模拟人在产科护理教学中的运用

产科护理的特点及目前医疗环境的现状使传统护理临床技能规范化培训受到了很大的限制。模拟人主导的模拟教学因安全、有效、可重复操作等诸多优点而迅速发展。正确使用模拟人,科学构建模拟教学方法,清楚了解模拟人教学的优缺点,能让模拟人在护理教学中发挥更大作用。     

基础为本，夯实基本功：规范把握诊疗指征，守住适度医疗底线

<正>医疗技术（medical technique）泛指医务人员以诊治疾病为目的而采取的专业手段和措施,必须具备安全和有效双属性。随着科学技术的不断进步,新的医疗技术在提高诊治能力、促进全民健康方面扮演着越来越重要的角色。作为医疗服务的载体,医疗技术与医疗质量、医疗安全密切相关,不规范的应用甚至滥用（misuse）,无疑会导致医疗质量滑坡或医疗安全隐患,甚至会危害患者的健康。为此,国家卫生健康委员会于2018年8月颁布了《医疗技术临床应用管理办法》,旨在通过加强医疗技术临床应用管理顶层设计,规范医疗技术临床应用管理,保障医疗技术的科学、规范、有序和安全的发展。中共中央、     

中医儿科理论授课与临床实践相结合量化指标研究

研究目的主要为临床实践的学生提供一套完整的评估体系,包括实习计划及运作方案的制定;师生互相提问;医疗临床实践能力及毕业论文的撰写等环节。量化体系的建立可教学相长,师生相互促进,对培养学生中医辨证思维能力,学习经典,及临床沟通、写作能力,对疾病的认识及预后判断等均有积极的意义。     

医院放射科技术员医疗纠纷注意事项若干

医疗技术水平决定医院的发展。法律意识决定医院正常工作的稳定。随着人民健康水平的提高,对医院的管理能力和医疗技术就有了新的要求,患者法律意识日渐提高的今天,给医疗工作和医院管理带来了更多更新的挑战。放射科技术员在确保正常医疗秩序前提下,法律知识和自我保护意识就要提高到一个新的台阶,潜在的医疗纠纷,是我们最难解决和最复杂的问题之一。     

早期预警体系与模拟培训在降低严重产科并发症中的作用

产科急重症严重威胁孕产妇及胎儿生命,为保障产科医疗安全,建立早期预警管理体系至关重要。加强产科急重症模拟培训,掌握预警触发标准、反应措施及处置流程。在病情变化的早期进行识别和诊断,并给予及时干预措施,可减少产科严重并发症的发生。     

生殖能力的保护和保存

文章从生殖能力的概念、卵巢储备的评判及影响因素、生殖能力的保护与保存,以及生物安全性和医疗咨询等方面综合阐述女性生殖能力的保护与保存的研究进展。     

中医儿科临床带教的体会

中医儿科临床带教中通过结合儿科特点进行入科教育,临床医疗中注重培养临床思维,严格规范医疗,注重病历书写及医患沟通能力,丰富教学形式,培养发散、创新思维等方法,为培养优秀中小儿科人才打下基础。     

妇科内镜技术应用中的医疗风险与防范

妇科内镜手术由于其自身特性、患者的个体化差异及医患双方对该类手术认同能力的差别,会给医疗活动带来潜在的风险。如果内镜医师与患者沟通充分,用严格的质量管理和不断提高的技术,来切实改善手术质量,就可以尽量降低医疗风险的发生率。     

小儿医疗安全与纠纷防范

目的:探讨小儿医疗安全以减少儿科医疗纠纷。方法:详细分析本科病儿医疗纠纷和死亡病例的医疗缺陷,对我科2005年1月至今的病例进行回顾性分析。结果:最易引起医疗纠纷的疾病包括颅内出血、过敏性休克,急性呼吸循环衰竭。结论:早期筛选高危病儿的临床措施能提高儿科医师对危重疾病的识别能力,执行儿科安全医疗模式,加强医患沟通能显著减少严重医疗纠纷。     

