专科医师培训工作的实践与认识

专科医师培训是医学生成长为能独立从事临床医疗工作医生的关键阶段．属于毕业后医学教育范畴．是医学教育连续统一体的重要组成部分．对提升临床医生的临床诊疗水平、提高医疗质量发挥着重要作用Ⅲ。而目前我国的专科医师培训工作尚处于试点阶段．在此阶段医院如何有效地做好专科医师培训工作．是医院管理者急需考虑的问题。本文以医院管理者的视角．简要介绍医院医师培训的概况．分析医院开展专科医师培训工作取得的经验．并结合工作实践提出做好专科医师培训工作的措施和建议。     

住院医师规范化培训将有“国标”

国家卫生和计划生育委员会网站发布《住院医师规范化培训标准(试行)》草案,向社会公开征求意见。《标准》提出,住院医师规范化培训是培养合格临床医师必经的毕业后医学教育阶段,为期3年的住院医师规范化培训以临床实践培训为重点,取得培训合格证书将逐步作为临床医师在医疗机构独立从事诊疗工作和进入专科医师培训以及中级职称晋升的必备条件。为尽快全面建立和实施住院医师规范化培训制度,进而为建立实施专科医师培训制度奠定基础,国家卫生计生委委托中国医师协会组织专家制定了《住院医师规范化培训标准(试行)》。该《标准》包括培训总则和     

美、英、法、新专科医师培养过程

接受12年的基础教育—4年大学教育——4年医学院校教育（2年基础．2年临床．毕业后授予博士学位．但不发医师执照）——4～8年的培训（1年的毕业后培训，3-7年专业培训）——取得专科医师资格证书．成为一名专科医师。2000年起．美国实行再认证制度．资格证书的有效期为7～10年．要想继续获得专科医师资格．必须定期参加本专业的继续医学教育．接受资格审查．     

国内外公共卫生医师规范化培训进展与现状

随着我国医疗卫生体制改革的深入,医师的个人素养和技能水平对于促进和改善医疗服务,提高人民健康水平起着举足轻重的作用.我国临床住院医师和临床专科医师规范化培训早在1993年就已起步,规范化培训制度已经比较成熟,相比之下,我国公共卫生医师培训尚未进入规范化阶段,现阶段开展的公共卫生医师培训均由各省自行组织,培训时间、内容设置及培训效果差异较大.     

我国专科医师培养制度与住院医师培训的联系和区别

全球大多数国家对临床医师执业都实行严格的培养和执业资格准入制度.尤其是欧美等发达国家经过多年的探索和实践,专科医师培训和准入制度相当完善和成熟.我国港澳台地区对临床专科医师的培训与管理也是遵循国际通用做法.     

专科医师培训人力资源管理体系调查研究

目的:探讨如何构建专科医师培训的人力资源管理体系,为天津市专科医师制度的实施提供参考.方法:采用问卷调查和专题小组访谈相结合的方法对天津市18所二级及以上医院的1100名管理人员、临床医师进行了调查.通过分析总结,对构建专科医师培训人力资源管理体系提出建议.结果:93.8%的被调查者认为有必要成立毕业后医学教育委员会,专门负责专科医师制度的具体实施;74.9%的被调查者认为专科医师培训经费应该由政府和个人共同分担;84.2%的被调查者认为参加培训的应届医学毕业生的工资和奖金应由专科医师培训基地支付,73.4%的被调查者认为已参加工作的受训医师的工资和奖金应由原单位支付.结论:人力资源管理体系涉及到培养对象的人事关系、培训组织管理机构、培训经费、薪酬设计和管理、考核奖惩等方面内容.应采取积极的措施构建完善、高效的人力资源管理体系.     

“专培”如何达到预期成效?

近日,国家卫生计生委、中国医师协会在京启动专科医师规范化培训(以下简称专培)制度试点工作,首批选择神经外科、呼吸与危重症、心血管内科进行试点.按照初步规划,到2020年,我国将初步建立专科医师规范化培训制度,形成完整的毕业后医学教育体系.开展专科医师规范化培训试点,最终目的是要在住院医师规范化培训的基础上,培养一批能独立、规范地从事疾病专科诊疗工作的临床专科医师.     

