上海市94名全科医师规范化培训学员学习意愿的调查

对94名参加全科医师规范化培训的学员进行问卷调查,了解学员的学习意愿及其影响因素.结果 表明,超过80%的学员学习态度积极,并希望获得继续教育的机会;76%的学员认为培训计划基本合理但有待进一步完善;94%的学员认为目前伞科培训模式需要进一步结合国情,更好地满足我国社区卫生服务中心实际工作需求.提示,全科医学教材应更符合我国国情,并增加社区常见慢性病相关科室学习时间,完善全科教育体系.     

病例导入式教学法在妇科教学中的初步应用

目的：在妇科临床教学中试行病例导入式教学法并与传统教学法比较。方法：以《妊娠早期异常阴道出血》、《子宫肌瘤》为实验课程,对两种教学法的考试结果及问卷调查作统计分析。结果：实验课程考试的合格率和优良率分别为97．6％和50．0％,显著高于传统方法讲授的课程。多数学生认为该方法优于传统教学法。结论：病例导入式教学法更符合临床思维过程,有利于临床能力的培养。     

Adolescent perspectives on sexuality, contraception, and pregnancy.

In order to better understand the phenomenon of adolescent pregnancy, a questionnaire dealing with sexuality was administered to 50 adolescent females and 50 adolescent males, all attending a low-income health clinic. 96% of the males and 78% of the females were sexually active. Despite their knowledge of and the availability of free contraception at the clinic, contraceptive practice was low among the group polled. General lack of concern regarding the possibility of pregnancy is probably the reason for this low level of contraceptive practice. Only 20% of the females and 16% of the males favored abortion of an unwanted pregnancy, preferring to have the female bear and keep the child. It was felt by the pollsters that the IUD is the most appropriate method of birth control for adolescents having frequent sex, since those taking oral contraceptives do not always take them as prescribed. Most males did not object to using condoms. The use of condoms could be increased by better information programs regarding venereal disease. Sex education programs in school were recommended as the most effective method for reducing unwanted adolescent pregnancies.     

伦理视域下护士与患者及家属对生活护理的认知探讨

目的:了解生活护理实践情况,从伦理视域探讨护士、患者、家属三方对生活护理的认知态度,为推广生活护理实践寻求方向。方法:采用自制生活护理认知调查问卷,在安徽省两家三级甲等医院开展问卷调查。结果:护、患、家属三方对护士实施生活护理的接受度均不超过15%,高于70%的被调查者拒绝护士执行生活护理是由于心理和情感因素。护士认为需要进行生活护理辅助的项目均明显少于患者及家属的要求(P<0.01);70%的护士认为生活护理应该由护工承担,60%的家属认为应该由家属承担,患者认为应由家属(35%)和护工(45%)共同承担,差异有统计学意义(P<0.01)。结论:护、患、家属三方对于生活护理认知既有共同点,也有不同点,推行生活护理实践时需要综合考虑。     

Brief intervention strategies for harmful drinkers: new directions for medical education.

Recent advances in the technology of behavioural interventions for harmful drinkers have created a new role for clinical practice and new challenges for medical education. Several reports from expert committees have recommended new initiatives in the secondary prevention of alcohol problems through physician-based interventions at the primary care level. The conceptual and scientific bases for these recommendations are discussed in terms of recent studies of harmful and hazardous drinkers. The behavioural principles thought to account for the effectiveness of brief interventions are explained. Despite these promising developments, difficulties are inherent in the introduction of new technologies, especially behavioural technologies, into medical practice. A major challenge to medical education will be the development of academic programs that not only teach skills and competencies in secondary prevention but also deal with the socialization of physicians as behavioural practitioners.     

