模块式教学法在临床医学博士后培养中的实践与探讨

本文介绍了模块式教学在北京协和医院临床医学博士后核心胜任力培养过程中的实践,并以“医学人文素养模块课程”为例,利用调查问卷与访谈等方法对2016年与2017年模块课程效果进行对比。结果显示,设置“医学人文素养模块课程”并且不断优化课程结构与内容,使得课程满意度有大幅度提升。学员认为模块课程有助于住院医师核心胜任力的养成,能够有效明确培养目标,加强过程管理。但对于课程内容、形式的优化以及长远效果,还需要进一步的探索与讨论。     

胜任力为基础的阶梯式评估与反馈体系在北京协和医院内科住院医师规范化培训中的应用

目的尝试建立跟踪式的、形成性的、以住院医师的胜任力为基础的评价与反馈体系,以便于对其反馈和提高。方法参考国际上住院医师规范化培训的经验,结合我国内科住院医师规范化培训的情况及要求,设计了全新的阶梯式培养评估与反馈体系,并在6名2016级内科临床博士后范围内尝试应用。结果评估后不仅可以反映临床博士后的整体水平,亦可以更个体化的反映不足以便于反馈。结论该阶梯式评估与反馈体系运用至临床实践中进行监测性、形成性、阶段性的评估具有较强的可行性和重要价值。     

富媒体导课法在人体寄生虫学教学中的应用∗

为探讨富媒体导课(Rich-media Based Lead-in,RBL)教学法在临床医学专业人体寄生虫学教学中的应用效果,选取北京协和医学院2017级临床医学专业的86名学生作为研究对象,将RBL教学法应用于人体寄生虫学课程部分章节教学中,通过问卷调查评价教学效果.学生的反馈结果显示,RBL教学法可提升学生对人体寄...     

基于岗位胜任力的急诊住院医师能力评价指标探讨

目的探讨适用于中国基于岗位胜任力的急诊住院医师能力的评价指标,为进一步完善急诊住院医师能力评价体系提供证据基础。方法本文参照美国毕业后医学教育委员会(ACGME)制定的急诊住院医师岗位胜任力标准,结合中国实际情况,创新性的提出针对中国急诊住院医师教育的岗位胜任力标准,并在2016年急诊住院医师规范化培训基地教学主任研修班上向全国基地主任和骨干师资发放关于此评价指标的调查问卷,征求关于急诊住院医师能力评价指标的看法与意见,数据统计采用Excel软件完成,使用SPSS 20. 0进行统计学分析。结果提出的急诊住院医师临床能力指标体系包括4项一级指标,22项次级指标。针对此指标体系,共发放问卷402份,回收问卷372份,其中填写完整的有效问卷367份,占发放问卷的91. 3%。有效的问卷中主管教学的院领导、教学主任及教学秘书共304人(占82. 8%)。调查问卷来自全国31个省市自治区的培训基地,因此调查结果应该具有代表意义。对于提出的能力指标体系绝大多数参与调查人员都给予了认可,并提出了一些补充能力建议。结论基于岗位胜任力的急诊住院医师能力评价指标得到了绝大多数教学基地管理人员认可,并为中国急诊住院医师能力评价指标体系的建立提供一定的证据基础。     

教学反馈的发展与特点及其在临床教学中的应用特点

从教学反馈的发展及时代变迁,阐述了新时代的教学反馈应关注学生全面发展,定量与定性评价相结合,评价主体、评价标准和评价内容多元化等新时代的特点。从教学反馈的明确性、及时性、真实性、针对性、双向性和多样性等特点入手,结合临床医学教育的准确性与灵活性,分析临床教学中反馈的应用特点。     

以新医科胜任力为导向的医学免疫学精准教学实践案例——以抗体章节讲授为例

新医科背景下如何培养具备岗位胜任力的高质量医学人才是医学高等教育的重要内容之一,因此,为培养不同领域的专业医学人才,使其更切合所学专业的特点,并适应未来职业发展需求,教学中应进行有针对性的“精准教学”,既包括课程内容设计的精准化,又包括教学模式和考核方式的精准化,从而达到精准化培养具备岗位胜任力的专业医学人才的目标。因此,教研团队以新医科岗位胜任力为导向,尝试探索医学免疫学精准教学的课程建设方式,并以抗体一章为例介绍具体方法。     

