妇产科住院医师第一阶段临床技能考核分析

自2004年北京地区开始推行住院医师第一阶段临床技能考核工作以来,每年由北京市卫生局科教处委托北京医学教育协会布置考核工作,由临床技能考核中心承担具体考核工作.考核目的是科学有效地评价住院医师的临床能力.我院自2004年开始,承担北京地区妇产科住院医师第一阶段临床技能考核任务.现对2006年至2010年妇产科临床技能考核资料进行分析总结,以寻求科学合理的考试、考核方法,比较被北京市卫生局认可为合格或基本合格的妇产科普通专科培训基地(以下简称基地)和未被北京市卫生局认可为妇产科普通专科培训基地(以下简称非基地)培训住院医师考核结果的差异性,探讨研究生毕业的住院医师纳入培训年限等问题.     

妇产科住院医师第二阶段临床技能考核分析

目的 探讨妇产科住院医师第二阶段考核方式的合理性、科学性,比较二级与三级医院、基地与非基地、不同学位层次考核结果的差异性,为科学地进行住院医师培训提供了一定的依据.方法 对参加妇产科第二阶段临床技能考核的人员及考核结果进行分析及统计学处理.结果 从考核通过率、妇科肿瘤和产科病历分析及辅助检查单项成绩比较可以看出,硕士、博士高于学士,基地高于非基地,三级医院高于二级医院.结论 妇产科住院医师第二阶段技能考核基本覆盖北京地区的医院.普通妇科、妇科肿瘤、产科病历分析及辅助检查的考核方式有效,能够反映住院医师的临床能力水平,针对住院医师培训的薄弱环节,非基地住院医师应有选择地进入基地进行培训.     

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。     

住院医师体检技能缺陷分析

体检技能是住院医师最重要的专业技能和临床基本功之一，体检技能水平高低一定程度上反映了住院医师实际工作能力，成为医院考核住院医师“三基”水平的重要内容。近年来，国家、军队卫生行政部门相继制定了住院医师规范化培训方法，将体检技能培训纳入了继续医学教育轨道...     

我院住院医师规范化培训绩效与运行模式的探索

住院医师规范化培训方案内容：1994年我院建院后参照美国医学会(American Medical Association)1993～1994．年版毕业后医学教育名录，并结合中国国情制定出我院“住院医师规范化培训方案”。其方案有以下几点：(1)培训时间由国内“二三制”改革为“三三制”，即增加1年轮转时间，加强三基训练。(2)有系统地开展“各级医师临床技能训练要求”、     

住院医师体检技能缺陷分析与对策

体检技能是住院医师最重要的专业技能和临床基本功之一,体检技能水平的高低在一定程度上反映了住院医师的实际工作能力,成为医院考核住院医师“三基”水平的重要内容。近年来,国家、军队卫生行政部门相继制定了住院医师规范化培训方法,将体检技能培     

住院医师规范化培训将有“国标”

国家卫生和计划生育委员会网站发布《住院医师规范化培训标准（试行）》草案,向社会公开征求意见。《标准》提出,住院医师规范化培训是培养合格临床医师必经的毕业后医学教育阶段,为期3年的住院医师规范化培训以临床实践培训为重点,取得培训合格证书将逐步作为临床医师在医疗机构独立从事诊疗工作和进入专科医师培训以及中级职称晋升的必备条件。为尽快全面建立和实施住院医师规范化培训制度,进而为建立实施专科医师培训制度奠定基础,国家卫生计生委委托中国医师协会组织专家制定了《住院医师规范化培训标准（试行）》。该《标准》包括培训总则和内科、外科、妇产科、儿科等18个专科细则,其中《全科医生规范化培养标准（试行）》已于2012年7月印发实施。各专科细则根据本专科住院医师规范化要求,对本学科有关科室轮转时间的分配、应掌握的内容及程度、病例病种数量等具体内容作出明确规定,并妥善处理“宽基础”与“精专科”的关系,注重统筹做好本专科及相关专科知识技能的学习掌握。同时,各专科细则对参考书刊作了统一规定,均采用最新版本,有利于住院医师了解最新的知识进展。《标准》提出,在3年培训周期中,住院医师在省级及以上卫生计生行政部门认定的住院医师规范化培训基地选择相关专科进行培训,按照《标准》完成规定的专业理论学习和临床实践技能培训。通过培训能够掌握本学科常见病和多发病的诊断、处理;要掌握危重病症的识别与紧急处理等,在轮转每个必选科室时,必须手写完成2份反映疾病诊断治疗全过程的系统病历;要掌握心肺复苏技术、突发性疾病院前急救等临床医师实践技能。有关实施住院医师规范化培训工作所涉及的编制、人事、发展改革、财政及教育培训管理等相关配套政策,国家卫生计生委将会同国务院有关部门另行规定。     

