督导式教学门诊在眼科住院医师规范化培训中的实践

目的：探讨督导式教学门诊在眼科住院医师规范化培训中的具体实践和教学效果。方法：通过合理排班、限制号源等措施设立每周固定的督导式教学门诊时间，安排老师和学员出诊；在教学门诊开展4个月后，通过问卷调查和临床技能考核的形式采集反馈意见并评估教学效果。结果：共有16名老师和8名学员参加了督导式教学门诊，调查问卷结果显示100%的带教老师和学员认可该教学模式，参加过教学门诊的学员临床技能考核得分显著高于对照组(t=3.631,P <0.0 5)。结论：督导式教学门诊应用于眼科住院医师规范化培训具有实际可行性，并可以提高学员的临床技能水平。     

智能手机裂隙灯照相功能在眼科临床教学实践中的应用

裂隙灯显微镜下眼部影像的实时呈现、采集是眼科临床教学的一大难题。智能手机裂隙灯照相功能与裂隙灯显微镜相接驳,可有效解决这一难题。本文介绍智能手机裂隙灯照相功能在眼科临床教学实践中的应用,分析其应用于眼科教学的优势及与传统教学方式的区别,指出智能手机裂隙灯照相功能在眼科临床教学实践中具有良好的应用前景,可提高学生学习的兴趣,加强临床资料的采集、演示、收集,以及提高眼科教学的实践性和可操作性。     

眼科住院医师规范化培训教学模式的应用研究

目的:探讨眼科住院医师规范化培训中不同教学模式的培训效果.方法:将60名于2015-01/2016-06在我中心进行住院医师规范化培训的住院医师随机平均分为讲授式教学(Lecture-Based Learning,LBL)、基于问题教学(Problem-Based Learning,PBL)和基于团队教学(Team-Based Learning,TBL)共三组,教学前后进行考核,对比考核成绩的变化.结果:教学后各组的成绩均有提高,TBL组成绩优于LBL组(P<0.001)和PBL组(P<0.001).亚组分析显示LBL可提高研究对象的基础知识(LBL vs PBL,P=0.002;LBL vs TBL,P=0.001);TBL有助于强化研究对象的临床思维能力(TBL vs LBL,P<0.001;TBL vs PBL,P<0.001).结论:TBL有助于强化培训对象的临床思维能力、提高眼科住院医师规范化培训的质量,其更适用于眼科住院医师规范化培训.     

贵州省眼科住院医师规范化培训现状调查

目的:通过描述贵州地区眼科住院医师规范化培训概况,以遵义医学院附属医院眼科为例具体分析评价培训内容及效果。方法:统计该地区眼科规陪学员的专业能力、就业情况、存在问题等现状,提出贵州省住院医师规范化培训保障机制的对策及建议。结果:自2006/2011年该地区共计培训学员16名,顺利毕业仅1名。结论:该地区眼科规培学员临床能力大幅提高,但保障政策是学员放弃培训的主要原因。建议医学本科生尽早考研,缩短教育成本。     

课程思政教育在眼科住院医师规范化培训中的实践研究

目的 探讨课程思政教育融入眼科规范化培训中的实践结果和影响因素。设计 回顾性教学研究及问卷调查。研究对象 2010年6月至2019年6月57位在上海市第六人民医院眼科规培的医师。方法 采用问卷调查量表评价课程思政融入规范化培训结果和影响因素。问卷量表包括6个问题及5个影响规范化培训课程思政教育效果的因素。每个问题分为5个等级,评为1～5分。主要指标 问卷评分。结果 规范化培训医师对课程思政教育看法6个问题的问卷结果：是否有助于提高处理医患关系能力4.89分,影响课程思政教育因素3.04分,医院开展情况2.28分,医院开展形式是否多样化2.18分,规培医师参加次数3.18分,开展课程思政有无困难1.81分。影响规范化培训课程思政教育效果的5个因素的调查结果：89.50%的规范化培训医师认为课程思政实践环节少,82.50%认为思政教育整体素质在思政教学效果中的影响作用大,17.50%认为社会等环节在课程思政教育中的影响作用大,57.90%认为医院的党政领导不够重视在课程思政教育中的影响作用大,仅3.5%的规范化培训医师认为医院现有课程思政教育手段单一。结论 已经开展的课程思政教育实践有助于规培化培训医师人文素养及处理医患关系能力的提高,影响课程思政教育效果的主要因素是课程思政实践环节少,思政教育整体素质也是影响课程思政教育效果的主要因素之一。（眼科, 2020, 29： 405-408）     

