Attitudes toward artificial intelligence in radiology with learner needs assessment within radiology residency programmes: a national multi-programme survey

INTRODUCTIONWe aimed to assess the attitudes and learner needs of radiology residents and faculty radiologists regarding artificial intelligence (AI) and machine learning (ML) in radiology.METHODSA web-based questionnaire, designed using SurveyMonkey, was sent out to residents and faculty radiologists in all three radiology residency programmes in Singapore. The questionnaire comprised four sections and aimed to evaluate respondents’ current experience, attempts at self-learning, perceptions of career prospects and expectations of an AI/ML curriculum in their residency programme. Respondents’ anonymity was ensured.RESULTSA total of 125 respondents (86 male, 39 female; 70 residents, 55 faculty radiologists) completed the questionnaire. The majority agreed that AI/ML will drastically change radiology practice (88.8%) and makes radiology more exciting (76.0%), and most would still choose to specialise in radiology if given a choice (80.0%). 64.8% viewed themselves as novices in their understanding of AI/ML, 76.0% planned to further advance their AI/ML knowledge and 67.2% were keen to get involved in an AI/ML research project. An overwhelming majority (84.8%) believed that AI/ML knowledge should be taught during residency, and most opined that this was as important as imaging physics and clinical skills/knowledge curricula (80.0% and 72.8%, respectively). More than half thought that their residency programme had not adequately implemented AI/ML teaching (59.2%). In subgroup analyses, male and tech-savvy respondents were more involved in AI/ML activities, leading to better technical understanding.CONCLUSIONA growing optimism towards radiology undergoing technological transformation and AI/ML implementation has led to a strong demand for an AI/ML curriculum in residency education.     

Evaluating the educational environment in a residency programme in Singapore: can we help reduce burnout rates?

INTRODUCTIONThe educational environment (EE) reflects the quality of a residency programme and has an association with burnout. Studying the EE allows for interventions to target specific weaknesses. We aimed to measure the EE of an internal medicine residency programme in Singapore, compare the perceptions between genders, residency grades and levels of work experience, and identify specific areas of weaknesses for intervention in hopes of reducing residency burnout rates in Singapore.METHODSThis study took place between October and December 2017. We adopted a mixed methods approach, quantitatively using the Postgraduate Hospital Educational Environment Measure (PHEEM), and qualitative exploration using semi-structured focus group discussion.RESULTSA total of 136 (88.9%) out of 153 residents responded. Our total PHEEM scores (112.23 ± 16.71), along with the scores for all three subscales, were higher than those of institutions in previous studies. There were no differences in overall PHEEM and subscale scores between genders, residency grades or levels of work experience. However, there were differences for individual questions, which were explored in the focus group discussion. Senior residents juggling heavier workloads, responsibilities and examinations appeared to be most prone to burnout. We identified three recurring themes that contributed to a poor EE in our programme: excessive workload, poor faculty relationships and differing unmet needs.CONCLUSIONAlthough our programme had a good EE, there were also areas of weaknesses revealed by specific questions, possibly contributing to burnout. We hope to implement interventions to these areas and subsequently assess for longitudinal changes in EE and burnout rates.     

腹腔镜培训在儿童普外科住院医师规范化培训教学中的应用研究

目的 探讨腹腔镜培训在儿童普外科住院医师规培教学过程中的应用效果。方法 选取2017年1月至2019年12月在深圳市儿童医院普外科参加住院医师规范化培训的轮转医师36名,接受腹腔镜培训教学。培训内容包括腹腔镜理论知识、腹腔镜手术视频、模拟操作系统的技能操作等的学习和训练。在培训前后分别进行考核,统计分析前后成绩的差异;并对学员学习效率的自我评价和任课教师的满意度进行问卷调查。采用SPSS 20.0进行配对t检验。结果 接受儿童普外科住院医师规范化培训后,36名医师学员在腹腔镜的理论知识和在对儿童普外科手术运用的认知水平方面有了提高,体外模拟箱模拟操作训练的各项技能在培训后用时明显减少,差异有统计学意义（P<0.05）。问卷调查显示,在儿童普外科腹腔镜培训教学过程中,学员对学习效率自我评价的满意度为97.22%（35/36）,对任课教师的满意度为94.44%（34/36）,对教学课程设置的满意度为100.00%（36/36）。结论 腹腔镜培训能够有效地提高儿童普外科住院规培医师的临床实践能力,值得推广。     