Hsa-miR-6841-3p对宫颈癌细胞系Caski增殖及侵袭转移的影响

目的:探讨miRNA-6841-3p对宫颈癌细胞生物学行为的影响。方法:将miRNA-6841-3p模拟物、miRNA-6841-3p抑制物转染至宫颈癌细胞系Caski。实时荧光定量PCR检测宫颈癌细胞系Caski转染后miRNA-6841-3p mRNA以及其预测靶基因TFF3的转录表达。CCK-8法检测细胞增殖能力。Transwell小室检测细胞体外侵袭转移能力。划痕实验检测细胞迁移能力。结果:实时荧光定量PCR显示,miRNA-6841-3p模拟物转染组与miRNA-6841-3p模拟物对照组相比,miRNA-6841-3p mRNA表达明显上调(P0.01),miRNA-6841-3p抑制物转染组miRNA-6841-3p mRNA转录表达明显受抑制,差异有统计学意义(P0.01)。其预测靶基因TFF3 mRNA转录表达在miRNA-6841-3p模拟物转染组明显低于抑制物转染组(P0.01)。与miRNA-6841-3p抑制物转染组比较,转染miRNA-6841-3p模拟物后,宫颈癌细胞系Caski细胞活性、迁移侵袭能力明显减弱(P0.05)。结论:上调miRNA-6841-3p表达可明显抑制宫颈癌细胞系Caski增殖,抑制其迁移、侵袭能力,其作用机制可能通过抑制预测靶基因TFF3表达实现。     

Simulation training in contemporary obstetrics education

AIM: To investigate the use of the Gaumard’s Noelle S550.100 Maternal and Neonatal Simulators for teaching forceps delivery. METHODS: Twenty two (n = 22) resident physicians were enrolled in a simulation course on operative forceps deliveries. The physicians enrolled in the course were all part of an accredited Obstetrics and Gynecology residency program and ranged in their training from post graduate year (PGY) 1-4. Each participant received simulation based teaching on the indications, contraindications, proper application, delivery and removal of forceps by a single teacher. The Gaumard’s simulator and Simpson forceps were used for this course. Statistical analysis using SPSS statistical software was performed after the completion of the simulation training program. A paired student t-test was performed to compare the cohort’s mean pretest and post simulation training scores. Follow up skills assessment scores at one month, 3 mo and 6 mo were compared to the baseline pretest score using a paired student t-test. RESULTS: There was statistically significant improvement in the post simulation training performance evaluations compared to the pretest, 13.7 (SD = 3.14) vs 7.9 (SD = 4.92), P < 0.05. Scores at 1 mo, 3 mo, and 6 mo were compared to the pretest score and showed retention of skills: 4.6 (SD = 5.5, 95%CI: 2.21-7.07), 4.4 (SD = 5.2, 95%CI: 2.13-6.70), and 5.6 (SD = 4.8, 95%CI: 3.53-7.75) points, respectively. There were statistically significant differences between residents by post graduate training year on pretest scores, however these differences were not present after simulation training. Pretest scores for PGY 1, 2, 3, 4 were 3.5 (SD = 2.27, 95%CI: 2.13-5.00), 7.25 (SD = 6.70, 95%CI: 1.50-13.00), 10.75 (SD = 1.5, 95%CI: 9.50-12.00), 12.17 (SD = 2.57, 95%CI: 10.33-14.00). After simulation training PGY 1 residents did as well as well as the upper level residents. Posttest mean test scores for PGY 1, 2, 3, 4 were 13.75 (SD = 1.49, 95%CI: 12.75-14.63), 10.25 (SD = 0.24, 95%CI: 4.25-14.00), 15.00 (SD = 1.16, 95%CI: 14.00-16.00), 15.17 (SD = 0.75, 95%CI: 14.67-15.67). CONCLUSION: Our simulation based training program not only produced short term gains, but participants were able to retain the skills learned and demonstrate their knowledge months later.     

