浅析加拿大家庭医生培养体系

加拿大家庭医学发展较早,对加拿大家庭医生培养体系进行分析介绍,着重于从家庭医生"4+4+2"培养模式、高等学校全日制教育、住院医师规范化培训进行综述。加拿大通过多个层面完善家庭医生培养体系、持续职业开展、倡导及制定执行一系列的严格标准,从而确保了高质量的初级卫生保健。借鉴加拿大家庭医学教育的成功经验,结合我国国情,探讨比较了两国家庭医师培养特点、教学组织方式和师资力量等方面的问题。加拿大家庭医生培养体系中的优势表现在:①培养制度步骤清晰、阶段目标和路径明确;②行业协会作用巨大,政府规划,大学培养,分工明确;③家庭医生生源优秀,师资充沛,爱岗敬业,家庭医学发展条件较好。加拿大家庭医生培养的特点正是在于其结构的完整性和连续性,以医学院校教育为起点,家庭医学住院医师规范化培训为重点,并通过继续医学教育把教育培训同家庭医生持续终身的执业生涯统一起来。相比之下国内的家庭医生培养目标真正实现和家庭医学的理性发展还面临着许多困难。学习和借鉴加拿大家庭医生培养体系的成功经验和先进教学理念,有利于构建和完善具有中国特色的家庭医学教育培训体系,对于缓解国内社区卫生服务对高素质的家庭医生的急需具有十分重要的意义。      

高等医学院校医学生灾难医学教育课程的设计开发

目的 为本教研室的医学生提供结构化的教育指导和资源，开发和设计灾难医学课程。方法 采用医学教育课程开发六步法作为组织流程，急诊及灾难医学专家的专业知识、文献检索灾害医师培训计划、科学证据，作为内容开发的基础。结果 最后课程由14个模块组成，每个模块教学事件2 小时。介绍灾难医学概念，包括灾难的响应、医疗救助、法律条款、指挥、协调、沟通和大规模灾难的管理。综述全球灾难援助的医院预案和经验。讨论灾难发生条件下挽救生命的急诊治疗与有限的个人治疗。介绍爆炸、战争、辐射/核事件、化学和生物事件尤其是传染病和恐怖袭击初始处理的特殊性。灾难疏散的演习，大规模灾难分诊分流与当地救灾机构合作的模拟。当地消防部门合作演练个人去污与净化。人体模型复苏练习，个人防护设备应用练习。职业道德、应激疾病、社会心理干预措施和质量改进的培训。结论 该课程设计提供了合理的时间框架、多学科、多实践的灾难医学教育模式，可以作为医学生灾难医学教育的基本模板。因其具有全面灵活的组织结构，其进一步深化，也有利于急救或灾难专业医疗学生的灾难医学教育课程     

Takeover of Ontario Blue Cross may be sign MDs will soon face US-style managed care.

The privatization of health care is becoming a major issue on the Canadian health care agenda, with even the prime minister musing that the Canada's medicare system may no longer be able to cover all medical needs. This would appear to indicate that there will soon be a growing market for private health care in Canada, and the recent takeover of Ontario Blue Cross by an American company, the Liberty Mutual Group, is a sign this market is being recognized. Milan Korcok says the privatization trend holds major implications for Canadian physicians, who soon may witness firsthand US-style managed care.     

从汶川地震救援看医学生专业素质培养

本文通过总结汶川地震救援的经验教训,指出汶川地震救援对医学生专业素质培养提出了新的要求:必须对医学生进行灾害救援意识教育,强化灾害救援技能训练,实施灾害救援管理教育,加强灾害卫生防疫和心理疏导技能训练,使医学生成为既能适应平时医疗卫生防治、又能适应各种应急救援的专业化人才.     

The Physicians Who Care plan. Preserving quality and equitability in American medicine

To expand health care to all Americans, the organization Physicians Who Care favors a reshaping of current U.S. health care financing structures in preference to a national health care program like Canada's. The proposal comes in five parts. First, Bronow, et al. suggest mandatory employer-provided basic coverage with high deductibles. Second, for people of limited means, high deductibles can be substituted by individual medical savings accounts, established with pretax dollars. Third, instead of being funded entirely through taxes each year, Medicare could be funded partly through medical IRAs, required for every American from his or her first year of life. Fourth, long-term care should be taken out of Medicaid, and eligibility requirements should be changed. Finally, instead of allowing insurance companies to set health benefits, scientific guidelines should be established for medical care. Bronow, et al. also recommend that patients be made fully aware of any financial incentives for physicians.     

