上海市住院医师规范化培训成效评估——在培医师角度

目的 :从仍在接受住院医师规范化培训的医师(以下简称"在培医师")角度评价上海市住院医师规范化培训(以下简称"规培")政策的成效,为政策的进一步推广提供依据与建议。方法 :2014—2016年每年6月对2013级在培医师进行问卷调查。结果 :在培医师对规培项目的认知程度有明显改善,对规培项目的满意度也呈现逐年提高的趋势。在培医师对自我能力的提升有较高认可度,其中临床技能的自评分增长最为显著,理论知识方面的自评分相对较低。结论 :上海规培项目通过制度化管理,改善在培医师的规培环境和生活条件,通过不断完善顶层设计,提高师资力量,有效地提升了在培医师的临床技能,并最终获得各方认可,目前上海规培项目成效已逐步呈现。在后续工作中仍需加强对在培学员工作待遇的改善,提高规培学员的科研学习能力,通过有效的政策解读,吸引医学生投入到规培学习中。     

上海市住院医师规范化培训成效评估:用人单位角度

目的 :了解上海市各医疗机构作为用人单位对于其所招收的2010级规范化培训住院医师的职业能力评价情况,对上海市住院医师规范化培训(以下简称"规培")政策进行阶段性评估,为改进下一步工作提供实证依据和政策建议。方法 :对上海市所有录用2010级规培住院医师的179家医疗机构进行用人单位问卷调查。结果:用人单位对规陪住院医师的职业能力评估总体平均分为8.12分(满分为10分)。不同级别医院对于就业住院医师职业能力的评估均数的差异有统计学意义。结论 :用人单位对就业医师的职业能力的总体认可程度较高,但二级医院和社区卫生服务中心对于规培住院医师职业能力的满意度仍有待加强。     

政策法规带教应常态化、规范化

根据最近发布的《住院医师规范化培训管理办法（试行）》（以下简称《办法》）,住院医师规范化培训（以下简称规培）目的是为各级医疗机构培养能独立、规范地承担本专业常见多发疾病诊疗工作的临床医师。     

期待规培管理制度进一步健全

正回应《培训规范化的住院医=?》(2014年第3期封面文章)建立住院医师规范化培训制度是加强临床医师队伍建设的一项重大系统工程。笔者认为,除了做好国家层面的顶层设计,加强统一组织领导和确保培训资金投入外,还需要建立健全住院医师规培工作的管理制度,加强宏观指导力度,完善培训者的人事政策保障等,以有利于实现我国医师培养的标准化、规范化和同质化。譬如在住院医师规     

刘清泉 探索中医住培特色模式

住院医师规范化培训(以下简称住培)是医学生毕业后教育的重要组成部分,对于培养高水平临床医师,提高医疗质量极为重要。1989年,北京中医医院开始实践住培工作,2012年成为北京市中医管理局认定的中医(中医全科)住培基地,2014年成为国家中医药管理局认定的中医(中医全科)住培基地。从2013年开始,在住培医师出站考核中,北京中医医院连续5年通过率在北京市位列前茅, 在2017年中医住培基地评估中,北京中医医院位列北京市第一,全国前三。     

住培学员对专科医师规范化培训的认知调查

目的了解住院医师规范化培训(规培)学员(住培学员)对专科医师规培相关政策的知晓度和认可度,并探讨相关影响因素,为该政策的顺利推行提供科学依据。方法选择南充市开展住院医师规培和专科医师规培的三甲医院为调查点,随机选取266名住培学员为调查对象,采用自制问卷进行问卷调查。结果不同规培状态住陪学员(社会人、单位人、专业型硕士)对专科医师规培相关政策的态度不同(P0.05),其中社会人、单位人及专业型硕士中认为专科医师规培"有必要"的人数比例分别为72.8%,60.7%及92.1%。83.5%的住培学员认为专科医师规培能有效提高临床医师技能,82.0%的住培学员认为专科医师规培能有效提高医疗质量,65.0%的住培学员认为专科医师规培可以促进个人职业发展。不同规培状态住培学员的家人对专科医师规培的态度不同(P0.05);仅有33.8%的住培学员家人支持专科医师规培。此外,71.9%的社会人、83.2%的单位人及81.6%的专业型硕士认为规培补贴不能满足日常花销。针对专科医师规培存在的问题,59.8%的住培学员认为培训质量不高,73.3%的住培学员认为国家经费投入不足,56.8%的住培学员认为专科医师规培缺乏科学化、规范化的考核方式。结论住培学员及其家人对专科医师规培的知晓度及支持率并不高,因此,有关部门需加强宣传教育,完善配套措施,以保障专科医师规培相关政策的顺利实施。     

