浅析国内外继续医学教育现状与发展

继续医学教育作为继续教育的组成部分,可以提升卫生从业人员的业务水平以及综合素质。本研究通过介绍继续医学教育理论的内涵以及国内外继续医学教育的进展,发现我国继续医学教育面临的问题,并针对这些问题,提出了一些合理的建议。     

基层医院医学继续教育工作存在的问题及对策

随着医学继续教育工作的全面铺开，基层医院医学继续教育在实施过程中暴露出很多问题，如管理政出多门，项目一哄而上；教育经费失控，医院无法承受；由于专业限制，院级医学继续教育项目开展困难；买卖学分等严重干扰了医学继续教育管理工作。针对以上问题，作者就如何建立一套既适合我国国情，又适应基层卫生专业技术人员的医学继续教育管理办法提出相应的对策和建议。     

上海市开展继续医学教育的现状分析

为总结上海市实施继续医学教育3年来的经验与不足,探讨继续医学教育发展的方向,我们于1999年初在全市随机抽取三级、二级和一级医院共30所,开展了继续医学教育的现况调查。调查看到：继续医学教育工作的实施已为大家所认可,现行的规章制度是可行的,但还存在一些问题,主要有：①条块分割,组织与管理不统一;②项目设立需重实效;③尚需完善学分考核制度;④项目收费尚需规范化;⑤效果评估尚无有效标准。就这些问题提出了相应的对策建议。     

妇幼保健机构专业人员继续医学教育内容和模式需求研究

目的通过对各级妇幼保健机构专业人员继续医学教育内容和模式需求调查分析,为开发妇幼保健机构人员继续医学教育大纲和教材提供依据。方法现场调查省市县妇幼保健机构各3个,对妇幼保健机构专业人员进行问卷调查和小组访谈。结果省市级妇幼保健机构继续教育工作开展得较好,县级机构较差。不同专业人员对继续教育内容需求各有侧重。前三位最受欢迎的继续教育形式为到上级机构进修、外出参加学术会议、远程教育。结论研究结果为制定各级妇幼保健机构人员继续医学教育大纲,开发培训教材提供依据。     

妇幼保健机构专业人员继续医学教育现状及需求分析

目的通过对各级妇幼保健机构专业人员继续医学教育现状和需求的调查分析,发现存在的问题,并提出建议。方法选择2008年度全国妇幼保健机构监测相关指标结果,并结合专题调查结果进行综合分析。结果各级妇幼保健机构比较重视专业人员的继续医学教育工作,开展形式多样的继续医学教育,并提供相应的政策支持。但是,妇幼保健机构对继续医学教育的投入相对不足,而且在不同级别、同级别的不同妇幼保健机构之间对继续医学教育的投入均存在较大差异。同时,妇幼保健机构继续医学教育缺乏系统性。结论建议将妇幼保健机构人员继续教育与机构发展整体规划、机构内部管理、学科建设结合起来,建立人员继续医学教育制度和长效的人才培养机制,加大继续医学教育经费投入和管理,保证妇幼保健机构的健康发展。     

Portfolios in continuing medical education – effective and efficient?

INTRODUCTION: A cross over comparison between 'traditional' continuing medical education (CME) activities and portfolio-based learning in general practice is described. METHOD: Thirty-two volunteer general practitioners (GPs) were divided into two cohorts; each cohort spent six months following a 'traditional' route to postgraduate educational accreditation (PGEA) and six months following a portfolio-based learning route supported by three CME tutors. OUTCOME MEASURES: These were the submission of a completed portfolio with evidence of the completion of learning cycles and participants reflections on the educational process. Qualitative and quantitative evaluation data were collected by questionnaire, semi-structured interview, participant observation and review of completed portfolios. RESULTS: The themes identified by GPs as hopes for the portfolios were largely fulfilled and the anxieties generally confounded. The flexibility of the portfolio learning process was particularly important to the participants. The breadth of topics covered by the portfolios was extremely wide and comparison with the submissions for 'traditional' PGEA showed a much smaller spread of learning activities and fewer subjects of study. EFFECTIVENESS: The use of the portfolios of critical incidents and the completion of learning cycles with application to practice provided evidence of the effectiveness of such learning. EFFICIENCY: The mean number of hours spent by GPs preparing the portfolios was 24.5 +/- 12 (SD) which was significantly more than the 15 hours of PGEA awarded. CONCLUSIONS: This study demonstrates that a portfolio-based learning scheme can meet the needs of GPs relevant to their professional practice; it can give learners control over how, what and when they learn and encourage active and peer-supported learning; it can build personal and professional confidence and be thought both valid and reliable by participants. Learning outcomes can also be reliably assessed by PGEA within the context of an individually created learning plan.     