Effects of electronic health record use on the exam room communication skills of resident physicians: a randomized within-subjects study

Background The effects of electronic health records (EHRs) on doctor–patient communication are unclear.Objective To evaluate the effects of EHR use compared with paper chart use, on novice physicians’ communication skills.Design Within-subjects randomized controlled trial using observed structured clinical examination methods to assess the impact of use of an EHR on communication.Setting A large academic internal medicine training program.Population First-year internal medicine residents.Intervention Residents interviewed, diagnosed, and initiated treatment of simulated patients using a paper chart or an EHR on a laptop computer. Video recordings of interviews were rated by three trained observers using the Four Habits scale.Results Thirty-two residents completed the study and had data available for review (61.5% of those enrolled in the residency program). In most skill areas in the Four Habits model, residents performed at least as well using the EHR and were statistically better in six of 23 skills areas (p<0.05). The overall average communication score was better when using an EHR: mean difference 0.254 (95% CI 0.05 to 0.45), p = 0.012, Cohen''s d of 0.47 (a moderate effect). Residents scoring poorly (>3 average score) with paper methods (n = 8) had clinically important improvement when using the EHR.Limitations This study was conducted in first-year residents in a training environment using simulated patients at a single institution.Conclusions Use of an EHR on a laptop computer appears to improve the ability of first-year residents to communicate with patients relative to using a paper chart.     

基于混合研究方法对比两个全科培训基地全科住院医师对培训的态度和看法

背景　中国正在完善分级诊疗和家庭医生制度,全科医生人才培养是实现这一制度的核心因素,目前我国全科医生缺口40万,全科住院医师规范化培训是培养高质量全科医生的主要途径。目的　通过混合研究方法广而深地了解来自两个城市的两个医院全科住院医师对其接受的全科规范化培训看法的异同,探讨不同规范化培训模式下可能带来的益处。方法　应用混合研究方法进行横断面研究。于2019年4月,采用整群抽样法抽取北京大学第一医院和北京大学深圳医院全科住院医师作为研究对象。两个医院均是“5+3”全科住院医师规范化培训基地,其中北京大学第一医院为“四证合一”的试点基地。结果　北京大学第一医院共发放问卷39份,回收有效问卷35份,有效回收率89.7%;北京大学深圳医院共发放84份问卷,回收有效问卷70份,有效回收率为83.3%。总体上,全科住院医师感觉到由于选择了全科专业而受到歧视,感觉作为全科医师能力不足。许多住院医师提到教学医师的教学态度较差。北京的住院医师比深圳的住院医师对培训更满意（P=0.001）,并觉得全科教学医师有足够的知识（P<0.001）和更合适的教学态度（P=0.004）,并且北京大学第一医院住院医师5项工作愿景得分均低于北京大学深圳医院,差异具有统计学意义（P<0.05）。结论　这些中国全科住院医师了解培训中需要改进的内容及培训的长项。北京全科住院医师对教学及工作满意度更高,其可以获得高水平教学医师的培训,并可以获得相关证明,提示教育改革可以增强培训力度并促进住院医师有更好的工作愿景。这些发现提示中国的住院医师面临着和国际相类似的情况,同时,也提示规范化培训教学课程的改革可能会带来益处。     

First-year family medicine residents' use of computers: knowledge, skills and attitudes.

OBJECTIVE: To identify the computer knowledge, skills and attitudes of first-year family medicine residents. DESIGN: Cross-sectional survey of family medicine residents during the academic year 1993-94; sampling began in July 1993 and ended in October 1993. SETTING: Canada. PARTICIPANTS: All 727 first-year family medicine residents, of whom 433 (60%) responded. OUTCOME MEASURES: Previous computer experience or training, current use, barriers to use, and comfort with and attitudes regarding computers. RESULTS: There was no difference in age or sex between the respondents and all first-year family medicine residents in Canada. French-speaking respondents from Quebec were underrepresented (p < 0.001). Only 56 respondents (13%) felt extremely or very comfortable with computer use. The most commonly cited barriers to obtaining computer training were lack of time (243 respondents [56%]) and the high cost of computers (214 [49%]) but not lack of interest (69 [16%]). Most residents wanted more computer training (367 [85%]) and felt that computer training should be a mandatory component of family medicine training programs (308 [71%]). CONCLUSIONS: Computer knowledge and skills and comfort with computer use appear low among first-year family medicine residents in Canada, and barriers to acquisition of computer knowledge are impressive. Computer training should become an integral part of family medicine training in Canada, and user-friendly applicable computer systems are needed.     

