八年制医学生物理医学与康复医学方向医工交叉课程改革效果

目的 观察物理医学与康复医学方向医工交叉课程改革对八年制医学生的学习效果。方法 选择2018年至2019年清华大学学习物理医学与康复医学课程的八年制医学实验班的医学生为研究对象,2018年入对照组(n = 20),2019年入观察组(n = 18)。对照组采用常规课程和康复医学专业教师,观察组课程增加神经科学理论和新进展、功能磁共振发展和康复医学领域应用、医学工程新技术和进展,并增加清华大学电子工程系、机械工程系和医学院教师。两组考核均分为理论考核、操作考核和平时考核,观察组在平时考核中增加综述成绩。另设计调查问卷,在观察组开课前和考核后进行调查。结果 观察组理论考核、平时考核和总成绩均明显高于对照组(t > 2.694, P < 0.01),两组操作考核成绩无显著性差异( P > 0.05)。观察组对物理医学与康复医学课程的了解程度、对医工交叉/医工转化进展了解程度及设置医工转化课程必要性的评分在课程结束后增加(| Z| > 2.304, P< 0.05)。对康复医学医工交叉和医工转化研究比较感兴趣和非常感兴趣的学生比例从77.78%增加到94.44% (P= 0.222),表示比较可能和非常可能从事康复医学领域医工交叉和医工转化学生比例从61.11%增加到83.33% (P= 0.043)。结论 物理医学与康复医学方向医工交叉课程改革能一定程度提高八年制医学生对物理医学与康复医学的学习兴趣,并提高学习成绩。     

Understanding Clerkship Student Roles in the Context of 21st-Century Healthcare Systems and Curricular Reform

ABSTRACT

Phenomenon: Preclerkship medical education has undergone extensive reform, and the clerkship years are growing targets for curricular innovation. As institutions implement new preclerkship curricula to better prepare medical students to practice medicine in the context of modern healthcare systems, the perspective of clerkship leaders regarding clerkship student roles and potential for change will facilitate redefining these roles so that preclerkship educational innovations can continue into clerkships. Approach: In this qualitative exploratory study, authors conducted semistructured interviews with clerkship and site directors for eight core clerkships from April to May 2016. Questions addressed how clerkship leaders perceive current student roles and the potential for change. Through iterative consensus building, authors identified themes describing current ideal clerkship student roles applicable to future roles. Findings: Twenty-three of 24 (96%) directors participated. Findings fell into four themes: factors influencing the clerkship role, clerkship student role archetypes, workplace authenticity and value, and potential for change. Student, supervisor, and context factors determine the clerkship student role. Three role archetypes emerged: the apprentice (an assistant completing concrete patient care tasks), the academic (a researcher bringing literature back to the team), and the communicator (an interdisciplinary and patient liaison). Each archetype was considered authentic and valuable. Positive attitudes toward preclerkship curricular changes were associated with openness to evolution of the clerkship students' role. These emerging roles mapped to the archetypes. Insights: Clerkship leaders perceive that student, supervisor, and context factors result in varying emphasis on role archetypes, which in turn lead to different types of learning. Medical educators can use the archetypes to articulate how expanded student roles align learning with clinical needs, particularly as they relate to health systems science and inquiry.     

Expanding Clinical Models of Nurse Practitioner Education: Service Learning as a Curricular Strategy

A context-relevant curriculum is responsive to educational and societal demands. Nurse practitioner (NP) faculty members are challenged to prepare practitioners to provide high-quality compassionate care to diverse populations. Changes in the health care environment, a limited number of clinical sites and preceptors, and competition for access to clinical sites necessitate creative solutions and curriculum development. Service learning, as a curricular strategy, facilitated NP students to achieve academic course goals, appreciate the NP role working with underserved populations, and translate classroom knowledge to the clinical environment.     

Integration of Ultrasound in Undergraduate Medical Education at the California Medical Schools

Since the first medical student ultrasound electives became available more than a decade ago, ultrasound in undergraduate medical education has gained increasing popularity. More than a dozen medical schools have fully integrated ultrasound education in their curricula, with several dozen more institutions planning to follow suit. Starting in June 2012, a working group of emergency ultrasound faculty at the California medical schools began to meet to discuss barriers as well as innovative approaches to implementing ultrasound education in undergraduate medical education. It became clear that an ongoing collaborative could be formed to discuss barriers, exchange ideas, and lend support for this initiative. The group, termed Ultrasound in Medical Education, California (UMeCali), was formed with 2 main goals: to exchange ideas and resources in facilitating ultrasound education and to develop a white paper to discuss our experiences. Five common themes integral to successful ultrasound education in undergraduate medical education are discussed in this article: (1) initiating an ultrasound education program; (2) the role of medical student involvement; (3) integration of ultrasound in the preclinical years; (4) developing longitudinal ultrasound education; and (5) addressing competency.     

