九省市县级医疗机构儿科医师继续医学教育需求调查

目的:了解我国县级医疗机构儿科医师在继续医学教育（continuing medical education,CME）授课内容方面的需求,以及参加CME的影响因素,为提升县级医疗机构儿科医师诊疗能力提供参考。方法:对参加"全国儿科医师培训项目"的九省市县级医疗机构儿科医师进行问卷调查。调查内容包括：一般资料、CME授课内...     

21世纪儿科医学人才培养方向研究与对策

1998年儿科专业从本科目录取消后，应当采取什么方式或途径培养儿科专业医学人才是儿科医学界十分关注的问题。为此，采用问卷调查形式，对上海地区和全国18所儿童医院的儿科医师队伍、医疗任务进行了调研。调查结果显示，现有儿科医师结构不合理，儿科医疗市场需求量大，而医师队伍从数量或质量上都必须提高。因此，必须进一步深化教育改革、调整临床医学专业儿科课程、拓宽知识面，为今后培养儿科专科医师打下良好基础；必须加强儿科住院医师规范化培训后考核力度，为进入专门化培训、选拔优秀人才提供依据；尽快建立儿科医师继续医学教育基地，为儿科医学事业的发展培养高素质人才。     

Canadian departments of pediatrics and family medicine: in need of family therapy?

Whether and how much the departments of pediatrics in Canadian medical schools collaborate with the family medicine departments in training for child care were the focus of a survey conducted in 1983-84. Responses to a questionnaire sent to department heads indicated that in general the most supportive relationships existed in the western provinces, with progressively more problems uncovered from west to east. The responses concerning the roles of pediatricians and family physicians paralleled this trend, with the western view being that pediatricians are consultants and not competitors for primary care. Many respondents supported the expansion of family medicine, particularly into ambulatory and behavioural areas. The data provide some cause for concern about the future health care of children, as the forecasted oversupply of physicians is likely to encourage competition rather than consultation between the two groups. Also, many Canadian pediatricians accept the US model of pediatrics, which includes primary care, although in Canada the ratio of family physicians to pediatricians is six times that in the United States, and Canadian specialists are concentrated in urban centres. This means that family physicians will continue to provide most of the child care in Canada and need adequate training. They also need to develop cooperative, supportive relationships with specialists in child health care to enhance appropriate referral patterns.     

儿科临床实践性教学改革体会

目的：改革传统的临床实践教学方法,以适应高等医学教育发展的要求,培养更多高素质、适应社会需要的儿科医学人才。方法：在教师方面,严格教师准入制度及教师教学综合能力培训、改良教师教学质量评估体系以提高师资教学水平。在学生培养方面,突出医学人文教育,注重医学生沟通能力培养;增加突出实践特色的儿科临床实践教学模块及临床技能模拟训练等。结果：儿科学教学达到了国际医学教育的基本标准,部分达国际医学教育高标准;学生质量社会评价良好;国家精品课程建设取得成功。结论：临床实践性教学活动开展具有学习、借鉴和推广的价值,将会对临床医学生的临床实践能力有极大的促进和提高作用,有助于为社会培养有用的人才。     

The Teaching of Psychiatry as Applied to Pediatrics: Proposals Based on a Report Prepared by the Education Committee, Canadian Paediatric Society

With changing patterns of pediatric practice, the practising physician needs to acquire a deeper understanding of the emotional and intellectual development of the child. Skill is also required in the techniques of interviewing and counselling parents, and, with a knowledge of the origin of behavioural disorders, in treating these disorders. The Education Committee of the Canadian Paediatric Society was asked to survey the present teaching of psychiatry as applied to pediatrics in all Canadian medical schools. Based on this survey and other studies, a training program for undergraduate medical students and graduates is proposed.     

