加强专科医师全面训练,不断提高神经外科手术中脑血管问题的处理水平

正专科医师培养制度是国际公认的医学人才培养制度。欧美国家的培养模式已基本成型,美国和日本的神经外科专科医师培养模式是医学生在完成医学学习和基础外科住院医师培训的基础上,再进行专科培训后取得资格认定,然后才能成为神经外科医师。我国神经外科医师来源不一,医学院校毕业的本科生可以直接进入神经外科开展临床工作,继而成为神经外科医师,或是由神经外科硕士、博士毕业后进入神经外科     

怎样培训优秀的消化外科医师

培训一名优秀的消化外科医师,要求做好以下5个阶段：（1）医学本科学习。一名优秀的本科毕业医师,要求具有：①良好的医德医风和专业操守;②良好的医学知识和治病能力;③良好的其他能力,包括沟通、决策、协作、领导、健康倡导、教学能力和拥有专业精神。（2）外科基础培训。在国际上,先进国家已发展到系统性的外科基础培训。培训完毕和考试合格后,可进入不同科目的高级外科培训。（3）普通外科的专业培训。香港的普通外科培训和英国的制度相近,培训结束后参加香港统一考试,通过后可获得香港外科医学院和英国爱丁堡皇家外科医学院的专业医师资格。香港外科医学院和英国爱丁堡皇家外科医学院已认同我国大陆14个培训中心为培训基地,经过这些培训基地培训出来的医师,可参加香港外科医学院和英国爱丁堡皇家外科医学院举行的联合考试,合格后可获得这两所学院的外科专业资格。（4）消化外科小专科培训。消化外科是普通外科培训后其中一个小专科。中国香港和很多先进国家均没有建立一个系统性的培训制度。在香港是否发展普通外科的小专科系统性培训尚在商议中。（5）终生继续学习。终生学习非常重要。在国际上,已经有继续医学教育、持续专业发展、持续专业教育、重新验证和重新认证等讨论。总之,培训优秀的消化外科医师,要从打好根基开始。此外,建立一个国家性的系统外科培训,才能培训出好的外科专业人才。     

我国普通外科专科医师规范化培训历史、现状和展望

上海市普通外科专科医师规范化培训自2013年开始试行至今已有9年,作为毕业后医学教育的重要组成部分,其核心培养目标、培训内容、培训模式通过学习欧美国家的先进经验并结合自身特点而逐步形成了国内的标准和体系,对于专培医师职业胜任力的培养具有深远的意义,尤其是其考核模式成为专科医师规范化培训考核极为有益的创举和探索,也为全国范围内推广实施起到了引领作用和示范效应。目前,仍然需要正视在专科医师规范化培训实施过程中出现的问题和带来的困惑,及时认识和突破这些瓶颈并补上持之以恒的短板,从而进一步推动我国毕业后医学教育继续向前迈进。     

逐步完善我国外科住院医师规范化培训质量和进程的思考与展望

外科住院医师规范化培训是毕业后医学教育中极为重要的组成部分,是医学毕业生成长为一名具备独立、正确、规范地处理临床常见问题能力的外科医师的必由之路,是培养同质化临床医师、加强医学人才队伍建设、提高医疗卫生水平和质量的治本之策。自2013年底在全国范围内启动和实施以来,取得了较大的成绩,也暴露了一些问题,面临着新的挑战和考验。尤其在微创外科蓬勃发展的今天,积极推动青年外科医师学习腹腔镜技术的同时,更不能忽略传统外科基本技能的培训和严格训练的教学精髓,而将互联网带来的一系列变革和突破充分应用于住院医师的临床教学和规范化培训管理系统的构建,也将成为未来医学教育的创新模式。     

逐步完善我国外科住院医师规范化培训质量和进程的思考与展望

外科住院医师规范化培训是毕业后医学教育中极为重要的组成部分,是医学毕业生成长为一名具备独立、正确、规范地处理临床常见问题能力的外科医师的必由之路,是培养同质化临床医师、加强医学人才队伍建设、提高医疗卫生水平和质量的治本之策。自2013年底在全国范围内启动和实施以来,取得了较大的成绩,也暴露了一些问题,面临着新的挑战和考验。尤其在微创外科蓬勃发展的今天,积极推动青年外科医师学习腹腔镜技术的同时,更不能忽略传统外科基本技能的培训和严格训练的教学精髓,而将互联网带来的一系列变革和突破充分应用于住院医师的临床教学和规范化培训管理系统的构建,也将成为未来医学教育的创新模式。     

