住院医师临床技能培训在SARS防治中的应用调查分析

目的　评价住院医师临床技能培训在SARS防治中的应用效果 ,制定医师应急技能培训计划。方法　采用问卷调查的方法对本院进入SARS病区的 10 1名住院医师进行调查。结果　通过对住院医师进行临床各项技能的培训 ,使住院医师在SARS治疗中得到了不同程度的帮助。调查中住院医师认为有帮助、能解决问题达 10 0 % ,认为培训有益处达 10 0 %。结论　技能培训使住院医师较熟练地掌握了基本技能 ,提高了在临床应用中的操作能力 ,并在SARS治疗工作中增强了应对突发事件的能力[1] 。     

临床医学技能培训中心的建立和完善

通过建立和完善临床医学技能培训中心，探讨临床医学实践教学的有效途径。我院自1999年以来陆续投资1500万元建造了临床技能培训中心，并有目的、有步骤地完善临床技能培训和考核中心的功能，为医学实践教学提供了设备完备、环境逼真、技能训练规范的教学环境；并结合教学对象及其教学目的、教学方式方法和师资状况，整合设置了不同类型的培训项目；开展不同层次的临床技能培训，为学员临床实践能力的提高奠定良好的基础。     

临床技能中心在住院医师临床能力培养中的应用

目的：探讨临床技能中心在住院医师临床能力培养中的作用,为临床教学医院临床技能中心建设提供经验总结。方法：采用便利抽样法,对68名2009届住院医师行临床基本技能操作培训考核工作,并对考核结果做统计分析。结果：考核合格率达77.9%（53/68）,本科组高于研究生组;不同工作时间者其考核得分有差别,经dunnettt检验组间比较：＂无工作经历＂组考核成绩高于＂工作1～3年＂组（P〈0.05）。结论：临床技能中心对于住院医师临床基本操作技能的培养和提高有重要作用,是提高住院医师临床能力的有效途径。     

Standardized patients in the early acquisition of clinical skills

OBJECTIVES: Facing dramatic reductions of inpatient beds and fewer faculty tutors, the Queen's University medical school has had to consider alternatives to the traditional inpatient encounter for the early acquisition of clinical skills. The purpose of this study was to investigate the feasibility and impact on students of a model for a first-year clinical skills course, using exclusively standardized patients in place of inpatients, and using a smaller ratio of faculty to students. DESIGN: Twenty volunteers were selected from the first-year class of 75 students to participate as the experimental group. The remaining 55 students formed the control group. SETTING: Queen's University medical school, Ontario, Canada. SUBJECTS: First-year medical students. RESULTS: In measures of student satisfaction with the amount of performance feedback received during the course, there was a non-significant trend towards greater satisfaction among the experimental group compared to the control group. This occurred despite a tutor to student ratio of 1.5:10 in the experimental group compared to 3:10 in the control group. In the student evaluation of their tutors, mean scores for the two groups were 4.28 for the experimental group and 4. 06 for the control group (P = 0.10). The mean OSCE scores for the two groups were 76.4 for the experimental group and 76.5 for the control group (P = 0.93). There is no practical or statistical difference in either of these two scores. CONCLUSIONS: We conclude that this new model is feasible, was well received by the students and that the reduced tutor to student ratio and lack of inpatient encounters did not appear to adversely affect their learning.     

Effects of basic clinical skills training on objective structured clinical examination performance

OBJECTIVES: The aim of curriculum reform in medical education is to improve students' clinical and communication skills. However, there are contradicting results regarding the effectiveness of such reforms. METHODS: A study of internal medicine students was carried out using a static group design. The experimental group consisted of 77 students participating in 7 sessions of communication training, 7 sessions of skills-laboratory training and 7 sessions of bedside-teaching, each lasting 1.5 hours. The control group of 66 students from the traditional curriculum participated in equally as many sessions but was offered only bedside teaching. Students' cognitive and practical skills performance was assessed using Multiple Choice Question (MCQ) testing and an objective structured clinical examination (OSCE), delivered by examiners blind to group membership. RESULTS: The experimental group performed significantly better on the OSCE than did the control group (P < 0.01), whereas the groups did not differ on the MCQ test (P < 0.15). This indicates that specific training in communication and basic clinical skills enabled students to perform better in an OSCE, whereas its effects on knowledge did not differ from those of the traditional curriculum. CONCLUSION: Curriculum reform promoting communication and basic clinical skills are effective and lead to an improved performance in history taking and physical examination skills.     

