发挥医院资源优势 做好住院医师临床能力考核工作

住院医师的培养与考核是分不开的。南京医科大学第一附属医院有着丰富的师资力量和教学设备。充分调动带教老师的积极性，运用多种考核方式进行分层次临床能力考核，是实践工作中首先要考虑的。在新的大环境下，不断创新，借助先进的科学技术，逐步建立起符合医院实际的考核方式。     

加强总住院医师培养的思考

文章阐述了总住院医师阶段的培养特点,对现阶段总住院医师培养中存在的问题及原因进行了分析,认为总住院医师培养是医学人才培养中不可或缺的重要阶段。只有加强总住院医师阶段的培养,才能造就合格的医学人才。     

Methods of teaching stapedectomy

OBJECTIVES: Establish a better method of teaching residents stapes surgery, with the goal of improving surgical outcome. STUDY DESIGN: A stapes surgery teaching module was developed with specific criteria to evaluate resident performance. A prospective study of stapes surgery performed by teaching module trained residents was compared with a retrospective review of stapes surgery performed by non-teaching module trained residents. METHODS: Four residents naive to stapes surgery were assigned to a stapes surgery teaching module. Stapedectomy of 20 temporal bones per resident, with six 3-hour laboratory sessions, was performed. Laser (CO2 and argon) as well as mechanical techniques were used. Specific scoring criteria were applied to measure performance. Results of actual stapes surgery of teaching module trained residents were compared with those of a comparable group of non-teaching module trained residents. RESULTS: Laser techniques in the laboratory resulted in statistically significantly better scores by defined criteria than mechanical techniques. Results of actual stapes surgery performed by teaching module trained residents demonstrated a trend toward better surgical results, although this was not statistically significant. CONCLUSIONS: Graded operative experience and standard temporal bone surgery courses may not adequately prepare residents for stapes surgery. A teaching module with criteria to evaluate performance better prepares residents for this delicate procedure. Lasers provide a significant advantage in the laboratory model and should be used by residents at surgery. Residents not wishing to perform stapes surgery because of career pathway should be encouraged to turn over their cases to fellow residents.     

Intimate Partner Relationships,Work-Life Factors,and Their Associations With Burnout Among Partnered Pediatric Residents

Background

Burnout is prevalent among pediatric residents, and reducing burnout is a priority for pediatric residency programs. Understanding residents’ personal circumstances, including relationship satisfaction and perceived work-life conflict, may identify novel determinants of burnout.

《住院医师规范化培训基地认定标准》和《住院医师规范化培训内容与标准》修订的解读

住院医师规范化培训(住培)是医学生成长为合格医生的必由之路。自2014年国家全面推行住培,儿科住培工作总体进展顺利,取得有目共睹的成绩。为进一步适应住培现状,符合全国儿科培训需求,提高儿科培训质量,儿科专业委员会组织专家代表集思广益,对儿科《住院医师规范化培训基地认定标准》和《住院医师规范化培训内容与标准》两个标准进行适当修订。修订标准遵循两个标准的延续性、可及性、先进性和一致性原则。主要聚焦降低基地规模、提出专业组概念、灵活专业轮转、强化分层培训等,以期在床位规模等不提高前提下,能提高基地培养住培学员临床科研和教学等综合能力。相信通过良好政策引导和支持、医教协同,儿科住培体系将为儿科医学人才培养提供坚实基础。     

What do surgery residents do on their call nights?

BACKGROUND: Surgical resident education is entering a critical era of achieving core competencies despite work hour restrictions. An assessment of on-call activity is needed to maximize educational merit. METHODS: A time-motion study of resident on-call activity was performed at a university medical center and an urban affiliate hospital. Residents were followed by "shadow" residents who concurrently recorded resident activity. RESULTS: Activities of daily living and patient evaluation comprised the majority of on-call activity. Residents slept a median of 200 minutes per night. Cross-coverage activities accounted for 41% of pages and 19% of patient evaluation. Direct patient contact comprised only 7% of call night duties. Communication activity occupied 15% of total minutes, and a mean of 16 pages were received nightly. Significant differences in activities existed between resident levels and hospitals. CONCLUSIONS: Call activity consists primarily of activities of daily living, patient evaluation, and communication. Sleep accounts for nearly one third of all on-call activity. These data may be useful in improving both patient care and resident call experience.     