Referral rates of senior family practice residents in an ambulatory care clinic

Discretion regarding the need for and appropriateness of consultations and referrals is an important dimension of clinical competence. However, the process of consultation by medical residents has not been well studied. In the study reported here, a review was made of office-based referrals requested by second- and third-year family practice residents over a three-year period. Significantly lower referral rates were found for the second-year residents than the third-year residents. Possible explanations for this finding included: differences in approach to case management, lack of referral experience by second-year residents, and differences in case mix. Although no explicit protocol existed for the distribution of patients to the residents, differences in case mix and patient age between the patients seen by the two groups of residents accounted for the difference in referral rates. This difference implies that patient distribution in graduate training programs may not be random as commonly thought.     

国外农村基层医师医学培养项目实施现状、成效及评价的系统综述

背景　2010年我国农村订单定向医学生免费培养工作启动，旨在为农村地区培养具备本科学历的全科医生，缓解农村地区基层医师匮乏的现状。本研究通过系统综述了解国外类似项目的实施现状、成效及评价，为我国农村订单定向医学生培养工作评价和改善提供理论参考。目的　了解国外农村基层医师医学培养项目实施现状、成效及评价指标方法等。方法　2019年2-7月，采用系统综述的方法，以“医学教育”“医学教育+医学本科生”“医学院校教育”“医学生”“住院医师规范化培训”“医学专业+人力资源”“农村地区”“农村基层医疗服务”“医师执业地点”“农村基层医师”“农村基层医师培养”“农村医学实习”“农村临床见习”为检索词，检索Ovid MEDLINE、PubMed、Cochrane及Google Scholar主要英文数据库，获取2000-01-01至2019-01-01发表的关于全球农村基层医师院校教育及住院医师培训等项目的实施现状、成效及评价的英文文献。结果　最终纳入53篇文献，分别来自美国、加拿大、澳大利亚、日本、泰国及南非6个国家，包括20个院校教育项目和6个住院医师培训项目。文献显示各国农村基层医师培养项目均具有指向性招生策略、面向农村卫生和全科医学的临床课程体系、以农村执业的家庭医生为临床导师及农村地区临床实践基地等要素；培养项目学生选择家庭医学为执业专业、农村地区执业率和长期农村保留率均明显高于非培养项目学生，两者国家医疗执照考试成绩和通过率无明显差异。长期农村地区临床实践培训、招生策略倾斜农村成长背景学生及农村执业的家庭医生导师是影响项目最终效果的关键因素。结论　医学教育是解决农村基层医师匮乏的有效途径。国外农村基层医师培养项目的招生策略、临床课程体系设置、导师指导及评价可为我国农村订单定向医学生培养工作提供有益参考。     