心胸外科住院医师规范化培训的几点思考

<正>专科医师培训和准入制度是国际医学界公认的医学生毕业后高等教育制度。该制度在欧美等发达国家已有100多年历史,它使专科医师培养更具科学性、规范性和系统性[1]。其历史渊源可以追溯到19世纪中期,德国柏林大学的Langenbeck教授率先提出了建立住院医师制度的思想,以及1876年美国Halsted教授参照Langenbeck教授的模式,在霍普金斯医院建立了外科住院医师制度。专科医师培训是专科医师制度的重要组成部分。我国迄今尚无规范     

中美骨科医师培训体系的比较

现代医学教育由医学生教育、医师资格考试和认证以及继续教育等几个重要部分组成。中美医学教育差异也体现在以上几个方面:美国建立了以住院医师培训计划(Residency Program)为主体的医学教育体系,而我国在相应的青年医师培训和继续教育方面尚处在探索和继续完善的阶段。通过对中美医学教育间的差异进行系统对比和分析,结合我国医学教育实际,讨论并提出了对我国骨科青年医师培训和继续教育模式进行改进和完善的观点,包括转变临床专业研究生培养模式、健全和完善医师资格考试制度、逐步建立骨科专科医师的资格考试和认证等。目的在于扭转现阶段以学术学位研究生教育替代青年医师培训的模式,探讨建立主要以临床为主导的医师培训、考核、认证和继续教育新模式并达到系统化、规范化、科学化的可行性,从而推动我国医学教育和医疗体系制度的发展和完善。     

心胸外科住院医师专科培训的改革与思考

<正>当前,不仅中国住院医师培养制度正在向着规范化、标准化变革,欧美发达国家也因为各种原因正在变革他们已经实施几十年的专科医师培养计划,尤其是在心脏外科的专科培养领域[1]。我国既往心脏外科人才培养存在着过于偏重专科而忽视外科基础的弊端。住院医师规范化培训有利于矫正这一缺陷。但目前北京地区试行的心脏外科专科住院医师规范化培训细则基本沿袭     

普通外科手术的发展及展望

普通外科(general surgery,亦称基本外科)在外科以至整个人体医学中的重要性首先在于普通外科疾病(包括创伤)是最常见的外科疾病,其范围包括了人体的重要器官如甲状腺、肝脏、胰腺、胃肠道等;其次,这些重要器官疾病的病理生理牵涉到许多外科基本问题,其手术又包含大量外科基本操作,因此,普通外科及其手术学是外科学的基础,是外科各专科医师完成其训练过程中不可欠缺的重要阶段。普通外科及其手术学的重要地位,在可见的将来还不可能有重大变化,手术对外科医师心理素质、学识、经验、技术水平、临机应变的能力和责任心的要求则将越来越高。     

胸外科专科医师规范化培训制度的国内外对比和试点思考

我国的胸外科专科医师规范化培训在受训者筛选和考核、培训内容设置和出站要求设定等方面尚未形成统一制度。从培训模式、基地认证、对象招收、培训内容、考核标准及科研能力培训六个方面, 对比我国与日本、美国、英国的胸外科专科培训制度后发现, 各国培训体制存在差异, 建立有效的专科培训制度需立足我国的基本国情。应建立住院医师规范化培训和专科医师规范化培训相衔接的培养模式, 逐步打造一体化培训体系, 并针对受训者的需求, 制定不同的培训模式, 提供多样化选择。通过设置全国统一的课程大纲, 严格筛选培训基地, 缩小各省市医院间培养的专科医师在业务能力和学术能力上的差异, 保障培训的同质化。同时需注重科研教学, 提升受训者的创新能力和科研素养, 推动科研型临床人才的建设。建立合理且高效的培训模式, 有望推动我国专科医学教育的进步。     