眼科专科医院住院医师规范化培训实践与思考

眼科住院医师规范化培训(以下简称“规培”)是培养眼科医师的必要环节。我国规培模式日臻成熟,但眼科规培过程管理中仍存在诸多问题,包括专科医院和综合医院的规培协调问题、师资激励、规培学员类型多样、研究生和规培“双轨制”、如何开展显微手术技能培训等,很多具体方案和措施仍在摸索中。眼科专科医院学科体系建设相对完善,配备更充足的教学资源,有一定的规培经验,是眼科规培的主力军。汕头国际眼科中心结合国家要求创建了一套规培模式,注重规范化、标准化和个性化相结合,并通过借鉴香港及海外住院医师培训经验,丰富理论培训形式,优化操作培训环境,突出外语和科研能力训练,强调系统性临床思维。本文基于汕头国际眼科中心五年来开展眼科规培的实践经验与思考,总结当前眼科专科医院规培现状,并提出对策和建议。     

智能手机配合裂隙灯前置镜检查在基层医院眼底病诊疗中的应用

目的：探讨在基层医院通过智能手机的照相功能联合手机夹子在眼底图像采集中的应用。

方法：自购手机夹子,将手机与裂隙灯一侧目镜相接,并牢靠固定。利用裂隙灯的裂隙光带,配合裂隙灯前置镜,进行眼底照相。

结果：手机夹子牢靠固定于裂隙灯,通过裂隙灯前置镜,利用裂隙灯显微镜的光学系统,能顺利成像。获得的图片清晰,色彩度及对比度均较好,病变重点突出,利于观察。对采集的图片利用互联网进行交流,可通过微信传输给患者进行个人资料保存或者发送给上级医院医生进行远程会诊。

结论：手机夹子购买方便,简单易得; 800～1 000万像素的智能手机广泛普及,成像质量完全可以满足临床需要,能够丰富临床资料,便于医患之间病情的顺利沟通,同行之间的快捷交流及学习。同时对于疑难问题,可快速远程会诊,及时快捷地对疾病做出诊断和治疗。     

将眼科住院医师规范化培训教育落到实处

住院医师规范化培训(简称“住培”)是我国新医改的一项重要举措，旨在通过住培来使我国临床整体医疗水平同质化提高，解决民众日益增长的医疗需求和各地医疗发展不平衡之间的矛盾。我国眼科住培改革经历十余年，在追求同质化的实践中发现一些值得重视的问题，如教学师资的选拔和培训、临床操作类教学的落实、教学师资待遇的提升以及包括人文在内的住院医师诊疗能力全面培养等。本文探讨了这些问题的根源和解决方法，希望通过改革将住培这一临床医学基础工程更好的落到实处。     

临床指南结合TBL教学在眼科住院医师规范化培训中的应用

目的:探讨眼科临床指南结合团队式学习(team-based learning,TBL)教学课程在眼科住院医师规范化培训中的应用及教学效果。方法:本研究选取2022年1月—2023年6月在广州医科大学附属第一医院眼科进行住院医师规范化培训的15名住院医师作为研究对象,先后交替使用自学讲课、TBL教学这两种教学模式进行眼科临床指南学习,通过填写满意度调查问卷及评估出科考通过率、学业水平测试成绩、结业考通过率,从主观及客观角度探讨临床指南结合TBL学习模式的教学效果。结果:住院医师对增加眼科临床指南学习具有较高评价,且不认为会增加其学习负担。开展指南学习后,住院医师出科考试及格率、学业水平测试通过率、结业考通过率均为100%。在培养团队合作能力、改善学习氛围两方面,TBL讲课的满意度均高于自学讲课(均P<0.001)。93.3%(14/15)的住院医师更喜欢TBL教学模式。结论:眼科临床指南结合TBL教学是一种有效的教学模式,住院医师在主观满意度调查问卷及客观考试成绩的评估中,均达到满意的教学效果。     