Handheld Computer Use in U.S. Family Practice Residency Programs

Objective: The purpose of the study was to evaluate the uses of handheld computers (also called personal digital assistants, or PDAs) in family practice residency programs in the United States.Study Design: In November 2000, the authors mailed a questionnaire to the program directors of all American Academy of Family Physicians (AAFP) and American College of Osteopathic Family Practice (ACOFP) residency programs in the United States.Measurements: Data and patterns of the use and non-use of handheld computers were identified.Results: Approximately 50 percent (306 of 610) of the programs responded to the survey. Two thirds of the programs reported that handheld computers were used in their residencies, and an additional 14 percent had plans for implementation within 24 months. Both the Palm and the Windows CE operating systems were used, with the Palm operating system the most common. Military programs had the highest rate of use (8 of 10 programs, 80 percent), and osteopathic programs had the lowest (23 of 55 programs, 42 percent). Of programs that reported handheld computer use, 45 percent had required handheld computer applications that are used uniformly by all users. Funding for handheld computers and related applications was non-budgeted in 76percent of the programs in which handheld computers were used. In programs providing a budget for handheld computers, the average annual budget per user was $461.58. Interested faculty or residents, rather than computer information services personnel, performed upkeep and maintenance of handheld computers in 72 percent of the programs in which the computers are used. In addition to the installed calendar, memo pad, and address book, the most common clinical uses of handheld computers in the programs were as medication reference tools, electronic textbooks, and clinical computational or calculator-type programs.Conclusions: Handheld computers are widely used in family practice residency programs in the United States. Although handheld computers were designed as electronic organizers, in family practice residencies they are used as medication reference tools, electronic textbooks, and clinical computational programs and to track activities that were previously associated with desktop database applications.Handheld computers, also called personal digital assistants (PDAs), are increasingly used by physicians for a variety of tasks dealing with clinical and patient information. However, there is relatively little literature regarding handheld computer use in residency education, particularly family practice, compared with the medical literature regarding electronic medical records (EMRs).^1–5 One study of a family practice residency described their use of handheld computers for resident procedure documentation.⁶ Implied in that article was an overall cost savings to the program due to increasing efficiency. The authors also indicated that the handheld computer was useful for providing ready access for conference scheduling and phone numbers. In a separate study,⁷ a hospital used handheld computers to develop laboratory and x-ray report tracking for inpatients. The authors indicated that 15 percent of U.S. physicians are currently using handheld computers. Potential benefits of handheld computer use described in the literature could be reduced prescribing errors^8,9 and usefulness as research tools.¹⁰ Personal digital assistants are portable, are relatively inexpensive, and have the ability to interface with other electronic devises, including desktop computers.The most popular brands of handheld computers are those equipped with either the Palm (Palm, Santa Clara, California) or the Windows CE (Microsoft, Redmond, Washington) operating system. The Palm is used in 88 percent of the handheld market in the United States.¹¹ Ebell and Royner¹² have published an article that fully describes available handheld computer hardware.Since family practice residency training involves not only state-of-the-art clinical medicine but also training in useful technologic tools, including computers, an understanding of handheld computer use in family practice residencies would be helpful for planning future curricula and implementing new informational technology. The objective of this study is to assess use of handheld computers in family practice residency programs, including actual use, factors influencing non-use, costs, handheld computer training, and types of handheld computer applications.     

护士临床护理心理评估知信行现状及影响因素分析

目的调查临床护士对病人进行临床护理心理评估知信行现状并分析其影响因素,为强化相关培训和质量管理提供依据。方法采用便利抽样法,选取湖北省某三级甲等医院2 454名临床护士为研究对象,应用自行设计的临床护士心理评估知信行调查问卷对研究对象进行调查。结果共回收2 453份有效问卷。临床护士的心理评估知信行总分为（87.98±37.67）分,其中知识维度得分（84.28±18.67）分,信念维度（96.17±10.61）分,行为维度（83.50±17.33）分。多元线性回归分析结果显示,性别为女性,相较于肿瘤科,所在科室为外科、五官科、高干科,所在科室开展心理评估培训,所在科室开展住院病人心理评估,临床护士心理评估知信行总得分较高（P < 0.05~P < 0.01）。结论临床护士心理评估知信行水平仍需提高,护理管理者需制定有针对性的心理评估培训方案,并强化相关质量管理,以提高护理队伍的整体素质。     

Computer multitasking with Desqview 386 in a family practice.

Computers are now widely used in medical practice for accounting and secretarial tasks. However, it has been much more difficult to use computers in more physician-related activities of daily practice. I investigated the Desqview multitasking system on a 386 computer as a solution to this problem. Physician-directed tasks of management of patient charts, retrieval of reference information, word processing, appointment scheduling and office organization were each managed by separate programs. Desqview allowed instantaneous switching back and forth between the various programs. I compared the time and cost savings and the need for physician input between Desqview 386, a 386 computer alone and an older, XT computer. Desqview significantly simplified the use of computer programs for medical information management and minimized the necessity for physician intervention. The time saved was 15 minutes per day; the costs saved were estimated to be $5000 annually.     

A survey of Canadian rheumatology training programs, 1968 to 1978.