大陆和香港地区继续医学教育学分的管理模式比较

文章比较了大陆和香港地区在继续医学教育学分管理模式上的区别,发现两者在学分要求、执行手段、授予标准、管理机构以及证书发放和管理等方面存在差异,并提出今后要从法制建设、信息系统建设以及评审激励机制方面加强对继续医学教育学分的管理。     

国内外全科医生继续教育研究可视化对比分析

目的 对比分析国内外全科医生继续教育领域研究热点、前沿趋势的变化,为我国全科医生继续教育的发展提供理论支持。方法 以Web of Science核心合集(WOS)、中国知网数据库(CNKI)为文献来源,利用CiteSpace 5.7.R2对近10年全科医生继续教育的相关文献进行关键词共现和聚类分析。结果 中文文献发文量呈上升趋势而英文文献持续平稳发展; 研究团队与机构显示国内以首都为代表的团队发展较好,西方国家中澳大利亚、丹麦、瑞士在该领域的研究经验丰富; 高频关键词表明我国在管理、人文关怀等方面存在盲区。结论 我国全科医生继续教育研究存在滞后性; 研究团队、机构的合作交流受地域距离影响较大; 全科医生继续教育研究存在盲点,需进一步优化。     

Comparison of problem-based learning and lecture format in continuing medical education on headache diagnosis and management

The purpose of the study was to compare the impact of continuing medical education for primary care physicians in Halifax, Nova Scotia, Canada, delivered through a problem-based learning (PBL) format with that of a lecture-based format, in the clinical area of headache diagnosis and management. From January to June 1995, 38 physicians participated in three problem-based learning sessions, and 49 in a lecture-based session in the clinical area of headache. Pre- and posttest assessments of knowledge were made of each group before and immediately after the educational sessions. A second evaluation using Key Features Problems (KFP) to measure clinical reasoning was administered to both groups 3 months later. Analysis of covariance between groups on the post-test, using the pre-test result as covariate, showed significantly greater knowledge in the PBL group. Mean post-test KFP scores also were significantly higher for the PBL group. The PBL group's satisfaction with several programme dimensions was significantly higher than that of the lecture group. These results must be viewed in the context of differing amounts of exposure for the two groups. Problem-based learning in continuing medical education in the area of headache management was associated with greater knowledge acquisition and with greater improvement in clinical reasoning skills than in a lecture-based approach. Problem-based learning also was preferred by family physicians. However, the cost-benefit of this approach was questioned, since the PBL group had more exposure. Several factors limit the generalizability of this study, e.g. the impossibility of randomly composing the two experimental groups. Further research is required to determine if the results are generalizable and whether a PBL approach results in change in practice behaviour.     

中外医学期刊继续医学教育模式调查分析

【目的】 探索医学期刊开展继续医学教育(Continuing Medical Education, CME)的模式,以提升医学期刊服务行业发展的能力。【方法】 通过期刊网站调查分析国外3种(Annals of Internal Medicine、JAMA、BMJ)和国内9种医学期刊(包括《中华医学杂志》《中华外科杂志》《中华儿科杂志》等)的CME模式,调查内容包括CME课程素材、主题、内容、结构及形式等。【结果】 3种国外期刊均在网站上创建了完善的CME平台/版块,包括多种主题和形式的CME课程,课程素材不仅局限于期刊文章;课程主题多样,包括医学专业知识和技能、医学伦理规范和医患沟通技巧等;均采用图文、音频和视频等多种媒体形式;测试内容兼顾实践能力评估,学分申领过程简便。相比之下,国内医学期刊网站缺乏完善的CME平台/版块,课程主题相对局限;素材仅来自期刊少数栏目的文章;形式相对单一,以纯文本为主;测试内容仅重视专业知识,且学分申领过程相对繁琐。【结论】 国内医学期刊应从课程素材、内容、形式及测试环节等方面改进以提高CME质量,从而推动医学知识向临床实践转化。     

