疫情防控常态化下耳鼻咽喉科住院医师规范化培训管理及教学实践探讨

住院医师规范化培训（以下简称住培）是国家医疗改革的重要举措之一,目前常态化疫情防控给耳鼻咽喉科住院医师规范化培训（以下简称住培）基地的管理也带来了新的挑战。本文从专业基地对住培生的管理角度出发,围绕住培管理制度与措施、培训内容及培训模式调整、考核管理、维护住培生心理健康等方面为切入点,总结新型冠状病毒肺炎疫情之下专科住培基地管理和教学实践中遇到的问题和解决方法,为进一步有效提升疫情防控常态下住培的教学质量和管理效果提供参考。     

“H”型切口和“∧”型切口在儿童感染性耳前瘘管切除术中的应用

目的 探讨"H （eta） "型（简称" H"型）切口和"∧（lambada）"型（简称"∧"型）切口在儿童感染性耳前瘘管切除术中的可行性。方法 回顾性分析2013年1月—2018年7月采用"H"型切口和"∧"型切口进行手术的175例儿童感染性耳前瘘管患者的临床资料。其中，161例采用"H "型切口（" H"组），14例采用"∧"型切口（"∧"组）。结果 所有患者手术顺利。术后随访1~2年。术后切口感染率1.1%（2/175），经换药治疗痊愈。皮瓣成活率100.0%（175/175）。无复发病例。结论 "H"型切口和"∧"型切口可以充分暴露瘘管组织以及感染灶，取得良好的手术效果。切口自然形成的皮瓣基本满足感染性耳前瘘管切除后皮肤缺损的Ⅰ期修补且存活率可靠。"∧"型切口靠近发际线，可以得到更好的美容结果。     

扁桃体鳞状细胞癌T2cN0M0诊治过程解析与NCCN指南临床实践

目的：通过对扁桃体鳞状细胞癌案例的临床诊治过程解析，掌握早期扁桃体鳞状细胞癌的诊治方法和标准，并提高医生的临床能力。方法对1例T2cN0M0扁桃体鳞状细胞癌诊断和治疗过程进行分解、分析，逐步以指南（NCCN）为依据确定治疗方案。包括：诊断过程及治疗方案设计。结果随访5年，患者咀嚼、吞咽、呼吸、构语等生理功能恢复正常，肿瘤无复发，生活及生存质量良好。结论对单例扁桃体鳞状细胞癌的诊治分析，不仅可以提高年轻医生对疾病的认识和理解；同时，单病例精细教学更有利于年轻医生临床水平的综合提高，值得推广。     

互联网+背景下混合式教学在耳鼻咽喉住院医师规范化培训中的应用#br#

目的　探讨互联网+背景下混合式教学在耳鼻咽喉住院医师规范化培训（简称住培）中应用。方法　选取本院2019年在耳鼻咽喉科参加住培的医师20例作为对照组,2020年在耳鼻咽喉科参加住培的医师20例作为观察组。观察组采用线上、线下混合式教学,对照组给予传统的线下教学。住培结束后进行理论考核和临床技能考核,比较两组对理论知识和临床技能的掌握程度,设计调查问卷调查学生的满意度。结果　理论考核中,观察组和对照组的成绩分别为（50.5±5.4）分和（41.6±3.1）分,差异具有统计学意义（P＜0.05）。临床技能考核中,观察组和对照组的成绩分别是（93.5±5.4）分和（71.6±3.1）分,差异具有统计学意义（P＜0.05）。观察组对课程满意度、激发学生兴趣、理论知识的掌握与应用、提高临床技能的满意度均高于对照组,差异具有统计学意义（P＜0.05）。观察组学生的临床诊疗思维能力评分高于对照组,差异具有统计学意义（P＜0.05）。结论　互联网+背景下混合式教学显著提高了住培医师对耳鼻咽喉科基础知识、基本技能的掌握程度和满意度,提高学生的临床诊疗思维能力。     