The committee on manpower of the Canadian Rheumatism Association retrospectively surveyed Canadian rheumatology training programs for the period 1968 to 1978. There were 133 trainees during that period, who accounted for a total of 201 trainee-years. Most trainee-years were taken up by first-year trainees, especially in the first half of the decade under study. Although three training centres accounted for two thirds of all the trainee-years, there was a progressive increase in the proportion of trainees attending other centres. The majority of trainees were Canadian medical graduates. More than one third of the alumni of these programs held full-time academic positions, and more than three quarters had some academic affiliation. One third were spending at least half of their professional time in teaching and research, but only 71 were spending half or more of their practice time in rheumatology in Canada. The remainder had established residence abroad or were spending at least half of their practice time in areas other than rheumatology. The rapid expansion of Canadian training programs has not been paralleled by a proportionate increase in rheumatologic manpower in Canada.     

泌尿外科教学实习改进的思考

目的临床教学与实习是帮助医学生将基础知识向临床应用过渡的重要环节。方法应用临床教学工作中基本技能,多采用启发式和病例讨论式教学方法,培养学生临床思维和循证思维。结果临床教学培养和提高了学生与医患沟通的能力,培养良好的医德医风,为临床实际工作做好充分准备。     

Inequitable provision of optimal services for patients with chronic heart failure: a national geo-mapping study

OBJECTIVE: To compare the location and accessibility of current Australian chronic heart failure (CHF) management programs and general practice services with the probable distribution of the population with CHF. DESIGN AND SETTING: Data on the prevalence and distribution of the CHF population throughout Australia, and the locations of CHF management programs and general practice services from 1 January 2004 to 31 December 2005 were analysed using geographic information systems (GIS) technology. OUTCOME MEASURES: Distance of populations with CHF to CHF management programs and general practice services. RESULTS: The highest prevalence of CHF (20.3-79.8 per 1000 population) occurred in areas with high concentrations of people over 65 years of age and in areas with higher proportions of Indigenous people. Five thousand CHF patients (8%) discharged from hospital in 2004-2005 were managed in one of the 62 identified CHF management programs. There were no CHF management programs in the Northern Territory or Tasmania. Only four CHF management programs were located outside major cities, with a total case load of 80 patients (0.7%). The mean distance from any Australian population centre to the nearest CHF management program was 332 km (median, 163 km; range, 0.15-3246 km). In rural areas, where the burden of CHF management falls upon general practitioners, the mean distance to general practice services was 37 km (median, 20 km; range, 0-656 km). CONCLUSION: There is an inequity in the provision of CHF management programs to rural Australians.     

Neurosurgery workforce in Canada, 1996 to 2011. Canadian Neurosurgical Society.

OBJECTIVE. To determine the number of neurosurgeons in clinical practice in Canada on Jan. 1, 1996, and their practice profile and to determine requirements for 2001 and 2011. DESIGN. Telephone survey and national mail survey. SETTING. Canada. PARTICIPANTS. All 174 neurosurgeons in Canada engaged in active clinical practice on Jan. 1, 1996, and all residents enrolled in neurosurgery training programs in Canada during the 1995-96 academic year. OUTCOME MEASURES. Demographic characteristics, full-time equivalents, workload, attrition, reasons for exit, vacancies, supply and shortfall. RESULTS. All 174 neurosurgeons responded to the survey. There is a chronic shortage of 25 neurosurgeons in Canada. Sixty-two established neurosurgeons will have stopped practice by 2001 and 181 by 2011. They will need to be replaced, for a total requirement of 87 and 206 neurosurgeons by 2001 and 2011 respectively. Canadian neurosurgery training programs can currently generate only up to 69 and 177 graduates by 2001 and 2011 respectively. During the period 1985-95, 50% of neurosurgery graduates emigrated from Canada within 2 years of obtaining certification, creating potential deficits of up to 52 and 117 neurosurgeons by 2001 and 2011 respectively. CONCLUSIONS. Strategies need to be developed quickly to address not only the chronic shortfall but also the attrition of established neurosurgeons. Strategies to increase and retain the number of Canadian neurosurgery graduates are also needed.     