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??Problems and strategies faced by training model and education of general surgeon YANG Zhen. Department of Surgery, Tongji Hospital, Tongji Medical College,Huazhong University of Science and Technology,Wuhan430030,China
Abstract At present, chinese general surgery should improve residency and subspecialty residencies training utilized global standards which is consisted of 3 overlapping phases.Fundamentals of surgery curriculum and surgical skills curriculum are an effective way to enhance the students' basic surgical skills and would obtain the global standards for postgraduate medical education. Working-hour restrictions and a heightened awareness of patient safety has changed resident education and training. Specialization and the current practices of general surgeons are a important problem.Postgraduate medical students program should be combined with resident training.Interprofessional education and service learning is a model for the future of health professions education. Simulation-based surgical education and simulator center has completely revolutionized the training process,especially in the laparoscopic and robotic surgery curriculum for resident training. Virtual realicy is the application of the computer aid technique in recent years, which shows its dominant position in medical education. E-learning will play an important role in the near future.     

Surgical council on resident education: a new organization devoted to graduate surgical education

The Surgical Council on Resident Education (SCORE) is a voluntary consortium of six organizations with responsibility for resident education in surgery and an interest in improving the training of surgeons. The founding organizations are the American Board of Surgery (ABS), the American College of Surgeons (ACS), the American Surgical Association (ASA), the Association of Program Directors in Surgery (APDS), the Association for Surgical Education (ASE), and the Residency Review Committee for Surgery of the Accreditation Council on Graduate Medical Education (RRC-S). SCORE emerged from a concerted desire to strengthen the graduate education of surgeons and to assure the competence of surgical trainees in the US. SCORE has a unique ability to foster change in resident education because it brings together the major regulatory organizations (ABS and RRC-S), the major professional organization in surgery (ACS), the senior academic organization in surgery (ASA), and the major surgical education organizations (APDS and ASE). SCORE envisions an ambitious agenda. At its meeting in Philadelphia on November 20, 2006, it began developing a standardized curriculum in general surgery to span the period from medical school to practice, and it defined the scope of the curriculum. It approved continued work of building a national Web site to deliver educational content to general surgery residents and to assist program directors. It endorsed continued development of a basic surgery curriculum for all first-year surgery residents and development of a comprehensive technical skills curriculum for all levels of general surgery training, both of which have been initiated by the ACS. In the future, SCORE plans to examine issues such as the assessment of technical competency, the role of simulation in surgical education, the teaching and assessment of professional behaviors, the practicing surgeon's view of the adequacy of residency training, faculty development, and the attrition of residents from surgery residencies. Members of SCORE intend to investigate best practices in surgical education in other countries. SCORE hopes to take a leadership position in improving the quality of surgical education and surgery in the US.     

Credentialing of surgical skills centers

Major imperatives regarding quality of patient care and patient safety are impacting surgical care and surgical education. Also, significant emphasis continues to be placed on education and training to achieve proficiency, expertise, and mastery in surgery. Simulation-based surgical education and training can be of immense help in acquiring and maintaining surgical skills in safe environments without exposing patients to risk. Opportunities for repetition of tasks can be provided to achieve pre-established standards, and knowledge and skills can be verified using valid and reliable assessment methods. Also, expertise and mastery can be attained through repeated practice, specific feedback, and establishment of progressively higher learning goals. Simulation-based education and training can help surgeons maintain their skills in infrequently performed procedures and regain proficiency in procedures they have not performed for a period of time. In addition, warm-ups and surgical rehearsals in simulated environments should enhance performance in real settings.Major efforts are being pursued to advance the field of simulation-based surgical education. New education and training models involving validation of knowledge and skills are being designed for practicing surgeons. A competency-based national surgery resident curriculum was recently launched and is undergoing further enhancements to address evolving education and training needs. Innovative simulation-based surgical education and training should be offered at state-of-the-art simulation centers, and credentialing and accreditation of these centers are key to achieving their full potential.     