Pain Education in North American Medical Schools

Knowledgeable and compassionate care regarding pain is a core responsibility of health professionals associated with better medical outcomes, improved quality of life, and lower healthcare costs. Education is an essential part of training healthcare providers to deliver conscientious pain care but little is known about whether medical school curricula meet educational needs. Using a novel systematic approach to assess educational content, we examined the curricula of Liaison Committee on Medical Education-accredited medical schools between August 2009 and February 2010. Our intent was to establish important benchmark values regarding pain education of future physicians during primary professional training. External validation was performed. Inclusion criteria required evidence of substantive participation in the curriculum management database of the Association of American Medical Colleges. A total of 117 U.S. and Canadian medical schools were included in the study. Approximately 80% of U.S. medical schools require 1 or more pain sessions. Among Canadian medical schools, 92% require pain sessions. Pain sessions are typically presented as part of general required courses. Median hours of instruction on pain topics for Canadian schools was twice the U.S. median. Many topics included in the International Association for the Study of Pain core curriculum received little or no coverage. There were no correlations between the types of pain education offered and school characteristics (eg, private versus public). We conclude that pain education for North American medical students is limited, variable, and often fragmentary. There is a need for innovative approaches and better integration of pain topics into medical school curricula.

Perspective

This study assessed the scope and scale of pain education programs in U.S. and Canadian medical schools. Significant gaps between recommended pain curricula and documented educational content were identified. In short, pain education was limited and fragmentary. Innovative and integrated pain education in primary medical education is needed.     

临床医学生对循证医学课程认知和态度分析

目的 对首都医科大学临床医学生学习循证医学课程的效果进行调查和评估,进而提出教学建议.方法 采用事先设计的调查问卷对该校2006级临床5年制和7年制医学生开设循证医学课程前、后在文献检索利用、循证医学常用术语掌握、学科认知态度方面进行调查,并辅以访谈法收集学生的意见进行统计分析.结果 开设循证医学课程后,医学生的文献平均阅读时间和文献检索次数较开设前明显增加(P＜0.05);循证医学实践涉及的术语理解程度在课程后也明显提高(P＜0.05);学生文献严格评价能力在5年制学生中也有明显提高(P＜0.05).在访谈中,学生建议增加文献检索和筛选文献课时,并对医学统计学内容进行复习.结论 循证医学课程的学习对学生认知和行为均有较大改变,结合案例教学法进行循证医学课程讲授具有较好的教学效果,循证医学理念和技能的学习对于临床医学生应用医学研究证据、自我学习和临床中付诸实践均有较大意义.     

11种地方性中医药期刊1995～2000年临床研究文献质量的初步分析

目的对11种地方性中医药期刊1995～2000年中所发表的临床研究类文献进行分析,以了解中医药临床研究的现状和存在的问题.方法对1995～2000年发表在<湖南中医杂志>等11种地方性中医药期刊(共66卷、390期)上的全部文章,采用手工逐期逐页鉴定,筛选出临床研究类文献,而后对其试验设计、随机方法、盲法、组间可比性描述、纳入排除标准、诊断标准、疗效判定指标明确与否,以及样本含量、统计方法、主要结果与不良结果的描述、随访和结论推荐与否等进行分析.结果该11种期刊6年间共发表了22 739篇临床研究,其中随机对照试验(RCT)1 416篇(双盲24篇,占RCT总数1.69%),占论文总数6.23%;非随机的对照试验(CCT)141篇,占论文总数0.62%;RCT数量呈逐年上升趋势,并以消化系统疾病研究最多.在1 416篇RCT中,对随机方法进行了描述的有38篇,占2.68%;1 220篇有明确疗效判定指标,占86.16%;1 203篇有统计学方法描述,占84.96%;设有可比性对照研究的共934篇,占65.96%;描述了诊断标准的有828篇,占58.47%;197篇有纳入和排除标准,占RCT总数的13.91%,仅有89篇报告了不良反应,占RCT总数的6.29%.结论虽然6年来发表在该11种地方性中医药期刊发表的RCT数量呈逐年上升趋势,但其RCT的质量尚有待进一步提高.     

A Case–based Emergency Medicine Curriculum for Senior Medical Students

Objective: To determine the effects of a case–based, core content–oriented emergency medicine (EM) curriculum on the basic EM knowledge of senior medical students.
Methods: All senior medical students rotating through the Milwaukee County EM elective during the 1992–1993 academic year were assigned specific chapter readings from a case–oriented EM textbook. A course curriculum consisting of goals and objectives for each chapter and two to three representative cases for the discussion topic also was distributed to each student. Interspersed with the cases was a series of questions directed at pathophysiology, diagnosis, management, and disposition. The EM faculty and residents conducted case discussions three times per week. AH students completing the rotation were given a pretest at the beginning and a final examination at the end of the rotation. In addition, the students rated the textbook, coursebook, and lecture series at the end of the rotation using a five–point Likert scale.
Results: Seventy–five students rotated through the elective. The students showed a significant improvement in their EM knowledge base as judged by improvement in final examination scores compared with pretest scores (pretest score 62.2 ± 7.1%; final examination score 76.2 ± 6.3%; p < 0.0001). The mean change in scores was 14.8%, with a range of –1.6% to 34%. The students also rated the textbook, coursebook, and lecture series as effective, as shown by high median scores on a Likert scale.
Conclusions: A case–based EM curriculum coupled with ED clinical experience improves basic EM diagnostic and management knowledge of senior medical students.     

