无锡市麻醉科专业住院医师规范化培训结业临床技能考核分析

目的：分析麻醉科专业住院医师规范化培训结业临床技能考核结果,探讨麻醉科专业住院医师培训方式。方法：分析无锡市麻醉科专业住院医师结业临床技能考核结果。结果：2013~2016年临床技能考核通过率为91.45%,不同学历、不同级别医疗机构的麻醉科专业住院医师考核结果差异无统计学意义（P＞0.05）。临床技能考核成绩均比检查判读和检验报告分析高,差异有统计学意义（P＜0.05）。结论：麻醉科住院医师检查判读和检验报告分析能力不理想,综合能力待提高。     

绩效考核在住院医师规范化培训中的作用

目的：探讨绩效考核在住院医师规范化培训中的作用。方法：以我院在培住院医师规范化培训学员66人为研究对象,比较绩效考核革新前后的学员绩效收入满意度、临床理论知识和技能操作考核评分、住院病历评分等。结果：绩效考核革新后,住培学员对学员收入满意度、临床理论知识和技能操作考核评分、住院病历评分显著高于绩效考核方案革新前,差异均具有统计学意义（p＜0.05）。结论：绩效考核有助于提高住院医师规范化培训学员工作积极性,提高住院医师规范化培训的质量,具有一定的推广价值。     

儿科住院医师规范化培训效果评价

目的 探讨儿科住院医师规范化培训效果评价,为临床培训工作积累经验。方法 选取2021年3月—2022年7月潍坊医学院附属医院参加儿科住院医师规范化培训的46名医师纳入研究,随机分为对照组和观察组各23例。对照组采用常规终结性评价,观察组采用形成性评价,比较两组儿科住院医师的年度考核及培训效果。结果 观察组的理论知识为（90.87±3.27）分、临床思维为（90.52±3.71）分、医患沟通为（92.78±3.79）分、技能操作为（93.82±4.13）分,高于对照组的（87.83±4.45）分、（85.93±5.04）分、（88.45±4.42）分、（88.84±5.25）分,差异均有统计学意义（P<0.05）。观察组临床专业知识、激发学习积极性、临床专业技能、查阅资料能力、培养解决问题能力、发展临床思维、提高合作能力、提高管理患者能力、语言表达能力、对评价的满意度评分高于对照组,差异均有统计学意义（P<0.05）。结论 在开展儿科住院医师规范化培训当中,加强科学的评价,能培养出更具责任感、胜任能力更强的儿科医师,在儿科规范化医师培训中发挥了良好的作用。     

妇产科住院医师第一阶段临床技能考核分析

自2004年北京地区开始推行住院医师第一阶段临床技能考核工作以来,每年由北京市卫生局科教处委托北京医学教育协会布置考核工作,由临床技能考核中心承担具体考核工作.考核目的是科学有效地评价住院医师的临床能力.我院自2004年开始,承担北京地区妇产科住院医师第一阶段临床技能考核任务.现对2006年至2010年妇产科临床技能考核资料进行分析总结,以寻求科学合理的考试、考核方法,比较被北京市卫生局认可为合格或基本合格的妇产科普通专科培训基地(以下简称基地)和未被北京市卫生局认可为妇产科普通专科培训基地(以下简称非基地)培训住院医师考核结果的差异性,探讨研究生毕业的住院医师纳入培训年限等问题.     

上海市内、外科住院医师临床专业技能培养中存在的问题及对策

作者通过对上海市二、三级医院住院医师临床专业技能（病史质量、带教质量、临床能力、综述与论文撰写能力）的考核，发现：①住院医师外科第二阶段的带教质量、总住院医师临床能力、外科手术能力和综述与论文撰写能力较弱；②二级医院住院医师的病史质量、病程录质量、门、急诊病史质量、第一阶段带教质量、病例分析能力、综述撰写能力较三级医院住院医师低。根据住院医师临床专业技能培养中存在的问题，作者分析了其原因，并提出相应对策：①保证外科住院医师有足够的手术机会；②使每位住院医师有机会进入总住院医师培养阶段；③加强培训基地建设，开展二级学科规范化培训。     