借鉴示范基地医院成功管理经验推动住院医师规范化培训管理全面提高

2015年湖北省卫生计生委对省内43家住院医师规范化培训(以下简称"规培")基地医院进行了全面督查评估,以此为依据,评选了首批8个全省住院医师规培示范基地。笔者通过总结这8家规培基地医院成功的管理经验,旨在发挥示范性基地的引领作用,促进湖北省规培工作全面发展。     

中医住院医师规范化培训的人文教育路径探索

<正>住院医师规范化培训是医学生向临床医师“角色转换”的重要桥梁。2013年，北京市启动新模式的中医住院医师（全科医师）规范化培训（以下简称住培），中医住培基地严格按照国家政策文件要求，积极推进基地建设，包括加强制度落地实施、规范过程管理、建设功能完善的临床技能培训中心、开展规范化技能培训、推动师资队伍建设等。     

重庆多措并举建设住培师资培训体系

2017年,重庆市住院医师规范化培训(以下简称住培)师资培训工作从阶梯式培训体系迈入新台阶,形成集基地、师资、学员多元化需求分析、培训课程设置、质量评价、课件制作、学分管理、讲授支持以及效果跟踪为一体的完整的培训体系,多方面实现对接和联动,为各个基地培养和输送高素质的住培师资队伍.在重庆市卫生计生委的领导下,重庆市住院医师、护士规范化培训事务管理办公室(以下简称规培办)以师资培训为主线,推开协同基地师资对接帮扶工作,开展了一系列探索与实践.     

上海住院医师规范化培训实践探索

2010年起,上海市经过顶层设计、探索创新,在全市层面统一实施与国际接轨的住院医师规范化培训(以下简称住培)制度,明确把住培合格证书作为全市各级医疗机构临床岗位聘任和晋升临床专业技术职称的必备条件之一.在国家卫生计生委的大力支持指导和上海市政府的高度重视下,通过建立完善的培训制度体系,上海市住培工作已稳步迈入第七年.     

我国农村订单定向医学生免费培养计划的政策分析

本文对我国16个省2016年农村订单定向医学生免费培养计划政策文件内容进行分析,发现我国定向医学生招收人数主要由国家确定并下达给各省,招收学生以农村生源为主,招生类别主要为本科生,招生专业为临床医学和中医学。该项政策目前存在定向医学生招收人数与基层医疗卫生机构对人才的实际需求数脱钩、定向医学生培养周期过长、培养模式缺乏针对性、与乡镇卫生院的合同签署工作难以完成等问题,建议应按照基层医疗卫生机构对卫生技术人才的需求确定定向医学生招收人数、创新设立三年制学士学位以缩短培养周期、创新定向医学生培养模式、采取多种措施进一步吸引和留住农村卫生人才等。     

The role of education in biostatistical consulting

Medical students, residents, postdoctoral fellows, and faculty commonly consult with biostatistical experts about study design and data analysis when conducting clinical research. The role of biostatistical training during these consultations is examined, and characterizations of the connections between biostatistical consultation and education are reviewed. The presence and kinds of teaching efforts during biostatistical consults at four academic research institutions over various periods of time between 1999 and 2005 (237 consultations in total) were recorded and are described. By site, 67, 70, 78, and 100 per cent of the consulting sessions included biostatistical training, with an overall 78 per cent (95 per cent CI: 73-83 per cent) of consultations including an educational component when all consultations were combined. Training covered a wide range of biostatistical topics. Seventy-five per cent of the consultations with faculty (120/161), 79 per cent with fellows and residents (31/39), and 100 per cent with medical students (10/10) included some degree of instruction in study design or statistical analysis topics. Results show that both the need and the opportunity exist for specialized biostatistical instruction during one-on-one sessions between a consulting biostatistician and physicians, medical students, and research staff. Academic researchers are ideally positioned to absorb this kind of training when they initiate a request for assistance with their own research project.     

The AMA Residency Training in Adolescent Preventive Services Project: report of the working group. The American Medical Association.