头颈肿瘤多学科联合查房在教学中的应用

头颈肿瘤学是一门交叉学科,多学科团队治疗模式在头颈肿瘤治疗中已经成为一种必然,与此同时多学科教学查房作为重要的教学手段,也是专科医师培养 的需要。北京同仁医院头颈肿瘤专业组实行多学科联合查房多年,主要涉及外科、影像诊断、肿瘤病理、肿瘤内科、放疗科、核医学、介入及营养科等相关科室。在教学效果、人才梯队建设及患者满意度等方面都获得良好的效果。     

遗传性血管神经性喉水肿1例

目的 通过报道1例遗传性血管神经性喉水肿（HALE）患者的发病和诊治经过，以提高临床医师对HALE这一罕见病的认识。方法 患者，女，71岁，因"咽痛、呼吸困难伴颈部肿胀半天"、以"喉水肿"收住院。患者反复发作喉水肿、颜面水肿、四肢水肿50余年，外院一直不能明确诊断。结果 入院后积极给予对症应急处理，患者口唇颜面及颈部肿胀较前明显减轻，完善补体C4和补体C1酯酶抑制剂检查考虑为HALE，患者后赴北京查补体C1抑制物0.05 g/L，确诊为HALE，现采用达那唑治疗中，发作频率明显减少。结论 HALE是一种罕见且有致命威胁的疾病，有家族遗传倾向，易误诊，临床医生应提高认知度，避免严重并发症的发生。     

以问题为基础学习教学对耳鼻咽喉科医学生批判性思维培养的研究

目的　探讨以问题为基础学习教学对耳鼻咽喉科医学生批判性思维的培养效果。方法　以62名见习学生为研究对象，将其随机分为以问题为基础学习教学组和传统见习教学组。采用批判性思维能力测量表分别对学生进行教学前及教学后评价。结果　见习前，两组学生在寻找真理、开放思想、分析能力、系统化能力、自信心、求知欲、认知成熟度及总分等方面得分无统计学差异（P >0.05）；见习后，循证医学见习教学组学生的寻找真理、开放思想、分析能力、系统化能力、自信心、求知欲、认知成熟度及总分等方面得分均优于传统见习教学组，差异具有统计学意义（P＜0.05）。结论　耳鼻咽喉科实施以问题为基础学习、教学对医学生批判性思维能力的培养具有积极的作用。     

耳内镜技术结合虚拟解剖系统在耳科解剖教学中的应用

目的选取上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科住院规培医师作为研究对象，在耳内镜技术结合虚拟解剖系统辅助下完成临床教学任务，通过两种教学手段在临床教学中的联合应用，使规培医师在临床教学中更好地理解和掌握外耳、中耳及内耳结构，耳内镜技术结合虚拟解剖系统对耳鼻咽喉科临床教学可以起到良好的辅助作用，对一些解剖结构的教学可以起到事半功倍的效果，尤其是结合虚拟解剖系统能有效对教学方式进行改良，填补医学教学中趣味教学的空白，在医学教学中具有广阔的应用前景。     

耳鼻咽喉科学五年制教学体系改革与实践

目的：为解决高等医学院校耳鼻咽喉科学教学中的难点及矛盾，进行一系列的教学改革研究。方法：建立了耳鼻咽喉教学体系改革方案，并在1997～2000级四届临床医学专业5年制本科生中进行了实施。结果：耳鼻咽喉教学体系改革方案的实施取得了良好的效果，学生成绩及能力有明显提高，教学督导组及管理干部评价极高。结论：新的耳鼻咽喉科学教学体系较好地解决了耳鼻咽喉科学中的教学矛盾与困难，对临床医学教学改革亦具有较大的借鉴价值。     

基于微课的翻转课堂教学模式在耳鼻咽喉头颈外科临床实习教学中的应用

目的 探讨微课结合翻转课堂教学模式在耳鼻咽喉科本科生临床实习教学中的教学效果。方法 特选取在本科室实习的2014级医学临床医学专业方向的72名本科生作为研究对象行对比分析，采用随机数表法将其分为两组，观察组即为翻转课堂组，每组36人。对比学习后两组学生的理论和技能考试，综合能力评分来评价教学效果。结果 观察组技能成绩（90.60±3.64）分高于对照组（86.74±6.85）分，观察组学生解决问题能力及自学能力方面高于对照组；差异具有统计学意义（P <0.05)。结论 在耳鼻咽喉科的临床实习教学中，使用微课结合翻转课堂模式不仅能提高教学效果，同时也锻炼和提高了学生解决问题，独立分析问题的能力。     

Teaching arms and screens for microscope and fibreoptic nasendoscope: are they effective teaching devices and are we utilising them?

