神经内科住院医师病历书写规范化培训探索

病历书写是住院医师规范化培训的基础.掌握神经内科疾病的病历书写和诊疗思路是住院医师必经的临床训练.结合首都医科大学宣武医院神经内科对住院医师培训的实践和经验,我们认为病历书写从基础到专病,从集中到个体化循序渐进的培训和考核、监控方法,有助于神经内科医师临床思维能力培养和临床水平的提高.     

神经内科住院医师规范化培训存在的问题与教学 改进

住院医师是医院人才梯队建设的基础,合理地安排培训工作,提高青年医师综合素质,对 培养高层次医学人才至关重要。宣武医院作为北京市首批神经内科住院医师规范化培训基地,近5年已 为社会培育出120名住院医师,取得北京市住院医师规范化培训合格证书。以宣武医院神经内科近5年 培训实践为例,探讨神经内科规范化培训的现状和管理实践,为持续改进培训工作提供参考。     

神经内科住院医师规范化培训探索

住院医师是医生职业生涯中的最初阶段,接受规范化培训非常重要.结合我院神经内科对住院医师培训的实践和经验,我们认为通过职业道德、医患沟通能力,临床技能及团队协作能力等方面的培训,可以提高神经内科住院医师的综合素质,使其适应目前复杂的医疗环境.     

神经内科住院医师规范化培训“单位人”和“行业 内社会人”的临床教学实践

“单位人”和“行业内社会人”是住院医师规范化培训中不容忽视的两类人群，现从首都 医科大学宣武医院神经内科住院医师培训基地的教学实践出发，从临床基本功训练、多模式教学、绩效 考核、建立导师制等方面，探讨对上述两类人群如何进行针对性的教学培训。     

关于中美两国神经内科住院医师培训的一点思考

2011年笔者有幸获得北京市李桓英医学基金资助,到美国Baylor医学院神经内科和全美最大的私立医院Methodist医院的神经内科参观学习。期间主要在神经内科病房和运动障碍门诊学习,因此,有机会了解两院神经内科住院医师的培训情况,并对中美两国住院医师培训进行了一点比较和思考。     

麻省总医院神经内科医师培训启示

美国住院医师制度相对成熟,我国虽然起步较晚,但也在不断完善。本文结合自身经历,分析美国神经内科住院医师培训的特点,旨在取长补短,为我国的医师培训提供参考。     

多种教学方法在神经内科住院医师规范化培训中的应用

    针对神经内科住院医师规范化培训过程中存在的神经系统查体不规范,诊断方法认识不足、临床技能培训不够、带教科室管理和培训不得法,提出完善培训制度、改进培训方法等方面的对策,介绍多种教学方法,以便带教老师在有限时间内,高质量完成神经内科规范化培训目标。     

新型冠状病毒肺炎疫情期间脑血管病住院医师网络教学效果评价与分析

目的 本研究对疫情期间通过网络教学实施的新型冠状病毒相关内容培训进行效果评价,并对网 络教学实践过程进行总结分析,为脑血管病住院医师规范化培训网络教学的开展及教学质量提高 提供参考。 方法 组织2017-2019级脑血管病住院医师进行新型冠状病毒相关内容网络教学培训,培训内容 包括操作规范、病毒知识与防控要点、诊断与治疗、诊疗流程等。采用自身对照研究的方法,通过对 比住院医师培训前后两次考核成绩对实施的网络教学进行效果评价。 结果 共189名脑血管病住院医师参加培训及考核。根据培训前后考试成绩的差异性分析结果,培 训后辅助检查、院感、诊断与治疗、防控、诊疗流程五项内容分数及总分均高于培训前（均P＜0.001）。 根据广义方程模型分析结果,校正学历和规培年限等因素后,培训后考试总分较培训前高9.14分 （95%CI 7.22～11.06,P＜0.001）。 结论 脑血管病住院医师网络教学培训效果较好,教学管理者需要充分发挥网络教学的优势,规 避劣势,将网络教学纳入脑血管病住院医师常态化教学活动。     

“慕课”式住院医师规范化培训对于医疗集团模式下神经内科教学的思考

随着医疗卫生体制改革的深化，医疗集团模式是近年来大型公立医院发展的一种重要模 式。“慕课”式培训可以有助于解决医疗集团模式下神经内科培训目前存在的诸多问题。“慕课”由具 有专业特长和带教经验丰富的医师精心准备并录制培训课程，再上传至网络平台，由住院医师根据 自身的时间和临床需求自行学习。“慕课”式培训集中了师资力量，具有形式更灵活、内容更丰富的特 点，是可供临床教学实践探索的方式。     

思维导图结合以问题为基础教学法在急诊神经内科住院医师卒中教学中的应用

将思维导图结合以问题为基础教学法（problem-based learning,PBL）应用于急诊神经内科 住院医师卒中培训的理论学习、急诊跟诊和全程诊治中,可以提高卒中诊疗的教学效果。思维导图结 合PBL的教学法有利于激发住院医师学习的主动性,提高学习效率,提升教学效果,对综合性教学医 院急诊卒中诊疗的培训工作有促进作用。     