Perceptions of surgical specialists in general surgery, orthopaedic surgery, urology and gynaecology on teaching endoscopic surgery in The Netherlands

Background Specific training in endoscopic skills and procedures has become a necessity for profession with embedded endoscopic techniques in their surgical palette. Previous research indicates endoscopic skills training to be inadequate, both from subjective (resident interviews) and objective (skills measurement) viewpoint. Surprisingly, possible shortcomings in endoscopic resident education have never been measured from the perspective of those individuals responsible for resident training, e.g. the program directors. Therefore, a nation-wide survey was conducted to inventory current endoscopic training initiatives and its possible shortcomings among all program directors of the surgical specialties in the Netherlands. Methods Program directors for general surgery, orthopaedic surgery, gynaecology and urology were surveyed using a validated 25–item questionnaire. Results A total of 113 program directors responded (79%). The respective response percentages were 73.6% for general surgeons, 75% for orthopaedic surgeon, 90.9% for urologists and 68.2% for gynaecologists. According to the findings, 35% of general surgeons were concerned about whether residents are properly skilled endoscopically upon completion of training. Among the respondents, 34.6% were unaware of endoscopic training initiatives. The general and orthopaedic surgeons who were aware of these initiatives estimated the number of training hours to be satisfactory, whereas the urologists and gynaecologists estimated training time to be unsatisfactory. Type and duration of endoscopic skill training appears to be heterogeneous, both within and between the specialties. Program directors all perceive virtual reality simulation to be a highly effective training method, and a multimodality training approach to be key. Respondents agree that endoscopic skills education should ideally be coordinated according to national consensus and guidelines. Conclusions A delicate balance exists between training hours and clinical working hours during residency. Primarily, a re-allocation of available training hours, aimed at core-endoscopic basic and advanced procedures, tailored to the needs of the resident and his or her phase of training is in place. The professions need to define which basic and advanced endoscopic procedures are to be trained, by whom, and by what outcome standards. According to the majority of program directors, virtual reality (VR) training needs to be integrated in procedural endoscopic training courses.     

What does leadership in surgery entail?

Background: Leadership is not formally taught at any level in surgical training; there are no mandatory leadership courses or qualifications for trainees or specialists, and leadership performance is rarely evaluated within surgical appraisal or assessment programmes. Methods: Literature obtained from a MEDLINE search was reviewed to determine the characteristics of surgical leaders; outline an analytical framework through which these characteristics can be developed both in surgeons and surgical departments; and reflect on future challenges and recommendations for the central role of leadership in the field of surgery. Results: Leadership in surgery entails professionalism, technical competence, motivation, innovation, teamwork, communication skills, decision‐making, business acumen, emotional competence, resilience and effective teaching. Leadership skills can be developed through experience, observation, and education using a framework including mentoring, coaching, networking, stretch assignments, action learning and feedback. Conclusion: Modern surgery will need leaders with superior leadership skills that are well defined. It is vital that leadership programmes to develop leadership skills are put into practice in medical education curriculum and postgraduate surgical training. This will ensure maintenance and improvement in the quality of patient care.     

Computer-based training initiatives for education in surgical decision making

PurposeTo determine how computer-based training (CBT) can be integrated into a general surgical residency education program for training and assessing decision-making skills in surgery.MethodsBecause of the emphasis on the American Board of Surgery In-training Exam (ABSITE) and Qualifying Exam preparation, traditional paper-and-pencil multiple choice quiz format testing predominates within most surgical programs. However, decision skills also require training and assessment for residents. Established methods of oral examinations for practice testing require a significant commitment of faculty time. Various CBT programs, with the necessary interactivity, are currently available for supplementing a residency’s education curriculum in the arena of decision making. Moreover, multimedia capability allows integration of new image technologies into training in decision making. One residency program is exploring new CBT systems to aid curriculum development and education in its subspecialty section curricula.ResultsThe divisions of cardiothoracic and vascular surgery have 2 concurrent and parallel CBT modules in place for service residents at the start of the 1998–1999 academic year. Both modules have flexibility that allows function as either testing or teaching modules. Either module can run when faculty are not available, requiring only a Windows-compatible computer. More important, both modules contain the requisite interactivity and branch-based decision trees that potentially model a certifying examination. The same decision branching also supports weighted scoring, allowing for emphasis and recording of certain responses. Each module also can integrate sophisticated multimedia, allowing exposure to medical imaging information. The enhanced and engaging feedback capabilities have generated high levels of resident acceptance.ConclusionsComputer-based training modules offer a promising new direction in decision-making-skill curriculum development for surgical education. It also allows integration of multimedia in creating tools for assessment and training of new image-intensive modalities in residency programs.     