基于MDT的小班授课在普通外科住培带教中的应用研究

目的 本研究旨在评估多学科协作诊疗（multi-disciplinary treatment,MDT）模式结合小班授课对普通外科住培医师获取专业知识、掌握临床技能以及整体学习体验的影响。方法 选取2023年1至8月在普通外科轮转的2021级住培医师共60名,分为MDT教学组（n=30）和传统教学组（n=30）。所有住培医师在入科前进行一次理论测试及Mini-CEX技能考核,并比较两组入科前的理论测试成绩及Mini-CEX技能考核成绩。随后进行分组教学,其中MDT教学组针对胃肠道肿瘤采用MDT模式进行小班授课;传统教学组即以传统的“一带一”方式进行日常教学。住培轮转结束时,比较两组住培医师的理论考试成绩、技能操作考核情况以及对教学满意度的评价。采用SPSS 26.0进行统计学分析。结果 两组住培医师在入科前的理论考核成绩及Mini-CEX技能考核成绩差异均无统计学意义（P>0.05）。带教后,MDT教学组理论考试成绩（88.15±3.45）相对于传统教学组（72.25±4.36）更高,差异具有统计学意义（P<0.05）。MDT教学组Mini-CEX技能考核成绩（86.35±2.24）相对于传统教学组（76.28±3.92）更高,差异具有统计学意义（P<0.05）。问卷调查结果显示,MDT教学组住培医师对MDT小班授课教学满意度更高,对教学效果的评价也更好。结论 基于MDT模式的小班授课有利于提高普通外科住培医师胃肠道肿瘤的规范化培训质量,且住培医师的接受度更高,是住培教学有益的尝试。     

亚专业分区形势下新型急诊医学住培教学模式的应用研究

目的 探讨亚专业分区形势下新型急诊医学住培教学模式的应用及教学效果。方法 30名急诊专业住培生随机分成两组,每组15人。试验组采取亚专业分区模式教学,对照组接受传统带教;采用SPSS 26.0进行t检验和卡方检验,对比分析两组学员在人口学变量、培训考核成绩、教学反馈等方面的差异。结果 两组学员在年龄、性别、学历、临床工作年限等人口学变量上差异无统计学意义;两组学员在重庆市结业考核成绩上差异无统计学意义（P>0.05）,但在结业考核前科内模拟理论考试成绩差异有统计学意义[（81.20±2.83） vs. （89.73±3.01）,P<0.001];教学反馈调查结果显示,两组对独立值班的信心和教学满意度都较高,差异无统计学意义（P>0.05）,但试验组对急诊亚专业发展的认同度高于对照组,同时在科研和自身发展方向定位上也优于对照组。结论 亚专业分区形势下新型急诊住培教学模式更利于急诊医学的长远发展,建议在急诊住培教学中进一步推广验证。     

Knowledge and attitudes of physicians toward forensic psychiatry in Saudi Arabia

Objectives:To assess the knowledge and attitudes of physicians of different specialties, including psychiatrists, regarding forensic psychiatry to determine whether further modification or training is needed in the psychiatry residency program.Methods:This cross-sectional study was carried out using a 3-page, 3-section questionnaire containing 21 questions disseminated randomly online via Google forms using social media platforms. The 482 participants were residents, specialists, and consultants of various specialties. The study was conducted between September 2020 and August 2021 in various tertiary hospitals across Saudi Arabia.Results:A total of 482 physicians were recruited. The most common age group was 25-35 years, comprising mostly Saudis (62.4%). Based on the results, “poor” and “good” knowledge of forensic psychiatry was identified in 89% and 11% of the physicians, while “negative” and “positive” attitudes were identified in 16.4% and 83.6% of the physicians.Conclusion:Although the perspective of physicians regarding forensic psychiatry was found to be positive, their knowledge of the topic seems to be lacking.     