专科医师培训的实践与探索

专科医师规范化培训是完善我国毕业后教育的重要工作.介绍某大型三级甲等医院专科医师培训工作,详尽分析专科医师规范化培训的开展情况及存在问题,为进一步完善医院专科医师规范化培训提出建议.     

中医院肿瘤科住院医师规范化培训的带教体会

当代医学的发展促使临床专科越分越细,对医师的专业化要求也相应提高。专科医师培养和准入制度作为国际医学界公认的医学生毕业后继续教育制度,正越来越受到重视。医学毕业生必须在经过认可的培训基地,以住院医师身份接受严格的、以提高临床能力为主的系统、规范化培训,完成培训并通过考核后才具备专科医师资格,才能成为独立从事某一专科临床工作的普通专科医师或亚专科医师[1]。     

临床医学博士专业学位与专科医师规范化培训衔接

毕业后医学教育包括研究生教育和住院/专科医师规范化培训,临床医学专业学位博士和专科医师规范化培训作为两种重要的毕业后医学教育,对医学人才的培养起着承上启下的作用.从临床医师培养规律、临床能力培养目标、制度保障以及试点经验等方面,阐述临床医学博士专业学位与专科医师规范化培训衔接的可行性,探讨可能出现的问题,并提出相应的建议,为完善我国毕业后医学教育提供依据.     

县级医院神经内科临床实习带教中存在的问题及对策

临床实习是培养医学生临床思维能力的主要途径。该文指出当前县级医院神经内科医学生临床实习中普遍存在的问题是学生对实习重视度不够,患者对于实习生接受程度不高,带教教师的能力限制及责任心不强。提出神经内科临床实习带教中的主要对策是重视岗前培训,重视学生的基本操作规范及技能的培养,加强病历书写的基本功培训,同时要科学带教充分调动学生在学习上的积极性和主动性,从而形成神经内科特有的临床思维,为其成为合格临床医师打下坚实的基础。     

An evaluation of the undergraduate teaching programme in ophthalmology in Sri Lanka and Malaysia

The knowledge and clinical and minor surgical skills acquired by 257 medical students in three universities in Sri Lanka and Malaysia were assessed by a questionnaire after they had completed their training period in ophthalmology. This study showed that many medical students graduating from these universities lacked the basic clinical and minor surgical skills essential for a doctor practising in a community in south-east Asia. The responses also indicated that teaching by consultants in all three universities was inadequate and due to these inadequacies the students requested that the duration of their training period be doubled. Ophthalmology is an important component of clinical practice and proper education in this subject is important. An urgent revision of the aims and objectives of the curriculum in ophthalmology is essential to place greater emphasis on this important and much neglected subject, for which very little curricular time is allotted.     

某社区卫生服务中心执业医师中医药知识技能调查

目的了解社区执业医师中医药知识和技能掌握运用情况以及对中医药知识的需求，从而为对社区执业医师加大有关中医药知识培训提供一定依据。方法设计调查表，通过调查问卷的方式，对社区执业医师（包括中医师和西医师）掌握中医药知识和技能进行分析。结果社区中医执业医师迫切需要专业技能的培训，其经常使用的中医药治疗方法比较单一，知识需要更新，而西医执业医师对中医基本知识缺乏。在平时诊疗过程中，较少运用中医药或中西医结合手段来治疗疾病。结论加大社区执业医师中医药知识培训，特别是要大力通过全科医师岗位培训或规范化培训和开展继续教育的途径，让社区执业医师更好掌握中医药知识和适宜技术，在社区诊疗过程中体现中医药的简、便、廉、验、效。     

加拿大家庭医学教育强化技能培训对我国家庭医生培养和职业发展的启示

加拿大家庭医学教育目前已形成较完善的规范化教育和培养体系,强化技能训练是加拿大家庭医生规范化培训体系中作为通科培训后继续教育的一部分,家庭医生完成两年的通科培训后,可申请就重点关注的特殊领域进行额外专科培训,至少为期一年.通过强化技能训练的家庭医生在获得资质认证后可拥有重点执业领域执业资格,更好地完成家庭医生工作,同时...     

