八年制医学教育临床教学工作的实践与思考

本文阐述了华中科技大学同济医学院八年制医学教育临床教学工作的目标、教学改革及其实践,并对八年制医学生的后续培养进行了思考。     

Medical school performance of initially rejected students

At the University of Texas Medical School at Houston we had a unique opportunity to examine performance through the medical curriculum and one year of postgraduate training of 50 students initially rejected for medical school. Each had been interviewed by the same Admissions Committee, which earlier had selected 150 students through the traditional process. In contrasting the initially accepted and initially rejected groups, academic and demographic variables accounted for only 28% of group difference. The 72% of group difference not accounted for by the variables examined was presumed to relate to Admissions Committee preference. In attrition and in both preclinical and clinical performance through medical school and one year of postgraduate training, there were no meaningful differences between the groups. The observations suggest that the traditional interview process probably does not enhance the ability to predict performance of medical school applicants.     

河南省医学研究生职业认同现状分析

目的了解河南省在读医学硕士研究生职业认同状况。方法利用自行设计的调查表对5所院校在读医学硕士研究生进行现况调查,调查方式采用自评调查。结果医学硕士研究生职业认同处于中上水平,不同群体间职业认同情况有差别。通过此次对进入临床学习的硕士研究生调研,整体对医学职业的认同度达到中上水平,说明仍存在一些负面因素影响了研究生对职业的认同。结论医生是国家急需人才,培养一个医学生需时长、投人多,医学生需要得到社会、政府及患者的支持理解,这样就更有利于提高医学生的职业认同感。     

Comparison of performances of students in programs at LSU Medical School in Shreveport

The purpose of the study reported here was to evaluate the performance of graduates of the accelerated six-year (combined B.S.-M.D. degree) program and compare it with that of graduates following the regular curriculum at the Louisiana State University School of Medicine in Shreveport. Cumulative medical school grade-point averages, scores on the Federation Licensing Examination, and failure rates for the two groups were compared; by these criteria, the six-year graduates performed adequately but not as well as expected from their high school credentials (the basis for their entry into the accelerated program). Advantages and disadvantages of the six-year program are discussed with respect to the students, the medical school, and the undergraduate college of LSU at Shreveport.     

Relationships between performance in medical school and first postgraduate year

Data from a longitudinal study of Jefferson Medical College graduates were analyzed to determine levels of clinical competence in the first postgraduate year and relationships between postgraduate ratings and performance during medical school. Ratings were obtained on knowledge, data-gathering skills, clinical judgement, and professional attitudes from the hospitals in which the graduates received their training. Significant relationships were found among three levels of performance in medical school and postgraduate ratings and in all four competence areas. Relationships were strongest at the highest and lowest performance levels. It is concluded that in a substantial number of cases good and poor performance in the first postgraduate year can be predicted on the basis of information already available to the medical school faculty.     

医学统计学PBL教学改革初探

在八年制临床医学专业学生的医学统计学理论教学中选择4个内容实施PBL教学,并与实施传统教学相互比较。发现实施PBL教学的学生成绩与传统教学无显著性差异,但是PBL教学对提高学生学习能力、促进知识掌握、激发学习兴趣、提高协作表达有积极作用。PBL教学法值得在八年制医学生医学统计学理论教学中进一步推广。     

临床医学专业学位研究生培养新途径探索

临床医学专业学位是我国医学研究生教育高层次人才培养方式的战略性调整,为医学应用型人才的培养开辟了新途径.近年来,天津医科大学总医院与天津医科大学研究生院加强了专业学位研究生的管理,提高了专业学位研究生的培养规模和标准,制订和完善了有关专业学位研究生的管理文件,规范了各个教学管理环节,使专业学位研究生的培养质量得到了有效的保证.     

复旦大学首届八年制临床医学专业学生在校学习、生活状况调查

目的了解复旦大学第一届八年制临床医学专业学生在校期间学习、生活方面的感受、认知和评价,为学校制订更为完善的八年制招生计划、教学方案、培养目标和就业政策提供有利参考依据。方法采用整群抽样法对复旦大学2004级八年制临床医学专业57名学生进行问卷调查;调查内容包含学生基本信息,其在通识教育、基础医学、临床医学、专业研究4个阶段的学习感受及对专业培养模式的评价。调查结果采用描述性统计方法进行分析。结果68．4％的学生认为八年制主体培养目标应该是以临床能力培养为主;26．3％的学生对临床医学八年制专业学习没有太大兴趣;26．3％的学生对八年制培养模式不太满意;33．3％的学生对于就业前景不太乐观。结论完善八年制临床医学专业招生计划和培养模式,有助于提高教学质量和学生对教学的满意度。     

不同层次临床专业医学生临床技能比较研究

目的 比较不同层次临床医学专业学生的临床技能.方法 用客观结构化临床考试(OSCE)方法对同年临床实习出科的临床医学专业不同层次学生(八年制和五年制)进行多项临床技能测试,采用统一标准进行评分.对不同学年制的成绩进行方差分析.结果 总体表现和部分单项操作中,八年制和创新班学生的成绩高于五年制学生.结论 五年制与八年制学生均能较好掌握临床技能,八年制和创新班学生的临床技能掌握情况略优于五年制学生.     

