北京地区国家医师资格考试合格的医师在岗胜任能力综合评价

目的对通过国家医师资格考试的住院医师岗位胜任情况进行调查,了解住院医师的从业水平与相关影响因素。方法在北京地区随机抽取10家医院对2004、2005、2006年通过国家医师资格考试的住院医师进行调查,选用调查问卷的方式对考生临床工作情况进行多方面的评价评分,对评分结果进行统计学分析。结果北京地区不同级别的医院的住院医师评价结果有统计学意义。结论三级医院具有良好的师资力量和教学环境,有利于住院医师的成长和素质培养。     

实施住院医师规范化培训导师制的探讨

住院医师规范化培训是医学院校人才培养的主要方式,其根本目的是提高住院医师的综合素质,而导师制的培养模式是提升住院医师综合素质的有效途径。本文阐述导师制的内涵、起源和发展,以及住院医师规范化培训实行导师制的必要性,并探讨可行的具体实施方法。     

住院医师医疗工作评价方法研究

目的建立住院医师医疗工作评价指标体系和评价方法,为医疗机构的人才管理提供理论和实践依据。方法运用医学、统计学、管理学的理论和方法,通过德尔菲(Delphi)法,建立评价模型和医疗工作评价指标体系。结果指标体系由二级指标构成,其中二级指标20个,能够对住院医师的工作质量、工作效率和经济效益进行测评。结论建立健全一套住院医师临床工作评价指标体系势在必行。此研究建立的评价指标体系基本能够满足现阶段住院医师医疗工作评估的需要。     

住院医师规范化培训中门诊教学的实践与探讨

目的探索住院医师规范化培训中门诊教学的方式方法和效果评价,提高住院医师门诊教学水平。方法探讨和比较中美住院医师规范化培训中门诊教学的差异,分析门诊教学的重要性,结合浙江省人民医院的"螺旋式"住院医师规范化门诊教学经验,展开讨论。结果浙江省人民医院的"螺旋式"住院医师规范化门诊教学能有效地促进住院医师实践能力和临床思维能力,扩大病例接触面,加强责任感和医患沟通技巧等的能力提高。结论门诊教学有助于培养住院医师综合素质,为今后独立从事临床工作打下基础。     

住院医师规范化培训存在问题分析与对策探索

住院医师是医院人才梯队建设的基础。完善临床住院医师规范化培训工作,是提高青年医师综合素质的重要途径,对培养高层次的医学人才起着承上启下的作用。针对住院医师规范化培训与在职研究生教育中的衔接不畅、评估考核机制不善、政策落实不力以及软硬件设施急需提高等问题,提出了实现二者的有效衔接,通过完善评估机制、配套设施和服务体系,以期探索出完善医师培养方法并提高青年医师综合素质的新途径。     

探索口腔住院医师规培教育研究

探索口腔住院医师规范化培训(以下简称规培)新模式在口腔临床教学中的应用。通过改善课程设置、加强实践、改革教学方法、完善评价体系等手段,研究口腔住院医师规培教育模式的转变进一步完善了住院医师的知识结构,培养住院医师多方面的素质,提高了住院医师的科研能力、创新能力。     

护士长能力素质评价模型构建研究

目的 打造护士长能力素质评价指标体系,构建智能化、自动化兼具实用性的护士长能力素质评价模型.方法 运用问卷调查、专家问询等方法确定指标体系及权重,采用改进模糊综合评价法,优化权重,运用关键业绩指标、360度绩效评估等评价方法确定打分对象.结果 根据对护士长的打分结果,该模型可自动计算护士长的能力素质各指标的综合评分.结...     

住院医师医疗工作评价体系的构建和应用

为做好住院医师医疗工作质量的评价,不断提高医疗服务质量。本文运用了TOPSIS法构建了"住院医师医疗工作评价体系",并对其实用性和操作性方面进行检验,有关结果     

多源反馈评估住院医生沟通能力调查

目的:通过对住院医师沟通能力现状的调查与分析,探讨医患沟通教育和客观评价的途径与方法。方法:采用多源反馈评估法,分别从患者、主治医生、护士和自我评价等多角度对某医科大学2所教学医院的住院医师进行评估。结果:不同评价者对住院医师沟通能力的评价结果不同,且差异有显著性意义;住院医师沟通能力较差,亟待提高。     

建立对住院医师培训综合评价的有效方法

评价是医院管理中的一项价值判断活动[1].实行对住院医师综合评价,是实施住院医师规范化培训是否满足社会、医院和个体需要的程度得出的价值判断.评价的目的是建立完善的质量评估体系[2],使住院医师管理工作能产生更大的价值.     