The effect of professional skills training on patient-centredness and confidence in communicating with patients

OBJECTIVES: The effect of introducing professional skills training on students' patient-centred attitudes and perceptions of ability to communicate was examined. The professional skills training included weekly training in communication skills, ethics and law, and clinical skills. METHODS: Consecutive cohorts of medical students receiving a traditional pre-clinical curriculum (n = 199) and a new curriculum including professional skills training (n = 255) were compared. Students completed the Doctor-Patient Scale to assess patient-centred attitudes and an 11-item scale to assess confidence in their ability to communicate with patients. Students completed the measures at the start of Year 1 and the end of Year 2. RESULTS: Students receiving the professional skills training showed increased confidence in communicating with patients and increases in 2 dimensions of patient-centredness ('holistic care' and 'patient decision making'). Students receiving the traditional curriculum showed increased nervousness in talking to patients. Gender and ethnic differences were found in patient-centredness and confidence in communicating, which were maintained over time. CONCLUSIONS: The introduction of professional skills training was successful in improving students' confidence in their ability to perform specific communicative behaviours and increasing patient-centredness relative to a traditional curriculum.     

Patient simulation for training basic and advanced clinical skills

Introduction  Patient simulators are increasingly used in the education and training of healthcare professionals. This paper describes the history of human patient simulator development, the features of contemporary simulators, the acquisition of basic and advanced clinical skills using patient simulators, and the benefits, cost, limitations and effectiveness of this innovative learning modality.
Simulator development  The development of human patient simulators began in the late 1960s, and accelerated in the late 1980s and early 1990s. Several simulator systems are now professionally manufactured, commercially available, and used at hundreds of medical centres, universities and colleges in the USA and throughout the world. Contemporary patient simulators have many clinical features, and look and respond to interventions with ever-increasing degrees of realism because sophisticated physiological and pharmacological models automatically control many features.
Simulator use in medical education  Simulators are used to teach basic skills, such as respiratory physiology and cardiovascular haemodynamics, and advanced clinical skills, e.g. management of difficult airways, tension pneumothorax, pulmonary embolism and shock.
Benefits, costs and limitations  The simulation laboratory offers distinct educational advantages, especially for learning how to recognise and to treat rare, complex, clinical problems. Costs of simulator-based educational programmes include facility, equipment and personnel. Current limitations include clinical realism of the patient manikin and faculty development.     

低年资护士临床护理技能培训与考核方法探讨

目的：探讨建立有助于护士临床素质提升的培训模式,以全面提升护士工作效率及服务满意度。方法：对护士培训采用教师项目负责制,制定统一的操作规程及考核标准,分层次对护士进行培训。结果：通过培训,护士培训考核的通过率均在95．00％以上,病人满意度逐年提高。结论：低年资护士经过集中培训考核后,能够较快适应护士角色转换,基础工作能力也得到了很大的提升,因而病人满意度也得到了提高,证明此培训方法能够在一定程度上满足医院对低年资护士的培训要求。     

Transition to clinical training: influence of pre-clinical knowledge and skills, and consequences for clinical performance