坚持改革创新，实现八年制医学教育新发展

2001年以来,为加快培养医学拔尖创新人才,我国在部分高校试点创办了八年制医学教育,经多年探索取得明显成效。本文在总结已有工作成绩的基础上,以北京协和医学院改革实践为例,对新发展阶段如何以更大力度改革创新、推动我国八年制医学教育加快发展进行了系统阐述,强调要聚焦培养定位的准确性、培养模式的先进性和培养体系的完整性等方面取得更大进展,形成具有中国特色的高水平八年制医学教育制度,在医学拔尖创新人才培养方面发挥更大的作用。     

高职康复治疗技术专业医学基础课程改革的探讨与研究

通过问卷、座谈及专家访谈等方式听取校内专业课教师、临床专家及毕业生对基础课程设置、教学内容及教学方法等方面的意见和建议,并在此基础上对本校康复专业医学基础课进行改革,旨在让学生通过三年的学习达到高职毕业生岗位技能要求,具备扎实的基础理论知识及职业可持续发展能力。     

北京协和医院复合型医学精英人才培养体系的探索与实践

随着我国社会经济水平的显著提高,人民群众对高质量医疗服务的需求快速增长,亟需更多基础扎实、技术精良、综合素质高的临床医师。北京协和医院不断传承创新优秀医学人才的培养模式,根据前期经验、文献检索分析及调研结果,自2016年起探索实施临床医学博士后培养项目,这是我国毕业后医学教育改革的创新模式之一,旨在高效、持续强化学员的临床、科研与教学能力,通过优化课程体系、创新培养模式、打造师资团队,构建有效的评价与考核体系,为培养高层次、复合型医学精英人才提供新的思路与经验,为国家医疗卫生人才发展提供重要的后备力量,为健康中国战略目标保驾护航。     

我是协和人--65年践行转化医学的轨迹

曹兴午教授就转化医学国内外概况进行简介,结合20世纪40年代北京协和医学院细菌学系和寄生虫系始建“实验室与临床密切联系”的模式,通过65年细菌学、寄生虫学和男科学的检验与临床事例与践行,诠释这一模式在实验室与临床实践中的相关性、可行性,在观念、模式、方法、思路、宏观及微观创新的实践中,介绍了以病人为中心,从检验到病房的密切配合取得的成绩。抛砖引玉,启迪后人,开拓进取,创新未来。
　　展望未来,对人才培养检验医师和转化医学---实验室到病房模式的普及与应用,提出建议,进一步促进医学检验学与男科事业的发展。     

非洲康复医学发展与中国援非医疗队

非洲约有1.33 亿残疾人,多由感染性疾病、战争创伤事故、单器官功能障碍、屈光不正等引起。非洲的医学康复与社区康复只能满足其康复需求的5%~55%,基础设施薄弱、贫穷及资金匮乏、工作不落实、人文环境单调等是制约康复医学发展的因素。中国康复医学模式适合非洲,医疗队在接诊康复患者、改善硬件条件、培训专业人员、开展新技术、制定新流程及扩大康复医学的影响上可以做很多工作。     

Derivation and Validation of a Methodology for Tracking Academic Stature of Medical Schools

Objective: To derive and validate a methodology for academic ranking of allopathic medical schools in order to track the development of emergency medicine (EM) at academic medical centers.
Methods: A methodology for institutional ranking according to NIH research grant funding was derived by using a well-known multiaxial ordinal ranking of all Liaison Committee on Medical Education (LCME)-accredited allopathic schools in 1990–91 as the criterion standard. This methodology was validated against the same annually updated criterion standard in 1995–96. Both ranking schemes were first stratified by quartile, then aggregated pairwise by contiguous quartiles to develop a 3 × 3 concordance matrix.
Results: Ranking by NIH grant funding produced concordance between all 126 schools in the derivation set and 123/124 schools in the validation set.
Conclusion: NIH research grant funding may be used as a valid methodology for broad categorization of allopathic medical school academic rank. This strategy should therefore serve as a suitable means of following the development of academic EM over time.
This project was supported by a grant from SAEM.     

加强医学生康复医学观念的几个问题

为加强医学生的康复医学观念，改善康复医学教育现状，提高康复医学教学效果，作者总结了多年的康复医学教学经验，提出了关于康复医学教育的几点思考。