中山医院全科住院医师规范化培训的实践研究

目的 对2010年以来复旦大学附属中山医院开展的全科住院医师规范化培训工作进行分析与总结.方法 以2010年以来中山全科基地招录的67名全科住院医师为对象,回顾性分析3年内的培训方法、培训内容、评估方法及培训管理.结果 67名全科住院医师的院内考核通过率均为100％ (67/67);2010年的19名住院医师中16人通过执业医师考试和结业考核并已完成培训计划,3人因未通过执业医师考试而延长培训计划1年,其中2人通过执医考试,1人退出培训计划;2011年的17名住院医师中16人通过执业医师考试.在培训过程中建立了“以人为中心”的培训模式与“以能力为中心”的教学及评估体系.结论 中山医院在全科住院医师规范化培训方面积累了丰富的经验,建立了较为完善的培训与考核体系,并在实践过程中不断改进.     

住院医师规范化培训考核结果分析

目的了解内科住院医师在规范化培训方面的质量现状。方法对2006年新入院的本院及二级医院内科住院医师进行培训前考核、培训一年、二年、和三年后的年度考核,比较考核成绩。结果内科住院医师经过医院规范化培训,平均分逐步提高、且本院及二级医院内科医师考核成绩无统计学差异。结论在内科基地进行全面正规严格的住院医师规范化培训,对提高住院医师的临床各项能力起到重要作用。     

某院规培医师入院记录书写质量分析

目的 通过对某院规培住院医师的入院记录进行书写质量分析,为提高住院医师规范化培训质量提供依据。方法 对2022年1月1日-2022年6月30日于某院进行规范化培训的住院医师60人,随机抽取同期每人1份入院记录,根据原国家卫生部印发的病历书写基本规范及某院教学部制定的规范化培训住院医师病案质量检查表进行质控评分。结果 内科规培医师的学历较高,全日制硕士在读研究生占77.78%,全科医学规培医师学历较低,本科毕业生占96.15%;外科规培医师入院记录平均92.24±5.02分,内科平均90.26±4.85分,全科医学平均89.19±4.85分。主要缺陷为遗漏有鉴别意义的阴性症状或症状,缺陷率为30%,家族史描述不规范占28.33%。结论 规培医师病历书写存在不足,应加强规培医师病历书写相关的法律法规培训,加强病历书写能力的培养,以提高住院医师规范化培训质量。     

基于混合研究方法对比两个全科培训基地全科住院医师对培训的态度和看法

背景　中国正在完善分级诊疗和家庭医生制度,全科医生人才培养是实现这一制度的核心因素,目前我国全科医生缺口40万,全科住院医师规范化培训是培养高质量全科医生的主要途径。目的　通过混合研究方法广而深地了解来自两个城市的两个医院全科住院医师对其接受的全科规范化培训看法的异同,探讨不同规范化培训模式下可能带来的益处。方法　应用混合研究方法进行横断面研究。于2019年4月,采用整群抽样法抽取北京大学第一医院和北京大学深圳医院全科住院医师作为研究对象。两个医院均是“5+3”全科住院医师规范化培训基地,其中北京大学第一医院为“四证合一”的试点基地。结果　北京大学第一医院共发放问卷39份,回收有效问卷35份,有效回收率89.7%;北京大学深圳医院共发放84份问卷,回收有效问卷70份,有效回收率为83.3%。总体上,全科住院医师感觉到由于选择了全科专业而受到歧视,感觉作为全科医师能力不足。许多住院医师提到教学医师的教学态度较差。北京的住院医师比深圳的住院医师对培训更满意（P=0.001）,并觉得全科教学医师有足够的知识（P<0.001）和更合适的教学态度（P=0.004）,并且北京大学第一医院住院医师5项工作愿景得分均低于北京大学深圳医院,差异具有统计学意义（P<0.05）。结论　这些中国全科住院医师了解培训中需要改进的内容及培训的长项。北京全科住院医师对教学及工作满意度更高,其可以获得高水平教学医师的培训,并可以获得相关证明,提示教育改革可以增强培训力度并促进住院医师有更好的工作愿景。这些发现提示中国的住院医师面临着和国际相类似的情况,同时,也提示规范化培训教学课程的改革可能会带来益处。     

