医学人文素质教育在全科医师中的实践

随着我国医疗卫生体制改革的深入,社区卫生服务发展迅速.在以社区居民个体为中心的医疗服务模式中,全科医师作为社区卫生服务的主要执行者,拥有较高的人文素质尤为重要.在全科医师培养过程中,加强和改进全科医学人文素质教育是培养工作的重中之重;本文分析医学人文素质教育的内涵与目前培养过程中医学人文素质教育的现状,并对未来全科医师的医学人文素质教育进行思考,期望通过完善医学人文课程设置、丰富教学方式及加强社区教学实践等途径,完善全科医师的医学人文素质教育过程.     

建设高素质社区卫生队伍 天津确立全科医学教育发展目标

据悉,天津市计划到2000年,建立起全科医学教育体系基本框架。即初步建立起市、区两级培训网络,启动全科医师规范化培训试点工作,全面开展以在职人员转型培训为重点的全科医师岗位培训和相关人中的培训工作,加强全科医学师资队伍建设。到2005年,初步建立起全科医学教育体系。完善市、区两级培训网,基本完成天津市城区在职人员全科医师岗位培训及其他卫技人员的岗位培训,全面推行毕业后全科医师规范化培训。到2010年,建立起完善的全科医学教育体系。培养和造就一支高素质的、符合社区卫生服务发展需要的、以全科医师为骨干的     

全科医师社区培训工作的实践与思考

根据卫生部“关于发展全科医学教育的意见”，加快我国全科医学教育改革步伐。尽快建立一支以全科医师为骨干的高素质的社区卫生服务队伍，既是当前我国卫生体制改革的需要，也是促进社区医学教学实习培训基地，保证全科医师规范化培训和全科医师岗位培训质量的必要条件。     

基层医疗单位转型社区卫生服务机构现状及对策

在新一轮的医疗卫生体制改革实践中,基层医疗单位向社区卫生服务机构转型存在着科室诊疗科目被全科化设置,全科坐诊并非均为全科医师,执业医师全科诊疗技能不足,全科医师培训方式脱离实际,法律法规建设尚待健全完善等问题.文章分析提出,转型的社区卫生服务机构应结合实际依法科学设置诊疗科室,规范全科坐诊医师执业行为,强化全科医师临床技能培训,完善全科医师培训方式内容;有关部门应健全法律法规完善相关体制建设.以此,共同推进基层医疗单位的转型,进一步深化医改,为社区居民的健康提供更好的服务.     

安徽省全科医学培训现状、问题及建议

发展社区卫生服务,加快培养全科医师和社区护士是现阶段全科医学教育工作的重点,针时全科医学岗位培训,我省采取了一系列有力措施,正在逐步建立一支专业化、高素质的社区卫生服务人才队伍,极大推动了我省社区卫生服务工作的发展.本文从全科医学组织、网络、基地和师资建设以及培训开展情况等方面进行了介绍,并提出存在的问题和几点建议.     

医院门诊开展全科医师规范化培训的探讨

全科医学是解决常见医学问题的综合性学科,服务内容非常广泛,全科医师所掌握的知识和技能要求有广度,以满足大量复杂的全科门诊工作.全科医学的本质和宗旨决定了门诊服务是其医疗重点,门诊教学也相应成为全科教学的重中之重[1].但我国全科医学教育起步较晚,基础较差,尚缺乏标准化的、符合全科医学特征的培训模式[2].目前我国大部分全科培训仍由大医院承担并由专科医生来担任老师[3],全科学员在专科病房培训过程中,主要接受疑难、重症住院病例教学,而缺乏门诊常见病、多发病规范化诊治的专门培训,教学内容缺乏针对性、实用性[4].这也是许多全科学员完成培训后仍不能很好地胜任基层全科临床工作的主要原因之一.因此,在全科医师培训中,如何加强门诊教学成为亟需解决的问题.     

某院开展全科医师培养实践与体会

军队基层组织的生活环境具备"社区"的基本特点,可视为既有生活社区又有功能社区特点的一种特殊的"社区".全科医学是"社区"卫生服务的最佳服务模式,军队有必要借鉴地方经验发展军队的全科医学[1].军队全科医学是在全科医学概念的基础上,适合部队基层卫生需求的综合性的临床医学学科,它以部队基层连队为单位,以基层部队官兵(及家属)为中心,提供主动性、连续性、综合性、协调性和人性化的医疗保健服务[2].承担全科医师教育的教师队伍,是发展军队全科医学教育的推动力和重要保障.本院作为一所军队医院,2007年成为上海市首批全科医师培训基地,在全科医师师资培养上进行探索,建立军地结合的全科医师师资培养机制.     