PURPOSE: To improve resident education in provision of adolescent preventive health care. The American Medical Association (AMA) Residency Training in Adolescent Preventive Services Project Working Group convened to identify specific goals and objectives (G&Os) for pediatric and family medicine resident education in adolescent clinical preventive services and recommend strategies to achieve these G&Os. METHODS: Iterative review process involving members of the working group, nine experienced teaching faculty and 16 resident physicians from family medicine and pediatric training programs, and an advisory board. RESULTS: We achieved consensus on appropriate G&Os for pediatric and family medicine residency education in adolescent clinical preventive services. Faculty and residents expressed concerns about achieving G&Os because of challenges to implementing effective training and evaluation strategies. Suggestions for achieving G&Os included development of an adolescent clinical preventive services curriculum and evaluation program that could be adapted for use in a variety of training program structures. Faculty and residents anticipated the success of a training curriculum would be influenced by: (a) availability of adequate numbers of skilled teaching faculty; (b) availability of time and support for faculty development and teaching efforts; and (c) exposure of residents to adequate numbers of adolescent patients in settings where there are clear expectations for delivery of comprehensive preventive services. CONCLUSIONS: The AMA Residency Training in Adolescent Preventive Services Project Working Group presents G&Os for organizing training experiences in adolescent clinical preventive services in family medicine and pediatric residency training programs and recommends strategies to achieve these G&Os.     

山西省住院医师规范化培训现况调查-以太原市规范化培训基地为例

目的了解山西省住院医师规范化培训(规培)的现况,为进一步提高规培效果提供借鉴。方法随机选取2016年10月—2017年2月在太原市规培基地进行规培的320人进行问卷调查,了解临床实践能力的提升情况和对规培的满意度情况。结果本单位规培学员的临床实践能力提升效果明显好于外单位规培学员;规培学员对规培满意度得分为(2.543±0.461)分,其中,对薪酬待遇的满意度最低(2.132±0.307)分;高年龄、未婚、高学历和外单位人员对规培的满意度普遍低于低年龄、已婚、低学历和本单位人员。结论应该为外单位规培人员制定合理的培训计划提高培训效果,提高整体规培学员的薪酬和待遇,解决其后顾之忧。     

A Comparison of Surgery and Family Medicine Residents' Perceptions of Cross-Cultural Care Training of Cross-Cultural Care Training

The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt''s Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents'' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups'' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and/or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents'' training in cultural humility — more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area.     

城乡基层医疗卫生机构基本公共卫生服务居民满意度研究:以湖北省为例

目的:分析湖北省城乡居民对基本公共卫生服务的满意度及影响因素,为改善我国基本公共卫生服务质量提供政策依据。方法:根据经济发展情况选取湖北省武汉、黄冈、荆州地区共12家基层医疗卫生机构,对就诊居民进行满意度问卷调查,测量居民对基本公共卫生服务的可及性、舒适性、安全性和有效性的满意状况。结果:城乡居民对基本公共卫生服务的满意度得分为71.62分,总满意率为73.44%。城乡居民对基本公共卫生服务具体指标满意度最高的为就诊方便性(83.03%)和隐私保护(80.25%),满意度最低的指标为医疗技术(61.61%)和设备设施(64.53%)。Logistic回归分析结果显示,基本公共卫生服务的可及性、舒适性、安全性对社区居民满意度影响较大,性别及年医疗支出对居民满意度也有一定的影响。结论:城乡居民对基本公共卫生服务总体满意度处于一般水平,有待提升;城市平均满意度高于农村,农村地区存在较大的提升空间;基本公共卫生服务应进一步强化质量建设,促进城乡基本公共卫生服务均等化发展。     

