社会化住院医师培训现状分析

社会化住院医师培训是我国住院医师规范化培训的发展方向.本文通过分析南京医科大学第一附属医院近4年来社会化住院医师培训现状,指出当前社会化住院医师培训的主要问题是优秀临床医学专业毕业生(含硕士研究生)对于参加社会化住院医师培训的矛盾心态,即一方面想通过培训获得大型医院培训的经历与经验,另一方面对培训后前景不明感到困惑;同时,探讨了产生上述问题的主要原因,并针对存在问题提出了改进建议与对策.

Abstract：

Socialized resident training is the growing trend of resident standardized training in China. This paper analyzed the status of socialized resident training in The First Affiliated Hospital of Nanjing Medical University in recent years, and came to an understanding of the contradictious mentality of good clinical medicine graduates (including postgraduates) who participated resident training. On the one hand,they wished to get work experiences in large hospitals. On the other hand, they felt confused about the unclear future after training. The main reason lay in unsound system and supporting policies. Therefore, to ensure the healthy and smooth development of social hospital resident training, more complete policies, the practitioners system and other relevant laws and regulations need in urgent to be established and the current medical education system be improved.     

硕士研究生学历住院医师培训方案的设计与思考

硕士研究生学历住院医师培训具有重要的意义,它是解决我国医学学历、学位多样化和临床能力培养之间矛盾的有益探索,也是培养各级临床医学人才的有效途径.如何制定培训方案并严格遵照执行是培训需要解决的关键问题.本文结合南京医科大学第一附属医院的实践情况,就硕士研究生学历住院医师培养方案制定、实施中的具体问题,参照上海、北京等地区做法,提出了一些思考与构想.

Abstract：

A specific training for the resident with a master degree was very important.It was profitable to explore the clinical training for residents with different levels of degrees. It was also an effective way to cultivate qualified clinical professionals. It was crucial to make a design plan before the training and abide by it strictly during the training. Based on the practices in Jiangsu Province Hospital, and by referring to the practices adopted in Shanghai and Beijing, the design of a specific training for the resident with a master degree and possible programs that might occur during the implementation were discussed in this article.     

北京市外科住院医师规范化培训基地复审存在的问题及思考

目的 了解外科住院医师规范化培训基地现状.方法 收集2009年北京地区11家外科住院医师规范化培训基地复审资料,进行分析.结果 11家外科住院医师培训基地中达标8家(73%),限期整改3家(27%).问题主要集中在个别科室的门诊、急诊量,师资的资质和水平,培训的环节管理,出科考核和培训效果.结论 外科住院医师规范化培训基地的某些标准、师资带教水平、住院医师的环节管理是存在问题较多的方面,也是影响培训效果的关键.

Abstract：

Objective To understand the current circumstance of the surgical resident training bases in Beijing Methods The reassessment data of the 11 surgical resident training bases in Beijing were collected and analyzed. Results 73%(8/11)surgical resident training bases have passed the assessment; and 27%(3/11)have not completely reached the requirements The most prominent problems found in the reassessment were that the numbers of clinic and emergency patients in some departments;the qualification and teaching level of the instructors;the administration in the training process;the test after finishing the rotation and the training results, Conclusion Surical resident training bases criterion,instructor for resident training and administration in the training process are the most important factors which influence the surgical resident training results     

从细节管理人手提高住院医师培训质量

住院医师培训是医学生毕业后教育的重要组成部分,是培养合格医学人才的重要途径.宣武医院经过20余年的住院医师规范化培训管理,提出:领导重视、组织落实、过程管理、基地建设、考试考核、24小时制度、指导教师制度、奖惩制度和科学研究8个方面关乎住院医师培训效果.

Abstract：

Resident training is an important part of after-graduation education for medical students,and is also an important way to cultivate qualified medical talents.With 20 years management experience of resident standardized training,Xuan-Wu Hospital has found 8 aspects,including leaders'attention and implement,process management,base construction,test assessment,24-hour system,guiding teacher system,rewards and punishment system,and scientific research were related to the quality of the resident standardized training.     

精神病学双语教学方法初探

实施双语教学是培养具有国际竞争力的高素质人才的需要.本文分析和探讨了临床医学专业学生精神病学课程实施双语教学的重点、难点,并提出了相应的对策.

