上海市住院医师规范化培训效果的初步评价

目的 :对上海市住院医师规范化培训制度实施一年的培训效果进行初步分析,为发现培训中的问题、提出改进意见提供信息支持。方法 :对上海市2010年招录的住院医师进行抽样问卷调查。结果 :2010年上海市住院医师规范化培训取得了一定成效,医院重视基本技能培训和带教老师带教,住院医师表示临床能力有一定程度提高。但细节规范方面仍有待完善。结论 :应从重视基本技能操作培训的规范性、加强带教老师培训内容的专业针对性以及建立住院医师培训协作交流平台方面进一步落实培训目的,同时,加强培训实施效果的评估,以监督培训的开展,保证培训质量。     

带教老师对上海市住院医师规范化培训政策的认知与态度调查研究

目的 :了解带教老师对上海市住院医师规范化培训(以下简称"规培")的认知和态度,为以后的规培工作提出改进建议。方法 :对上海市现有带教老师进行抽样问卷调查。结果 :带教老师对规培的认知情况较好,仅有2.82%的人完全不了解各阶段规培的要求;47.92%的被调查者认为带教工作增加了自己的工作负担;带教老师对规培工作的满意度较高,仅有8.08%的被调查者选择不太满意和完全不满意。结论 :大部分带教老师对规培认知程度较高,并且对医院规培工作和规培总体满意度较高。但是带教积极性有待提高。建议提高师资培训的针对性,建立有效的激励机制,提高带教老师积极性。     

医改动态

上海市：2012年拟招录2 500名医学生工作全面启动 自2010年实施住院医师规范化培训制度以来,全市共招录医学生3 809名。上海住院医师规范化培训继续稳步推进实施,2012年拟计划招录2 500名医学生,预计于5月底完成招录工作。本市在原先39所已确定的住院医师规范化培训医院的基础上,根据专家评审结果,     

单位人·行业内社会人·行业内卫生人——上海瑞金医院住院医师规范化培训模式初探

2010年7月底,随着第一批1831名由上海市卫生局统一招录的住院医师进入39家基地医院,上海市新一轮住院医师规范化培训的大幕正式拉开,标志着作为公立医院改革中的一项重点：推进住院医师规范化培训正在上海全面试点。     

加强住院医师规范化培训，推动医院可持续发展

2010年上海在全国率先推出了在全市性的公共平台上“面向全国公开招录、统一标准、统一考核”的住院医师规范化培训举措,徐汇区中心医院作为上海市住院医师规范化培训39家医院之一,已探讨出一整套适应当前医学发展需要的住院医师规范化培训管理模式,以达到培养高质量医学人才的社会需要,推动医院可持续发展。     

复旦大学住院医师规范化培训学员基本信息的调查分析

目的:在推进住院医师规范化培训的背景下,切实了解复旦大学住院医师规范化培训学员基本信息的现状及变化情况。方法:对复旦大学2010期、2011期两期住院医师规范化培训学员基本信息进行回顾性调查和分析。结果:与2010期招录学员比较,2011期招录学员中博士研究生、本科生分别增加4.10%和16.74%,而硕士研究生则减少20.84%。本地学校毕业学员减少20.16%,外地学校毕业学员增加20.16%。结论:有关部门应从"建立绩效考核,明确奖惩制度"、"保证培训质量,打造优质品牌"、"加大政策扶持,提升配套服务"等方面进一步重视和完善住院医师规范化培训工作。     

住院医师／专科医师对规范化培训带教师资和培训管理的满意度调查分析

目的调查参加规范化培训的住院医师／专科医师对带教师资综合职业能力和培训管理的满意度,进一步了解不同医院开展毕业后医学教育所面临的问题和进行毕业后医学教育规范化培训异同。艿珐采用自制问卷对成都市4所三级甲等医院598名住院／专科医师进行问卷调查．对收集的数据进行因子分析和方差分析。结呆受调查的598名住院医师／专科医师对带教师资的综合职业能力的满意度评分在3．83～4．11之间（满分为5分）．而对培训管理的满意度评分在2．91～3．75之间,且不同医院住院医师/专科医师的满意度有差异性P〈0．05。结论无论教学医院还是非教学医院,都应加强带教师资建设和培训管理．才能提高住院医师／专科医师对规范化培训的满意度,以促进住院医师／专科医师规范化培训的顺利开展。     

福建省住院医师规范化培训满意度研究——基于结构方程模型

目的:了解福建省住院医师规范化培训学员对规范化培训工作的满意度现状,并探讨其影响因素。方法:采用分层抽样法抽取福建省501名规范化培训学员,利用自制调查问卷进行调查。结果:学员对规范化培训整体满意度的均分为3.62±0.53;多元线性回归分析显示,年龄、性别、规范化培训身份属性、培训学科、所在规范化培训基地属性这5个因素影响规范化培训满意度,可以解释满意度15.1%的变异量。结构方程模型显示,制度设计、基地条件、带教师资、过程管理、保障机制这5个维度的满意度对培训效果满意度具有预测作用,可以解释培训效果满意度76%的变异量。结论:相关部门应通力协作提升住院医师规范化培训的工作质量,提升规范化培训总体满意度,提高政策运行效率。     