With training time for junior doctors now reduced, it is crucial to optimise training opportunities during elective clinical activities. Teaching ENT examination skills presents unique challenges as often, only the examiner can observe what’s going on. We set out to explore the utilisation of microscope and nasendoscope teaching devices for ENT junior doctors. Telephonic survey of 102 English ENT units. ENT junior doctors spent an average of 7 h per week in elective ENT outpatient clinics. 92% of them felt that spending time in outpatient clinics helped improve their confidence in patients’ management. 81% of ENT junior doctors stated that being able to observe others or being observed themselves would help to improve their clinical abilities. The availability and utilisation of nasendoscopy and microscopy teaching tools are currently suboptimal. Doctors working in departments that utilised the teaching tools stated that their educational needs were more likely to be met. Most ENT junior doctors found it beneficial to attend elective outpatient clinics although their learning needs were more likely to be met should ENT teaching devices be available. The availability and utilisation of ENT teaching devices are currently suboptimal and needs addressing.     

Patient perceptions of the otolaryngology ward round in a teaching hospital

OBJECTIVE: This survey assesses patients' perceptions of a daily otolaryngology ward round in a teaching hospital. METHODS: Initial, open-ended questionnaires generated themes from which a structured questionnaire was constructed. Patients' perceptions in a wide range of areas were examined by asking them to indicate on a Likert scale the extent to which they agreed or disagreed with a number of statements concerning various aspects of the ward round. RESULTS: One hundred patients were surveyed. The response rate was 79 per cent. The findings showed overall patient satisfaction with the ward round, particularly in the areas of information-giving regarding diagnosis, treatment and follow-up arrangements. The large size of the ward round appeared to be intimidating and induced anxiety for approximately one-third of patients. Patients wished the roles of staff present to be better defined and to be informed of the presence of medical students. One-third of patients perceived staff to use language that was difficult to understand. CONCLUSIONS: The survey identified some improvement opportunities and will assist our department with its on-going endeavours to improve the ward round experience for both patients and staff.     

Staff attitudes to a daily otolaryngology ward round

This survey investigates the attitudes of medical and nursing staff towards the daily otolaryngology ward rounds in a teaching hospital. Initial, open-ended questionnaires generated themes from which a structured questionnaire was constructed. Respondents indicated on a Likert scale the extent to which they agreed or disagreed with statements concerning their attitudes towards the ward round. Thirty-five members of staff were surveyed. The overall response rate was 74.3 per cent (n = 26). The majority of staff agreed that the ward round was a constructive use of their time and served to promote team spirit. It allowed for adequate communication between medical and nursing staff but there was uncertainty about the provision of adequate patient communication. The nursing staff agreed that the ward round provided a valuable learning experience. There was uncertainty about this among the medical staff. There was agreement in both groups that patients find the ward round to be reassuring. A significant majority of staff expressed concerns over maintenance of patient confidentiality. These findings could be used to inform changes in the departmental ward round structure. Specific attention should be directed to discussing sensitive issues in a more private setting and maximizing educational opportunities for junior medical staff.     

重提主治医师教学查房在医学教学工作中的作用

摘要：近年来医学院校教学查房制度形同虚设，和医学查房合二为一，而教学查房有其不可替代的地方，值得重视，重提教学查房在医学教育的重要性，规范教学查房迫在眉睫。     

Assessment of knowledge regarding tracheostomy care and management of early complications among healthcare professionals