持续质量改进应用于住院医师临床能力考评

目的探讨持续质量改进对提高住院医师临床能力考评效能的具体应用与收效。方法采用计划-实施-检查-处理（PDCA）循环应用的持续质量改进方法,改进住院医师临床能力考评效能。结果通过调查问卷、教学联席会等发现影响临床能力考评的主要问题包括临床实践机会少、考核形式较单一、评分标准不一致、人文观念欠缺等;通过开放临床技能中心、细化考评标准、多元化考评模式的应用、强化人文医学等方法,提高临床能力考评的效度与信度;一系列改进措施实施后再通过问卷调查评估质量改进效果,总结并提出质量改进方案。结论持续质量改进能有效提高住院医师临床能力考评效能,是一种实用、有效的方法,值得推广应用。     

目标管理法在新护士临床工作能力培养中的应用

目的：探讨目标管理法在新护士临床工作能力培养过程中的应用效果。方法：选取杭州市第一人民医院2009年新入职的39名护士作为研究对象,随机分成实验组20名,对照组19名,实验组应用目标管理法对新护士进行为期一年的临床工作能力培养;对照组采用＂跟班式＂上岗,由有经验的护士指导,护士长采用与实验组相同的方法进行考核,但未制定目标及评价系统。结果：实验组护士一年内三基考试、护理操作考核合格率及平均分均明显高于对照组,有统计学意义;实验组护士一年内无患者投诉、无护理差错事故发生,同事对实验组护士的工作能力评价得分明显高于对照组。结论：应用目标管理法对新护士临床工作能力进行培养是一种科学、有效的方法。     

PBL联合MDT教学病例讨论用于骨科住培的实践及效果

目的：探析在骨科住院医师规范化培训中,运用PBL联合MDT教学病例讨论的实践与效果。方法：在我院2018年7月—2021年7月住院医师培训工作中,选取58例接受骨科规范化培训的住院医师,依照培训模式不同分为传统教学组和联合组,每组29例。传统教学组接受常规教学法,联合组应用PBL联合MDT教学病例讨论,对比应用效果。结果：住院医师评教：联合组教学病例讨论评分高于传统教学组（P＜0.05）;住院医师考核：培训后,联合组住院医师出科理论考试、技能考核成绩均高于传统教学组（P＜0.05）。结论：PBL联合MDT教学病例讨论的教学方法用于骨科住培工作,有助于提高住培整体培训质量,并得到住培医师认可。     

妇产科住院医师第二阶段临床技能考核分析

目的 探讨妇产科住院医师第二阶段考核方式的合理性、科学性,比较二级与三级医院、基地与非基地、不同学位层次考核结果的差异性,为科学地进行住院医师培训提供了一定的依据.方法 对参加妇产科第二阶段临床技能考核的人员及考核结果进行分析及统计学处理.结果 从考核通过率、妇科肿瘤和产科病历分析及辅助检查单项成绩比较可以看出,硕士、博士高于学士,基地高于非基地,三级医院高于二级医院.结论 妇产科住院医师第二阶段技能考核基本覆盖北京地区的医院.普通妇科、妇科肿瘤、产科病历分析及辅助检查的考核方式有效,能够反映住院医师的临床能力水平,针对住院医师培训的薄弱环节,非基地住院医师应有选择地进入基地进行培训.     

应用病例分型法分析住院医师规范化培训质量

目的：评价规范化培训对培养住院医师临床能力的作用。方法：收集3所三级甲等医院34名住院医师2003年共1316份病例的诊疗情况,采用SAS6．12进行统计分析。结果：经过规范化培训的住院医师与未经过培训者相比,部分临床技能数据有显著性差异。结论：规范化培训对提高临床能力有明显效果。     

Can medical schools rely on clerkships to train students in basic clinical skills?

OBJECTIVE: Many medical schools have drawn up lists of basic clinical skills that students are required to have mastered at the end of medical training. To determine whether undergraduate students actually perform these basic clinical skills during clerkships and whether different approaches to skills training led to different results, we surveyed 365 final-year medical students in 1996 and 1997. METHOD: A questionnaire containing items on 265 skills in eight body systems was administered to students from two conventional medical schools (Ghent and Antwerp, Belgium), and one Dutch medical school, Maastricht, which offers a problem-based curriculum and systematic skills training. RESULTS: Although quite a few skills were not performed by Maastricht students, the results of this school compared favourably to those of the Ghent and Antwerp medical schools. Significant differences between Ghent and Antwerp were found for surgery, paediatrics and gynaecology/obstetrics. In the non-obligatory clerkships in dermatology, otorhinolaryngology and ophthalmology a great percentage of skills were not performed. CONCLUSIONS: The main conclusion is that all three medical schools cannot rely on clerkship experiences alone to provide adequate basic skills training. A problem-based learning environment and training in a skills laboratory appear to result in students performing more skills during clerkships. Assessment of clinical skills, obligatory clerkships in specialties and general practice, and continuous monitoring of the quality of clerkships may also be strong determinants of the present findings.     