浅析加拿大家庭医生培养体系

加拿大家庭医学发展较早,对加拿大家庭医生培养体系进行分析介绍,着重于从家庭医生"4+4+2"培养模式、高等学校全日制教育、住院医师规范化培训进行综述。加拿大通过多个层面完善家庭医生培养体系、持续职业开展、倡导及制定执行一系列的严格标准,从而确保了高质量的初级卫生保健。借鉴加拿大家庭医学教育的成功经验,结合我国国情,探讨比较了两国家庭医师培养特点、教学组织方式和师资力量等方面的问题。加拿大家庭医生培养体系中的优势表现在:①培养制度步骤清晰、阶段目标和路径明确;②行业协会作用巨大,政府规划,大学培养,分工明确;③家庭医生生源优秀,师资充沛,爱岗敬业,家庭医学发展条件较好。加拿大家庭医生培养的特点正是在于其结构的完整性和连续性,以医学院校教育为起点,家庭医学住院医师规范化培训为重点,并通过继续医学教育把教育培训同家庭医生持续终身的执业生涯统一起来。相比之下国内的家庭医生培养目标真正实现和家庭医学的理性发展还面临着许多困难。学习和借鉴加拿大家庭医生培养体系的成功经验和先进教学理念,有利于构建和完善具有中国特色的家庭医学教育培训体系,对于缓解国内社区卫生服务对高素质的家庭医生的急需具有十分重要的意义。      

泰安市儿科医生抗生素使用认知状况调查分析

目的：调查儿科医生对抗生素使用知识的认知情况,发现影响儿科医生抗生素合理使用的影响因素,为临床合理使用抗生素提供依据。方法使用自编的《儿科常用抗生素知识问卷》分别对泰安市四家医院的70名儿科医生进行了问卷调查,计算问卷及格率来判断医生对抗生素应用知识的掌握情况。结果泰安市各级医院的儿科医生对应用抗生素的知识掌握情况较差,及格率为50%。不同职称、不同儿科工作时间的医生,及格率差异有统计学意义（P﹤0.05）。医生的年龄、学历、医院级别、有无进修、有无继续教育无统计学差异（P﹥0.05）。结论临床儿科医生对抗生素的使用知识的掌握情况普遍较差,提示管理部门应在临床普及抗生素使用知识,加强培训,提高抗生素正确使用率。此外,经验丰富的儿科临床医生应发挥传帮带的作用,使临床抗生素的使用更加规范、合理。     

从医患关系视角谈高等医学教育面临的挑战与对策

医患矛盾是我国社会转型期多种社会矛盾共同作用的结果,是近年来社会关注的热点问题.本文以紧张的医患关系为背景,就当前医学教育面临的矛盾、传统临床实践模式的困境、治病救人与自我保护的博弈等问题进行分析,在此基础上探索高等医学教育在人才选拔、人才培养等方面的应对策略.     

Family physician anesthetists: continuing education, observations, evaluation

A method is described whereby continuing education for family practitioner anesthetists is taken to community hospitals, where patterns of practice, local problems and facilities are different from those of larger urban areas. Five Ontario communities were visited for 4½ days each, by invitation, providing the visiting clinician with an opportunity to observe the quality of anesthesia services and to measure, through a self-evaluation test, the deficiencies in applied basic and clinical knowledge thought to be necessary for modern, safe practice. These programs were well received and thought to be of real benefit to the participants. Similar programs could be provided in general medicine, cardiology, gastroenterology, pediatrics and psychiatry.     

Public policy and the supply of primary care physicians

The decline in general practice, the arrested growth of family medicine training programs, and the increased subspecialization of internal medicine and pediatrics are responsible for the continuing decrease in the proportion of physicians in the United States who practice a primary care specialty. Since 1963, the number of physicians has more than doubled, but the ratio of office-based primary care physicians to the national population has decreased. This trend has been especially pronounced in rural areas and impoverished urban communities. There is evidence that the proportion of young physicians entering primary care specialties is declining. Medical education has become increasingly reliant on service income, making it difficult to fund training in primary care specialties. Grants for graduate training in primary care specialties have not increased with inflation, and outright elimination of these programs is under consideration. Public programs that fund medical education must be reformed to improve the geographic and specialty distribution of physicians.     