综合性医院教学能力评价指标体系构建

目的 构建医院教学能力评价指标体系,建立医院教学管理模式,为客观评价医院教学提供研究工具,为规范医院教学管理提出政策性建议.方法 采用问卷调查法、专家德尔菲法、层次分析法,建立医院教学能力评价指标体系和管理模式.结果 医院教学能力评价指标主要包括教学意识、教学条件、教学管理、教学状态、教学结果等,其中人才培养、教学经费投入、教学人员设置、住院医师规范化培训、教学风气等子指标所占权重较大,表明其在教学工作中的重要性.结论 为提高综合性医院的教学能力,医院应制定科学的教学人才培养目标、强化教学意识、增加教学投入、规范教学管理、加强师资队伍建设、加强教学手段创新.     

基于DRG的主诊组医疗服务能力综合评价

目的基于DRG指标对主诊组医疗服务能力进行综合评价,为提升医疗服务质量和医院管理水平提供参考。方法提取该院2019年出院患者病案首页信息,利用CN-DRG分组器进行自动分组获得主诊组DRG数据。选取院外标杆（该地区4家同级别医院均值）和院内标杆（本院近3年均值）对评价指标进行同度量处理,采用加权秩和比法对各主诊组医疗服务能力进行综合评价及排序。结果综合排名前10的各主诊组在两类排名中位次均靠前。临床心理科各主诊组以院外标杆标化后的综合排名更优;泌尿外科、老年病科多个主诊组以院内标杆标化后的综合排名较好。东院疼痛科各主诊组在两类综合评价中排名均靠后。结论运用DRG等相关指标进行主诊组医疗服务能力评价较为合理,以院外标杆标化后的评价结果考虑了主诊组的医疗服务能力在同级别医院中所处的位置,以院内标杆标化后的评价结果考虑了各主诊组近年来的发展水平。两种评价方法相互补充,可从不同角度评价主诊组医疗服务能力发展情况。     

Evaluation of the cost-effectiveness of an automated multiphasic health testing system

We present an evaluation of the cost-effectiveness of an automated multiphasic health testing system (AMHTS) compared with a manual system for providing comprehensive health examinations of large populations. The automated technology was found to be more economical (50–75% less/examinee) than the traditional system in performing each phase of the comprehensive screening and overall battery at a certain examinee load per month. Direct costs had a larger effect on cost per examinee than indirect costs and equipment depreciation. Highly automated phases (tests) were relatively more cost-effective than phases requiring more time and participation of physicians or trained personnel. This study demonstrates that an AMHTS can be utilized (within its parent medical care delivery organization) as an efficient, economical, and convenient method for conducting large-scale multiphasic screening.     

基于DRGs平台的主诊医师团队医疗质量评价研究

目的基于DRGs分组平台对主诊医师团队的医疗服务水平进行评价,探索以DRGs平台数据为工具,评价临床医师团队医疗质量。方法利用DRGs的评价指标,运用综合指数法,从医疗能力、医疗效率和医疗安全3个方面对样本医院肝胆胰外科主诊医师团队的医疗质量进行评价,并进行比较分析。结果综合评价排名前3的医师团队分别是F、E、C,排名后两位为B、D。其中医疗能力的分值B、C、D团队较低,建议提高专业技能,增加疾病收治种类,提高疑难杂症病例的诊治能力;医疗效率D、G团队分值较低,建议在保证医疗质量的前提下适量减少住院日,选择更经济的治疗方法降低医疗费用。结论基于DRGs绩效评价指标,构建主诊医师团队医疗质量评价架构,能真实反映医师团队的医疗质量情况。     