硕士研究生住院医师规范化培训的实践与成效分析

目的实施硕士研究生住院医师规范化的临床培训,提高住院医师的业务素质与临床技能。力弦探讨硕士研究生住院医师临床培训的运行机制与模式,利用统计描述法对培训成效进行分析。结果2006-2008年度,203位硕士研究生住院医师的阶段培训考核合格率高于80％：品德素质、理论知识、技能操作、病历质量、临床教学与科研能力等指标均达到培训要求。结论明确硕士研究生住院医师规范化培训的目标,探讨适宜的培训运行机制与模式,对实现住院医师规范化培训有积极意义。     

妇产科住院医师规范化培训的做法

住院医师培训是医学教育中三个重要环节之一,是医学生毕业后专业知识和技能进一步深化定向的过程,是提高I临床医疗水平的关键.尤其是规范化住院医师培训,对培养21世纪高层次的医学人才,起着承前(医学生教育)启后(继续医学教育)的重要作用.近年来,全国各地均逐渐实施专科医师规范化培训计划[1].妇产科学是一门实践性很强的学科,从医科毕业生到成熟的妇产科医师,不但需阅读许多专业文献,更重要的是必须进行大量的临床操作实践和总结,并逐渐养成良好的职业习惯.我院作为北京市惟一一家妇产科三级甲等专科医院,同时作为妇产科专科医师的培训基地,在住院医师培训模式上进行了探索和实践.     

住院医师规范化培训基地建设及问题探讨

住院医师规范化培训是培养临实用医学人才、提高临床医疗工作水的重要措施之一,也是完善继续医学教育制度的重要组成部分[1-2].福建省1992年开展试点工作,2010年,全面展开住院医师规范化培训工作,目前在内科、外科、妇产科、儿科、急诊科等17个普通专科设置培训基地.我院于2010年组织申报,2011年通过了内科、外科、神经内科、麻醉科、医学影像科和病理科等6个培训基地,同年9月首批招收30名住院医师,正式开展住院医师规范化培训工作.     

A Pilot Structured Resident Orientation Curriculum Improves the Confidence of Incoming First-Year Obstetrics and Gynecology Residents

A prospective, observational study was performed to evaluate a pilot orientation curriculum which involved all 7 incoming obstetrics and gynecology residents in June 2012. The objective of this study was to assess how a structured orientation curriculum, which employs an evaluation of baseline competency, affects the confidence of incoming first-year obstetrics and gynecology residents. The curriculum included didactic lectures, online modules, simulation, and mock clinical scenarios. Pre- and post-course surveys were conducted online via SurveyMonkey™ and were sent to all incoming obstetrics and gynecology residents. All seven incoming obstetrics and gynecology residents completed the orientation curriculum which included evaluations at the end of the orientation to assess baseline competency prior to taking part in clinical care. Confidence levels improved in all 27 elements assessed. Statistically significant improvement in confidence levels occurred in cognitive skills such as obstetric emergency management (2.9 vs 3.9, P< .05) and technical skills such as knot tying (3.9 vs. 4.6, P< .05). Certain teaching skills also demonstrated statistically significant improvements. A structured orientation program which improves resident self-confidence levels and demonstrates baseline competencies in certain clinical areas can be valuable for many residency training programs.     