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。     

数字

231名经过3年培训,上海市2010年招录的首批中医住院医师规范化培训本科学员近日完成培训并考核取得合格证书正式出站。然而,在近日举行的上海市2013年中医住院医师供需见面会上,对这批学员需求最迫切、需求量最大的社区卫生服务机构普遍遇冷,多家社区卫生服务中心甚至空手而归。据介绍,首要原因是供需数量绝对值差距大。今年结业出站的中医住院医师仅有231名。而据上海市卫生人才交流服务中心统计,上海市各级医疗机构中医住院医师规范化培训专业岗位的需求是471人。其中,社区服务最对口的中医全科即将结业的住院医师只有54名,却要面对60多家社区卫生机构。     

放疗专业住院医师规范化培训考评体系的构建

目的探讨肿瘤放射治疗专业住院医师规范化培训考评体系的构建。方法采用文献研究法、专家访谈法、德尔菲法,初步建立肿瘤放射治疗专业住院医师的改良培训模式,运用双向选择法及问卷调查法进行评价。采用SPSS 16.0版统计软件对本基地学员与其他基地学员规范化考试成绩行t检验。结果两组学员、临床教员对基地教评体系评价调查问卷,试验组学员满意度为80.77%(21/26)、教员满意度为66.67%(14/21);对照组学员满意度为54.55%(12/22)、教员满意度为52.94%(9/17)。本基地学员的规范化考试成绩(77.89±14.83 vs.72.45±18.78,P<0.05)、临床技能操作水平得分(83.01±12.67 vs.77.34±15.11,P<0.05)及沟通能力得分(85.94±9.33 vs.81.76±11.19,P<0.05)均优于其他基地学员。结论肿瘤放射治疗专业住院医师规范化培训考评体系与传统模式相比,培训效果有较明显的提升,但仍需在实践应用中持续改进。     

A Strategy to Increase the Number of Urban Family Practice Resident Physicians Who Enter Rural Practice

Physician geographic maldistribution is a problem in the United States health care system. Innovative strategies are needed to entice resident family physicians training in the larger, more numerous suburban and urban training programs to practice in rural areas upon completing their training. This paper describes a strategy used at St. Elizabeth Medical Center Family Practice Residency Program, Dayton, OH, to encourage rural practice. In the St. Elizabeth plan, the interested family practice resident moonlights in a rural practice provided by the local county hospital. The county medical staff covers the resident physician's practice during the frequent absences. The residency program faculty provide on-site supervision, telephone back-up coverage, and practice consultation. The county hospital provides billing services; the resident physician retains 100 percent of collections. The resident physician gains exposure to the knowledge, skills, and attitudes needed in rural practice. Upon completion of residency training, the physician remains in practice and is not required to pay back any expenses incurred by the hospital. Two resident physicians participate currently; three others have expressed interest in practicing in the community. A similar plan might work in parts of the United States where, like Ohio, training programs and rural communities are not far apart.     

住院医师英语实践能力的培养途径

住院医师英语实践能力的培养倍受各大医院的关注,我院在住院医师规范化培训中加大了英语实践能力的培养,经过近三年的探索,总结出一条具有一定操作性的培养途径,提出了以语言为基础,以文化为导向,实现语言与文化能力同步提高的目标,取得较为满意的效果,本文在实践总结的基础上对现存问题提出了具体的建议。     

目标管理指标体系在住院医师规范化培训过程管理与质量控制中的应用

本文以目标管理理论为指导,探讨建立住院医师规范化培训的过程管理指标和成果管理指标,通过量化考核的办法以期推动住院医师培训过程管理和质量控制。同时探讨了激励和保障机制,创造有利环境与条件,推动我院住院医师规范化培训工作进一步发展。     

Knowledge, attitude, and practices regarding contact precautions among Iranian physicians.

OBJECTIVE: To assess the knowledge, attitudes, and practices of Iranian physicians regarding contact isolation precautions. DESIGN: Data were collected between May and November 2002 using a cross-sectional survey design. SETTING: Teaching hospitals in Shiraz, Iran. PARTICIPANTS: A total of 155 physicians: 78 attending clinicians and 77 resident physician surgeons or internists. RESULTS: The mean scores for knowledge and attitude were acceptable, with 71% of physicians scoring the maximum for knowledge and 65% achieving the maximum scores for attitude, whereas the mean score for practice was low, with only 26% achieving the maximum score. A good level of knowledge be associated with a good attitude (odds ratio [OR], 68.4 [95% confidence interval {CI}, 20.0-285.6]; P<.001), good practices were associated with good knowledge (OR, 22.5 [95% CI, 7.1-91.3]; P<.001), and a good attitude was associated with good practice (OR, 20.0 [95% CI, 5.7-105.2]; P<.001). CONCLUSION: Although strong associations were found among knowledge, attitude, and practice, the level of compliance with precautions was not nearly as high as it should be.     