Employment-seeking experiences of residents in 1996: a window into the neurology marketplace

OBJECTIVE: To assess career choice and employment-seeking experience of senior neurology residents in 1996. METHODS: Graduating residents in adult and pediatric neurology (n = 573) were surveyed to obtain career plans, initial job selection, health care attitudes, and demographic information. Results were compared with 1996 data on all United States neurologists and data from an American Medical Association (AMA) resident survey regarding the employment status of new physicians. RESULTS: Survey response rate was 71%. There was a significant increase in international medical graduates and women entering neurology compared with the current workforce. Seventy-four percent of graduates planned to enter a fellowship position; 19%, private practice; 5%, an academic position; and 2%, a career outside of clinical medicine. Neurology residents differ from aggregate national data because only 28% of residents responding to an AMA survey across all specialties applied to fellowships in 1996. Overall, 44% of neurology graduates planned an academic career. CONCLUSIONS: Changing demographics and career choice of recent graduates may require continued monitoring and could be important in neurology workforce planning. The high rate of fellowship training and plans for academic careers in 1996 is of interest and may reflect both resident response to new demands in the changing health care market and a need to modify residency programs to enhance academic training and competitiveness of neurology graduates.     

The role of the Academia Brasileira de Neurologia in the teaching of neurology. A personal view]

The Brazilian Academy of Neurology (ABN) may play an important role for a better education of medical students and residents in neurology in Brazil. Its field of action ranges from suggesting a core curriculum in neurology to Medical Schools and Residency Programs to assess the quality of teaching they offer in order to guide students and graduates who apply for positions. In addition to that ABN may be itself a teaching institution offering educational activities in a Program of Continuing Medical Education with a well-designed system of credits. Courses on basic sciences, methods of diagnosis and therapeutic advances, symposia and workshops as well as a Programmed Teaching in Neurology suitable to residents and practitioners are to be included. A video collection and a bank of data on the current literature may widen the available set of services. The ABN Committee on Teaching is to play a central role defining policy, deciding on priorities, planning and establishing timing and placing of all educational activities. Of utmost importance is to define humanistic qualities desirable in the neurologist identifying qualities students and residents bring to the educational process and those acquired in the practice of neurology. The cognitive dimensions of moral and ethics can be taught and should be regularly included in the educational activities sponsored by the Academy.     

标准化病人在脑血管病住院医师规范化培训人文素养教学和考核中的应用

目的 探讨标准化病人在神经科住院医师规范化培训中人文素养教学和考核中的应用效果。      

Residency training: developing a program of quality and safety to train resident neurologists for the future

Attention to quality and safety metrics is increasingly important for all physicians in practice due to mandates by governmental organizations, insurers, the public, and accreditation bodies. Neurology resident trainees need to acquire these skills, but little research in and outside of neurology provides guidance as to how to teach these important concepts. In the setting of new requirements mandating that training programs address these topics, we propose a number of strategies that can be implemented immediately in neurology residency training programs and call for increased investigation and sharing of best practices in order to adequately prepare neurology residents for the current and future environment of practice.     

Debate: is the neurology residency program of Japan to be standardized?: "Yes"]

Japanese Neurological Association (JNA) should establish the standardized nationwide neurology residency program, and JNA should disclose the minimal requirements of both knowledge and practice for the board of neurology to the public and guarantee the quality of the neurology specialists. Standardization of the residency program will facilitate not only standardization of the knowledge, skill and art of the neurology specialists but also inter-institutional cooperation among the individual teaching hospitals in completing the training programs for the residents. Neurology professionals whose quality is guaranteed by JNA will satisfy the demands of the patients who want excellent neurological services of high quality and safety, and will be favorably accepted by high level hospitals which supply medical services of high quality. Nationwide standardized neurology residency program will thus be welcomed by both residents who aim for the board of neurology and teaching hospitals which accept the residents. It will facilitate to efficiently educate neurology residents for specialists, and will benefit the patients and hospitals. JNA should establish the standardized neurology residency program as soon as possible and go to action to socially and economically improve the condition and treatment of the specialists (for example; approval of doctor's fee by the government).     

The neurology resident as teacher: evaluating and improving our role

There is a need to improve the quality of teaching done by neurology residents because neurology residents are intimately involved in medical student education. This article reviews the available literature on techniques to improve the teaching ability of resident physicians. Eight randomized prospective studies were identified from health and education databases. The outcomes measured were student ratings of residents or objective ratings of interactions between residents and students. The skills curriculum provided a more robust response, and the objective standardized teaching examination (OSTE) provided a standardized outcome. There continues to be a need for studies specifically addressing the teaching by neurology residents and fellows.     