Abstract：

Bilingual teaching is a way to cultivate high quality talents with competitive abilities. Psychiatry should follow the new situation which is an important subject in the clinical subjects. In this study, it was explored and discussed that the importance and difficulty in performing bilingual teaching of psychiatry as well as how to solve bilingual teaching of psychiatry in clinical students.     

中医儿科住院医师培养模式的探讨

本文分析了中医儿科住院医师培训中存在的问题,建议制定明确的中医儿科住院医师培养目标,在加强中医基础理论学习与实践的同时,合理安排西医儿科临床各科室的轮转,培养良好的科研能力;同时,建立中医儿科住院医师的规范化考核标准,提高中医儿科住院医师的培养质量.

Abstract：

In this article,the the problems on the training of TCM pediatrics resident are analyzised, and have the following conclusions; to improve the training quality of TCM pediatrics resident, a clear training objective should be developed reasonably, the pediatric residents' learning and practice on the basic theory of TCM should be enhanced, the various departments of clinical rotation should be arranged reasonably, a good research capability should be formed, and a standardized assessment criteria of traditional Chinese pediatrics medicine resident should be also established.     

八年制医学生阶段导师制的初步探讨

八年制医学教育是目前我国培养精英医学人才的全新模式,实行阶段导师制是八年制教育的客观需求.本文简要介绍了八年制医学教育实行阶段导师制的重要性和必要性,对不同阶段导师的职责和任务进行了初步探索.

Abstract：

Eight-year medical program is a new model for medical education at present in China. It is necessary to carry out a system in which the tutorial supervision is implemented at certain stages. This paper briefly introduces the importance and necessity for implementing the system and discusses the tutors' responsibilities and tasks at the different stages.     

Standardized training for resident doctors in China

Medical graduates are not fully trained physicians when they leave medical school.Currently,standardized training for resident doctors in most hospitals in China is carried out according to the Ministry of Health guidelines.However,these guidelines provide only outline guidance,and specific resident training is managed independently by and varies with individual institutions.Therefore,it is important to study training demand to learn about the content and emphasis of training.     

社区医学新课程体系的构建与实施

目的 初步构建临床医学专业适用的社区医学新课程体系,促进临床医学专业学生树立预防保健的整体观念,提高其社区卫生服务能力.方法 结合我国实际情况,通过借鉴国内外院校社区医学教学经验,对武汉市相关社区卫生服务中心进行实地考察和调研,收集资料,形成社区医学新课程教学大纲、教学计划及评估方法并付诸实施.结果 通过实施初步构建的社区医学新课程体系,学生初步树立了预防保健整体观念,社区卫生服务的能力得到了提高.结论 初步构建的社区医学新课程体系符合当前我国深化医药卫生体制改革的方向,有利于临床医学专业学生树立社区预防保健整体观和提高社区卫生服务能力.

Abstract：

Objective To construct a new curriculum system of community medicine that could promote clinical medical students to form a concept of preventive health care as a whole and improve their abilities to serve for community health. Methods On the basis of the interrelated data that collected after the inspection and investigation in some community health service centers in Wuhan City, the syllabus, teaching programs and assessment methods of the new curriculum of community medicine were constructed and put into effect according to the actual situation in China as well as some teaching experiences of community medicine from domestic and overseas colleges. Results The concept of preventive health care as a whole was constructed among clinical medical students and their abilities of community health service was improved after the implementation of new curriculum system. Conclusions The new curriculum system fits with the current reformation of medical and health system in China and benefit a lot for clinical medical students to built a concept of preventive health care as a whole and improve their abilities to serve for community health.     

Deafness genes for nonsyndromic hearing loss and current studies in China

Objectives To review the identified deafness genes related to nonsyndromic hearing loss (NSHL) and summarize their expressions and functions in the cochlea and to introduce the current studies of molecular genetics on NSHL in China.Methods The presented data are based on a review of the literature as well as the author’s experience with NSHL and communications with other researchers in China over the past 3 years.Results Currently, 23 deafness genes related to NSHL have been cloned and identified.Some genes are associated with both NSHL and syndromic hearing loss (SHL), in both dominant and recessive deafness.Deafness genes have a highly specific expression pattern in the inner ear.Some functional categories are starting to emerge from a characterization of deafness genes.There are interacting genes in the genetic background that influence the extent of hearing impairment.The GJB3 gene, which is associated with high-frequency hearing impairment, was cloned in a Chinese laboratory.Mutations in some genes, such as GJB2 and mitochondrial 12S rRNA, have been screened in Chinese patients with NSHL.Mapping new deafness gene loci as well as identifying new genes and their functions is an active area of study in China.Conclusions It is challenging for us to continue identifying new deafness genes and analyze gene functions.By identifying genes responsible for monogenic hearing impairment, more insight may be gained into the molecular process of hearing and the pathology of hearing loss.     