医学影像学实践教学进展

本文主要阐述医学影像学实践教学重要性、特点及演变,总结传统医学影像学实践教学存在的弊端,介绍现代医学影像学实践教学信息化特征,列举国内外不同院校开展医学影像学实践教学的一些具体做法,指出只有充分利用电子信息学技术构建医学影像学实践教学平台,才能真正让学员掌握临床实践技能,满足医学影像学人才培养的岗位任职需求。     

Lectures and skills workshops as teaching formats in a history-taking skills course for medical students

The consulting skills acquired by medical students during their training are an important determinant of their ability to conduct adequate and efficient clinical interviews. These skills comprise: the acquisition of medical knowledge and the ability to apply this; and communication skills required to obtain full, accurate clinical histories from patients and to be able to give to patients the information they need to comply with prescribed regimens. Until recently, consulting skills training has certainly not had a high profile in medical curricula, despite evidence that students do not gain sufficient expertise during their medical training. A history-taking skills course within the Austin Hospital Clinical School, utilizing mass lecture and small-group skills workshops is described. Independent evaluation of students' videotaped interviews with patients, completed before training, after mass lectures and following small-group workshops, showed that students trained in consulting skills demonstrated significant improvements in interview skills and techniques, compared with a similar group of students for whom training followed the more traditional model. Whilst there were some improvements after mass lectures, most significant gains in history-taking skills were obtained following skills workshops. Ongoing evaluation of these students will determine if these short-term improvements in consultation skills persist over their clinical training and internship.     

心肺复苏术分类培训效果分析

目的通过对两类医务人员(刚毕业来本院接受规范化培训的本科医生和下级医院来本院学习的进修医生)进行心肺复苏术短期(1小时30分钟)强化培训,了解培训后二者对心肺复苏术的掌握情况,为今后本院对同时期新进的本科规培生和进修生关于心肺复苏术培训顺序的决定提供参考依据。方法以2010年10月发布的《2010美国心脏协会(AHA)心肺复苏(CPR)及心血管急救(ECC)指南》(简称《2010心肺复苏指南》)为标准,对此两类医务人员进行短期强化培训,培训完后进行理论知识及操作技能的考核。结果本科规培医生与进修医生的理论知识考核合格率分别为:90%、80%(p>0.05),差异无统计学意义;模拟人急救成功率分别为90%、66.7%(p<0.05),差异有统计学意义。结论本科规培医生较进修医生培训效果好。基于培训结果 ,分析两类医务人员的急救相关基础知识和培训前工作环境等差异可能对心肺复苏培训效果有影响,因此今后每年本院新上岗人员可安排进修医生先接受心肺复苏术培训,以达到在短期内迅速提高每年新进医务人员的急救水平,然后依次通过对本科生、研究生等的心肺复苏规范化培训使全院的整体急救水平再上台阶。     

Students' opinions about their preparation for clinical practice

INTRODUCTION: There are data that suggest that medical students do not feel sufficiently prepared for clinical practice in the clerkships. The transition from pre-clinical to clinical training causes problems. OBJECTIVES: To seek quantitative verification of qualitative findings from an earlier focus group study on problems medical students encounter when entering the clinical phase of undergraduate training. METHODS: At the start of the clinical phase, all Year 4 students at Maastricht Medical School were surveyed on the transition from pre-clinical to clinical training and its effects on workload, knowledge, skills and learning. RESULTS: The response rate was 67%. Students were uncertain as to how to behave and act, mainly because they did not know what was expected of them. They experienced a drastic increase in workload and a lack of time for studying. They considered themselves to be moderately prepared with regard to knowledge and they regarded their physical examination skills as satisfactory. Students reported having difficulty applying theoretical knowledge in clinical practice and perceived shortcomings in basic science knowledge. In addition, they felt compelled to change their learning strategies. DISCUSSION: The results of this study confirm the findings of the focus group study. The students experienced problems related to professional socialisation and workload and deficiencies in knowledge and the organisation of knowledge. A good starting point for improvement may involve exploring students' suggestions of an extensive introduction into the clerkships, a more gradual transition with regard to workload and closer integration of pre-clinical and clinical education.     

临床医师“三基”培训与考核

强化临床“三基”（基本知识、基本理论、基本技能）培训,是目前提高、更新医学知识,培养临床医学人才的重要手段和途径。作为一家军队综合性医院,一贯强调“三基”培训的重要性,制定了详细的“三基”培训计划和要求,将培训的具体内容与临床实际相切合,并通过开展系统规范的“三基”考核,切实提高了临床医师“三基”功底,从而真正做到以病人为中心,提高医疗质量。