Current state of reflective learning in anaesthesiology residents: a call for ‘reflection-on-action’ training in Singapore

INTRODUCTIONReflective learning is the cognitive process whereby information from new experiences is integrated into existing knowledge structures and mental models. In our complex healthcare system, reflective learning (specifically ‘reflection on action’) is important for postgraduate learners. We observed that our anaesthesiology residents were not building on their competence through deliberate experiential and reflective practice. This qualitative study explored the current state and challenges of reflective learning in anaesthesia training in Singapore.METHODSThis study was conducted at KK Women’s and Children’s Hospital, Singapore, from 1 January 2018 to 31 October 2018. A semi-structured interview format was used in focus groups. Information collection continued until data saturation was reached. The interviews were coded and analysed, and themes were identified. Seven focus group interviews involving 19 participants were conducted.RESULTSReflective learning was found to be poor. It was of concern that the stimuli for reflection and reflective learning emerged from medical errors, critical incidents and poor patient outcomes. Challenges identified were: (a) lack of an experiential learning framework; (b) need for reflective training; (c) quality of experiential triggers; (d) clinical pressures; and (e) poor learner articulation and feedback. We described some strategies to frame, teach and stimulate reflective learning.CONCLUSIONThis study described the state and challenges of reflective learning in anaesthesia training. We advocate the implementation of reflective training strategies in postgraduate training programmes in Singapore. Research is warranted to integrate patient feedback and outcomes into reflective practice.     

儿科住院医师规范化培训学员职业倦怠现状及对策分析

目的 调查了解儿科住院医师规范化培训学员（以下简称“儿科住培医师”）职业倦怠现状，分析存在的问题，并提出对策建议。方法 本研究通过调查问卷的方式，对浙江大学医学院附属儿童医院的儿科住培医师进行问卷调查。调查问卷由一般信息调查、Maslach工作倦怠调查两部分组成。数据统计使用SPSS 26.0进行处理。对分类变量采用卡方检验。连续型变量进行组间比较，若变量服从正态分布，两组间比较采用t检验，对多组间比较，如果方差齐则采用方差分析，若不齐采用Kruskal-Wallis H检验；若变量不服从正态分布，多组间比较采用Kruskal-Wallis H检验。多因素分析采用多元线性回归分析方法。结果 138名儿科住培医师中职业倦怠检出率为65.2%（90/138），其中轻度倦怠、中度倦怠、重度倦怠分别有45名（32.6%）、29名（21.0%）、16名（11.6%）。单因素分析中，不同住培年限的儿科住培医师职业倦怠轻、中、重度差异有统计学意义（H=7.22，P=0.027）；一年级儿科住培医师的低成就感得分（27.90±8.48）高于二年级儿科住培医师（23.54±6.79），两组比较差异有统计学意义（t=-2.25，P=0.025）。多元线性回归分析显示回归模型差异无统计学意义。结论 儿科住培医师的工作倦怠水平高，应重视其职业倦怠问题，并从社会、组织及个人3个层面采取措施加以应对。     

Ethics education for medical house officers: long-term improvements in knowledge and confidence.

OBJECTIVE: To examine the long-term effects of an innovative curriculum on medical house officers' (HOs') knowledge, confidence, and attitudes regarding medical ethics. DESIGN: Long term cohort study. The two-year curriculum, implemented by a single physician ethicist with assistance from other faculty, was fully integrated into the programme. It consisted of monthly sessions: ethics morning report alternating with didactic conferences. The content included topics such as ethics vocabulary and principles, withdrawing life support, informed consent, and justice. Identical content was offered simultaneously at the largest affiliated community hospital. SETTING: A multi-hospital university training programme from July, 1992 to June, 1994. PARTICIPANTS: Thirty-nine HOs responded in 92. Thirty HOs from the same cohort responded in 94 (response rates = 83% v 71%; P = 0.19). RESULTS: The curriculum was well received, with 96% of HOs finding the sessions stimulating. Previously validated scales of knowledge and confidence were administered at baseline and at follow-up. The average knowledge score improved 14% (P < 0.001). Confidence also improved, rising from 3.3 to 3.8 on a 5-point Likert scale (P < 0.001). These findings were independent of age, gender, religion, and prior education. The only attitudinal change was an increase in the proportion of residents who thought that ethics should be a required part of residency training (57% v 80%, P = 0.05). CONCLUSION: This curriculum appears practical, popular, and effective. It should be readily transferable to other institutions.     