北京世纪坛医院继续医学教育现状与问题分析

为了解北京世纪坛医院继续医学教育的现状,以期不断改革和完善继续医学教育的教学管理工作。采用查阅文献和资料检索的方法,针对医院继续医学教育的内容、形式、时间与建议对相关人员进行访谈。结果表明,继续教育工作中存在培训内容过宽、培训方式单一、缺少对医学人文素质培养等问题。应该增加多种培训方式、加强医学人文素质教育培训、开展特色培训等工作,使继续医学教育更加科学、规范、高效率。     

Pediatric manpower in Canada: a cross-country survey.

Health care costs and government cutbacks in Canadian training posts have caused concerns about physician manpower. To determine the present pediatric manpower situation a cross-country survey was undertaken of all pediatricians and their practice patterns. Of the 2060 recipients of a questionnaire 5% were found to not be pediatricians. Of the remaining 1960, 69% returned a completed questionnaire. Overall, 70% of the pediatricians were men, although among those less than 35 years of age 49% were women. Across Canada 37% of the pediatricians practised primary care, 25% secondary care and 38% tertiary care. There were wide regional differences in practice patterns, with large numbers of primary care pediatricians in Winnipeg, Toronto, Ottawa and the province of Quebec; few pediatricians in the Maritimes and the remainder of western Canada practised primary care. Non-Canadian graduates accounted for 33% of the pediatricians and represented a considerable proportion of tertiary care pediatricians. Cutbacks in numbers of pediatric training positions and restrictions on immigration of foreign pediatricians may lead to unexpected deficiencies in the availability of some types of pediatric practitioners, especially those in tertiary care.     

四川省基层医院护士继续教育现状与对策研究

目的:了解四川省基层医院护士继续教育现状、需求及存在的问题,提出对策,为完善基层医院护士在职培训体系提供理论依据。方法:以四川省32所乡镇卫生院和15所县级医院460名护理人员为调查对象,每所乡镇卫生院随机选取5人参与调查,每所县级医院在内科、外科、妇科、儿科中各随机抽取5人参与调查。调查内容包括年龄、学历、收入等一般资料和在职培训、学历教育现状和需求等。资料采用SPSS13.0软件进行统计分析。结果:四川省基层医院护士年龄偏小,学历偏低,聘用人员占很大比例;县级医院护士入职后参加过在职学习培训的百分比大于乡镇卫生院,分别是74.9%和61.8%,二者之间差异具有统计学意义(χ~2=8.423,P=0.004);乡镇卫生院护士参加过多次培训的百分比低于县级医院,二者之间差异具有统计学意义(χ~2=11.295,P=0.01);培训内容需求方面,乡镇卫生院护士想获得基本专业理论知识和技能的百分比高于县级医院,分别为40.8%和27.5%,想获取专业新理论、新技能的百分比低于县级医院,分别是52.2%和69.1%,差异均有统计学意义。影响基层医院护士培训的首要因素是工作太忙。对于学历教育基层医院护士都持积极态度。结论:基层医院护士在职培训中存在的问题较多,时间、经费不足,重视度不够,建议基层医院管理者重视护理人员继续教育,完善护士在职培训和继续教育制度,不断提高护理人员业务和综合素质,为患者提供满意的护理服务,促进卫生事业健康发展。     

地方医学院校在基层卫生人才培养中的作用

基层卫生人才队伍建设对开展基层卫生服务,提高城乡居民的健康水平和生活质量具有举足轻重的作用.本文探讨了地方医学院校在基层卫生人才培养中的作用,包括积极承担全科医师培训,加强培训基地建设,提高培训教材质量.同时指出,地方医学院校在本科教学中应当深化教学内容改革,加强全科医学教育,开设全科医学课程,增加社区实践教学,大力推进全科医学毕业后教育和继续医学教育.     

地方医学院校在基层卫生人才培养中的作用

基层卫生人才队伍建设对开展基层卫生服务,提高城乡居民的健康水平和生活质量具有举足轻重的作用.本文探讨了地方医学院校在基层卫生人才培养中的作用,包括积极承担全科医师培训,加强培训基地建设,提高培训教材质量.同时指出,地方医学院校在本科教学中应当深化教学内容改革,加强全科医学教育,开设全科医学课程,增加社区实践教学,大力推进全科医学毕业后教育和继续医学教育.     