我国省级疾病预防控制专业技术人员对公共卫生医师规范化培训的态度和认知分析

目的 了解我国省级疾病预防控制专业技术人员对公共卫生医师规范化培训（公卫医师规培）的态度及认知状况,为推动我国公卫医师规培模式的探索和实施提供依据。方法 整群抽样选择江苏省和广东省、山西省和湖北省、四川省和新疆维吾尔自治区的省级CDC专业技术人员作为研究对象共2 193名,调查样本量估计为1 933人。结果 调查对象1 716名省级CDC专业技术人员中,公卫医师规培的总支持率为70.7%（1 213/1 716）;875名公共卫生与预防医学专业的调查对象中,硕士研究生及以上学历组对公卫医师规培的支持率为61.6%（318/516）,低于本科学历组的73.1%（225/308）和大专及以下学历组的86.3%（44/51）。公卫医师规培年限认知为2年的占14.9%（232/1 555）;规培主要方式认知为现场实习的占60.4%（933/1 544）;在培训主要内容上选择“流行病学调查和公共卫生实践”的为86.6%（1 355/1 564）,选择“基础理论与方法”的为76.7%（1 199/1 564）。结论 省级CDC专业技术人员对开展公卫医师规培的积极性相对不高,尚未形成共识;对培训时限、主要形式和内容的认知程度不足。省级CDC专业技术人员尤其是高学历者是试点期间加强宣传动员的重点群体。建议全国CDC系统推行公卫医师规培,以实践效果促进全行业形成共识,加快论证和出台公共卫生人才毕业后的教育制度。     

Medical School Hotline: A History of the University of Hawai‘i Postgraduate Medical Education Program at Okinawa Chubu Hospital, 1966–2012

The University of Hawai‘i (UH) has been collaborating with Okinawa Prefectural Chubu Hospital for over 46 years. This collaboration started as a post-World War II effort to increase the physician workforce. At the initiation of the US Army and State Department, the University of Hawai‘i was recruited, in cooperation with the government of the Ryukyus and USCAR, to initiate a US style postgraduate clinical training program. The Postgraduate Medical Training Program of University of Hawai‘i at Okinawa Chubu Hospital introduced a style of training similar to that in the US by offering a rotating internship. The initial contract had UH establish and run the Postgraduate Medical Training Program of University of Hawaii at Okinawa Central Hospital. After Okinawa''s reversion to Japan, under a new contract, UH physicians participated as consultants by providing lectures at “grand rounds” and guidance to faculty, staff, and students. To date, 895 physicians have completed the University of Hawai‘i Postgraduate Medical Training Program with 74 currently training. Approximately 662 (74%) of the trainees have remained in Okinawa Prefecture to practice medicine. As a result, the program has enhanced the physician workforce for the islands of Okinawa and neighbor archipelagos of Miyako and Yaeyama Islands.     

2016-2017年西藏拉萨市医疗机构医用辐射防护调查分析

目的 为了解西藏自治区拉萨市医用辐射防护现状。方法 按照《医疗卫生机构医用辐射防护监测工作方案》要求,选取拉萨市部分医疗机构,对放射工作场所的放射防护及设备性能进行检测,并对结果进行统计分析。结果 两年共计监测24家医疗机构,68台设备和64个工作场所,合格率分别为75.00%和92.19%。其中2016年共监测5家医疗机构,共计22台放射治疗设备和20个放射工作场所,合格率分别为59.09%和75.0%。2017年共监测19家医疗机构,共计46台放射治疗设备和44个放射工作场所,合格率分别为82.61%和100.0%。结论 西藏医疗机构放射诊疗设备性能及工作场所监测率较低,监测合格率不高,有关方面应引起重视,加强相关工作。     

Experiences with a combined residency in internal and preventive medicine

BACKGROUND: The importance of integrating preventive medicine training into other residency programs was reinforced recently by the residency review committee for preventive medicine. Griffin Hospital in Derby CT has offered a 4-year integrated internal medicine and preventive medicine residency program since 1997. This article reports the outcomes of that program. METHODS: Data were collected from surveys of program graduates and the American Boards of Internal and Preventive Medicine in 2005-2007, and analyzed in 2007-2008. Graduates rated the program in regard to job preparation, the ease of transition to employment, the value of skills learned, the perceived quality of board preparation, and the quality of the program overall. Graduates rated themselves on core competencies set by the Accreditation Committee for Graduate Medical Education. RESULTS: Since 1997, the program has enrolled 22 residents. Residents and graduates contribute significantly toward quality of care at the hospital. Graduates take and pass at high rates the boards for both for internal and preventive medicine: 100% took internal medicine boards, 90% of them passed; 63% took preventive medicine boards, 100% of them passed). The program has recruited residents mainly through the match. Graduates rated most elements of the program highly. They felt well-prepared for their postgraduation jobs; most respondents reported routinely using preventive medicine skills learned during residency. Graduates either have gone into academic medicine (31%); public health (14%); clinical fellowships (18%); or primary care (9%); or they combine elements of clinical medicine and public health (28%). CONCLUSIONS: Integrating preventive medicine training into clinical residency programs may be an efficient, viable, and cost-effective way of creating more medical specialists with population-medicine skills.