美国内分泌专科医院住院医师培训计划及其启示

要培养高素质的医学人才,必须做好临床住院医师规范化培训。在此简要介绍了3所美国著名医院的内分泌专业受训住院医师培训的内容,结合中国的现状,提出了“厚基础、宽知识、强能力、高素质”的培养要求,为我国内分泌专业住院医师培训训’划的制定提供参考。     

外科专业学位硕士研究生培养方式的探索

根据目前外科专业学位研究生的培养目标要求和生源情况,针对其临床与科研两方面能力,进行临床二三级学科临床科室轮转以及读书报告、文献综述等相关训练,以期达到提高外科专业学位研究生培养质量的目标。     

乡村医生健康管理服务技术培训评价量表的编制与信效度检验

背景目前我国针对乡村医生健康管理服务技术培训效果评价的研究相对较少,且缺乏有效的评价工具。目的编制乡村医生健康管理服务技术培训效果评价量表,并对其进行信效度检验。方法基于柯氏模型设计乡村医生健康管理服务技术培训效果评价初始量表,通过专家咨询、课题组讨论等方式形成乡村医生健康管理服务技术培训效果评价试测量表。于2021年5—6月,使用试测量表进行预调查,采用样本1（n=100）进行初测阶段的信度分析和探索性因子分析,形成乡村医生健康管理服务技术培训效果评价正式量表。于2021年7月,对问卷进行正式施测,采用样本2（n=306）进行验证性因子分析和同质信度、组合信度、判别效度及结构效度检验。结果正式量表包括反应层、学习层、行为层及结果层4个维度15个条目。预调查数据抽取合适性度量值（KMO）为0.847,Bartlett球形检验结果显著（χ2=1 862.826,P<0.05）,探索性因子分析的累积方差贡献率为87.575%。验证性因子分析结果为：χ2/df=3.906,近似误差均方根（RMSEA）=0.098,比较拟合指数（CFI）=0.961,修正的标准拟合指数（IFI）=0.961,标准拟合指数（NFI）=0.948,模型拟合基本良好。最终量表的Cronbach's α系数为0.967,反应层、学习层、行为层及结果层4个维度的Cronbach's α系数分别为0.962、0.958、0.971和0.919,各维度的组合信度（CR）值分别为0.963、0.958、0.971和0.919。平均方差抽取量（AVE）的算术平方根大于因子之间的相关系数,各维度之间的相关系数为0.538~0.842,各维度与量表总分之间的相关系数为0.754~0.934。结论本研究编制的乡村医生健康管理服务技术培训效果评价量表信效度较为良好,可作为一种有效的乡村医生健康管理服务技术培训效果评价工具。     

低年资护士参加护理继续教育培训情况的调查

目的了解低年资护士参加护理继续教育培训情况。方法对2009年度工作1~2年的护士参加护理继续教育培训情况进行统计分析。结果到课率随工作年限增加而减少,本科护士参加护理继续教育培训到课率与专科、中专护士有显著性差异。结论各种护理继续教育培训有利于低年资护士更好的了解护理新知识、新业务及与护理学科的相关知识。护理部应根据低年资护士的需求,合理安排培训内容,调动护士学习积极性,加强管理,使低年资护士护理继续教育培训见成效。     

从文献计量看信息组织与医学生信息素养教育

信息化社会对医学人才提出了更高的要求,医学教育除了专业知识与技能,还必须进行包括信息检索、组织与利用等内容的信息素养教育。本文采用文献计量学方法对国内医学生信息素养教育内容进行分析,发现在医学生信息素养教育方面关于信息组织培养的内容普遍较少。而在大数据环境下,信息组织与利用能力对新一代医学人才的培养及医学科学发展具有重要意义。由此,本文提出应加强对医学生的信息组织教育,发挥信息组织在医学生信息素养培养中的作用。     