Alternatives and options for funding continuing medical education: a debate

There are four main categories for funding continuing medical education (CME) in Europe: public funding, industrial funding, private funding, and a combination of the three. Reasons behind funding are different in countries with a prevalent state or free-market economy; public funding should have public health as its main concern, while individual funding should have concern with individual benefits. This paper describes the main alternatives and options for funding CME in Italy, a European country with a national health service (NHS) and a free-market economy. In Italy CME is a legal obligation for permanent NHS staff and for doctors who participate in the NHS. A budgeted item in the Health Fund is assigned to CME, but few Regions have clearly set out a CME programme strategy.     

Problem-based learning in distance education: a first exploration in continuing medical education

The Wellcome Tropical Institute has assisted countries in the tropics to establish viable systems of continuing medical education, particularly for young doctors practising in rural areas. As part of this strategy the Institute has developed material for use in distance learning. The first attempt to apply the problem-based learning approach to written material for use by an individual learner in the absence of a tutor led to a trial in Ghana, Kenya and Pakistan to compare a conventionally designed module with a problem-based learning module on the same topic for their respective acceptability, effectiveness and efficiency. The design, implementation and results of these three comparative trials are presented.     

Development of continuing medical education in Europe: a review

This short review sets out some general facts and features concerning the development of continuing medical education (CME) in Europe. The review is intended as a basis for proposing plans and action for CME in the future. Europe, as it happens, was the birthplace and cradle of both scientifically based medical education in general and CME in particular. Three stages of development are distinguished: (1) Development of CME from the 19th century up to the beginning of the Second World War; (2) After 1945; (3) CME in the present.     

The development of a participant questionnaire to assess continuing medical education presentations

OBJECTIVE: Feedback on presentation skills is important for developing skilled educators, but often this feedback is based on evaluation tools that have been developed with little concern for psychometric issues or for how the information will be used for feedback. The purpose of this study was to develop a reliable participant questionnaire to assess the quality of continuing medical education (CME) presentations and to provide presenters with feedback. DESIGN: The questionnaire was developed using an iterative approach, with doctors as raters, and tested during a variety of CME presentations. The resulting questionnaire consists of 9 items rated on a 7-point Likert scale. The psychometric analysis reported in this paper was completed using data from grand rounds presentations. RESULTS: Psychometric analysis, based on 319 evaluations from 17 presentations (average of 19 evaluations/presentation), revealed a high level of reliability (0.91), indicating that the items met a reasonable standard and that the raters were discriminating between the quality of the presentations adequately. CONCLUSION: This 9-item, participant questionnaire provides a reliable measure of the quality of CME presentations, while also providing presenters with useful feedback. Further studies will investigate if this instrument can be used to assess other CME formats and how best to provide feedback to presenters.     

Undergraduate public health education in UK medical schools - struggling to deliver

INTRODUCTION: Recent policy initiatives in the United Kingdom (UK) have underlined the importance of public health education for health care professionals. We aimed to describe teaching inputs to medical undergraduate curricula, to identify perceived challenges in the delivery of public health teaching and strategies that may overcome them. METHODS: We undertook a cross-sectional survey; questionnaires were sent electronically to 28 teaching leads in academic departments of public health in UK medical schools. These were followed-up by telephone interviews. RESULTS: We obtained a 75% response rate. We found a great deal of variability between schools in teaching methods, curricular content and resources used. In 76% of medical schools, public health and clinical teaching were integrated to some extent. The proportion of teaching delivered as lectures is decreasing and that of self-directed learning is increasing. A range of methods is used to assess students and in 33% of schools these assessments contributed to final Medical School marks. More than half the medical schools had difficulty finding teachers and staffing levels had deteriorated in 55% of schools. Many interviewees felt that their contributions were undervalued. Few were aware of the level of funding received to support teaching. DISCUSSION: There is a need to increase the supply of well-trained and motivated teachers and combine the best traditional teaching methods with more innovative, problem-based approaches. Faculties need to share 'learning about what works' and teaching resources across medical schools as well as addressing a culture of neglect of teaching in some departments. Suggestions are made as to how undergraduate public health teaching can be strengthened.     