八年制医学生科研创新能力提升的课程体系构建及初步成效

中南大学湘雅医学院作为八年制医学专业首批试办高校,结合多年的实践经验,构建了全程提升八年制医学生科研创新能力的课程体系。在通识教育阶段设置了医工交叉课程;在医学核心教育阶段,设置了基础医学创新实验课外研学课程等;在研究生培养阶段,设置了为期2年的海外交流项目;结合各培养阶段任务采用相应的评价标准和方式。上述措施目前已取得初步成效。     

Predicting academic performance at a predominantly black medical school

A study was conducted by the authors that examined the validity of the Medical College Admission Test (MCAT), undergraduate grade-point average (GPA), and "competitiveness" of undergraduate college in predicting the performance of students at a predominantly black college of medicine. The performance measures used in the analysis consisted of course grades in all four years of medical school and scores on both Part I and Part II of the National Board of Medical Examiners (NBME) examinations. The predictive validities of the MCAT scores and undergraduate GPAs were found to be similar to those revealed in earlier studies conducted at predominantly white schools. Two exceptions to these similarities were found. First, the MCAT scores at the black school had a somewhat lower validity in predicting NBME examination scores than was the case at the other schools. Second, of the six MCAT subtest scores, Skills Analysis: Reading had the highest correlation with first-year grades, in contrast to results at the other schools. No differences between men and women were found in the validity of MCAT scores and the GPA. The competitiveness of the undergraduate college attended was found to contribute significantly to the prediction of all measures of medical school performance.     

医学生内科学泌尿系统疾病英语教学的实践与体会

医学教育国际化的要求,使得医学专业英语教学越来越受到重视。华中科技大学同济医学院附属同济医院肾内科,近年来承担了五年制、六年制、七年制、八年制学生和留学生的双语教学及全英语教学任务,根据各学制学生英语教学的特点和要求,在理论授课、PBL、临床见习和实习中实施了不同程度的英语教学,总结经验,有助于提高双语教学质量。     

八年制临床医学专业毕业生科研能力培训成效的调查

目的调查八年制临床医学专业毕业生的科研情况以及对在校教学的反馈,为提高八年制毕业生科研能力提供参考。方法2019年12月至2020年1月,选择复旦大学上海医学院2004级至2011级八年制临床医学专业413名毕业生为研究对象。采用问卷调查方法,了解研究对象一般资料、目前科研成就和其对在校教学的反馈等。结果共有26.0%(98/377)的毕业生获得了课题资助,住院医师规范化培训阶段中有67.6%(75/111)毕业生拥有1篇及以上的SCI论文;而完成住院医师规范化培训的毕业生中这个比例上升至76.7%(204/266)。76.0%(314/413)毕业生表示仍然应该进一步加强在校期间的科研能力培养。结论目前八年制医学毕业生具有良好的科研实力,但毕业生对院校科研能力培养仍有需求。     

Possible impact of increase in female medical student admissions in Nepal: Findings from a qualitative study among medical undergraduates

Background

In Nepal, a developing country in South Asia, the number of female medical students has increased significantly.

Aims

The present study was carried out to explore perceived perceptions for this increase, study the perceived impact on teaching-learning activities, medical school infrastructure and possible perceived changes in the doctor-patient relationship.

Method

First, second and third year students were invited to participate in focus group discussions (FGDs). Fifty-four students were willing to participate. Twenty-five were from the first year, 20 from the second and 9 from the third year. The FGDs conducted over a 90 minute period were voice and video recorded. The groups consisted of both males and females from a particular intake. The findings were transcribed verbatim.

Results

Participants felt more female students were taking up medicine in the country because of more colleges opening in the cities and towns making it easier for female students to enrol in the course. Also parents consider medicine as a safe, noble and dignified profession for their daughters. Participants suggested women are more empathetic doctors and the doctor-patient relationship might become more patient-focused. Women doctors can serve as a source of inspiration and the overall impact on Nepal would be positive.

Conclusion

Participating students perceived the increasing number of female medical students may be due to changes in Nepalese society. This study was carried out only among three batches of students in a single medical school. Further studies among different batches of students and among interns in other medical schools are required. Studies among postgraduate students and doctors are also needed.     