智能手机照相功能在裂隙灯显微摄影中的应用

目的探讨智能手机附带的照相功能在裂隙灯显微镜显微摄影中应用的价值。方法利用易获取的材料自制转接环,将智能手机的照相机与裂隙灯显微镜目镜接驳,在自制辅助照明光和弥散光配合下,进行裂隙灯显微镜眼前段摄影,对采集的图片进行数据库管理、利用互联网进行交流。结果自制接口能够精确接驳于裂隙灯显微镜的光学系统,能使智能手机附带的照相机顺利成像。所获得的照片清晰度、色彩还原度、对比度均较好。能够较为清晰地显示组织细节、病变特点。结论500～800万像素的智能手机采集的裂隙灯显微镜照片,在影像质量上可满足临床需求,能够丰富客观临床资料,有助于方便快捷地进行同行交流,直观地进行医患交流,在眼外伤方面,可为法医和医保鉴定提供图像资料。自制转接环成本低廉、易于普及。     

智能手机在眼科学互动式教学中的应用

以智能手机为标志的移动互联网,不仅对高等学校课堂教学构成了严峻的挑战,也是教育信息化的重大机遇。我们将以智能手机为载体的“互联网”引入眼科学课堂,利用智能手机具有丰富的教学资源、多元的学习方式、灵活的学习时间、整理和记录功能以及及时、全面、准确的教学反馈等特点,整合案例教学,进行互动式教学,可以激发学生的学习兴趣和热情,提高教师教学水平,获得良好的教学效果。     

Impact of a month-long training program on the clinical skills of ophthalmology residents and practitioners

A cohort study was performed to assess the impact of an intensive, hands-on, supervised training program in ophthalmic clinical evaluation, for ophthalmology residents and private practitioners. All students underwent one-month training in comprehensive ophthalmology examination and investigations at a tertiary care center between January 2004 and January 2006. The training methodology included didactic lectures, video-demonstrations and hands-on training. The participants completed a self-assessment with a set of 23 questions designed to assess the level of confidence in various skills on the first and last day of the training. Of a total of 118 students, 67 (56.8%) were residents and 51 (43.2%) were practitioners. The mean score pre-training was 38.3 out of 92 (S.D. ±16.9), and was 70.6 out of 92 (S.D.± 10.1) post-training. The mean increase in the scores was 32.3 (P value < 0.001). We concluded that intensive, short-term training programs could improve the self-perceived level of confidence of ophthalmology residents and practitioners.     

Ophthalmology residency trainers‘ perspective on standardization of residency training in India

Purpose:The aim of this study was to study the perception of residency trainers about an optimum residency program.Methods:A survey, using a pre-validated questionnaire, was conducted by the Academic and Research Committee of the All India Ophthalmological Society, in 2019-20 with questions directed to teachers in medical colleges and national board of examination‘s ophthalmology residency programs on demography, teaching experience, imparting clinical and surgical skills, ideal academic schedule and dissertation in the post-graduate residency program.Results:The response rate in the survey was 47.6%. Valid responses were obtained from 309 residency trainers. Of these, 132 of 309 (42.7%) were females. The mean age was 45.3 ± 9.5 years, range 26-68 years. The trainers believed that on a scale of 0-10, clinical skills teaching should be taught, mean ± SD: slit lamp 9.8 ± 0.7; indirect ophthalmoscopy 9.3 ± 1.3; gonioscopy 9.2 ± 1.5; perimetry 8.9 ± 1.5; OCT 8.4 ± 1.9; applanation tonometry 9.5 ± 1.2 and orthoptic evaluation 8.1 (±1.9). A resident should ideally perform independently surgeries (median, inter-quartile range IQR): SICS 50 (IQR 40-100); phaco 50 (20-60); pterygium excision 20 (10-40); DCR 10 (5-20); chalazion 20 (10-50), trabeculectomy 7 (5-15); strabismus 5 (2-10), LASIK and retinal detachment 0. Ideally there should be four lectures, four seminars, four case presentations, five journal clubs and four wet labs every month.Conclusion:Teachers expected their wards to become competent professionals. There was near unanimity about the content of clinical skills training, non-medical skills and academics, but there was a significant variation on extent of surgical training that should be imparted to the residents.     