“全科-专科”联合教学并过程评估对住院医师规范化培训工作的效果

目的 探讨“全科-专科”联合教学并过程评估对完善全科专业住院医师规范化培训工作的效果。方法 选择2020年3月至2022年12月铜陵市人民医院全科住院医师规范化培训基地的带教老师42人、住培医师29人为研究对象，采用“全科-专科”联合教学并过程评估的模式培训，于培训前后对老师和住培医师进行问卷调查和临床演练评测，并从理论考试与技能操作、病例分析、辅助检查判读等方面对住培医师进行评价。结果 培训后，带教老师和住培医师中对全科理念认知很明确、对全科诊疗与专科区别很了解、对联合教学与专科教学区别很了解的人员数较培训前均明显上升，且认为会增加临床负担的人数显著减少，差异均具有统计学意义（P<0.05）。培训后，带教老师人文关怀、组织效能维度，住培医师各维度评估成绩均较培训前明显提升，差异均具有统计学意义（P<0.05）。住培医师培训后的理论考试、病例分析、辅助检查判读成绩均明显优于培训前，差异均具有统计学意义（P<0.05）。结论 “全科-专科”联合教学并过程评估的模式不仅能提高专科老师在实际临床教学中的全科思维，还能提升住培医师的岗位胜任力。     

探讨莱斯特评估套件在全科住院医师全科思维培养中的作用

全科住院医师规范化培训具有和专科医师培训不同的特点,目前存在着师资力量不足、培训内容与社区工作脱节、全科思维培养不足等问题。莱斯特评估套件以形成和监管为目的,对临床技能和诊疗过程进行综合的客观评估,可用于全科住院医师全科思维的培训和评估,有助于弥补目前培训的不足,促使医学生深切理解自己思维的步骤,奠定今后临床情况及诊疗行为的基础,提高全科思维培训水平,保证培训效果。在实际诊疗行为中引入莱斯特评估套件既能规范全科医师诊疗过程,也有助于提高全科诊疗能力。     

提升血液内科住院医师规范化培训质量的思考及建议

我国住院医师规范化培训工作取得了显著的成绩,但受限于血液内科的专业特性,目前血液内科的住院医师规范化培训工作仍存在管理体系不健全、师资力量薄弱、带教方法死板、教学内容单调、考核指标片面等问题,严重影响血液内科住院医师规范化培训质量。只有通过优化管理组织结构、加强过程管理及控制、扩大师资队伍、提高教师带教技能、增强教师考核评价、应用新型教学方法培养学员临床、科研、人文综合素质并建立完善科学的出科考核评价体系,才能提高血液内科住院医师规范化培训质量,为国家住院医师规范化培训工作添砖加瓦。     

上海市全科住院医师规范化培训学员的培训情况调查

目的了解全科住院医师规范化培训开展的实际情况,探讨完善培养制度的有效途径,为解决全科医师培养问题提供理论依据。方法对2010年参加上海市住院医师规范化培训(全科医学科)的培训学员进行问卷调查。结果 80.0%的学员认为在当前形势下医学院校毕业生有必要在从事医疗工作前经过住院医师规范化培训;培训在提高临床实践及专业技能方面有重要作用;学员对教师带教意识的满意度较低;有75.4%的学员,尤其是本科毕业生对住院医师培训与研究生培养相结合的模式表示认可。结论完善全科住院医师培训制度,加强规范化培训医院及社区培训基地师资建设,突出临床技能和社区技能培训,制定倾斜政策,培养高质量的全科医师。     

信息速递

首批正规全科医师在浙江“出炉”11月19日,在浙江大学医学院会议厅里,举行了浙江省首届全科医师规范化培训结业典礼,浙江省卫生厅厅长亲自为30名接受该培训的医师颁发了“中华人民共和国住院医师规范化培训合格证书”和“浙江省全科医师规范化培训合格证书”。浙江省卫生厅和浙江大学医学院于2000年10月在全国率先联合开展全科医师规范化培训,内容包括4年的全科医学理论课程学习、医院轮转和社区实践培训。首批学员已通过政治思想、医德医风考核,并参加了包括内科、外科、妇产科、小儿科及精神科、外伤科的模拟病人考试。对全科住院医师采取…     

“健康中国”背景下对全科住院医师 规范化培训的探讨

“健康中国2030”规划纲要对我国全科医师的培养提出更高要求,住院医师规范化培训是我国医学生毕业后医学教育的一项重要内容,虽然目前全科住院医师规范化培训已基本形成“5+3”模式,但仍存在培训体系不完善、师资力量薄弱、培训工作创新性不足、全科医师岗位胜任力低等诸多问题,借鉴国外全科医学发展经验,结合我国发展现状,本文提出对全科住院医师规范化培训的思考与改革,通过提高住院医师及全科教师的积极性,强化人文教育,多样化培训模式,加强师资力量,落实导师制,加强住院医师文献阅读能力和科学研究能力的培养,“走出去,引进来”,促进国际合作等举措提高我国全科医师的综合能力,推动“健康中国”伟大目标的实现。     

