浅谈专科医师规范化培训

专科医师培训主要是指医学专业毕业生完成院校教育之后，在经过认可的培训基地，以住院医师的身份，接受以提高临床能力为主的系统、规范的培训。其培训目的是使住院医师达到某一临床专科所需要的基本理论、基本知识和基本技能要求，成为能独立从事某一专科临床医疗工作的专科医师。整个培训过程分为普通专科培训和亚专科培训两个阶段。     

浅谈住院医师规范化培训

医学教育大体上可分为学校教育、毕业后教育和继续医学教育三部分，三者构成医学教育的全过程和有机的整体，在医学教育中占有同等重要的地位。毕业后医学教育主要指医学本科、硕士、博士研究生毕业后至成为专科医师之前的学习和培养过程，它又分为住院医师规范化培训和专科医师培训两大阶段。因此，毕业后医学教育作为医学教育的组成部分和今后医学院校及各教学医院教学工作的重要内容日益受到重视。住院医师规范化培训是毕业后医学教育的起步和开始阶段。     

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     

社会化学员的探索——试点中的专科医师培训

2003年卫生部在全国开展住院医师规范化培训和全科医师培训基础上．开展“建立我国专科医师培养和准入制度”课题研究．探索我国专科医师制度。在“中国医师协会2005年度医师管理者峰会”上．卫生部科教司副司长孟群明确指出我国现有的住院医师培训制度与专科医师培训制度的联系：“住院医师培训制度是专科医师培训制度一个重要的组成部分．住院医师培训是一个必备的过程．     

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。     

建立专科医师制度的实践和探索

北京市卫生局在总结过去进行多年的住院医师规范化培训的基础上，2004年8月根据卫生部“开展专科医师培养与准入制度”的部署，在全国率先进行住院医师／专科医师培训试点。在培训对象，培训模式，培训期间人事管理、有关待遇，培训经费及培训基地建设等方面进行了大胆的实践和探索，尤其是对北京地区专科医师培训实行辖区管理进行了有益的探索。     

开展专科医师培训工作的实践探索

2010年2月卫生部等五部委发布了<关于公立医院改革试点的指导意见>,明确提出"建立住院医师规范化培训制度",并作为改革试点的九项主要任务之一,把住院医师培训作为全科医生、专科医生培养的必经环节[1].住院医师/专科医师培训是遵循医学人才成长规律的必然要求,对培养临床医师的临床工作能力至关重要[1-4].我国的专科医师培训工作目前尚处于试点阶段[2],在此阶段医院如何有效地做好专科医师培训工作,是目前医院管理者急需考虑的问题.我们从基地软件建设角度出发,简要分析医院开展专科医师培训工作的意义和面临的主要问题,并分别从医院可采取的措施和需政府部门协调的措施二个层面提出相应的对策和建议.     

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。     

住院医师/专科医师通科培训必要性的探讨

当前医学生临床实践活动在时间上不能保证,质量上又明显下滑的情况下,增加住院医师/专科医师通科培训是十分必要的。不仅能弥补临床实践的不足,而且也能为医学生向住院医师平稳顺利过度作铺垫。住院医师/专科医师培养是医学生向临床医师角色转换的一个重要的过渡阶段,因此,培训时间、学习内容安排的科学、合理与否将直接影响培养效果。住院医师/专科医师通科培训应为培养具有较高临床综合能力的医学人才奠定基础。     

住院医师麻醉相关技能的培训

住院医师培训是毕业后医学教育的一个重要组成部分,在这个阶段,住院医师在上级医师的指导下进行临床实践,通过规范的要求和严格的考核,从而学习到合格医师所必需的知识、技能、工作态度.在国外住院医师的培养都必须经过1～3年的通科培训或轮转阶段,其中麻醉科的轮转培训几乎是不可或缺的[1].在住院医师的培训中进行麻醉科专科性的临床技能与临床思维能力的培养是非常必要的,日本的住院医师要求一定要学会并且熟练掌握气管插管等心肺复苏必需的基本技术[2].我们对麻醉科作为临床科室在住院医师规范化培训过程中所起的作用进行了初步探讨.     

Specialist training of Slovene family physicians

Family medicine in Europe started to develop in the 1960s with the introduction of obligatory specialist training. Slovenia is a country with a long tradition of family medicine specialist training, but up until 2002 this was neither elaborated on nor conducted by peers in general practice/family medicine. When the country's socialist system started to transform due to political reforms, Slovenia began to modify its system in order to meet the criteria of the European Union. One of the changes was the introduction of a new healthcare system with an influential Medical Chamber responsible for postgraduate training in all specialities. A new model for vocational training in family medicine was established in 2002, following the recommendations of the European Union of General Practitioners (UEMO). According to the new programme, which lasts 4 years, trainees spend half of their training in a hospital setting and half in general practice, where they are supervised by a trainer in practice. This article describes the legal process of introducing new forms of specialist training in Slovenia, and its content. CONCLUSION: A comparison with UEMO countries shows that the new model is comparable to other countries.     

Specialist training of Slovene family physicians

Family medicine in Europe started to develop in the 1960s with the introduction of obligatory specialist training. Slovenia is a country with a long tradition of family medicine specialist training, but up until 2002 this was neither elaborated on nor conducted by peers in general practice/family medicine. When the country's socialist system started to transform due to political reforms, Slovenia began to modify its system in order to meet the criteria of the European Union. One of the changes was the introduction of a new healthcare system with an influential Medical Chamber responsible for postgraduate training in all specialities. A new model for vocational training in family medicine was established in 2002, following the recommendations of the European Union of General Practitioners (UEMO). According to the new programme, which lasts 4 years, trainees spend half of their training in a hospital setting and half in general practice, where they are supervised by a trainer in practice. This article describes the legal process of introducing new forms of specialist training in Slovenia, and its content.