External Practicum-Year Residency Training in Occupational and Environmental Medicine: the University of Pennsylvania Medical Center Program

We describe a competency-based training program that allows physicians employed full-time in occupational and environmental medicine to satisfy the supervised practicum year of training required by the American Board of Preventive Medicine (ABPM). The program is designed for trainees with greater clinical experience than the 1 clinical year required by the ABPM. To date, 25 physicians from clinic-based, academic, corporate, and government employment across most geographic regions of the United States have been admitted into the program. Most completed a master's in public health (MPH) in a distance-learning, on-job, on-campus, or executive program. The practicum-year training has been highly successful, as evidenced by improvements in resident self-assessment of competency, resident satisfaction with the training, faculty evaluation of resident performance, and success rate in the ABPM examination. The program has opened a new pathway for physicians making a mid-career shift to occupational and environmental medicine to obtain high-quality, in-depth education and board certification.     

Job Satisfaction and the Work Situation of Physicians: a survey at a German University hospital

Summary. Objective: Job demands and workload of hospital physicians are increasing. The object of this survey was to examine the factors that constitute job satisfaction and to analyse physicians’ work situation in the area of in-patient care. Methodology: 447 physicians at a German University Hospital received questionnaires with regard to work situation, job satisfaction and personal health. Data were analysed by MANOVA and multiple regression models. Results: A first regression model explained 53% of the variance in satisfaction with ‘work and profession’. Among the explanatory variables ‘superiors and hierarchy’ showed the highest beta-weight (β = −0.49). ‘Personal health’ also determined job satisfaction, for female physicians stronger (β = −0.31) than for male physicians (β = −0.11). In a second regression model on satisfaction with ‘Financial situation’ only 18% of the variance was explained, whereby ‘work condition on the ward’, ‘personal health’ and ‘collaboration between occupational groups’ showed the highest beta-weights. Discussion: Among resident physicians, work conditions, superiors, hierarchy, transparency and participation in decisions are very important variables for job satisfaction. Improvements in these aspects may improve job satisfaction and help to reduce physician shortage in hospitals. Submitted: 2 March 2005; Revised: 31 May, 29 August 2005, 15 November 2005; Accepted: 9 June 2006     

Effect of technical traning program on intern physicians' and nurses' knowledge and attitudes regarding emergency contraceptives

In spite of the effectiveness of modern contraceptives, unwanted pregnancies occur in large number throughout the world and many seek termination so emergency contraceptive methods can be used by women in the first few days, following unprotected intercourse to prevent unwanted pregnancy, induced abortion, and its consequences for women and couples. So this study was conducted to determine the effect of technical training program on upgrading a newly graduate physician and nurses knowledge and attitude regarding emergency contraceptives. The study included 50 intern physicians and 50 intern nurses who are working at El-Shatby maternity university hospital during 1st of march 2001. The study used pre and post test with no control group design. An interview questionnaire sheet was used to assess intern physician and nurses, knowledge about emergency contraceptives while 3 point Likert scale was used to assess the attitude of both groups (physician and nurses) were divided into two sub group. A four hours technical training program were implemented for each group separately on two successive days (2 hours/day). Before implementing the technical training program the study depicted a general lack of knowledge among all physician and nurses regarding emergency contraceptives. Methods added to that the majority of intern physician and nurses 70%, 84% respectively had negative attitude toward emergency contraceptives however, the technical training program had an obvious effect on intern physicians and nurses. Knowledge regarding emergency ,contraceptives. Although improving in the study subjects, Knowledge had a positive impact of their attitude toward emergency contraceptives.     

Effect of crew resource management training in a multidisciplinary obstetrical setting.

OBJECTIVE: To assess the effect of a Crew Resource Management (CRM) intervention specifically designed to improve teamwork and communication skills in a multidisciplinary obstetrical setting. METHOD: Design--A before-and-after cross-sectional study designed to assess participants' satisfaction, learning and change in behaviour, according to Kirkpatrick's evaluation framework for training programmes. Setting--Labour and delivery units of a large university-affiliated hospital. Participants--Two hundred and thirty nine midwives, nurses, physicians and technicians from the department of anaesthesia, obstetrics and paediatrics. Intervention--All participants took part in a CRM-based training programme specifically designed to improve teamwork and communication skills. Principal measures of outcome-We assessed participants' satisfaction by means of a 10-item standardized questionnaire. A 36-item survey was administered before and after the course to assess participants' learning. Behavioural change was assessed by a 57-item safety attitude questionnaire measuring staff's change in attitude to safety over 1 year of programme implementation. RESULTS: Most participants valued the experience highly and 63-90% rated their level of satisfaction as being very high. Except for seven items, the 36-item survey testing participants' learning demonstrated a significant change (P<0.05) towards better knowledge of teamwork and shared decision making after the training programme. Over the year of observation, there was a positive change in the team and safety climate in the hospital [odds ratio (OR) 2.9, 95% confidence interval (CI) (1.3-6.3) to OR 4.7, 95% CI (1.2-17.2)]. **There was also improved stress recognition [OR 2.4, 95% CI (1.2-4.8) to OR 3.0, 95% CI (1.0-8.8)]. CONCLUSION: The implementation of a training programme based on CRM in a multidisciplinary obstetrical setting is well accepted and contributes to a significant improvement in interprofessional teamwork.