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.     

Peer-assisted learning: a novel approach to clinical skills learning for medical students

OBJECTIVE: This study aimed to determine whether peer-assisted learning (PAL) can enhance clinical examination skills training. METHODS: Three student trainers studied small-group theory and clinical examination and provided PAL as extra tuition for 86 trainees. Trainees watched an examination video, were videotaped practising the examination and, after constructive feedback, repeated the examination. Responses to PAL were evaluated to attain an overview of trainee and trainer performance using visual analogue and Likert scale analyses. Year-group review was undertaken using questionnaires. RESULTS: Trainees evaluated all aspects of PAL highly, including their post-training confidence in examination skills (mean > 7.7 on a 10-cm scale), indicating that the PAL was effective. Written comments confirmed the students perceived the sessions as well structured and of high quality. Compared with trainees in the first groups, those from later groups gave all parameters similar or higher gradings. Those for interest (P = 0.03) and appropriateness (P = 0.01) were significantly higher, suggesting that trainers may improve their technique with time. Students with previous degrees gave similar or lower gradings than standard entry students, with answers about post-training confidence and recommendation to friends being statistically lower (P < 0.006). Six months later, year-group analysis showed that 90% of trainees rated PAL highly, and 86% wished to become trainers. Of the trainers' year group, 79% perceived that PAL training could improve examination skills. CONCLUSIONS: In the context of clinical skills training, PAL was highly evaluated across many parameters, including confidence after training. Student interest and enthusiasm supports suggestions that PAL could be a useful adjunct to clinical skills training.     

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.     

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.     

A factor analytic study of clinical competence in undergraduate psychiatry

This study used factor analysis to define the components of clinical competence of medical students during their undergraduate psychiatric training. Four factors were defined; factor 1 related to cognitive and psychological problem-solving; factor 2 tapped the interpersonal and observational skills students showed with patients; factor 3 was characterized by knowledge in the examination setting, and factor 4 related to students' capacity to demonstrate their ability in an interpersonal setting. These are similar to the component skills of clinical competence demonstrated by students in other areas of the medical curriculum. They also correspond to the skills which Walton (1986) has suggested should be focused upon in undergraduate psychiatric education.     

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。     

Translating learning principles into practice: a new strategy for learning clinical skills

AIM: There are data to suggest that medical school may not adequately prepare doctors for practice and that there are deficiencies in undergraduate teaching of skills in history taking, physical examination, diagnosis and management (clinical skills). There is a need to re-evaluate methods by which we can teach clinical skills effectively. This aim of this review was to describe the literature concerning the important principles underpinning effective clinical learning. Subsequently a structured learning tool and teaching process was developed in order to support these principles. METHOD: The principles of effective clinical learning were derived after a search of the medical education and relevant behavioural science literature. Consequently, a structured learning tool and teaching process was developed in order to potentiate the translation of these principles into practice for medical school training in clinical skills. RESULTS: Ten principles were derived from the 68 articles referred to in this review. These were: making active decisions, an individual focus to learning, gaining experience, feedback to the learner, reciprocal learning, holistic care, relevant learning, feasibility, cost efficiency and mentoring. A process for history taking, physical examination and management plan was developed for medical students which incorporated these principles. CONCLUSION: Relevant literature can provide the foundations for teaching and learning methods in medical education. We plan to trial this method and evaluate the impact on student learning outcomes.     

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.     

基于临床操作技能中心加强研究生的培养

随着医疗卫生体制改革的深入,医学生动手能力的培养受到重视,临床操作技能的培训成为新的研究热点,但是关于临床操作技能中心的管理研究起步较晚,研究成果相对较少.在现代教育技术引领教学模式变革的时代,更好、更有效地发挥现代教育技术的作用是时代发展需要解决的实践研究课题.该研究以临床操作技能中心日常运行管理中存在的问题为主要出发点,通过提出"临床技能训练超市"的管理设想,深入研究,并以医院研究生为研究主体,不断实践,改进管理方式,采取开放、灵活的临床操作技能中心管理策略.文章通过探讨临床操作技能中心的管理经验,提高医学生临床操作技能的培训效果.