从汶川地震救援看医学生专业素质培养

本文通过总结汶川地震救援的经验教训,指出汶川地震救援对医学生专业素质培养提出了新的要求:必须对医学生进行灾害救援意识教育,强化灾害救援技能训练,实施灾害救援管理教育,加强灾害卫生防疫和心理疏导技能训练,使医学生成为既能适应平时医疗卫生防治、又能适应各种应急救援的专业化人才.     

广东省农村居民健康档案建立现状及影响因素分析

目的：调查广东省农村居民健康档案建立情况,分析其影响因素,为今后广东省农村居民健康档案建设研究提供依据。方法于2014年7~9月在广东省18个乡镇随机抽取74个村卫生室,对目标机构及村医进行自填式问卷调查。比较不同地区、财政补助情况和卫生机构培训情况等因素造成的建档率差异,采用Logistic回归分析法分析农村居民健康档案建设的影响因素。结果村卫生室举办形式以村集体办和个体办为主,分别占48.6%和47.3%;有58个村卫生室接受财政补助,占82.4%;农村居民健康档案平均建档率为(65.1±32.7)%;乡村医生接受培训、村医年龄和村卫生室有财政补助对农村居民健康档案的建立差异有统计学意义(P<0.05);Logistic回归分析结果显示,乡村医生接受培训和村卫生室有政府补助对健康档案的建立有影响。结论广东省农村居民健康档案建档率基本达到《广东省城乡居民健康档案项目实施方案》要求,但对于重点人群健康管理方面,粤东地区重点人群健康管理完成度低于其他地区,其重点人群健康管理工作还有待提高。健康档案建立的关键影响因素是乡村医生培训情况和村卫生财政补助情况。     

中西医结合的灾难医学课程在规培教育中的实施效果研究

为培养规培医师的灾难应答响应能力,本研究参考国内外经验设计了中西医结合的灾难医学课程。该课程由8个模块组成,共26学时,分别介绍了灾难的定义和分类,以及中医药在灾难医学中的位置等。针对上海中医药大学附属第七人民医院急创中心84名规培医师进行中西医结合的灾难医学课程教学,并进行教学效果评价。结果显示,培训前后规培医师客观成绩课前测试分数为（45.00±2.51）,课后测试分数为（76.25±2.76）,差异具有统计学意义（P<0.001）。课程前后分别对规培医师进行中西医结合的灾难医学相关知识主观了解程度的问卷调查,结果显示课前测试分数为（50.88±1.41）,课后测试分数为（64.64±1.80）,差异具有统计学意义（P<0.001）。结果表明,通过灾难医学教学相关课程,规培医师的理论知识、技能、灾难救援中的综合能力都有了很大的提高,为中西医结合的灾难医学教育相关课程的建立提供了参考。     

通过汶川地震看如何提高我国紧急医疗救援能力

通过研究汶川地震中绵竹市等地应急医疗救援信息与数据,比较救援效果,得到这样的提示:专业化的灾害医疗救援队在灾害医疗救援中起到了重要作用,成立我国地区性的专业化灾害医疗救援队,重视相关人员的培训和救援物资的储备是提高我国医疗救援水平和效率的重要举措.     

Northern Health Service in Canada

The current state and future development of Canada's North present significant medical problems. The medical facilities available at present are inadequate and, although they are improving rapidly, they must keep pace with the coming expansion of the North. Arctic regions of other northern countries do not show the great discrepancies in health standards that Canada's North does in comparison to her southern areas. To improve the situation adequate communication, transportation, personnel and facilities are needed. It is proposed that residents in hospital training programs work for a period in the North to supplement recommendations of the Hall Commission in this connection and to broaden their own training.     

