication skills with patients and with caregivers, physical examination, clinical judgment, clinical management, professionalism, and organization.ResultsThirty-four residents participated in the study. The total overall rating of residents from pediatric hospitals and general hospitals was 4.20 (4.07-4.34) and 4.14 (3.94-4.34), respectively. We found no statistically significant differences in the areas assessed according to the residents’ training site.ConclusionThe Mini-CEX as an assessment tool within the first level of care allowed the detection of strengths and weaknesses in residents’ training. Implementation was affected by limitations inherent to this setting. Standardization of assessors was a key element for criteria unification.     

美国哈佛大学BWH医院神经外科专科医师培养过程及借鉴

以美国哈佛大学附属布列根与女子医院神经外科专科培训为例,介绍美国神经外科专科培训体系,阐释其逐年递增的临床知识、技能、决策、人文关怀、职业规范、沟通技巧等培训措施,以及注重神经科学科研思维与产出的培养模式,以期为促进我国神经外科专科培养提供借鉴。     

Art in medical education: Especially plastic surgery

The importance of art studies in the training of plastic surgeons has not been well recognized. Presently, very few medical schools offer courses on art or include it in the humanities. Because the study of art is a great experience that helps to develop the trained eye, the inclusion of art in medical education is recommended. For plastic and aesthetic surgeons, art knowledge can greatly add to the development of surgical skill. Courses in drawing, modeling, and casting are recommended along with lectures or seminars on art appreciation.Delivered as the Nojarova Lecture at the New York Academy of Medicine, the New York Regional Society of Plastic and Reconstructive Surgery, March 3, 1990. Also given at the Italian-American Conference of Plastic Surgeons, Venice, Italy, September 23, 1990     

The impact of surgical training on the practice of recently graduated ophthalmologists at Riyadh’s ophthalmology residency program

PurposeTo evaluate how well the training residency program prepared recent graduates to practice comprehensive ophthalmology with special focus on surgical competency.MethodsThis is a cross-sectional study that included Ophthalmologists who graduated from Riyadh ophthalmology residency program between the years 2002–2012. A total of 126 graduates were invited through e-mails and electronic social media platforms to anonymously complete an electronic survey. The survey included questions that aim to assess the surgical competency of graduated ophthalmologists in doing various surgical procedures that were among the requirements of residency training.ResultsNinety participants in the mean age of 38.7 years completed the survey. The majority of respondents (93%) joined fellowship programs and around half of them sub-specialized in anterior segment. More than half (55.6%) of the respondents reported that the acquired surgical skills during residency training were adequate. By the end of the residency period, the respondents’ competency in doing extra capsular cataract extraction was better than phacoemulsification while 52% of them reported incompetence in both glaucoma and strabismus surgeries whereas the majority were incompetent in oculoplastics’ procedures (e.g. entropion repair). However, the majority felt competent in doing primary repair, minor and laser procedures. Lack of exposure was the major cause of such incompetency.ConclusionThis self-reported survey showed that the lack of adequate surgical exposure during residency training was the main reason of incompetency. This resulted in reduction of ophthalmologists’ future practice of surgical procedures outside the scope of their sub-specialty. This emphasizes that physicians mainly practice what they surgically acquire during their fellowship training.     

Training residents and nurses to work as a patient-centered care team on a medical ward

Objective

To train medical residents and nurses to work together as a patient-centered care (PCC) team on a medical ward and test its feasibility, nurses’ learning, and patient outcomes.

Method

Working with administrative leadership, we consolidated residents’ patients on one 32-bed ward. Already training residents in an evidence-based patient-centered method, we now trained 5 nurse leaders similarly, and they then trained all staff nurses. A national consultant visited twice. Specific team-building activities for nurses and residents fostered ward interactions. We used a retrospective pre/post/6-month post-design to evaluate nurses’ knowledge and self-efficacy of patient-centered skills. Patients were assigned non-randomly to our unit or comparison units from our emergency room; using a post-test only design, the primary endpoint was patient satisfaction.

Results

28 trained nurses showed improvement in knowledge (p = 0.02) and self-efficacy (p = 0.001). 81 treatment patients showed no improvement in satisfaction (p = 0.44).

Conclusion

Training nurses in patient-centered practices were effective. Unique in this country, we also trained nurses and residents together as a PCC team on a medical ward and showed it was feasible and well accepted.

Practice implications

We provide a template for team training and urge that others explore this important new area and contribute to its further development.