PDCA循环在全科医师规范化培养社区带教管理中的应用研究

目的 探讨PDCA循环模式在全科医师规范化培养社区带教管理的应用效果.方法 选取2018年1-10月在静安区某两家全科医师规范化培养社区教学基地学员16例为对照组,再选取2019年1-10月学员16例为观察组.对照组学员以传统模式开展全科医师社区培训,观察组采用PDCA循环管理模式进行全科医师社区培训质量控制管理.项目结束后,对两组全科学员的教学效果、满意度及患者对学员满意度进行比较.结果 观察组全科学员的理论知识和操作技能考试成绩明显高于对照组(P<0.05),满意度高于对照组(P<0.05),且患者对全科学员满意度高于对照组(P<0.05).结论 PDCA循环管理模式可改善全科医师规范化培养社区基地带教质量,提高学员带教满意度及患者对学员的满意度.     

全科医师骨干培训大纲

一、培养目标遵循以全科医学的基本理论为指导,社区卫生需求为导向,实践、思考、学习为方法,培养全科医师的综合服务能力为目标,通过较为系统的全科医学及相关理论、临床和社区实践技能培训,培养学员热爱、忠诚社区卫生服务事业的精神,掌握全科医疗的工作方式,全面提高其对社区常见病多发病的诊断、鉴别诊断、转诊、预防保健和健康教育技能,具有一定的社区卫生服务组织管理能力,达到全科医师骨干的基本要求,成为社区卫生服务队伍中的业务骨干人才。     

全科医学住院医师规范化培训中“以问题为基础的学习”体会

本文通过11个“以问题为基础的学习”教学单元的学习，总结其在全科医学住院医师培训中的优点和不足。“以问题为基础的学习”能够全面锻炼全科医师发现问题、解决问题的能力。     

急诊科全科医师培训的实践与探索

全科医师培训是大型综合性教学医院临床教学和医疗工作的重要组成部分,培训学习是全科医师提高专业技术水平的重要途径。急诊科是全科医师培训的重要基地,全科医师的培训对急诊科乃至急诊医学的发展都非常重要。本文旨在加强全科医师的筛选,保证生源质量;注意因材施教,突出实践能力培养;拓展培养空间,注重综合能力提高;建立考评机制,调动教学双方积极性;使用与关爱结合,提供良好的后续发展支持等方面,对于提高综合性教学医院急诊科全科医师培训质量进行了有益的探索。使急诊科全科医师临床实际操作技能、专业理论知识、临床诊疗思维和职业道德素质均有了新的提高,为其今后的终生教育和发展成为一名合格的急诊科医师奠定良好基础。本文总结了急诊科全科医师培训过程中的优势和不足,并对此提出了相应的建议。     

加强全科医师队伍建设 推动社区卫生服务工作

丰台区卫生局为培养、建立并发展一支高素质的高科医学专业人才队伍进行了积极探索和尝试。制定全科医师队伍发展规划;培育全科医学教学、实习基地;组织高质量的师资力量;对全区医疗卫生机构的领导干部、业务骨干、基层医疗人员进行了全科医学在职学历教育、学科带头人教育和在职专业证书教育等多层次、多渠道培训,逐步建立起良好的全科医学培训机制,将全区的全科医疗培训工作纳入规范化管理轨道,有力推动了社区卫生服务工作的     

PBL结合CBL教学模式在传染病学临床见习教学中的应用

传染病学临床见习教学是医学基本理论与临床实践的桥梁.传统教学模式以教师为主体,强调知识灌输,影响了学生的主动性和积极性,该文作者所在教学组将问题教学法和病例教学法结合起来应用于传染病学临床见习教学活动中,能明显提高学生自学能力,建立科学的临床思维,提高教学质量.     

Reducing unmet needs: a prevocational medical training program in public health medicine and primary health care in remote Australia

OBJECTIVES: To describe the development and implementation of a prevocational medical training program in public health medicine and primary health care in remote Australia and to evaluate the program's adherence to adult learning principles. METHODS: Reports, funding applications and other relevant material relating to the program were reviewed to document learning objectives, and teaching and program implementation strategies. RESULTS: The 24-week program employs two prevocational medical practitioners each year and comprises four weeks at Fremantle Hospital's sexual health clinic followed by 20 weeks in the Kimberley. Curriculum objectives include clinical and public health aspects of sexually transmitted infection management, immunisation, clinical audit and quality improvement, primary health care in remote Aboriginal communities, oral and written presentation skills and working as part of an interdisciplinary team. Teaching strategies used were in accordance with adult learning principles. CONCLUSIONS: Prevocational medical training in public health medicine and primary health care in remote Australia is achievable and reduces current gaps in prevocational medical education.     