基于分层分级模式的超声医学科住院医师科研胜任力的评估

目的探讨分析超声医学科住院医师科研胜任力情况,为住院医师的科研能力培养方案提供依据,以更好地提高其科研胜任力。方法对北京协和医院超声医学科一阶段在培住院医师进行自评问卷调查,探讨分析基于分层分级模式的住院医师科研胜任力情况。结果不同学年、不同生源的住院医师科研胜任力存在差异。不同学年规培住院医比较:从高到低为第三年、第一年、第二年,平均分数为256±48,231±28,214±48。不同生源规培住院医比较:从高到低为临床博士后、在读专业型硕士(即并轨研究生)、外院派送至北京协和医院的一阶段规培基地医师(即基地住院医),平均分数为(294±18)分、(236±33)分、(214±42)分。此外,全体住院医在科研设计与基金撰写申请、论文写作、通过阅读学习科研知识方面均有欠缺。结论建议对超声医学科住院医师开展基于分层分级模式的针对性的强化培养及指导,以胜任现代医学发展对医教研全面性医学人才的要求。     

基于成果导向教育理念的局部解剖学教学改革与实践

局部解剖学是基础医学与临床医学的桥梁课程,是临床医学专业学生的基础必修课程之一.传统的局部解剖学多采用教师"讲授式"和学生"验证性学习"的教学模式,导致学生的主观能动性及其主体作用被忽略[1],在教育部关于建设一流本科课程的背景下,如何加强课程建设、提高课程质量,寻找局部解剖学教学的新理念迫在眉睫.成果导向教育(outcome based education,OBE)是20世纪80年代由美国著名学者斯派迪?怀特提出的一种教育模式,强调以学生为中心,关注学生能力和综合素质的提升[2].该教育模式应用于多个领域,并取得广泛认可.探讨基于OBE理念,以本校临床医学专业局部解剖学课程为载体,以提升岗位胜任力为导向,从教学内容、教学方法和课程考核评价体系等方面进行初步改革,构建以知识、能力和素质相融合的课程体系.     

北京协和医学院超声诊断教学需求的问卷调查及反馈分析

目的对北京协和医学院八年制临床医学学生传统超声教学现状及对新型教学模式的需求进行调查研究。方法问卷调查八年制学生传统超声诊断教学现状、对新型教学模式的评价,对比北京协和医学院试点班新型超声诊断教学的反馈结果,为课程设置提出建议。结果八年制临床医学学生对超声诊断学科的基础知识及技术发展的知晓程度不佳,对目前教学效果不满意,希望在教学内容、授课方式及课程安排方面改进课程。结论建议医学院校针对学生需求调整课程涉及教学方式,重视健康人体解剖结构及常见疾病的超声检查术表现等基础内容。     

基于胜任力模型的哀伤咨询培训体系构建及其效果

目的：本文旨在探索基于胜任力模型构建的哀伤咨询培训的效果。方法：通过网络形式面向社会招募心理咨询师，达到入组标准的咨询师接受8次包含提升个人胜任力、知识与技能概念化、评估技能、哀伤治疗技能和专业技能的哀伤培训。在培训前后咨询师分别填写哀伤咨询胜任力问卷，共120人有效完成了两次问卷。结果：1.咨询师以往的哀伤培训经验能够显著预测哀伤咨询胜任力；2.培训后，咨询师整体和各维度的哀伤咨询胜任力较培训前均有显著提升。结论：基于胜任力的哀伤咨询培训体系能够有效帮助各个流派的咨询师做好处理来访者哀伤议题的准备。     

Continuum: el poder del aprendizaje virtual y la Web 2.0 en la formación médica en Pediatría. Tres años de experiencia

Doctors are committed to maintain competence and be critical in their professional practice. The internet revolution has led to a new age of disseminating information and knowledge. The Scientific Societies are entrusted with the training needs of those that they represent, with the development of strategies to link training and medical practice. They also have a responsibility to provide optimal healthcare to the population. The experience of Continuum is presented in this article. It is a training platform based on the Global Curriculum for Paediatric Education (GPEC), designed ad hoc by the Spanish Paediatric Association. Continuum promotes a competency-based training, in which students (undergraduate, graduate, and practicing physicians) are the centre of the teaching-learning process. The Continuum approach establishes a direct relationship between the competences that are needed for a competent paediatric practice (knowledge, skills, and attitudes), as well as training material.Training activities in Continuum include: training courses and individual learning activities, distributed into different sections (“Weekly image”, “interactive clinical cases”, “News in bibliography”, “Highlighted Article”, “Pills” and “tools for daily practice”). In this article we present the hallmarks and strengths of Continuum, the training platform of the Spanish Paediatric Association, and the experience achieve during these first three years of its existence.     