医学模拟教育结合PBL在八年制妇产科临床见习中的应用研究

目的了解医学模拟教育结合PBL在八年制妇产科临床见习中的教学效果。方法将27名学生分为两组,实验组临床见习采用医学模拟教育结合PBL的教学模式,对照组采用单纯临床见习带教模式,应用理论考试、临床技能操作考核、课后问卷调查方式来评估课堂教学效果。结果两组基本理论成绩差异无统计学意义,但临床病案分析、实践技能考核及总成绩实验组明显高于对照组;课后问卷调查教学效果满意率实验组高于对照组。结论医学模拟教育结合PBL在八年制妇产科临床见习中的应用,可以提高学生临床操作能力及临床思维能力,为培养高素质的医学人才打下坚实的基础。     

妇产科护理学临床教学方法初步探讨

现阶段,随着妇产科医疗技术的发展和进步,医学院对妇产科招生规模不断扩大,妇产科护理医疗事业取得先进发展。但是,在妇产科护理教学中存在临床教学资源不足、医患矛盾重重以及思想观念落后等教学问题,在很大程度上制约和限制了妇产科护理临床教学。妇产科作为医学中重要的门类,对女性身体健康发挥着重要影响作用,因此,提高妇产科护理临床教学质量具有重要意义。本文主要根据妇产科护理临床特点,来探讨多样化的教学方法,提高妇产科护理教学质量和教学效果。     

多模式教学方法用于妇产科临床带教中的意义分析

目的分析多模式教学方法应用于妇产科临床带教中的意义。方法选取该院2017年1-12月期间实习的50名实习生,随机分为两组,对照组25名实习生进行常规带教,实验组25名实习生进行多模式教学方法,比较两组带教效果。结果实验组理论与操作各项成绩、对带教满意度均优于对照组(P<0.05)。结论采用多模式教学方法进行妇产科临床带教可以灵活调整教学内容,同时提高实习生理论基础与操作技能的熟练度,提高了带教质量。     

妇产科模拟教学的管理实践

随着社会发展和人们维权意识的增强,妇产科临床教学遇到严峻考验,传统的临床实践医学教育模式亟待改进。通过在妇产科临床教学中应用模拟教学方法,提高医学生的妇产科知识、技能,以及主动学习的积极性,有利于医学生综合能力的培养,从而全面提升临床教学的质量。     

Twenty Years of the Ryan Residency Training Program in Abortion and Family Planning

ObjectiveTo summarize the effects of routine, opt-out abortion and family planning residency training on obstetrics and gynecology (ob-gyn) residents’ clinical skills in uterine evacuation and intentions to provide abortion care after residency.MethodsData from ob-gyn residency programs supported during the first 20 years of the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning were analyzed. Postrotation surveys assessed residents’ training experiences and acquisition of abortion care skills. Residency program director surveys assessed benefits of the training to residents and the academic department from the educators’ perspectives.ResultsA total of 2775 residents in 89 ob-gyn programs completed postrotation surveys for a response rate of 72%. During the rotation, residents – including those who only partially participated – gained exposure to and skills in first- and second-trimester abortion care. Sixty-one percent intended to provide abortion care in their postresidency practice. More than 90% of residency program directors (97.5% response rate) reported that training improved resident competence in abortion and contraception care and 81.3% reported that the training increased their own program's appeal to residency applicants.ConclusionOver 20 years, the Ryan Program has supported programs to integrate abortion training to give ob-gyn residents the skills and inspiration to provide comprehensive reproductive health care, including uterine evacuation and abortion care, in future practice. Residency program directors noted that this integrated training meets resident applicants’ expectations.ImplicationsRyan Program residents are trained to competence and are prepared, both clinically and in their professional attitudes, to care for women's reproductive health.     

Effectiveness of a training program in supervisors’ ability to provide feedback on residents’ communication skills