Doctors and social media: knowledge gaps and unsafe practices

INTRODUCTIONEasy access and availability of communication tools have facilitated doctors’ communication, adding new challenges. Through this study, we aimed to determine the profile of the knowledge and practices of doctors in our institution, and to identify knowledge gaps in the use of social media accounts.METHODSAn anonymous survey was sent by electronic mail in March–May 2018 to 931 doctors working in National University Hospital, Singapore. It included questions on demographics; use of social media; and case-based scenarios involving professionalism, patient-doctor relationship and personal practices of social media use.RESULTSThe response rate was 12.8%. The majority of the respondents owned a social media account (93.3%), had not received education on social media use in medical school (84.0%), did not own a separate work phone (80.7%) and claimed to have no medical education on this as a doctor (58.8%). Unawareness of the institution’s social media policy was reported by 14.3% of the respondents. Questions on knowledge of the privacy settings of their account were incorrectly answered. Only 75.6%–82.4% of the participants responded ‘no’ when asked if they would post pictures of patients or their results, even if there were no patient identifiers.CONCLUSIONThere is inadequate knowledge regarding institutional social media policy and privacy settings of social media accounts among doctors. Regarding practices in social media use, while most agree that caution should be exercised for online posts involving patients, ambiguity still exists. The emerging knowledge deficit and potentially unsafe practices that are identified can be addressed through continuing medical education and training on social media use.     

Prevalence of stress and its determinants among residents in Saudi Arabia

Objectives:

To examine perceived stress among residents in Saudi Arabia and its associated risk factors.

Methods:

A cross-sectional study of all residents registered at the Saudi Commission for Health Specialties, Riyadh, Saudi Arabia, was conducted between May and October 2012. We assessed the likelihood of stress using the perceived stress scale (PSS).

Results:

Out of the 4000 residents contacted, 1035 responded and 938 were included. The mean (±standard deviation) PSS score was 22.0±5.1 (median 22 and inter-quartile range of 18-25). With the exception of gender and nationality, no significant associations were found between stress and socio-demographic or behavioral factors. Stress was associated with higher workload, sleep deprivation, dissatisfaction with colleagues and the program, and harmful ideations. Stressors included work-related, academic, and homesickness stressors. In multivariate analysis, the following were independently associated with stress: Saudi nationality, facing homesick stressor, facing work-related stressor, dissatisfaction with relationships with colleagues, and frequent thoughts of quitting the medical profession.

Conclusion:

Residents in Saudi Arabia are at comparable or slightly higher risk of perceived stress than that reported among residents worldwide. Unfortunately, most of the participants never received stress management, which highlights the need for stress management programs during residency.The healthcare profession needs adequate medical residency training programs to increase its members’ professional qualifications and to maintain patient safety. However, residency training is a difficult and stressful stage of development in a professional career.1 Residents are often subject to prolonged working hours, prolonged sleep deprivation, uncontrolled schedules, high job demands, and inadequate personal time.2 High job demands are combined with poor job resources, such as poor opportunities for professional development and low supervisor support. These factors may cause burnout, which is characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment.3,4 Additionally, residency may impact the residents’ quality of life5 and cause them to experience sleep disorders,6 family problems,7 and even psychiatric disorders.8 These stress symptoms may in turn negatively impact patient care and result in frequent medical errors9 and suboptimal care practices.10 Some countries have implemented mandatory work hour limitations to improve residents’ quality of life with promising results, but this approach may diminish patient care and educational outcomes.11,12 We categorized the stressors that residents face into the following categories: institutional stressors, such as heavy workload, sleep deprivation, and poor learning environments; personal stressors, such as social problems, family problems, and financial difficulties; and professional stressors, such as career planning issues and information overload.13 Several studies from various parts of the world have already evaluated the presence of stress symptoms or their risk factors among medical residents in different programs.14-18 However, we struggled to compare the findings from these studies, because they employed different tools to assess the presence of stress. The study populations also varied considerably. In recent years, universities, and other major healthcare providers have been implementing additional recognized residency programs and have been enrolling more residents in Saudi Arabia to fix the huge deficiency in the number of Saudi-National practicing physicians.19 Yet no data pertaining to the stress among residents in Saudi Arabia exists. This information is a critical step toward occupational stress management, so the objective of the present study is to examine perceived stress among residents in Saudi Arabia and its associated risk factors, including personal and work-related stressors.     