规范化培训模式在临床药学专业本科毕业实习中的应用

目的 探讨规范化培训模式在临床药学专业本科毕业实习中的应用.方法 以2010级临床药学专业本科毕业生为为对象,以问卷调查的形式评估实习模式及内容.结果 在药房实习时间太短及临床药学科（室）实习时间太短的学生分别占到63.41％及58.24％,95.12％的学生都希望能增加自己做病例讨论的次数,41.46％的学生希望减少药历书写的量,仅有7.32％学生认为每周4.5天应在临床工作.结论 规范化培训的教学模式比较适用于当前我校四年制临床药学专业本科的实习,但对实习考核指标还需研究后做进一步调整,并应规范实习带教队伍,从而提高实习的教学质量.     

护理大专生临床实习状况调查与分析

目的：了解护理大专生在医院临床实习的状况，为制定相关的实习管理提供依据。方法：使用自制调查问卷，分别测查某高专02级、03级761名在医院实习的护理大专生，并对结其结果进行相关分析。结果：有47．8％的学生认为实习医院实习条件好，有39．7％学生认为实习医院管理规范。48．9％学生认为带教教师带教能力强，26．6％学生认为学校的教学还需注重与临床接轨，34％学生认为自身主动性学习不够。结论：学校要安排实习条件较好的三甲医院作为实习医院，要加强实习管理，改进学校教学，使之更结合临床。注重学生人文知识的学习和学习能力的培养。     

毕业学员对复旦大学中山医院全科医师规范化培训的评价调查

目的调查毕业学员对复旦大学附属中山医院全科医师规范化培训工作的评价和建议,为今后培训工作的进一步改进提供参考。方法采用问卷调查方式,对2000年1月至2011年6月在中山医院全科医学科接受规范化培训的毕业学员进行调查。结果共183名毕业学员中,剔除失访及本院工作人员共15人,调查表发放总数为168份,回收有效问卷165份,回收率98％。165人中,将近2／3的学员是在单位指派的同时抱着更新知识结构、提高专业层次的目的前来参加培训的;对培训的期望程度高和很高者占85％,培训结束后个人期望全部达到和大部分达到者占56％。超过68％的学员认为中山医院的培训特色是临床实践锻炼临床能力、教师的教学水平高以及培训提高了大家的理论水平。超过半数以上的学员认为可以学到很多知识、临床轮转带教老师水平高、管理严格是培训的优点。超过84％的学员认为接受培训之后在技能、知识和理念方面收获很大或较大。对中山全科培训计划的总体评价是很好和较好的学员占74％。48％的学员认为培训缺点是社区轮转的社区师资力量比较薄弱,此外缺点还包括部分专科带教老师对学员要求较低,部分理论课内容与社区实际脱节等;认为培训计划最需要改进的是实践安排、缩短规范化培训的总时间、增加科研方面的教学内容等。结论中山医院全科医师规范化培训工作得到肯定,同时也存在一些问题有待改善,以利于今后更加合理规范地开展培训工作,提高培训效果。     

利用“临床营养风险筛查计划”科研项目培养医学生调查研究能力

目的通过培训并实践"临床营养风险筛查计划",提高医学生进行合理调查研究的能力。方法对入选医学生进行调查研究方法学培训,并进行临床资料采集等实践活动。培训结束后,对医学生科研训练效果进行总结和评价。结果自2010年6月～2011年6月,共培训医学生46人,并对386例患者进行营养风险筛查。97.83%(45人)研究参与者赞同安排医学生参与科研项目训练,80.43%医学生对此次调查研究工作满意,认为对后期学习能力的提高有促进作用。医学生科研能力影响因素集中体现在科研选题、统计学理论及软件操作、论文写作能力三方面。结论采用成立科研小组、安排有针对性的培训等方法,使医学生系统接受科学研究方法训练,对其科研教学能力培养可能会有重大促进作用。     

在综合医院开展儿科见习教学的困境及对策

儿科临床见习教学是教学工作的一个重要环节,是培养学生临床思维能力和提高综合素质的重要途径。新形势下在综合医院开展儿科见习教学面临诸多困难,只有建立健全的教学制度,提高教师素质,不断总结经验,应用多种教学手段,才能切实提高综合医院儿科见习的教学质量。