Implementation of laparoscopic virtual-reality simulation training in gynaecology: a mixed-methods design

Objectives

Virtual-reality (VR) training has been demonstrated to improve laparoscopic surgical skills in the operating theatre. The incorporation of laparoscopic VR simulation into surgical training in gynaecology remains a significant educational challenge. We undertook a pilot study to assess the feasibility of the implementation of a laparoscopic VR simulation programme into a single unit.

Study design

An observational study with qualitative analysis of semi-structured group interviews. Trainees in gynaecology (n = 9) were scheduled to undertake a pre-validated structured training programme on a laparoscopic VR simulator (LapSim^®) over six months. The main outcome measure was the trainees’ progress through the training modules in six months. Trainees’ perceptions of the feasibility and barriers to the implementation of laparoscopic VR training were assessed in focus groups after training.

Results

Sixty-six percent of participants completed six of ten modules. Overall, feedback from the focus groups was positive; trainees felt training improved their dexterity, hand-eye co-ordination and confidence in theatre. Negative aspects included lack of haptic feedback, and facility for laparoscopic port placement training. Time restriction emerged as the main barrier to training.

Conclusions

Despite positive perceptions of training, no trainee completed more than two-thirds of the modules of a self-directed laparoscopic VR training programme. Suggested improvements to the integration of future laparoscopic VR training include an additional theoretical component with a fuller understanding of benefits of VR training, and scheduled supervision. Ultimately, the success of a laparoscopic VR simulation training programme might only be improved if it is a mandatory component of the curriculum, together with dedicated time for training. Future multi-centred implementation studies of validated laparoscopic VR curricula are required.     

Faking it? Simulation in the training of obstetricians and gynaecologists

PURPOSE OF REVIEW: This paper discusses the use of simulation as a training tool in obstetrics and gynaecology. RECENT FINDINGS: Modern medical training and patient pressure for treatment by more experienced clinicians have contributed to a reduction in the training opportunities available to junior doctors. Advances in information technology have led to the successful introduction of simulator-based training in many safety-critical industries such as aviation and nuclear power. In this editorial we describe simulation devices that are available to obstetrics and gynaecology and explain how simulation can benefit the patient, trainee and educator. We also explore how simulation could be integrated into obstetrics and gynaecology training programmes. SUMMARY: At present simulation is very much underused as a training tool in medicine, and features little in the postgraduate training curriculum. In obstetrics and gynaecology simulation could be used as an educational tool to assist in (1) transfer of knowledge, (2) practising diagnostic and simple practical skills, (3) surgical skills training, (4) emergency drill training and (5) human factors and team training. Whereas simulation should not be perceived as a replacement for training with real patients, educators should embrace the opportunities that simulation provides and integrate it into current training programmes to maximize training opportunities and patient safety.     

Outcomes from a labor and delivery team training program with simulation component

We evaluated the implementation of a labor and delivery unit team training program that included didactic sessions and simulation training with an active clinical unit. Over an 18-month follow-up time period, our team training program showed improvements in patient outcomes as well as in perceptions of patient safety including the dimensions of teamwork and communication.     

Existing and Future Educational Needs in Graduate and Postgraduate Education

IntroductionThis review was designed to make recommendations on future educational needs, principles of curricular development, and how the International Society for Sexual Medicine (ISSM) should address the need to enhance and promote human sexuality education around the world.AimTo explore the ways in which graduate and postgraduate medical education in human sexuality has evolved and is currently delivered.MethodsWe reviewed existing literature concerning sexuality education, curriculum development, learning strategies, educational formats, evaluation of programs, evaluation of students, and faculty development. We reviewed literature relating to four main areas: (i) the current status of the international regulation of training in sexual medicine; (ii) the current delivery of education and training in sexual medicine; (iii) resident and postgraduate education in sexual medicine surgery; and (iv) education and training for allied health professionals.ResultsThe main findings in these four areas are as follows. Sexual medicine has grown considerably as a specialty during the past 20 years, with many drivers being identified. However, the regulatory aspects of training, assessment, and certification are currently in the early stages of development and are in many ways lagging behind the scientific and clinical knowledge in the field. However, there are examples of the development of curricula with accompanying assessments that have attempted to set standards of education and training that might underlie the delivery of high-quality care to patients in sexual medicine. The development of competence assessment has been applied to surgical training in sexual medicine, and there is increasing interest in simulation as a means of enhancing technical skills training. Although the focus of curriculum development has largely been the medical profession, there is early interest in the development of standards for training and education of allied health professionals.ConclusionOrganizations of professionals in sexual health, such as the ISSM, have an opportunity, and indeed a responsibility, to provide and disseminate learning opportunities, curricula, and standards of training for doctors and allied health professionals in sexual medicine.Eardley I, Reisman Y, Goldstein S, et al. Existing and Future Educational Needs in Graduate and Postgraduate Education. J Sex Med 2017;14:475–485.     