Milestones for medical students completing a clinical genetics elective

PurposeWe are not aware of any competency-based evaluation method that is specifically designed for a genetics elective for medical students. Here, we aimed to create a milestone template to improve evaluation and to use the feedback from the template to improve the elective.MethodsThrough an iterative process using feedback from eight medical students and eight attendings, we crafted a milestone template for the medical student genetics rotation. A “scavenger hunt” of activities was developed to address several gaps discovered through this process.ResultsAll participants felt that the milestone template was complete for the student level and that it improved evaluation. In response to faculty feedback, we modified the evaluation process such that several evaluators rated students in only selected domains. Scavenger hunt activities were designed to address five domains that the students reported to be inadequately covered.ConclusionDeveloping a milestone template has taken us a step closer to meaningful assessment of students completing the genetics elective and simultaneously allowed us to strengthen the elective. Meaningful elective experiences in genetics that provide individual feedback within a learner-centered assessment of progress and flexible out-of-classroom activities may contribute to lifelong learning and interest in genetics and genomics.     

内分泌临床专科医师集中培训课程设置及效果评价

目的为满足内分泌代谢专科医师提高诊治水平的需求,组织短期集中培训并评价培训效果。方法设立了内分泌专科医师短期集中培训课程,并以微信投票方式设计课程评估表。统计分析受训者对课程的满意度。结果内分泌专科医师短期集中培训课程按内分泌疾病系统划分,共包括6类,35个课程:甲状腺疾病(4个),代谢性骨病(4个),糖、脂、尿酸代谢疾病(8个),下丘脑-垂体疾病(9个),肾上腺疾病(5个),临床思维培训(5个)。全部课程在6 d内完成。结果以分类和评分两种方式呈现,分类结果包括非常满意、一般、不满意,分别统计投票人数的百分比。评分采用5分制,直接计算出全体评分学员的平均分。参加培训者总体对课程满意度高(平均分>4.5分),评价结果为“非常满意”者比例78.2%~100%,“一般”者比例为0~21.8%。对常见病课程授课质量要求更高(受训者不满意比例1.19%~2.30%),对疑难病、罕见病课程满意度更高(7个课程平均分5分)。结论内分泌临床专科医师培训课程设置应以满足临床工作需求为目标,建立分层培训体系,授课形式应多样化,采用量化的课程评估方法。     

重症医学科进修医生临床规范化培训模式与考核体系初探

目的探讨关于重症医学进修医生规范化培训模式和考核体系。方法于2015年至2017年,针对在北京协和医院重症医学科的进修医生,实施“基础培训、感控培训、重症思维和重症科研”等系列模块规范化培训,并建立以3个月为周期的“理论考核+操作考核+主观考核”的综合临床能力考核体系。结果来自全国共161名进修医生在学习期间参加规范化培训,初始理论摸底考试通过率为34%,经过3个月基础培训,理论考核通过率显著提高到75.5%(P<0.05)。无菌考核第一次通过率为25%,经过强化培训考核通过可显著提高到95%(P<0.05)。在第1个考核周期内(第3个月)临床综合能力考核的通过率为44%,在第2个考核周期内(第6个月)临床综合能力考核的通过率为91%。结论重症医学科进修医生的基础重症理论知识、感控观念和重症思维相对薄弱,经过规范化培训后均可得到提高。“理论考核+操作考核+主观评价”综合评估体系有助于评价和提高进修医生的重症临床能力。     

Relationship Between Essential Hypertension and Cognitive Functioning II: Effects of Biofeedback Training Generalize to Non-Laboratory Environment

Eight male essential hypertensives underwent 9 weekly 2-hr biofeedback training sessions in which feedback (i.e., lights and tones) was contingent upon decreases in systolic pressure. Three weekly control sessions (with no feedback) preceded feedback training. Outside the laboratory, patients recorded blood pressure 5 times per day both at home and at work. Patients continued monitoring their blood pressure for up to 4 months after termination of feedback training. Both prior to and following the 9 weeks of biofeedback training, patients were given the Category Test (a subtest of the Halstead-Reitan Neuropsychological Test Battery). Feedback training resulted in significant reductions in blood pressure both within and outside of the laboratory. The reduction in non-laboratory pressure readings persisted for up to 4 months after feedback training was terminated. A significant positive correlation was found between systolic pressure and number of errors on the Category Test given prior to biofeedback training, and between magnitude of decrease in systolic pressure recorded during biofeedback training and improvement in Category Test performance measured subsequent to training. After completion of the study, patients were rated (on the basis of structured interview data obtained following weekly feedback sessions) as to overall level of stress (i.e., general stressfulness of life style, accidents, illnesses, emotional problems, etc.). Patients rated high in overall stress had significantly higher blood pressure readings during the control period. However, magnitude of decrease in blood pressure recorded during feedback training was essentially the same regardless of rated stress level.     