Medical education for practice in nonmetropolitan areas

A study of patient records sampled from the office practices of 28 family practitioners and general surgeons in a 16-county nonmetropolitan area revealed that a sizable percentage of the diagnoses of problems encountered by family practitioners concern conditions the management of which is primarily taught on a residency service other than family practice, internal medicine, or pediatrics. Surgeons, conversely, are seeing a large percentage of patients with conditions the management of which is generally taught on a primary care residency service. Data from office records were augmented by interview responses of 32 family practitioners and general surgeons to questions about the training that family practice and general surgical residents should receive if they are to be well prepared for practice in nonmetropolitan areas.     

Public policy and the supply of primary care physicians

The decline in general practice, the arrested growth of family medicine training programs, and the increased subspecialization of internal medicine and pediatrics are responsible for the continuing decrease in the proportion of physicians in the United States who practice a primary care specialty. Since 1963, the number of physicians has more than doubled, but the ratio of office-based primary care physicians to the national population has decreased. This trend has been especially pronounced in rural areas and impoverished urban communities. There is evidence that the proportion of young physicians entering primary care specialties is declining. Medical education has become increasingly reliant on service income, making it difficult to fund training in primary care specialties. Grants for graduate training in primary care specialties have not increased with inflation, and outright elimination of these programs is under consideration. Public programs that fund medical education must be reformed to improve the geographic and specialty distribution of physicians.     

Perioperative medical assessment of the podiatric surgical patient

Patients undergoing podiatric surgery should receive a thorough perioperative evaluation. Medical "clearance" is no longer sufficient; rather, formal risk assessment should be performed and risk-reducing strategies provided. A collaborative, multidisciplinary approach involving practitioners in internal medicine, anesthesiology, and podiatry is generally most appropriate. Unfortunately, expertise and training in this critical dimension of clinical practice are variable. Thus podiatric physicians should develop independent competence in perioperative evaluation in order to ensure optimal care for their patients. A general systematic approach is described that can be readily incorporated into clinical practice.     

Psychological aspects of medical care: a training seminar for primary care providers.

A seminar devoted to the psychological aspects of medical care has formed the major portion of the psychiatric training of primary care internal medicine residents at the Kenmore Center of the Harvard Community Health Plan since 1973. The group includes a psychiatrist, a psychiatric nurse, staff physicians, residents, and nurse practitioners. The atmosphere is open and supportive, and discussion focuses on particular situations causing discomfort to members. Content issues include professional identity, relationships with co-workers, and difficulties in handling patients. The group teaches the value of communication and sharing and improves skills in caring for patients.     

Correlates of certification in family medicine in the billing patterns of Ontario general practitioners.

There is conflicting evidence as to whether physicians who are certified in family medicine practise differently from their noncertified colleagues and what those differences are. We examined the extent to which certification in family medicine is associated with differences in the practice patterns of primary care physicians as reflected in their billing patterns. Billing data for 1986 were obtained from the Ontario Health Insurance Plan for 269 certified physicians and 375 noncertified physicians who had graduated from Ontario medical schools between 1972 and 1983 and who practised as general practitioners or family physicians in Ontario. As a group, certificants provided fewer services per patient and billed less per patient seen per month. They were more likely than noncertificants to include counselling, psychotherapy, prenatal and obstetric care, nonemergency hospital visits, surgical services and visits to chronic care facilities in their service mix and to bill in more service categories. Certificants billed more for prenatal and obstetric care, intermediate assessments, chronic care and nonemergency hospital visits and less for psychotherapy and after-hours services than noncertificants. Many of the differences detected suggest a practice style consistent with the objectives for training and certification in family medicine. However, whether the differences observed in our study and in previous studies are related more to self-selection of physicians for certification or to the types of educational experiences cannot be directly assessed.     