Context  Many students experience a tough transition from pre-clinical to clinical training and previous studies suggest that this may constrict students' progress. However, clear empirical evidence of this is lacking. The aim of this study was to determine: whether the perceived difficulty of transition influences student performance during the first 2 weeks of clerkships; whether it influences students' overall performance in their first clerkship, and the degree to which the difficulty of transition is influenced by students' pre-clinical knowledge and skills levels.
Methods  Clerks ( n  = 83) from a university hospital and eight affiliated hospitals completed a questionnaire measuring the perceived difficulty of the transition period. Data collected included student scores on pre-clinical knowledge and skills, their performance during the second week of the first clerkship, and their overall performance in the first clerkship. Univariate and multivariate multiple regression analyses were used to analyse the data.
Results  The perceived difficulty of transition was neither predictive of student performance during the transition period (adjusted R ² = 11.8%, P  = NS), nor of their overall clerkship performance (adjusted R ² = 8.6%, P  = NS). Students' pre-clinical knowledge and skills played a minor role in the perceived difficulty of the transition period.
Conclusions  The negative effect of the transition period on student progress suggested in the literature was not found in this study. A possible explanation for the limited influence of students' knowledge and skills on performance during the transition period is that the workload in this period causes a cognitive overload, interfering with students' abilities to apply their pre-clinical knowledge and skills.     

临床技能教学改革的初步效果评价

对临床医学本科专业2005级学生进行临床技能学课程培训,培训结束后进行临床技能考核,并与未进行临床技能学课程培训的2003级学生的临床技能考核成绩做对比分析,以评价临床技能教学改革的初步效果.结果显示,经过技能培训后的2005级学生,其诊断学、内科学、外科学技能考核成绩及总评成绩均显著提高(均P＜0.05-0.001)...     

Relationship of resident characteristics, attitudes, prior training and clinical knowledge to communication skills performance

PURPOSE: A substantial body of literature demonstrates that communication skills in medicine can be taught and retained through teaching and practice. Considerable evidence also reveals that characteristics such as gender, age, language and attitudes affect communication skills performance. Our study examined the characteristics, attitudes and prior communication skills training of residents to determine the relationship of each to patient-doctor communication. The relationship between communication skills proficiency and clinical knowledge application (biomedical and ethical) was also examined through the use of doctor-developed clinical content checklists, as very little research has been conducted in this area. METHODS: A total of 78 first- and second-year residents across all departments at Dalhousie Medical School participated in a videotaped 4-station objective structured clinical examination presenting a range of communication and clinical knowledge challenges. A variety of instruments were used to gather information and assess performance. Two expert raters evaluated the videotapes. RESULTS: Significant relationships were observed between resident characteristics, prior communication skills training, clinical knowledge and communication skills performance. Females, younger residents and residents with English as first language scored significantly higher, as did residents with prior communication skills training. A significant positive relationship was found between the clinical content checklist and communication performance. Gender was the only characteristic related significantly to attitudes. CONCLUSIONS: Gender, age, language and prior communication skills training are related to communication skills performance and have implications for resident education. The positive relationship between communication skills proficiency and clinical knowledge application is important and should be explored further.     

Monitoring the development of clinical skills during training in a clinical placement

Background The education and training of health care practitioners has undergone recent reform, and indicate that curricula should place emphasis on the development of clinical skills and attitude. The purpose of this study was two‐fold: to define the key skills necessary for a competent dietetic student practitioner and to devise a reliable assessment tool to measure and track performance in these key skill areas throughout the period of clinical placement. Methods Key clinical skills were identified by a concensus group of experienced dietitians and academic practitioners. An assessment tool was then developed to measure these attributes in 43 students undertaking clinical placement at a number of training centres in Scotland. Development of skills was tracked for the entire duration of placements using the novel assessment tool. The assessment tool used a visual analogue scale (VAS) as the measuring score. Results A high level of skill attainment was equated with high VAS scores. Performance in three of the four key skills (written skills: r = 0.762, P ≤ 0.001; interviewing skills: r = 0.697, P < 0.001; and dietary assessment technique: r = 0.697, P ≤ 0.001) showed impressive correlation co‐efficients, indicating a striking and significant positive correlation with the length of training. A high skill performance level attainment was achieved by week 16/17 of training. Conclusion The authors are confident that the assessment tool is valid and reliable and measures skill performance objectively. A high level of skill attainment was observed in most students by about the mid‐point in training: this allows the student to consolidate these skills in the latter stages of training which is in keeping with educational and practice philosophy of placement learning outcomes.     