Conclusion: A comparison with UEMO countries shows that the new model is comparable to other countries.     

上海市实行专科医师制度的策略研究

目的探讨上海市建立既符合实际又与国际接轨的专科医师制度办法。方法通过对相关文献回顾,借鉴先进国家和地区实践经验,就其中关键问题,如专科医师制度的管理框架、专科培训基础、资格认定模式以及配套政策等,进行问卷调查。共对上海市122所二级及以上医院1467名管理人员、临床专家和住院医师进行问卷调查、通过分析总结,提出上海市实行专科医师制度的策略。结集认为行业学会应承担制定标准和资质认定职能的分别占67.17%和66.64％,认为卫生行政部门有必要对行业协会的评定结果进行复审的占45.40％;有72.35％的被调查者认为专科医师培训可以构筑在住院医师规范化培训基础上;67.10％的被调查者认为培训经费应由政府和个人共同分担;95.66％的被调查者认为在获得专科医师资质认定证书后需要定期接受资质再认定。结论依据调查结果,同时借鉴其他国家和地区的实践经验,可以认为,上海实施专科医师制度可采用“行政授权”模式,关键在于克服人事等配套政策上存在的问题。此外,专科医师资格认定模式可归纳为“PPCR”模式。     

肿瘤专科医师培训构想

根据我国专科医师培训制度的设计,结合我国肿瘤防治特点,提出肿瘤专科医师培训的设想:肿瘤专科医师培训应采取分阶段培训方式,以肿瘤专科医院作为培训基地,将肿瘤的规范化治疗、综合治疗为亚专科培训的重点内容,以"专病专治"医师作为肿瘤专科医师培训的目标.     

University teaching hospitals hold primacy in graduate medical education

The university teaching hospitals are legally commissioned for the development and implementation of the initial medical training for doctors and for the training of specialist registrars, i.e. graduate medical education. They are able to carry out this task partly due to the professionals' collective sense of ambition and a strongly focussed organization that has the necessary critical mass at its disposal.     

专科医师培养人事分配管理模式的思考

我国建立专科医师培养制度的序幕已经拉开,如何建立专科医师培养期间人事分配管理模式是面临的新课题.通过对目前住院医师培养人事分配管理现状分析,阐述了建立专科医师培养人事分配管理模式应注意的五方面内容,旨在为我国专科医师培养制度的建立和完善提供参考.     

军队手术室专科护士灾害救援能力培训模式

目的 探讨军队手术室专科护士灾害护理救援能力的培训模式,提高军队各级医院手术室专科护士灾害救援能力和水平.方法 以全军手术室护理示范基地为依托,在专科护士培训的基础上增加灾害救援能力培训,以教学设计为基础,模块化的灾害救援理论知识为支撑,结合灾害现场模拟化急救技能训练,采用单人训练和多人互训模式,以标准化的能力训练流程为规范,对受训护士进行技能和理论考核.结果 受训的军队手术室专科护士在灾害救援能力方面得到较大提高,训练效率得到有效提升.结论 该院建立的军队手术室专科护士灾害救援能力培训模式,能适应军队手术室护士灾害救援能力的培训需求,且培训效果较好,具有较强的实用价值,可推广到各级医院手术室专科护士的灾害救援能力训练中.     

Progression of junior doctors into higher specialist training

OBJECTIVES: To report on the transition of junior doctors into higher specialist training in the UK, following the Calman reforms and recent initiatives to promote training in general practice. Design and setting Postal questionnaire survey carried out in the UK. PARTICIPANTS: All graduates of 1996 from UK medical schools were surveyed in 2002. MAIN OUTCOME MEASURES: Outcome measures were considered to be details of applications, outcomes of applications, intentions to apply for specialist training, and career plans with regard to such issues as flexible training and work. RESULTS: Of 2312 responders, 39% had applied for specialist registrar (SpR) training and 35% for general practice (GP) training. Of applicants for SpR training, 68% were successful; 24% failed, almost all of whom intended to reapply, many after gaining research experience; 4% awaited a decision, and 4% had had another outcome (e.g. they withdrew their application). A sixth of responders intended to apply but had not yet done so. Of applicants for GP training, 95% had been successful. A further 2% intended to apply but had not yet done so. Responders viewed flexible and part-time training and work opportunities, and information about available posts, as being more widely available in general practice than in hospital practice. Half of the responders did not agree that their postgraduate training had been of a high standard. CONCLUSIONS: Progression into GP training seemed to have been a smoother and less protracted process than that into SpR training. Delayed applications for SpR training were common, and many of those who had applied had not been accepted. The use of research experience to strengthen a re-application was common.     

Specialisation in general surgery

This survey was designed to determine the current status of specialisation within general surgery amongst newly appointed consultants in the United Kingdom, and to document the extent of specialist training on programmes of higher surgical training. It was carried out in 1988 under the auspices of the Association of Surgeons in Training, to determine whether consultants appointed in recent years had maintained, developed, or abandoned subspecialist practice. A separate survey of senior registrars in general surgery examined their attitudes to the apparent need to offer a special interest at the time of consultant appointment, and afterwards in practice. Although a majority of general surgical trainees and newly appointed consultants support specialist training as a part of higher surgical training programmes, this survey suggests that some programmes are not achieving this ideal.     

专科医师培训网络管理系统的构建

作为卫生部首批专科医师培训基地,南京大学医学院附属鼓楼医院在考察、借鉴国内外专科医师培训的管理制度后,结合实际,开发了专科医师规范化培训网络管理系统并投入使用,有效地提高了专科医师培训管理的效率。