The mental health status of children who have been evacuated or migrated from rural areas in Fukushima prefecture after the Fukushima daiichi nuclear power station accident: results from the Fukushima health management survey

Introduction: We evaluated the mental health status of children residing in Kawauchi village (Kawauchi), Fukushima Prefecture, after the 2011 accident at the Fukushima Daiichi Nuclear Power Station, based on the children’s experience of the nuclear disaster. Methods: We conducted this cross-sectional study within the framework of the Fukushima Health Management Survey (FHMS); FHMS data on age, sex, exercise habits, sleeping times, experience of the nuclear disaster, and the “Strengths and Difficulties Questionnaire (SDQ)” scores for 156 children from Kawauchi in 2012 were collected. Groups with and without experience of the nuclear disaster — “nuclear disaster (+)” and “nuclear disaster (−)” — were also compared. Results: Our effective response was 93 (59.6%); the mean SDQ score was 11.4±6.8 among elementary school-aged participants and 12.4±6.8 among junior high school-aged ones. We statistically compared the Total Difficulties Scores (TDS) and sub-item scores of the SDQ between “elementary school” and “junior high school” or “nuclear disaster” (+) and (−). There was no significant difference between these items. Conclusions: We found indications of poor mental health among elementary and junior high school-aged children in the disaster area immediately following the accident, but no differences based on their experience of the nuclear disaster. These results indicate the possibility of triggering stress, separate to that from experiences related to the nuclear disaster, in children who lived in affected rural areas and were evacuated just after the nuclear disaster.     

Simplified instructional phrasing in dispatcher-assisted cardiopulmonary resuscitation – when ‘less is more’

INTRODUCTIONIn our national emergency dispatch centre, the standard protocol for dispatcher-assisted cardiopulmonary resuscitation (DACPR) in out-of-hospital cardiac arrests (OHCAs) involves the instruction ‘push 100 times a minute 5 cm deep’. As part of quality improvement, the instruction was simplified to ‘push hard and fast’.METHODSWe analysed all dispatcher-diagnosed OHCAs over four months in 2018: January to February (‘push 100 times a minute 5 cm deep’) and August to September (‘push hard and fast’). We also performed secondary per-protocol analysis based on the protocol used: (a) standard (n = 48); (b) simplified (n = 227); and (c) own words (n = 231).RESULTSA total of 506 cases were included: 282 in the ‘before’ group and 224 in the ‘after’ group. Adherence to the protocol was 15.2% in the ‘before’ phase and 72.8% in the ‘after’ phase (p < 0.001). The mean time between instruction and first compression for the ‘before’ and ‘after’ groups was 34.36 seconds and 26.83 seconds, respectively (p < 0.001). Time to first compression was 238.62 seconds and 218.83 seconds in the ‘before’ and ‘after’ groups, respectively (p = 0.016). In the per-protocol analysis, the interval between instruction and compression was 37.19 seconds, 28.31 seconds and 32.40 seconds in the standard protocol, simplified protocol and ‘own words’ groups, respectively (p = 0.005). The need for paraphrasing was 60.4% in the standard protocol group and 81.5% in the simplified group (p < 0.001).CONCLUSIONSimplified instructions were associated with a shorter interval between instruction and first compression. Efforts should be directed at simplifying DACPR instructions.     