新疆南疆地区村卫生室建设现状调查

目的深入了解新疆南疆地区村卫生室建设现状及存在的问题,为卫生行政部门合理配置卫生资源提供科学决策依据。方法采取新疆卫生资源填报系统对南疆喀什、和田地区村卫生室进行调查。结果村医队伍结构不合理,服务能力不高;村卫生室业务用房面积小,医疗设备配备不足。结论政府应加大对少数民族偏远地区村卫生室财政投入力度,采取建立乡村医师养老机制、加大对乡村医师的培训力度等措施提高村医整体素质。     

Computers a cornerstone of evidence-based care, conference told.

Computers are poised to become key players in the delivery of health care, but are physicians ready for them? A recent conference on medical communication in the electronic era examined the potential of computers to assist in diagnosis, provide continuing medical education, disseminate evidence and research findings, and simplify practice management. However, delegates were told that even though many medical practices are computerized, it is often staff members and not physicians who use the technology. For computers to gain wider acceptance for medical purposes, physicians need to be made comfortable with their use at an early stage of training.     

Emergency Health Planning

This paper outlines the development of emergency health planning as a function of government. Ten provinces have the basic responsibility for the organization, preparation and operation of medical, nursing, hospital and public health services in an emergency. The Department of National Health and Welfare is responsible for the provision of advice and assistance to the provincial and municipal governments in such matters. Eight provinces have now hired full-time planning staffs to co-ordinate the health planning of the Provincial Departments of Health and Provincial Emergency Measures Organization.

Four major programs have been established. The first program provides for the continuity of leadership and guidance by health authorities at the federal, provincial and municipal level. Essential records have been developed and emergency legislation prepared. This program, however, will be of little use unless health services are organized at the municipal level. In this organizational program, advice and assistance have been provided to existing hospitals and departments of health in the conduct of disaster planning. The efforts of these agencies are co-ordinated by municipal health authorities into a community disaster plan. The third program deals with information and education of the general public and the health workers. This program is designed to make the family unit self-sufficient for up to seven days and the health worker prepared to undertake his emergency role. The first three programs are directed to the organization and training of manpower; the fourth program provides the necessary supplies. From the national medical stockpile of $18,000,000, some $12,000,000 has been received, packaged for long-term storage and distributed to regional depots across the country. To ensure their ready availability in time of emergency an agreement has been reached with seven provinces for the release of hospital disaster kits.

     

Women in medicine: practice patterns and attitudes.

Increasing numbers of women are entering medicine in Canada. In 1959 women accounted for 6% of the medical school graduates, but by 1989 they accounted for 44%. Although there has been little systematic investigation of the impact of this increase on Canada's health care system, there are grounds for believing that female physicians bring with them distinctive values and interests, which may be reflected in the way they conduct their professional practices. We used data from a recent national survey of 2398 Canadian physicians to examine differences between women and men in their practices and their attitudes toward health care issues. Significant differences were found in the organization and management of the practices. Women preferred group over solo practice and were overrepresented in community health centres, health service organizations and centres locaux de services communautaires in Quebec. One-third of the women, as compared with half of the men, were in specialties. Even after adjusting for differences in workloads the incomes of the women were significantly lower than those of the men. Only minor differences were observed in the assessment of the health care system and alternative modes of organizing health care services. We believe that the differences were due to the double workload of women as professionals and family caregivers and the powerful socialization effects of medical education. As women overcome their minority status in the medical profession, differences between the sexes may become more apparent. Thus, the extent and effects of the progressive increase in the number of women in Canadian medicine should be assessed on an ongoing basis.     

The alluring myth of private medicine.

Canada's medicare system has provided Canadians with high-quality health care for almost three decades. Now Canadian health care appears to be at risk of losing the single-payer system, which is the premise on which medicare is built. As medicare comes under increasing financial pressure, many are calling for the introduction of private care as a means of bolstering our health care system and maintaining its quality. Although it appears alluring to some politicians, physicians and commentators, privatization could very well lead to the demise of the principles and practices of the Canadian health care system as we know it, with little clear benefit to the public or physicians.     