Teaching communication skills (CS) to residents during clinical practice remains problematic. Direct observation followed by feedback is a powerful way to teach CS in clinical practice. However, little is known about the effect of training on feedback skills in this field. Controlled studies are scarce as well as studies that go beyond self-reported data. The aim of the study was to develop and assess the effectiveness of a training program for clinical supervisors on how to give feedback on residents’ CS in clinical practice. The authors designed a pretest–posttest controlled study in which clinical supervisors working in two different medical services were invited to attend a sequenced and multifaceted program in teaching CS over a period of 6–9 months. Outcome measures were self-perceived and observed feedback skills collected during questionnaires and three videotaped objective structured teaching encounters. The videotaped feedbacks made by the supervisors were analysed using a 20-item feedback rating instrument. Forty-eight clinical supervisors participated (28 in the intervention, 20 in the control group). After training, a higher percentage of trained participants self-reported and demonstrated statistically significant improvement in making residents more active by exploring residents’ needs, stimulating self-assessment, and using role playing to test strategies and checking understanding, with effect sizes ranging from 0.93 to 4.94. A training program on how to give feedback on residents’ communication skills was successful in improving clinical supervisors’ feedback skills and in helping them operate a shift from a teacher-centered to a more learner-centered approach.     

Abortion training in U.S. obstetrics and gynecology residency programs, 1998

CONTEXT: Since the late 1970s, the number of obstetrics and gynecology residency programs providing abortion training in the United States has steadily decreased. Given the documented shortage of abortion providers, assessing and ensuring the availability of abortion training in graduate medical education is critical. METHODS: In 1998, the National Abortion Federation surveyed the 261 accredited U.S. residency programs in obstetrics and gynecology, and analyzed the availability of first- and second-trimester abortion training. RESULTS: Of the 179 programs that responded to the survey, 81% reported that they offer first-trimester abortion training--46% routinely and 34% as an elective. Seventy-four percent of programs offer second-trimester training--44% routinely and 29% as an elective. Some programs that do not offer training give residents the option of obtaining it elsewhere. While 26% of programs indicated that all residents in their programs receive abortion training, 40% said that fewer than half are trained, including 14% that train no residents. The operating room is the most common training site: Fifty-nine percent of programs reported that abortion training takes place in the operating room. CONCLUSIONS: After a decades-long decline in the availability of abortion training, opportunities for abortion training have increased. However, there is reason to be cautious in interpreting these results, including possible response bias and pressure to report the availability of abortion training because of new guidelines from the Accreditation Council for Graduate Medical Education.     

案例教学法在妇产科学教学中的应用效果评价

目的评价采用案例教学法在妇产科学教学中的应用效果。方法随机抽取2018年11月—2020年5月该院的82名医实习生,平均分成采用常规教学的对照组(n=41)和接受案例教学法的实验组(n=41)。比较两组实习生的知识掌握优良率、学习态度评分、学习效率评分以及理论成绩和实践操作成绩。结果实验组的知识掌握优良率显著高于对照组,学习态度评分、学习效率评分以及理论成绩和实践操作成绩均显著优胜于对照组,差异有统计学意义(P<0.05)。结论对于妇产科带教,采用案例教学法能够显著激发实习生的学习热情,提高实习生的学习效率和知识掌握水平,改善实习生的临床实践操作能力,进而提高教学质量,值得临床重视。     

The perceptions of attending doctors of the role of residents as teachers of undergraduate clinical students

INTRODUCTION: Much of undergraduate clinical teaching is provided by residents. An earlier study showed the attitude of residents towards teaching to be generally positive. Little is known, however, about attending doctors' views on their own and residents' roles as teachers of medical students. OBJECTIVES: To examine attending doctors' perceptions of the (dis)advantages of resident teaching, their own teaching abilities and the need for a teacher training programme for residents. METHOD: A questionnaire survey of 76 attending doctors was carried out in the Departments of Obstetrics & Gynaecology and Paediatrics at the teaching hospitals of the Universities of Maastricht and Amsterdam, the Netherlands. RESULTS: Attending doctors perceive teaching by residents to be beneficial for students and residents alike. Although they consider themselves to be better suited than residents to teach medical students, they see teaching as an integral part of residency training and feel it should be recognised as such by departments and medical schools. Attending doctors are in favour of a teacher training programme for residents, which should include communication, clinical and teaching skills as well as skills such as time management and (self-) assessment. DISCUSSION: Despite the uneven distribution of participants between the departments, no significant differences were found between departments. It is interesting that attending doctors perceive teacher training as beneficial to residents' teaching skills, but provide more feedback on residents' attitudes than on their teaching. The results show that, in general, attending doctors share residents' views that teaching is an important component of residency and that a teacher training programme for residents is to be recommended.