Errors and adverse outcomes on a surgical service: what is the role of residents?

PURPOSE: The extensive changeover in residents that occurs every July in university-affiliated hospitals has been postulated to result in impaired delivery of patient care as new house staff are less experienced and unfamiliar with hospital-specific systems (the "July phenomenon"). To assess the impact of this process on patient safety, we examined the incidence and sources of medical error and adverse outcomes on a pediatric general surgery service during the final month of an academic year and the first month of the subsequent academic year. MATERIALS AND METHODS: All admissions to two pediatric surgeons during June and July 2002 were prospectively followed. The attending surgeon, a surgical fellow, and a medical student reviewed in-patient care daily. Errors committed by doctors, nurses, and allied health workers were identified through daily patient encounters, nursing rounds, medical rounds, and chart audit. Adverse outcomes were evaluated based on type and contributing factors, including involvement of residents. To correct for variations in patient volume, the incidence of errors and adverse outcomes were expressed as a percentage of total patient days. RESULTS: The error rate was 46/643 patient days (7.1%) in June, and 58/776 patient days (7.5%) in July (P = 0.9). Resident error accounted for 52.2% of errors in June and 39.7% of errors in July (P = 0.28). There was no significant difference in the adverse outcome rates (5% versus 6.7%, P = 0.21) or incidence of error-related adverse outcomes (10.8% versus 22.4%, P = 0.2) between June and July. Most errors were made by the on-call resident. CONCLUSION: Resident changeover at the completion of an academic year did not result in an increased number of medical errors or adverse outcomes, indicating that effective systems are in place to prevent the "July phenomenon."     

住院医师培训实践与体会

我国住院医师培训制度是医学生毕业后教育的重要组成部分.从发展趋势看,我国住院医师培训制度正向专科医师培训制度发展.本文介绍了我院目前在住院医师规范化培训制度取得的经验,面临的困难和存在的问题,并对此提出积极的建议.     

2000～2004年天津市居民膳食营养状况调查

目的研究2000～2004年天津市城市居民膳食营养摄入状况。方法利用天津市统计局2000～2004年天津城市居民各种食物的消费量和人口资料,通过膳食计算和统计分析,研究天津市2000～2004年食物消费状况、各种营养素摄入及营养素的食物来源情况。结果天津市城市居民动物性食物、水果、蔬菜摄入较合理,蛋白质质量较好,谷类、奶类、豆类食物摄入偏低,维生素A、B1、B2、钙摄入量占推荐摄入量（RNIs）或适宜摄入量（AIs）百分比偏低,脂肪占总热量偏高（34%～35%）。结论天津城市居民膳食不均衡,部分微量营养素摄入不足,脂肪摄入偏高。应进一步加强合理营养教育,完善居民饮食结构,以满足平衡饮食和合理营养的要求。     

江西省城市社区居民蜚蠊知识认知水平调查分析

目的了解居民住宅蜚蠊侵害现状和居民对蜚蠊知识的认知水平,为社区开展健康教育和蜚蠊防治提供依据。方法对452名居民进行问卷调查。结果居民住宅蜚蠊侵害率为96.02%;居民防治蜚蠊的意识很强烈,态度很积极;蜚蠊防治知识的认知水平停留在比较浅显的程度,有大环境治理概念,但对于清除卵鞘、堵洞抹缝等重要的治本措施了解甚少,蜚蠊防治知识不专业、不全面;37.83%的居民不知道蜚蠊是否传播疾病;居民获得蜚蠊知识的主要途径是大众媒体,来自社区健康教育的比较少。结论政府部门应重视居民住宅蜚蠊防治工作,加强社区健康教育,普及有关蜚蠊专业知识,做好环境治理。