Hurricane preparedness among healthcare workers in St James

OBJECTIVE: To assess the preparedness of health workers in St James, Jamaica, to respond to natural disasters. METHODS: A cross-sectional survey was conducted on a 25% quota sample of hospital and health department staff in St James in 2005 (n = 307). Awareness of and attitudes to disaster management policies, plans and training and how these influenced their response in Hurricane Ivan were evaluated Statistical package for the Social Science 11.5 was used to summarize quantitative data, while qualitative data were analyzed manually. RESULTS: Most respondents (67%) knew of the disaster plan but only 40% had been trained in disaster management. More nurses (68%) and paramedicals (51%) reported being trained than ancillary/ auxilliary (33%), medical (21%) or administrative/clerical (18%) staff Most (96%) had participated in at least one disaster preparedness drill, usually a fire drill, but not in the previous two years. Attitudes towards disaster management were positive (99% insisted training should be compulsory, 95% agreed they should help in a hurricane). The majority (86%) reported being available to work at any time and 77% had worked as scheduled during Hurricane Ivan. Transportation and personal responsibility (to children, elderly or property) were the main limiting factors. Provisions for staff welfare (eg transportation, protective gear, media updates) were perceived as inadequate. Having defined disaster response roles was positively correlated with age, years of service and occupation (p < 0.01) CONCLUSION: Health workers in St James have positive attitudes to disaster management but require routine training to compensate for staff turnover. More attention must be given to staff welfare during disasters.     

CMA membership survey: opinions on issues facing the medical profession

A sample survey of Canadian Medical Association (CMA) members, conducted in early summer 1985 and designed to provide information to help guide the association's activities and policies, shows that most Canadian physicians support involvement in political activities both by CMA and by indivudual physicians. A majority wishes to maintain the concept of extra/balance billing, to pursue the position that the health care system is underfunded and favours medicare premiums and hospital user fees as the preferred methods for increasing revenue.

Most respondents believe that the number of doctors in Canada is about right but would prefer any reduction to be achieved by cutting medical school admissions or reducing postgraduate training positions open to graduates of foreign medical schools.

Most of those members who know of CMA policies on a number of health care issues agree with them and also find them useful, but a significant proportion are not aware of their content.

There is support for compulsory payment of dues by all licensed physicians to both their provincial medical association and CMA. A majority would like more information on pharmaceutical products and additional membership surveys.

     

Tuition fees for residents: one physician''s perspective

Although the education, expertise and guidance of Canada's academic physicians cannot be overlooked, individual universities appear to see tuition fees for residents as an easy source of much needed revenue. If tuition should "rise to market levels," perhaps residents' wages should similarly rise to reflect the amount of training received, skills required, responsibilities discharged and time expended. Unfortunately, tuition fees will be an area of contention for some time. Support of provincial resident associations and medical societies may lend both moral and, possibly, financial support to future members of the profession.     

北京市德胜社区卫生服务中心-内蒙古自治区乌兰察布市社区卫生健康帮扶带教工作的探索与实践

“十二五”期间,随着京蒙医疗帮扶的不断深入,京蒙社区卫生服务机构之间建立了帮扶关系,北京市西城区德胜社区卫生服务中心自2015年6月开始对内蒙古自治区乌兰察布市7家社区卫生服务中心进行医疗帮扶,为期6个月。帮扶期间通过远程视频、电话、微信、电子邮件、QQ群等方式,责任到科室点对点结对帮扶,进行远程中西医基本临床技能、心电图、B超、X线片、药品管理、处方点评、网络建设等各方面带教及业务培训指导,探索出了京蒙社区卫生服务机构健康帮扶带教的适宜模式。帮扶带教6个月后,乌兰察布市社区卫生服务中心的门诊量、医疗收入、医技检查数量、医生收入等较帮扶前有明显提高,医护人员诊疗技术水平得到一定程度的提升,健康帮扶工作得到了政府部门、医疗机构及居民的认可,带教帮扶方法具有一定的应用推广价值。本文介绍了德胜社区卫生服务中心-内蒙古自治区乌兰察布市社区卫生健康帮扶带教的具体方法,希望可以为其他地区开展帮扶带教工作提供 参考。     

Polls point to growing gap between MDs, patients over financing of health care

An unprecedented round of CMA polling points to some startling differences in the way physicians and patients perceive the financial problems facing Canada's health care system. One poll indicates that doctors consider recent federal budget cuts a sign that the private sector will soon have a major role to play in health care financing. However, a poll of nonphysicians shows that Canadians oppose any move toward “out-of-pocket” payments for health care services, including payments for private insurance. The CMA board has responded by turning much of the 1995 annual meeting over to the topic of the future of health care in Canada, including financing, and the medical profession's response.