IntroductionTracheostomy is commonly performed surgical procedure in ENT practice. Postoperative care is the most important aspect for achieving good patient outcomes. Unavailability of standard guidelines on tracheostomy management and inadequate training can make this basic practice complex. The nursing staff and doctors play a very important role in bedside management, both in the ward and in the intensive care unit (ICU) setup. Therefore, it is crucial that all healthcare providers directly involved in providing postoperative care to such patients can do this efficiently.ObjectivesThe objective of this study is to assess the knowledge regarding identification and management of tracheostomy-related emergencies and early complications among healthcare professionals so as to improve practice and further standardization.MethodsCross-sectional observational study included two hundred and fifty-four doctors and nurses from four large tertiary care hospitals. The questions used were simple and straightforward regarding tracheostomy suctioning, cuff care, cuff management, tube blockage, and feeding management in patients with tracheostomy.ResultsBased on evidence from our study, knowledge level regarding tracheostomy care ranges from 48% to 52% with knowledge scores above 50% being considered satisfactory. Significant gaps in knowledge exist in various aspects of tracheostomy care and management among healthcare professionals.ConclusionOur findings demonstrated an adequate knowledge level among health care professionals ranging from 48% to 52% with knowledge scores above 50% being considered satisfactory and revealed that gaps in knowledge still exist in various aspects of tracheostomy care and management.     

Is undergraduate otorhinolaryngology teaching relevant to junior doctors working in accident and emergency departments?

Undergraduate ENT teaching provides junior doctors with skills and knowledge useful for the practice of medicine. However, ENT has been removed from the curriculum of nine of the 29 medical schools in the United Kingdom, as it was not deemed relevant to general medical practice. A telephone survey was performed of 20 senior house officers working in accident and emergency (A&E) departments across the United Kingdom. The results showed that 90 per cent felt their undergraduate ENT teaching was directly beneficial to working in A&E, 75 per cent felt they had not received enough undergraduate ENT teaching and 45 per cent currently received no postgraduate teaching whilst working in A&E. These results illustrate the importance of ENT teaching in the undergraduate curriculum and its value to practising doctors. They highlight the fact that prospective studies are required to examine the effect on junior doctors of changing the curriculum.     

What is the impact of consultant supervision on outpatient follow‐up rate?

This study investigated the impact of consultants on recycling rates of patients in the ENT outpatient clinic. A retrospective case review of 4205 consecutive patients who attended ENT outpatient clinics of an UK teaching hospital over a 3‐month period was conducted. There was a significant association between grade of medical staff and recycling rate of new patients, and also for review patients. Junior doctors have lower recycling rates in consultant‐led clinics compared with clinics in the absence of consultants for both new patients (consultant‐led 41.0%, without consultant 60.1%; P < 0.01) and old patients (consultant‐led 48.9%, without consultant 65.0%; P < 0.01). Individual consultant's practice was reflected upon the overall recycling rate of the clinic as a whole (r = 0.94, P = 0.001). In conclusion, individual consultant's practice dictated recycling rate in the ENT outpatient clinic. Junior doctors were less likely to make follow‐up appointments when directly supervised by their consultants.     

临床前期咽喉部模拟器教学与传统教学的比较研究

目的:探讨与传统的临床实习教学相比,咽喉部模拟器教学能否提高咽喉部临床操作的质量。方法:将65名实习医生随机分成试验组和对照组。试验组在传统临床实习的同时利用模拟器进行咽喉部教学训练,对照组只进行传统临床实习,而后通过操作考核比较模拟器教学效果。结果:接受模拟器教学训练的学生,其各项考核表现均优于对照组,差异均有统计学意义(均P<0.05)。结论:咽喉部模拟器教学可以切实提高咽喉部操作的教学质量,是教学医院和医师培训基地的推荐教具,值得进一步推广。     

Use of Hearing-Aid-Processed Stimuli in Hearing Aid Evaluation

In ‘hearing aid consultation’, recommendations for an aid are made without observing the patient's aided performance. This practice is undesirable since aided auditory discrimination ability is different to predict on the basis of unaided scores. On the other hand, maintenance in the clinic of a representative stock of hearing aids is costly and time- consuming. As a possible alternative, the intelligibility of ‘hearing-aid-processed’ PB lists (recorded through a hearing aid) was compared with aided discrimination under clinical conditions. Fifteen subjects with sensorineural loss were used. No differences resulted between the two test conditions, indicating that hearing-aid-processed stimuli can give useful information about aided discrimination ability