Postgraduate neurology training in new clinical training system]

Postgraduate neurology training in new clinical training system in Oita University Hospital was presented. Clinical intern training for first 2 years are performed according to programs proposed by Clinical Training Institute for Interns in Oita University Hospital. This program includes neurology for at least 1 month. Interns will get in clinical management for common and main neurological disorders such as convulsion, unconsciousness, stroke, Parkinson disease and intractable neurological disorders in addition to standard medical skills. Neurology resident training for specialist begins after clinical intern training and is performed in own program proposed by our department. However, the level of educational and training quality is not always high, because of the lack of teaching staff, and insufficient curriculums without rotation system to neuropathology and neuroradiology. To improve this educational program, we need to alter own well-established postgraduate educational programs. The quality of programs must to be approved by Japanese Society of Neurology.     

Program Director Survey: Attitudes Regarding Child Neurology Training and Testing

BackgroundAs a result of major clinical and scientific advances and changes in clinical practice, the role of adult neurology training for Child Neurology and Neurodevelopmental Disability (NDD) certification has become controversial. The most recently approved requirements for board eligibility for child neurology and neurodevelopmental disability residents still include 12 months in adult neurology rotations. The objective of this study was to assess United States child neurology and neurodevelopmental disability residency program directors' opinions regarding optimal residency training.MethodsThe authors developed an 18-item questionnaire and contacted all 80 child neurology and neurodevelopmental disability program directors via e-mail, using SurveyMonkey.ResultsA total of 44 program directors responded (55%), representing programs that train 78 categorical and 94 total resident positions, approximately 70% of those filled in the match. Respondents identified multiple areas where child neurology residents need more training, including genetics and neuromuscular disease. A substantial majority (73%) believed child neurology and neurodevelopmental disability residents need less than 12 adult neurology training months; however, most (75%) also believed adult hospital service and man-power needs (55%) and finances (34%) would pose barriers to reducing adult neurology. Most (70%) believed reductions in adult neurology training should be program flexible. A majority believed the written initial certification examination should be modified with more child neurology and fewer basic neuroscience questions. Nearly all (91%) felt the views of child neurology and neurodevelopmental disability program directors are under-represented within the Accreditation Council for Graduate Medical Education Residency Review Committee.ConclusionsThe requirement for 12 adult neurology months for Child Neurology and Neurodevelopmental Disability certification is not consistent with the views of the majority of program directors, who favor more training in subspecialized fields of child neurology.     

Evaluating a formal evidence-based clinical practice curriculum in a neurology residency program

BACKGROUND: Since 1998, the University of Western Ontario Evidence-Based Neurology Programme has been fostering life-long self-teaching, self-evaluation, and promoting improvement of the care of neurological patients by teaching neurology residents to practice Evidence-Based Clinical Practice (EBCP). DESIGN/METHODS: Using a questionnaire/survey we evaluated participation during EBCP sessions and the applicability of EBCP to current and future clinical practice. Also, using a rating scale we investigated how likely our residents' and graduates' clinical practice has been influenced by the EBCP knowledge; and, if they were teaching these concepts to residents or medical students. The questionnaire was sent to all neurology residents and neurologists that graduated after implementation of the programme. RESULTS: All residents (100%) returned the survey/questionnaire, indicating that they attended the sessions consistently. Even though all respondents believed that the EBCP concepts were useful during their training, the concepts were infrequently utilized because of time constraints. On a scale of 1 to 10, they rated the influence to include EBCP concepts in their daily clinical practice as high (average: 6.8, S.D. 1.5). They all had frequent contact with medical students and non-neurology residents, but did not teach EBCP concepts to them on a consistent basis, because of time limitations. 10 (77%) out of 13 graduates returned the survey/questionnaire. They also believed the EBCP concepts were useful, but only used them when time allowed. They also rated the influence to include EBCP concepts in their daily clinical practice as high (mean 8.5, S.D. 1.2). Most graduates had frequent contact with trainees, but did not teach EBCP concepts to them on a consistent basis because of time constraints. Finally, all expressed the need to continue having this formal curriculum during residency. CONCLUSION/RELEVANCE: Although EBCP incorporated into the curriculum of a neurology residency programme increased neurologists and neurology trainees' confidence in knowledge of existing evidence, and reinforced the EBCP principles, these concepts were not used in daily clinical practice and were not taught to more junior trainees due to time constraints.     

Training the next generation of child neurologists: a child health-based approach

In the United States, child neurologists continue to value close, historical ties to adult neurology. However, the mandatory year of adult training for American Board of Psychiatry and Neurology certification in "Neurology with Special Qualification in Child Neurology" deprives residents of educational opportunities that would yield greater benefit for children afflicted with neurologic diseases. The need for modernization has been recognized in a Professors of Child Neurology survey in which a majority of program directors favored reducing adult neurology training and changing the certification to "Child Neurology." This article reviews the rationale for an overdue transformation of Child Neurology training.