A survey of influences on the practice of psychotherapists and clinical psychologists in training in the UK

A questionnaire survey of 95 qualified psychotherapists of various therapeutic orientations and 69 psychologists in clinical training was carried out to investigate the main influences on their clinical practice, using the Questionnaire of Influencing Factors on Clinical Practice in Psychotherapies (QuIF‐CliPP). For the qualified group the most highly rated factors were current supervision, client characteristics, client feedback, psychological formulation, intuition/judgement, professional training and post‐qualification training. For the trainees, those rated highest were current supervision, past supervision, client characteristics, client feedback, psychological formulation and professional training. Evidence based factors such as treatment manuals and evidence based guidelines were rated relatively low for both groups, although the cognitive behaviour therapists rated them significantly higher than the other groups. Personal therapy was rated highly by the psychodynamic, psychoanalytic, person centred and eclectic therapists but not by CB therapists. The implications of these findings for the application of evidence based practice and the need to evaluated supervision, personal therapy and training are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Becoming an eCoach: Training therapists in online cognitive-behavioral therapy for chronic pain

Objective

Online cognitive-behavioral therapy (iCBT) is effective in supporting patients’ self-management. Since iCBT differs from face-to-face CBT on several levels, proper training of therapists is essential. This paper describes the development and evaluation of a therapist training based on theoretical domains that are known to influence implementation behavior, for an iCBT for chronic pain.

Using Low-Fidelity Simulation to Maintain Competency in Central Line Care

PurposeMany healthcare facilities require staff nurses to complete annual competency assessments on central line care. However, the question arises, could simulation provide a better assessment of competency and possibly help nurses retain competence longer?Review of Relevant LiteratureA thorough review of the literature revealed that limited investigation has been done regarding the perception or effectiveness of simulation as a tool for competency evaluation. Multiple authors have identified simulation as an advantageous method for training health care providers in central line care. Several studies have linked simulation based training with decreased central line associated bacteremia rates. There is also evidence in the literature that simulation has great potential as a competency validation technique.DiscussionA sample of staff nurses participated in one of four central line care scenarios in a simulation environment. The participants were asked to complete a demographics survey as well as a self-assessment on central line competency prior to the simulation experience. Debriefing followed the simulation, offering the participant feedback on performance and verification of correct and incorrect actions. The self-assessment was then repeated to measure participant perception post-simulation.Implications for Clinical PracticeNo significant difference of performance in the simulation was inferred from baccalaureate-prepared nurses versus diploma or associate-prepared nurses. Almost all participants rated their competence in caring for a central line as either “competent” or “highly competent.” However upon demonstration of central line skills in the simulation, all but two participants omitted a critical step. Omitting these steps places the patient at risk for infection or other complications.     

No Train,No Gain?

[Clin Psychol Sci Prac 17: 36–40, 2010] What kind of training is needed for what type of clinician to deliver what type of therapy? Beidas and Kendall’s (2010) well‐considered recommendations for further research into systematic strategies for training clinicians to utilize evidence‐based treatments highlight the limitations of didactic training alone (without supervision, fidelity monitoring, and feedback) in conferring specific skills to clinicians. To further amplify some of the points made, we summarize findings from our recent series of trials, which involved training community‐based addiction clinicians to perform evidence‐based therapies in a multisite randomized clinical trial. In particular, review of tapes from the “treatment as usual” condition in that study suggests that (a) delivery of interventions associated with evidence‐based treatment was infrequent, (b) clinicians overestimated the time spent on evidence‐based interventions, and (c) ongoing supervision and performance‐based feedback appear to suppress time spent in session on discourse unrelated to the patient’s problems and concerns. We also discuss computer‐assisted treatment and computer‐assisted clinician training as important new tools for disseminating evidence‐based therapies.     

Competency-based residency training: the next advance in graduate medical education.

The goal of all graduate medical education is to ensure that the graduating physician is competent to practice in his or her chosen field of medicine. The evaluation of a resident's competency to practice, however, has never been clearly defined, nor has the fixed period of time given for residency training in each specialty been shown to be the right amount of time for each individual resident to achieve competency. To better ensure that new physicians have the competencies they need, the author proposes the replacement of the current approach to residents' education, which specifies a fixed number of years in training, with competency-based training, in which each resident remains in training until he or she has been shown to have the required knowledge and skills and can apply them independently. Such programs, in addition to tailoring the training time to each individual, would make it possible to devise and test schemes to evaluate competency more surely than is now possible. The author reviews the basis of traditional residency training and the problems with the current training approach, both its fixed amount of time for training and the uncertainty of the methods of evaluation used. He then explains competency-based residency education, notes that it is possible, indeed probable, that some trainees will become competent considerably sooner than they would in the current required years of training, quotes a study in which this was the case, and explains the implications. He describes the encouraging experience of his neurosurgery department, which has used competency-based training for its residents since 1994. He then discusses issues of demonstrating competency in procedural and nonprocedural fields, as well as the evaluation of competency in traditional and competency-based training, emphasizing that the latter approach offers hope for better ways of assessing competency.