The market and educational principles in continuing medical education for general practice

In an attempt to increase participation by established general practitioners (GPs) in continuing medical education (CME) the Department of Health in 1990 created an allowance (the Postgraduate Education Allowance, PGEA) to be spent by GPs on the educational provision of their choice. Although the PGEA has increased attendance by established GPs at educational activities, the market created in CME provision has favoured low cost activity of questionable value. This paper examines criteria for the validation of general practice CME, based on the principles of adult learning, which could be used to manage this market. Failure to adopt an appropriate validating process could lead to the PGEA becoming discredited and the imposition of periodic reaccreditation as a means of enforcing participation by GPs in CME.     

Problem-based learning in medical education: Developing a research agenda

While the use of problem-based learning (PBL) methods continues to increase in medical education, three literature reviews of PBL have appeared in the past several years which come to different opinions about their merits. This analysis summarizes the research evidence regarding PBL by examining how well it has met its originators' goals, what we know about how PBL works, and how PBL fares in a goal-free comparison with conventional curricula. A research agenda is suggested to refine our understanding of well-documented effects of PBL, to probe for other possible longer term PBL outcomes, and to examine if and how PBL affects knowledge acquisition and retention. Consistency of evidence from a variety of PBL implementations can help decide whether the effects seen can be attributed to PBL or are the results of other curricular features unique to one setting.     

医院四级远程医学教育平台建设与效果评价

介绍了医院远程医学教育平台建设情况,探讨了远程医学教育质量保证体系,并进行了效果评价.认为医院依托远程医学教育平台向基层医院提供理论授课、手术演示、病案分析等,对规范基层医院诊疗服务,提高其学术水平和管理水平,实现医疗同质化,具有积极意义.     

Crisis resource management training for an anaesthesia faculty: a new approach to continuing education

BACKGROUND: Human error and system failures continue to play a substantial role in adverse outcomes in health care. Anaesthesia crisis resource management addresses many patient safety issues by teaching behavioural skills for critical events but it has not been systematically utilized to teach experienced faculty. METHODS: An anaesthesia crisis resource management course was created for the faculty of our medical school's anaesthesia teaching programmes. The course objectives were to understand and improve participants' proficiency in crisis resource management (CRM) skills and to learn skills for debriefing residents after critical events. Through surveys, measurement objectives assessed acceptance, utility and need for recurrent training immediately post-course. These were measured again approximately 1 year later along with self-perceived changes in the management of difficult or critical events. RESULTS: The highly rated course was well received in terms of overall course quality, realism, debriefings and didactic presentation. Course usefulness, CRM principles, debriefing skills and communication were highly rated immediately post-course and 1 year later. Approximately half of the faculty staff reported a difficult or critical event following the course; of nine self-reported CRM performance criteria surveyed all claimed improvement in their CRM non-technical skills. CONCLUSIONS: A unique and highly rated anaesthesia faculty course was created; participation made the faculty staff eligible for malpractice premium reductions. Self-reported CRM behaviours in participants' most significant difficult or critical events indicated an improvement in performance. These data provide indirect evidence supporting the contention that this type of training should be more widely promoted, although more definitive measures of improved outcomes are needed.     

'Swallowing the medicine': determining the present and desired modes for delivery of continuing medical education to rural doctors

ABSTRACT: A National Needs Assessment of the continuing professional educational needs of Australian rural medical practitioners was conducted on a model previously successfully used in Queensland. The objective was to describe and quantify the continuing education needs of rural medical practitioners in order that service providers might more expeditiously set educational curricula in continuing medical education (CME) provision. A major component of the study was to determine which modes of CME delivery rural doctors currently use and which they would prefer to use. Rural doctors were perceived to be slow to access new technologies and training may be required in order for the doctors to use them.