临床医学专业型研究生核心胜任力的现状与思考

目的 了解临床医学专业型研究生核心胜任力整体情况，分析医院在专业型研究生培养过程中的优势与不足，为更好地优化与修订培养目标与培养计划提供依据。方法 采用问卷调查的方式对264名临床医学专业型研究生进行匿名网络问卷调查，了解学生对于核心胜任力的认知及自评情况，比较并分析不同年级、不同类型学生核心胜任力各个指标得分差异。使用SPSS 23.0进行独立样本t检验，单因素方差分析对分类变量进行分析。结果 核心胜任力总分博士高于硕士，高年级学生高于低年级学生（P<0.05）；“系统改进能力”[硕士（2.94±1.07），一年级（2.82±0.97）]、“病人管理”[一年级（2.77±1.22）]、“学术研究”[一年级（2.90±1.03）]等7个指标存在学生平均分不足3分的情况。结论 学生对医生职业的认同感较好，高学历、高年级学生核心胜任力总体情况优于低学历、低年级学生，可能与接受临床实践教育的深入程度不同有关。针对学生核心胜任力存在“短板”的情况，应予以重点关注并强化培养。     

CPTM联合CBL教学在内分泌科规范化培训中的应用

目的 探讨临床路径教学法（clinical path teaching method,CPTM）联合CBL教学方法在内分泌科住院医师规范化培训中的应用效果。方法 选择 2020年6月至2021年6月在中国科学技术大学附属第一医院参加内分泌科规范化培训的120名住院医师作为研究对象。将其分为对照组（传统模式教学）、CPTM组、CBL组、教改组（CPTM联合CBL模式教学）,各30名。比较各组医师出科成绩及平时成绩,并对教学效果进行满意度调查。结果 教改组学生的学习方法、任务完成度、临床思辨能力、技能考核均高于余下3组,学生学习积极性高于对照组及CPTM组,差异均有统计学意义（P<0.05）。教改组出科总成绩为（55.97±5.58）分,高于对照组（51.97±4.54）分、CPTM组（53.48±3.37）分及CBL组（51.36±3.72）分。各组学生的教师满意度调查,教改组的满意度大于对照组。带教教师在教改组的教学体验更好。结论 CPTM联合CBL教学法在内分泌科住院医师规范化培训的教学中,能提升学习主动性,提高诊疗思维,具有重要临床教学意义。     

住院医师规范化培训结业考核专业理论考试结果的影响因素分析

目的 分析2018至2021年上海某三甲综合医院的住院医师规范化培训（住培）结业考核专业理论考试成绩的影响因素并建立预测模型,为进一步提升住培质量提供参考。方法 收集并整理该基地2018至2021年参加住培结业考核的556名住院医师数据信息,预测分析方法采用二元回归法和逻辑回归模型方法,分别分析住院医师基本信息、住院医师进入基地培训的各类日常考核成绩及反映专业基地培训质量的专业基地绩效考核分数等方面与结业考核专业理论考试成绩的相关性,并构建预测结业考核专业理论考试成绩模型。应用SPSS 26.0进行统计分析,应用二元回归法和逻辑回归法构建模型数据集。结果 2018至2021年该基地共有556人参加住培结业考核,第一站专业理论考站首次合格率为97.48%（542/556）,其中双一流学校毕业生一次通过率最高为98.09%（359/366）,博士研究生通过率最高为98.59%（140/142）,培训两年制的通过率最高为98.34%（297/302）。在住院医师基本信息等分类变量对结业综合考试专业理论考试成绩的影响分析中,使用二元回归法发现专业基地所属级别与住院医师是否通过专业理论的考试有一定相关作用（P<0.05）。在住院医师规培期间的各类日常考核成绩及专业基地绩效考核分数对结业考核专业理论考试成绩（具体分数）的逻辑回归分析中,发现年度专业考核理论成绩、执业医师资格考试首次理论成绩、年度业务水平测试成绩及专业基地绩效考核分数是影响结业考核专业理论考试成绩的关键因素（P<0.05）。结业考专业理论考核成绩的回归分析中,年度业务水平测试成绩回归系数最高,其共线性统计方差扩大因子（variance inflation factor,VIF）也是最高,表明存在较强的多重共线性,因此年度业务水平测试成绩对最终的结业考核专业理论成绩起到较强预测作用。结论 利用二元回归法及逻辑回归模型可分析专业理论考试的可能影响因素及其关联度大小,通过建立的两个住院医师结业考核专业理论考试预测模型,拟预测风险学员。通过贯彻分层递进的理念,增加个性化的辅导等,实现住培信息化管理,智能提前干预,有望进一步提升住培结业考的通过率,最终达到提升住培质量的目的。