中医全科医学在心血管疾病防治中的作用与模式

目前中国基层医疗卫生服务机构在防治心血管疾病方面仍存在瓶颈,而中医全科医学作为社区基层卫生服务的主力,在其中发挥着关键性作用。在我国中医与西医并存的国情下,中医全科医学在保持传统中医学“全科”特色及优势的基础上,运用中医独特的理论体系、思维方法、临床经验,不断探索实践,融合现代医学的模式及经验技术,以满足社区卫生服务的需要,为社区居民解决身体健康问题。本文全面阐述了中医全科医学在中医“整体观念、辨证论治、治未病”理论指导下,提倡以“人”为中心,充分发挥中医药及全科医学优势及特色,通过中西医结合治疗方式防治心血管疾病;分析了中医全科医学在防治心血管疾病中的作用及模式,运用未病先防、既病防变、病后防复等中医“治未病”医疗措施,对心血管疾病进行诊疗、康复、预防及保健,减少心血管疾病给人体带来的危害,以缓解心血管疾病所带来的医疗压力。中医全科医生作为中医学的传承者、实践者及社区居民健康的服务者,为居民提供以预防为导向的、连续综合的、便捷有效的社区卫生医疗服务。在国家基层医疗建设的大力支持及中医全科医生的不懈努力下,中医全科医学将成为未来中国防治心血管疾病的中坚力量。     

Effects of residency training in family medicine v. internship training on professional attitudes and practice patterns.

OBJECTIVES: To determine whether the professional attitudes and practice patterns of physicians with residency training in family medicine differ from those of generalists with internship training. DESIGN: Mail survey conducted in 1985-86. SETTING: Province of Quebec. PARTICIPANTS: A stratified random sample of French-speaking family and general practitioners who graduated after 1972 (325 physicians with residency training and 304 with internship training) (response rate 82%). MAIN RESULTS: Physicians with residency training were 3 years younger on average than those with internship training, were more likely to be female (38% v. 18%, p less than 0.001) and were more likely to work on a salaried basis in CLSCs (public community health centres) (36% v. 14%, p less than 0.001). Even after these confounding factors were controlled for, physicians with residency training seemed to be more sensitive to the psychosocial aspects of patient care and tended to attach more importance to informing patients about useful materials and resources concerning their health problems. They were not, however, more likely to value health counselling or integrate it in medical practice. CONCLUSION: Our findings provide some evidence that the new requirement that physicians complete a residency in family medicine to obtain medical licensure in general practice in Quebec may foster a more patient-centred approach to health care.     

Patterns of practice in internal medicine in Ontario.

To determine the feasibility of wholly referral practice in internal medicine within a prepaid health service, the practice profiles of 694 internists in metropolitan, nonmetropolitan urban, and rural areas of Ontario were delineated by analysis of data from questionnaires and health-insurance billing. The questionnaire showed that two thirds of internists, chiefly younger practitioners, confined themselves to a referral consultant practice; the other one third included primary care. Subspecialists practised predominantly in metropolitan areas; most general internists in such areas provided primary care, whereas most general internists elsewhere had an entirely referral practice. This pattern of practice is greatly different from that in the United States but probably similar to that in other provinces in Canada. Extension of wholly referral practice to all internists in Ontario appears feasible, provided the numbers entering residency training are controlled. The present Ontario curricula for internal medicine and its subspecialties appear suitable for such a pattern of practice.     

The characteristics of training in ambulatory medicine in U.S. residencies

To determine the characteristics of training in ambulatory internal medicine, all internal medicine residency programs in the United States were surveyed in 1981-82. Thirty-eight percent of 477 hospitals responded. Quantitative information was sought regarding the specific features of the ambulatory residency programs, formal teaching conferences, supervision of residents, and evaluation of residents in ambulatory care. According to the responses, the training of the small cadre of primary care residents does emphasize ambulatory medical experience, supervised by an increasing number of faculty members in general medicine. Formal post-clinic conferences, analogous to inpatient attending rounds, are held substantially more often in hospitals with primary care programs than in hospitals without primary care programs. Formal ambulatory teaching conferences stress both traditional topics important in internal medicine and psychosocial issues. However, the authors could detect little effect of these activities in primary care programs on the training of traditional internal medicine residents even within the same hospital.     

全科医学教育的现状与展望

全科医学是一门以初级卫生保健和社区医疗服务为目的的医学专科,经过多年的发展,全科医学逐渐形成了整体的医学观,现代的医学服务模式,独特的医疗方法、服务内容与艺术,为社区居民提供连续性、综合性和个体化的医疗服务．全科医生是全科医疗服务的提供者,全科医疗是以解决社区常见健康问题为主要目的的基础医疗服务．我国自2000年开始启动全科医师规范化培训和岗位培训,至今已形成以高等医学院校的全科医学知识教育,全科医师规范化培训为重点的临床医学专业毕业后医学教育,以及全科医师岗位培训所构成的我国全科医学的培养模式．