E-Learning in der ärztlichen Aus- und Weiterbildung

E-learning has been established in the education and training of physicians in various types: linear sequential and hyper-textual forms of multimedia presentations and texts, tutorial systems and simulations. Case-based e-learning systems are of special importance in medicine because they allow for mediation of process and practical knowledge by presentation of authentic medical cases in a simulated environment. The integration into the medical education and advanced professional training is crucial for the long-term success of e-learning; in case-based systems this can be accomplished by blended learning approaches which combine elements of traditional teaching with e-learning. Learning management systems (LMS) support integration of traditional teaching and e-learning by serving as an organizational platform for content of teaching. Further, they provide means of communication for trainers and trainees, authoring tools, interactive components, course management and role-based sharing concept. The dissemination of e-learning can be fostered by attention to requirements and user analysis, early adoption to organizational structures, curricular integration and continuous cooperation with students. Summarized, didactic and organizational aspects determine the success of our own e-learning offers as well as they influence the general further development of e-learning more than technical features.     

军队全科军医培养模式探析

面向基层部队的全科军医学历教育在我军尚处于空白。通过分析基层部队全科军医人才培养所面临的形势,开展适合基层部队的全科医学教育势在必行,并提出构建部队基层全科军医人才培养模式的总体思路及培养目标、课程体系、教学方法和师资队伍建设。     

The philosophy of palliative medicine: a challenge for medical education

The hospice movement has admirably improved management of the dying under its care. However, the majority of medical care of the terminally and chronically ill remains in the hands of practitioners outside hospices and is often open to criticism. This paper reviews the philosophy and practice of palliative medicine from the perspective of general practice and the shortcomings of present medical education in this area. Proposals are made for a radical shift in medical undergraduate teaching through an organized interdepartmental contribution by enthusiastic teachers to all years in training.     

浦东新区全科医师心身医学能力调查分析*

目的了解全科医师心身疾病临床实践能力,为改进心身医学培训方式和制定区域政策提供依据。方法采用自编问卷调查的方法对浦东新区各社区卫生服务中心全科医师进行调查。结果本次调查回收问卷102份,其中,有效问卷100份,有效率为98.04%。全科医师中以女性,工作年限11年以上,中级及以上职称,本科及以上学历为主。在临床实践中,对于识别和处理心身疾病不确定或否定的全科医师分别达到67%和78%。结论基层医疗的医患关系更持久、全面,医患双方的熟识有助于疾病的诊疗,开展针对性的心身医学知识培训,有望提升全科医师心身疾病诊疗能力。     

新冠肺炎疫情下全科医师规范化培训社区教学的实践与思考*

突如其来的新型冠状病毒感染肺炎(以下简称新冠肺炎)疫情是对社区卫生防控体系和能力的一次大考,也给全科医师规范化培训(以下简称规培)社区教学带来很大的挑战。上钢社区卫生服务中心根据上海市新冠疫情形势的变化情况,对疫情特殊时期"理论+实战+云端"教学模式进行了合理探索,将教学扩展到疫情一线,针对疫情中全科医生应具备的技能,开展实战教学与线上教学,保证教学质量,完成教学任务。通过对比学员培训前后新冠肺炎相关理论知识成绩及处理能力,发现运用该模式教学后,规培医师对突发公共卫生事件应急处置能力提升显著。这种在实践中不断探索与提升全科规培教学水平的"理论+实战+云端"教学模式,为特殊时期全科医师规范化培训社区教学提供了新的思路。     

Preparatory graduate professional training in general practice by using the 'experiential learning' framework

Background

General practitioners (GPs) in Indonesia are medical doctors without formal graduate professional training. Only recently, graduate general practice (GP) is being introduced to Indonesia. Therefore, it is important to provide a framework to prepare a residency training in general practice part of which is to equip GP graduate doctors to deliver person-centered, comprehensive care in general practice. Experiential learning theory is often used to design workplace-based learning in medical education. The aim of this study was to evaluate a graduate professional training program in general practice based on the ‘experiential learning’ framework.

Methods

This was a pre-posttest study. The participants were 159 GPs who have been practicing for a minimum of 5 years, without formal graduate professional training, from two urban cities of Indonesia (Yogyakarta and Jakarta). A 40-week curriculum called the ‘weekly clinical updates on primary care medicine’ (WCU) was designed, where GPs met with clinical consultants weekly in a class. The participant’s knowledge was assessed with pre-posttests involving 100 written clinical cases in line with each topic in the curriculum. Learning continued with a series of group discussions to gain reflection to reinforce learning.

Results

Participants’ knowledge regarding clinical problems in general practice was moderately increased (p?<?0.05) after the training from a mean score of 50.64–72.77 (Yogyakarta’s doctors) and 39.37–51.81 (Jakarta’s doctors). Participants were able to reflect on the principles of general practice patient-care. Participants reported satisfaction during the course, and expressed a desire for a formal residency training.

Conclusions

A graduate educational framework for GP based on the ‘experiential learning’ framework in this study could be used to prepare a graduate GP training; it is effective at increasing the comprehension of general practitioners towards better primary care practice.