儿科学临床实习教学思考

临床实习是医学教育的重要阶段。根据儿科学特点与实习要求,认真做好入科指导,注重培养实习医师的临床工作能力,实施全面规范的综合考评,有助于提高儿科学临床实习质量。     

江苏省三甲医院医务人员伦理认知状况调查

目的：了解江苏省医务人员对医学伦理的认知情况,为医院医学伦理组织的建设提供参考。方法：采用问卷调查的方法对江苏省26家三甲医院的医务人员进行问卷调查。结果：312名医务人员中54人（17．3％）表示在继续教育中接受过医学伦理教育;227人（72．8％）知道所在医院已经设立伦理组织,但其中70％的人不知道所在医院设置伦理组织的种类或数量,18％认为伦理审查有利于患者而不利于科研;多数医务人员听说过伦理相关制度规范,但不了解详细内容,部分人员不知道所列举规范的名称及内容。结论：江苏省三甲医院医学伦理组织建设已经取得一定成效,但仍存在一些问题。需要加强医学伦理知识培训,促进医院伦理组织常态化运行,规范服务行为,健全卫生法律法规等。     

An Exploration on the Post Training Mode of the Pediatric Specialists in Tertiary Comprehensive Hospitals (Summary of the Meeting of the Clinical Ability Teaching Training Mode of the Pediatrist in 2018)

In order to improve the post competence of the pediatricians in the medical treatment alliance of the pediatric department in the central regions of Shanghai, and improve the collaboration ability of the main unit Ruijin Hospital of the medical treatment alliance of the pediatric department in the central regions of Shanghai and the pediatric departments of the community hospitals, the medical treatment alliance of the pediatric department in the central regions of Shanghai convoked the Seminar of Enhancement Mode of Pediatrician Post competence in the Shanghai Science Hall on September 15, 2018. The experts from the United States, Europe and China were invited to participate in discussions and exchanges, a seminar was had on the pediatrics sickness, the role definition of the medical personnel in the pediatric department and the training mode, and whether the trustworthy medical practice activity behaviors of the American pediatric department conform to the daily practice of the pediatric department in China was deliberated, all of which laid the foundation for establishing the training system of the post competence of the pediatricians in the medical treatment alliance and declaring the Chinese national pediatric digestive endoscope base.     

生命周期管理在国家级继续医学教育项目管理中的应用

北京大学医学部继续教育管理实践具有三级管理明确、管理培训多样和质量控制严格等特点，同时存在多级管理导致管理规定和要求的落实逐级衰减、管理质量因人为因素起伏不定等不足。通过将生命周期管理引入国家级继续医学教育项目管理中，使管理贯穿于国家级继续医学教育项目的整个生命周期，即从申报与公布、计划与宣传、举办与督查、结业与证书 和总结与反馈等五个方面进行管理，为规范医学部国家级继续医学教育项目举办，提高项目质量发挥了重要作用。     

复旦大学附属中山医院培训全科医师方法初探

日的 探讨在教学医院中全科医学科的住院医师培训方法。方法 对自1994年6月-2000年7月从上海医科大学五年制本科毕业后的20名住院医师,按全科住院医师的规范化培训要求,时间3-5掉,考核并追踪他们在内科,全科病区,急诊及社区卫生服务站点工作的能力,并与同期毕业的内科医师作比较。结果 以全科执业医师为目标,经规范化的住院医师培训,五年后均能顺利地晋升为全科主治医师,他们能胜任一般内科或其他专科医师不能承担的工作,工作范畴之广涉及到围生期的保健,婴幼儿的预防接种,计划生育技术指导,慢性病的防治,内、外、妇、儿、五官、眼科等疾病的诊治。心理咨询,残疾后的康复乃至临终关怀,并在本地卫生局举办的全科医师岗位培训班及各类医师继续教育中担任师资,撰写论文、科普文章20余篇,结论 本培训方法尚有成效,但存在师资缺乏,生源困难及教育经费不足的问题。