Choice of general practice for postgraduate training among medical graduates and undergraduates in Nigeria

A questionnaire survey of career choices was carried out among 112 medical graduates, after one year's internship (group I), during their National Youth Corps programme in Kaduna, Lagos, Cross River and Oyo states of Nigeria, and 365 final-year medical undergraduates (group 2) in the colleges of medicine in the corresponding states. A total of 13% in group I and 40% in group 2 were undecided as regards their first choice. Obstetrics and gynaecology was the most popular first choice in both groups. General practice ranked fifth among group I, but displaced surgery to rank second among group 2. The differences were statistically significant. A total of 41% of group I and 46% of group 2 preferred to work in a teaching hospital, reflecting the high preference for surgical specialties. Twenty-six per cent and 33.7% of respondents in groups 1 and 2 respectively wished to own their own practice or work in the private sector. General practice is a new specialty and its growth is supported by a national postgraduate training programme. A shift towards general practice is seen compared with previous studies of career preference among Nigerian medical graduates and students. This may be due to a changing balance of supply and demand in the medical work-force, or a better assessment of the nation's health problems and manpower needs.     

Postgraduate qualifications of British doctors

Among British-qualified doctors of 1974 and 1977, about 80% held postgraduate qualifications of some kind. The commonest qualifications were DRCOG, MRCP and MRCOG. There were considerable differences between medical schools in the numbers of qualifiers taking various examinations. Apart from the MRC Psych, DRCOG and Family Planning Certificate, qualifications were more commonly held by men than women. Tables show the type of work being done 9-13 years after leaving medical school by holders of various postgraduate qualifications; e.g. 60% of MRCP holders were working in medicine or a medical specialty and 84% of FRCS holders in general surgery or a surgical specialty. Discussion deals with the plurality, specificity, variability, perceived necessity, sufficiency, international utility and career significance of British postgraduate qualifications.     

Home, training and work: mobility of British doctors

This study examines the locations of family homes, medical schools and places of specialist training, and work of doctors qualifying from UK medical schools in 5 calendar years between 1974 and 1993. The contribution of each UK region to the medical workforce relative to its population is assessed and trends over time are examined. The relationship between place of family home and medical school attended is examined for 14,108 doctors. Career appointment location and its relationship to medical school and family home loc‐ation are examined for over 4000 doctors. For the qualifiers of 1983, an additional analysis incorporating place of training is included. Large differences were found in the percentage of medical students from local family homes attending each regional medical school. In some cases differences reflected local populations but other cases had no obvious cause. Over all cohorts studied, 38% of respondents attended a medical school in the region of their family home (32% of 1993 qualifiers), 42% held a career post in the same region as their medical school, and 38% held a career post in the same region as their family home. Among the qualifiers of 1983, 65% had a career post in the same region as their postgraduate training, 34% also attended medical school in the same region, and 19% also came from family homes in the same region. More women than men took up a career post in the same region as their postgraduate training. The relationships to family home and medical school did not differ by gender. Consultants appeared slightly less likely than GPs to have stayed within a region, but this difference was not statistically significant.     

The workload of trainees in general practice

During their first training period in general practice the authors felt that they did not encounter the balanced workload which is the foundation for learning to be a GP. Previous studies confirmed the existence of differences in overall and specific workload between trainees and trainers. From their own experience and from the relevant literature they addressed several factors which might affect the workload of trainees. A study was undertaken to determine differences in workload between trainees and trainers, and to investigate whether certain characteristics of practice and of trainees affect the workload of trainees. Details of surgery consultations with 34 trainee-trainer partnerships were recorded in the north of the Netherlands over 2 weeks. Questionnaires were filled in by trainers, trainees and practice assistants from these 34 general practices. The total number of contacts recorded was 10,103. It was found that trainees see fewer elderly and female patients, less chronic and oncological conditions, but more minor illnesses. They see only 30% of patients with problem behaviour. Factors that influence the trainees' workload, as compared to their trainers' are: list size; selection in the allocation of patients; trainee's experience prior to starting the training stage, and the trainee's sex. Except for problem behaviour, trainees generally see a cross-section of their trainer's practice population. Selection would provide a more balanced workload for trainees.     