黄埔军校的军事体育思想与实践简

黄埔军校是新民主主义革命时期国共两党创办的第一所革命军事学校。黄埔军校的军事体育思想既汲取了我国传统社会军事文化的精华，如尚武、勇敢、团结、服从、兼容等品质，也重视采纳近代西方体育和苏联军事体育的教育原则和训练方法。黄埔军校的军事体育训练通过集合、跑步、跳马、双杠、单杠、爬高、过天桥、拳术、刺杀、射击等训练方法，增进学员的体力，磨练士兵坚韧不拔的意志，培养士兵刚毅、勇敢、团结合作的品质和克敌致胜的意志，并唤起官兵的爱国主义精神。这所学校通过众多国民党人、共产党人和苏联顾问的积极参与和共同努力，为中国民主革命培养了大批优秀的军事政治人才，对后来中国的政治、军事产生了重大影响，并加速了中国民主革命的发展进程。     

对我国骨干全科医师岗位培训的思考

针对我国骨干全科医师培养存在理论、临床和社区分段培训等方面缺陷,培训基地和师资"力不从心",培训计划和培训管理不完善等的问题。建议完善培训计划,实施一体化培训,理论融入实训;建立师资队伍和基地长效考核制度;多开展有针对性的专题讲座、案例讨论、角色扮演、操作演练等活动;加强培训管理。     

医教协同背景下全科医生沟通技能培训需求及影响因素研究

背景　医教协同加强以全科医生为重点的人才培养，是提高医疗卫生保健质量的关键。沟通能力是全科医生必备核心能力之一，尽管我国开展了全科医生沟通技能培训，但效果不佳。研究显示以需求为导向的培训模式可快速满足临床需要，显著提高教学质量。目的　探讨在医教协同背景下，全科医生沟通技能培训需求及影响因素。方法　采用整群抽样的方法，于2018年10月选取“华西医院-社区”医教协同体下承担全科医师规范化培训的社区基地为调查地点，以其内所有社区卫生服务中心共12家的全部全科医生104名为调查对象进行结构式问卷调查。问卷主要内容包括全科医生基本情况、对医患沟通重要性的认识、既往参加沟通技能培训、沟通技能培训需求和参与意愿、医患沟通影响因素。采用二分类Logistic回归分析全科医生沟通技能培训需求内容的影响因素。结果　共发放问卷104份，回收有效问卷104份，有效回收率为100.0%。95.2%（99/104）的全科医生认为医患沟通重要和非常重要，66.3%（69/104）的全科医生既往参加过医患沟通技能培训。在既往培训中接受过建立关系培训的人占比最多，为82.6%（57/69），接受过表达同理心培训的人占比最少，为29.0%（20/69）。全科医生均对沟通技能培训有需求，在培训需求方面共同决策需求占比最高，为71.8%（61/85）；采集病史需求占比最低，为16.4%（17/104）。二分类Logistic回归分析结果显示培训需求内容受性别、年龄、文化程度、培训经历、沟通能力和医患关系满意度的影响（P<0.05）。基于全科医生视角影响医患沟通的医方因素中排名第一是“工作任务繁忙，没有时间精力”，其次是“缺乏沟通技巧，不会和患者有效沟通”。结论　医教协同背景下全科医生对医患沟通重视，培训需求率高，参与意愿强烈。既往培训内容与培训需求存在差异，持续动态评估培训需求是保证全科医生医患沟通能力培养质量的关键环节。     

医学教育多媒体信息资源表征体系研究

本研究以医学教育多媒体信息资源的建设为出发点，紧密给合我国医学院校、医院教学训练的实际情况，就多媒体信息资源的表征体系及分类编目提出了规范性的解决方案。     

美国普通外科住院医师培训的经验与借鉴

本文以美国华盛顿大学医学院（西雅图）普通外科住院医师培训项目为例,详细介绍了美国普通外科住院医师培训的制度与方法;同时,为解决我国住院医师规范化培训中所面临的问题提出了建议,以期为国内正在开展住院医师规范化培训的医学院校提供参考。