MDT模式下PBL教学法在研究生培养实践中的应用

目的 探讨基于多学科(MDT)协作模式的PBL教学法在医学专业学位研究生培养实践中的应用策略及效果。方法 以目标抽样原则选取符合纳入标准的医学专业学位研究生(以内科学方向为主)64名作为研究对象,按照随机数字表法分为实验组和对照组,对照组(n=32名)根据全日制医学专业硕士培养方案中有关内容要求,执行传统的LBL讲授+实践训练教学模式,实验组(n=32名)在相关研究生培养课程中,开展基于MDT条件下的PBL教学模式。对两组研究生临床技术能力进行专业考核,采用《中文版批判性思维能力测评量表(CTDI-CV)》以及自主设计的《教学效果评估问卷》对两组研究生进行相关指标调查。结果 实验组学生的基础理论、病案分析及内科学实践技能总成绩均明显高于对照组,差异均有统计学意义(均P<0.05),实验组学生CTDI-CV测评量表的评估总分及多数因子分较对照组提高,差异有统计学意义(P<0.05),两组学生对教学效果的评价结果也存在统计学差异(P<0.05),实验组学生对教学效果的评价满意率明显好于对照组。结论 在研究生培养实践中,开展MDT模式支撑指导下的PBL教学,可显著提高研究生专业技术能力并促进学科更好的发展,有利于高层次医学人才培养目标的实现。     

医学研究生《分子病理学》课程建设实践与思考

为提高我校医学研究生培养质量,满足基础医学及个性化医疗发展的需要,面向医学研究生开设了《分子病理学》课程。通过优化《分子病理学》的理论内容、建设与本课程相配套的分子病理诊断技术平台及理顺基础病理和临床病理之间的管理体制等措施,使《分子病理学》课程真正成为基础医学和临床医学之间的桥梁学科。实践证明,《分子病理学》课程促进了医学研究生转化医学理念、科研创新能力和临床实践能力等方面的培养。     

Career choice of 'fifth pathway' graduates from New York state medical schools

Graduates of "fifth pathway" programs at medical schools in New York state between 1976 and 1978 were studied to determine their professional careers and choice of medical specialties. Of the 545 physicians participating in the program, 510 were able to be located. Of this latter cohort, 177 (34.7 percent) had entered primary care fields as of 1981. Of the physicians no longer in residency training, 19.1 percent had full-time salaried positions in academic institutions, and the remaining physicians were engaged in various clinical medical activities. Of the 545 fifth pathway graduates, 74 (13.6 percent) had not been able to pass the licensing examinations as of 1981, and an additional 54 (9.9 percent) had not taken those examinations. Comparisons with regular students graduating from a medical school in New York state showed that fifth pathway graduates were more likely to select nonprimary care specialties than primary care specialties (p less than 0.001). These data suggest that although a majority of graduates of fifth pathway programs in New York state are involved in the provision of health care, a small number are still unable to engage in the practice of medicine.     

循证医学理念在军医大学八年制学员骨科临床实习教学中的引入

目的：探讨军医大学八年制学员医学教育中引入循证医学（evidence-based medicine, EBM）理念的实施效果。方法选取2012年进入上海长征医院骨科轮转实习的临床医学八年制学员50人,随机分为实验组和对照组,各25人。实验组教员在查房过程中选取合适病例,根据临床中遇到的困难或不足以及设置相关战创伤情景对小组学员提出问题。让学员展开讨论,检索有关医学文献,找出最有用的相关资料进行EBM系统分析,把结果与当前病例结合进行讨论,同时对设置问题进行答辩。教员最后根据科室相关诊疗经验以及资料进行总结。对照组采取传统灌输式教学,通过教员的临床经验指导学员工作与学习,辅以大、小班课讲授教材以及临床新进展等。骨科实习结束后,对两组学员进行统一的出科考核;并对实验组学员行问卷调查。用SPSS 17.0软件对考试成绩进行统计学分析,计量数据以均数＆#177;标准差（x＆#177;s）表示,两组间均数比较采用t检验。结果实验组学员在理论考试中主观题和军事相关题平均成绩高于对照组学员,差异有统计学意义（P＆lt;0.001）。实验组在临床病例答辩中优良率达80%（20/25）,对照组学员优良率为60%（15/25）。针对实验组的调查问卷结果显示,学员在学习中能够处于主导地位,学习主动性、综合运用能力等都得到增强,并且拓宽了知识面;其中96%（24/25）的学员提高了对既往接触较少的军事相关知识的学习效率,88%（22/25）的学员对教学法表示认同并希望继续实施。结论军医大学八年制学员开展EBM教学,能够培养学员的自学精神、严谨认真的态度和独立创新的能力。最终使学员能够掌握学习方法和科研思维,受用终身,同时能够加强学员对军事医学知识的认知和研究。     

基于素质优先原则下中西医结合临床专业硕士研究生临床培养模式的探索

临床医学专业的硕士研究生教育是我国研究生教育改革的方向之一,它是对已经经历系统的医学基础知识教育学习和进行了专科技能培养的优秀医学人才的进一步具有针对性的培养和教育,是我国培养具有较强专业技能和较好专业知识的高层次医学人才的教育。对于我国的医学教育而言,临床专业硕士研究生的培养进一步向科研型与临床型分立以及复合型的医学人才格局迈向崭新的一页。其中偏重临床工作能力的专业性硕士研究生是临床教学单位的主要培养和发展方向。因此,针对我国高等医学教育的发展方向和培养模式,如何才能提高临床医学专业硕士研究生的基本工作能力是每个研究生培养单位值得思考的问题。我们面临的工作不但包括全面提高临床医学专业硕士研究生的整体素质,而且要对研究生的毕业后就业、学科的良性发展均有较好的效果。