SimMom模拟人在产科医师培训中的作用

产科是一门实践性强、应急性高、对团队合作要求高的临床医学。在患者安全性要求更高的今天,产科医生需要通过模拟训练来提高临床操作技能和团队合作能力以应对各种急危重症。现对SimMom模拟人在产科医师培训中的研究进展进行讨论。     

Qualité et sécurité des soins : expériences de l’anesthésie,perspectives pour la périnatalité ?

This review examines current research on healthcare safety in highly dynamic domains of anesthesia and surgery. It emphasizes how checklists implementation and training program based on CRM and simulation may significantly improve interprofessional teamwork in a multidisciplinary obstetrical setting.     

Simulation training and resident performance of singleton vaginal breech delivery

OBJECTIVE: To determine whether simulation training improves resident competency in the management of a simulated vaginal breech delivery. METHODS: Without advance notice or training, residents from 2 obstetrics and gynecology residency programs participated in a standardized simulation scenario of management of an imminent term vaginal breech delivery. The scenario used an obstetric birth simulator and human actors, with the encounters digitally recorded. Residents then received a training session with the simulator on the proper techniques for vaginal breech delivery. Two weeks later they were retested using a similar simulation scenario. A physician, blinded to training status, graded the residents' performance using a standardized evaluation sheet. Statistical analysis included the Wilcoxon signed rank test, McNemar chi2, regression analysis, and paired t test as appropriate with a P value of less than .05 considered significant. RESULTS: Twenty residents from 2 institutions completed all parts of the study protocol. Trained residents had significantly higher scores in 8 of 12 critical delivery components (P < .05). Overall performance of the delivery and safety in performing the delivery also improved significantly (P = .001 for both). CONCLUSION: Simulation training improved resident performance in the management of a simulated vaginal breech delivery. Performance of a term breech vaginal delivery is well suited for simulation training, because it is uncommon and inevitable, and improper technique may result in significant injury. LEVEL OF EVIDENCE: II-2.     

Simulation for Training and Assessment in Hysteroscopy: A Systematic Review

Hysteroscopy simulation complements conventional training on patients, yet evidence-based recommendations about its implementation and use are lacking. This systematic review analyzes and critically discusses hysteroscopy simulation literature published over the last 30 years. Systematic searches on PubMed, Embase, PsychINFO, ERIC, and the Cochrane Library produced 27 original articles published through 2017. Strategies based on different simulation models (e.g., animal organs, vegetables, synthetic uteri, virtual reality) were evaluated by users and appeared to facilitate learning. Observational studies have suggested a large impact on the knowledge and technical skills of novices for a wide range of hysteroscopic procedures, including for diagnosis, resection, and sterilization. Pretest/posttest studies show large improvements in performance time (6 studies; pooled effect size, 1.45; 95% confidence interval, 1.06–1.85) and overall performance scores (4 studies; pooled effect size, 3.19; 95% confidence interval, 1.45–4.94). Additionally, performance assessment on simulated models distinguishes novices from experts. Caution should be exercised because the available evidence largely originates from heterogeneous studies with weak designs, conducted in experimental settings with nonclinical participants (i.e., medical students). Moreover, neither clinical outcomes nor the clinical value of simulation-based assessment has been addressed. Hysteroscopy simulation may be supported ethically and pedagogically, but its role should be evaluated in pragmatic contexts, with robust interventional studies and broader competence-defining outcomes that include nontechnical skills.