Using the CanMEDS roles when interviewing for an ophthalmology residency program

Background: To improve the admissions process for the Université de Montréal (UdeM) ophthalmology residency program, the interview structure was modified to encompass the seven CanMEDS roles introduced by the Royal College of Physicians and Surgeons of Canada (RCPSC).These roles include an applicant’s abilities as a communicator, collaborator, manager, health advocate, professional, scholar, and medical expert.Methods: In this retrospective pilot study, the records of all applicants were reviewed by 8 members of the admissions committee, with a high intraclass correlation coefficient of 0.814. Four 2-person interview teams were then formed. The first 3 groups asked the applicants specific questions based on 2-3 of the CanMEDS roles, marking their impressions of each candidate on a visual analogue scale. The last group answered candidates’ questions about the program but assigned no mark.Results: The intraclass correlations for the teams were 0.900, 0.739, and 0.585, demonstrating acceptable interrater reliability for 2 of the teams. Pearson correlation coefficients between groups of interviewers were considered adequate at 0.562, 0.432, and 0.417 (p < 0.05). For each interviewer, the Pearson correlation coefficient between record marking and interview scoring was either not statistically significant or very low.Interpretation: By basing the 2006 interview process on the CanMEDS roles defined by the RCPSC, information was obtained about the candidates that could not have been retrieved by a review of the medical students' records alone. Reliability analysis confirmed that this new method of conducting interviews provided sound and reliable judging and rating consistency between all members of the admissions committee.     

Feedback of final year ophthalmology postgraduates about their residency ophthalmology training in South India

Background and Aims:

This study documents a survey of final-year ophthalmology postgraduate students on the subject of their residency training. A similar survey conducted 7 years ago published in IJO had concluded that the residency program was not up to expectations in many centers. Our study aimed to see if ophthalmology training and student perceptions differed since then.

Materials and Methods:

For our study, we added a few questions to the same questionnaire used in the article “which is the best method to learn ophthalmology? Resident doctors’ perspective of ophthalmology training” published in IJO, Vol. 56 (5).

Results:

Forty-nine students (62.02%) returned completed forms. Most students desired an orientation program on entering residency, and wished to undergo diagnostic training initially. Case-presentation with demonstration and Wet-lab learning were most preferred. There was a big difference between the number of surgeries students actually performed and the number they felt would have been ideal.

Conclusion:

On the whole, the students still felt the need for improved training across all aspects of ophthalmology.     

Adoption of newer teaching methods to overcome challenges of training in ophthalmology residency during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has disrupted training programs across all specialties. Surgical specialties, such as ophthalmology, that need continued microsurgical training are affected the most. The pandemic has resulted in ophthalmology residents being taken off their regular duties in ophthalmology and inducted into COVID duties. The focus on COVID care has de-emphasized training in ophthalmology. We highlight the challenges that teachers face in continuing the training programs of theory, clinical skill, and surgical skill transfer. Embracing technology is the need of the hour. We discuss the multiple options available to enable continued training programs and emphasize the need for all training institutes to include technology as an additional component of their training curricula.     

眼科八年制学生临床和科研培养的思考

针对眼科八年制学生的培养要求,结合自身从事眼科八年制学生的教学经验,就眼科基础理论学习、医患沟通能力培养、临床基本技能训练、显微手术技巧学习、眼科亚专业兴趣培养及基本实验技能培训等方面进行了思考,以期提高眼科八年制学生的综合能力。     

临床眼科专业在职硕士研究生培养的回顾与思考

随着临床医学生培养的多元化,在职研究生的培养逐渐形成完善的体系。如何培养高质量的眼科在职研究生是很多学院和导师面临的重要问题。本文分析了临床眼科在职研究生培养中存在的问题和相关解决方法的探索。