The Development of a Novel Perfused Cadaver Model With Dynamic Vital Sign Regulation and Real-World Scenarios to Teach Surgical Skills and Error Management

The landscape of graduate medical education has changed dramatically over the past decade and the traditional apprenticeship model has undergone scrutiny and modifications. The mandate of the 80-hour work-week, the introduction of integrated residency programs, increased global awareness about patient safety along with financial constraints have spurred changes in graduate educational practices. In addition, new technologies, more complex procedures, and a host of external constraints have changed where and how we teach technical and procedural skills. Simulation-based training has been embraced by the surgical community and has quickly become an essential component of most residency programs as a method to add efficacy to the traditional learning model.The purpose of this paper is twofold: (1) to describe the development of a perfused cadaver model with dynamic vital sign regulation, and (2) to assess the impact of a curriculum using this model and real world scenarios to teach surgical skills and error management. By providing a realistic training environment our aim is to enhance the acquisition of surgical skills and provide a more thorough assessment of resident performance.Twenty-six learners participated in the scenarios. Qualitative data showed that participants felt that the simulation model was realistic, and that participating in the scenarios helped them gain new knowledge, learn new surgical techniques and increase their confidence performing the skill in a clinical setting. Identifying the importance of both technical and nontechnical skills in surgical education has hastened the need for more realistic simulators and environments in which they are placed. Team members should be able to interact in ways that allow for a global display of their skills thus helping to provide a more comprehensive assessment by faculty and learners.     

Vascular surgical training of general and vascular surgery residents

Objective: The opinions of general surgery program directors (SPDs) and vascular surgery program directors (VPDs) regarding vascular surgery training of general surgery residents and the construct of the vascular surgery residency were compared.Methods: Questionnaires were mailed to 55 VPDs and 290 SPDs in 1987 and 1988, and to 80 VPDs and 277 SPDs in 1995. Both questionnaires included questions regarding attitudes about vascular surgical competence, operative experience, future vascular practice opportunities of general surgery residents, and the impact of a vascular surgery residency on general surgery resident education. In addition, the 1995 survey included questions regarding the duration, content, and prerequisite versus requisite experience for the vascular surgery residency.Results: Significant differences in opinions between SPDs and VPDs persisted regarding vascular surgery training of general surgery residents. SPDs were more likely to feel that general surgery graduates are fully competent in vascular surgery, should be exposed to more complex vascular surgery during training, and should be granted unlimited vascular surgical privileges on entering practice. Most VPDs felt that general surgery graduates lack competence in vascular surgery, should be exposed to less complex vascular surgery during training, and should have limited vascular surgery privileges in practice. Both groups of program directors agreed about the construct of vascular surgery residencies and that such residencies have had a favorable impact on general surgery resident education. Both SPDs and VPDs were willing to consider creative restructuring of vascular surgery residencies to accommodate governmental restrictions on funding of graduate medical education.Conclusions: External pressures forcing residency reform may provide an opportunity for SPDs and VPDs to creatively work with regulatory bodies to resolve differences in expectations of vascular surgery education and practice. (J Vasc Surg 1996;24;1057-63.)     

The role and leadership of the Japan Surgical Society in the future reforms in surgery

Changes in medical sciences medical technologies, and medical care system of Japan during the last decade are quick and drastic. Surgery seems to be losing its glory, and carrier as a surgeon seems no more appealing nor attractive to the graduates from the medical school. In order to recover its attractiveness and former glory, education and training system of surgery in medical school, curriculum and training system in surgical residency and continuing education should be revisited and reorganized. Also, critical evaluation of surgical care, and reform in fee schedules for each surgical procedures and operations are inevitable and it is also important that these informations should freely be accessible by patients as requested. The Japan Surgical Society is the oldest and the most prestigious society of surgery in Japan, and the society should take leadership and actively participate in future reforms in surgery.