四步法在麻醉科住院医师素质培训中的应用

为提高麻醉科住院医师临床操作水平,在临床培训中采四步临床实体教学法。实践显示,四步临床实体教学法效果显著,麻醉科住院医师临床操作水平得到迅速提高,有利于为社会培养更多的优秀医学人才。     

住院医师规范化培训评估体系的研究

培训效果评估作为培训活动中的重要一环,对发现培训中存在的不足与问题,提高培训质量有着积极的作用。笔者在综合分析泰勒目标评价模型、柯氏评估模型和CIPP模型的基础上,探索住院医师规范化培训的评估体系,将培训评估体系分为3个层次:培训前评估、培训过程评估、培训后评估,同时对评估模型的应用提出建议。     

Mini—CEX与住院医师能力评估

从住院医师的培养目标入手讨论了住院医师核心能力要求及其评估系统;针对目前临床评估缺少直接观察的缺陷,详细分析了Mini—CEX这一测评工具的定义、实施步骤及有关信、效度研究的成果;最后指出开展应用Mini—CEX,实现多元化评估的意义。     

临床医师综合绩效评价标准与方法

临床医师综合绩效评估机制是对临床医师素质、水平、行为表现、工作能力和绩效状况进行全面评估考察的重要手段。本文拟通过对临床医师绩效考评标准及方法的研究,探索一个与市场经济发展相适应的、科学的、先进的、公平的人才管理机制,将更有利于医疗卫生事业的健康发展。     

The 'Collaborative Care' curriculum: an educational model addressing key ACGME core competencies in primary care residency training

AIM: The 'Collaborative Care' curriculum is a 12-month senior resident class project in which one evidence-based clinical guideline is designed, implemented and evaluated in our residency practice. This curriculum specifically addresses three of the six Accreditation Council for Graduate Medical Education (ACGME) core competencies: Practice-Based Learning and Improvement, Interpersonal and Communication Skills and System-Based Practices. Additionally, the project enhances the quality of patient care within the model family practice centre in a family practice residency. METHODS: During the project, the third-year residency class selects the disease, develops the clinical guideline, leads its implementation and guides the evaluation process. Select faculty members serve as mentors and coach the resident class through each phase of the project. Specific educational objectives are developed for each content area: evidence-based medicine, clinical guideline development, continuous quality improvement and team leadership. A series of seminars are presented during the project year to provide 'just-in-time' learning for the key content and skills required for each step in the project. By working together to develop the practice guideline, then working with nurses and allied health staff to implement the guideline and review its effectiveness, the resident team gains competence in the areas of practice-based learning and improvement, interpersonal and communication skills and system-based practices. RESULTS: The self-reported level of resident confidence in skill acquisition for each content area was measured for each resident at the time of graduation from the residency programme. Results from the first 2 years of this curriculum are reported (resident n = 12), and demonstrate a high level of physician confidence in the skills addressed and their utility for future practice. CONCLUSIONS: The senior resident seminar and team project model reported here creates learning experiences that appear to address at least three of the ACGME general competency expectations: practice-based learning and improvement, interpersonal communication skills, and systems-based practice. From the initial resident feedback, this educational model seems to establish a high level of physician confidence in the skills addressed and their utility for future practice.     

Social policy implications of physician shortage areas in Missouri

A model is used to identify counties in Missouri in which the supply of physician services is inadequate to serve the resident population. In the model, a formula is used to assess the gap between the physician services available in a county and the visits which would be required to serve the residents. Incorporated in the model are adjustments for the age and specialty of the physicians and the age and sex of the population. The model is applied to 1976 and 1981 data in order to analyze the changes which have occurred within the state during that time. The results show that in spite of a 34 per cent increase in the number of physicians practicing in Missouri between 1976 and 1981, 24 of the 115 counties in the state experienced a decrease in their ability to serve their resident populations adequately. Of these 24 counties, 23 had populations of less than 25,000 and 12 had populations of less than 10,000. A factor magnifying the underservice problem is the sharp increase in the proportion of older physicians located in small, rural counties. In 1981, 47 per cent of the primary care physicians located in counties with less than 10,000 people were aged 60 and over, compared to 34 per cent in 1976. This portends major problems in the future in obtaining replacements.