The effect of communication skills training on patient-pharmacist communication in pharmacy education: a meta-analysis

Communication skills in pharmacy education and practice are increasingly regarded as a crucial component. However, thus far, estimating of the overall communication skills training (CST) effects in a variety of outcomes is lacking. The aim of this study was to synthesize the effects of CST in pharmacy education by performing a meta-analysis of CST studies. We searched MEDLINE, EMBASE, ERIC, CINAHL, PsycINFO, Cochrane Library, Web of Science, Communication and Mass Media Complete (CMMC), key journals, and bibliographic databases. The effect sizes (ESs) were extracted and pooled in random effects meta-analyses. We assessed the quality of the study using the Medical Education Research Study Quality Instrument (MERSQI). From 34,737 articles, 9 studies were included in this meta-analysis. The overall effect size for CST was 0.611 (95% CI 0.327–0.895), and it was statistically significant (p = 0.000). We found based on the subgroup analyses that CST has a large effect size when it used stand-alone courses, lecture-lab based courses, video recordings, feedback, training for 2 or more semesters, hours per week ≥5 h and external assessments. For the CST effect, the effect sizes were ranked in order of confidence, knowledge, skills, and attitudes. The result of the meta-regression is that the total number of attendees is significantly negatively correlated with the effect sizes of the CST. The findings of the present meta-analysis provide evidence that CST in pharmacy education may act as an efficient way to improve the communication competency of students, and it may serve as a guide for pharmacy educators.     

The effects of patient communication skills training on compliance

OBJECTIVE: To examine the relationship between communication skills training for patients and their compliance with recommended treatment. DESIGN: A randomized control design was used, with patients nested within physicians. Each physician was audiotaped with 6 patients, 2 patients in each of the 3 intervention conditions: (1) a trained group (n = 50) received a training booklet in the mail 2 to 3 days prior to the scheduled appointment, (2) an informed group (n = 49) received a brief written summary of the major points contained in the training booklet while in the waiting room prior to the scheduled appointment, and (3) an untrained group (n = 51) did not receive any form of communication skills intervention. SETTING: Participants included physicians and patients from 9 different primary care, family practice locations. Two locations were clinics associated with a large, university-based medical school and hospital, while 7 were private practice offices in the community. PARTICIPANTS: The sample included 25 family physicians (averaging 11 years postresidency) and 150 patients. Patients were randomly selected from appointment records and randomly assigned to 1 of 3 intervention conditions. INTERVENTION: A training booklet designed to instruct patients in information seeking, provision, and verification. MAIN OUTCOME MEASURE: Patients' compliance with medications, behavioral treatment (e.g., diet, exercise, smoking cessation), and/or follow-up appointments and referrals. RESULTS: Trained patients were more compliant overall than untrained or informed patients. Training positively influenced compliance with behavioral treatments and follow-up appointments and referrals. CONCLUSION: Training patients in communication skills may be a cost-effective way of increasing compliance and improving the overall health of patients.     

导师与新毕业护士对基础护理技术培训需求差异的研究

目的研究导师与新毕业护士对基础护理技术培训需求的差异及其影响因素,探讨这种差异对培训的影响。方法自行设计调查问卷对导师和新毕业护士进行调查,内容包括84项基础护理技术项目,通过多重响应分析对每一项目进行分类,按个案百分比的不同分为共识项目和非共识项目,然后对两种项目数量的差异进行卡方检验,得出两组调查对象关于基础护理技术培训需求的差异。结果两组调查对象的培训需求存在明显差异(P<0.001),导师组的需求较集中(共识项目数量多),主要是一般基础护理技术,而新毕业护士组的需求分散在各专科基础护理技术(共识项目数量少)。导师组的工作年限和第一学历对培训需求有影响(P<0.001),而新毕业护士的学历没有影响(P=0.081)。结论对新毕业护士培训时,需充分考虑导师和新毕业护士的不同需求,扎实基础,循序渐进。