浅议影响研究生创新能力的导师因素

培养研究生的创新能力是研究生教育的核心，也是评价研究生教育质量的根本标准。在影响研究生创新能力的诸多因素中，导师队伍是根本性因素。培养具有创新型的研究生需要导师具备优秀的学术道德、精湛的业务素质、严谨求实的科学态度、锲而不舍的科学精神、洞悉把握研究方向的发展趋势和立志创新的意识。文章从导师自身素质、导师学术水平、导师道德品质及其人格等方面，阐述导师因素在研究生创新能力培养过程中的作用。     

The Value of Bedside Rounds: A Multicenter Qualitative Study

Background: Bedside rounds have decreased on teaching services, raising concern about trainees’ clinical skills and patient–physician relationships. Purpose: We sought to identify recognized bedside teachers’ perceived value of bedside rounds to assist in the promotion of bedside rounds on teaching services. Methods: Authors used a grounded theory, qualitative study design of telephone semistructured interviews with bedside teachers (n = 34) from 10 U.S. institutions (2010–2011). Main outcomes were characteristics of participants, themes pertaining to the perceived value of bedside rounds, and quotations highlighting each respective theme. Results: The mean years in academic medicine was 13.7, and 51% were associate or full professors. Six main themes emerged: (a) skill development for learners (e.g., physical examination, communication, and clinical decision-making skills); (b) observation and feedback; (c) role-modeling; (d) team building among trainees, attending, and patient; (e) improved patient care delivery through combined clinical decision-making and team consensus; and (f) the culture of medicine as patient-centered care, which was embodied in all themes. Conclusions: Bedside teachers identify potential benefits of bedside rounds, many of which align with national calls to change our approach to medical education. The practice of bedside rounds enables activities essential to high-quality patient care and education.     

浅论产学研联合培养中药学研究生的策略与实践经验

产学研合作教育是充分利用学校与企业、科研院所等多种不同教学环境和教学资源以及在人才培养方面的各自优势,将以课堂传授知识为主的学校教育与直接获取实际经验、实践能力为主的生产、科研实践有机结合的教育形式[1-2].企业、科研院所的发展,需要高校的人才和科研技术;高校的发展,可以借助企业、科研院所的研究平台.     

贯穿临床诊疗流程的并轨研究生临床思维课程构建与评价

目的　探索"贯穿临床诊疗流程"的并轨研究生临床思维课程构建与实施效果。方法　本研究选取山西省人民医院2016级、2017级94名临床医学专业学位研究生作为研究对象。将2017级48名并轨研究生作为试验组,采用"贯穿临床诊疗流程"的临床思维课程,除参加学位课程、住培基地课程外,引入提升临床思维能力的系列课程内容;2016级46名并轨研究生作为对照组,采用传统课程内容,仅参加学位课程、住培基地课程。两组分别采用t检验、卡方检验及重复测量方差分析的方法,比较不同课程下两组学生迷你临床演练评估（mini-clinical evaluation exercise,Mini-CEX）评分、临床操作技能评估（direct observation of procedural skills,DOPS）评分、客观结构化临床技能考试（objective structured clinical examination,OSCE）成绩及学生满意度的差异性。结果　试验组在Mini-CEX评分中,除人文关怀外,其他方面平均得分均高于对照组;且沟通技能得分明显高于对照组[（6.55±0.98） vs. （5.77±1.12）],差异有统计学意义（t=3.62,P<0.001）。试验组在DOPS评分中,除与病人沟通的技巧、是否顾及病人感受并具有职业素养外,其他方面平均得分均高于对照组;且临床技能的实际操作能力得分明显高于对照组[（6.38±1.38） vs. （5.53±1.23）],差异有统计学意义（t=3.12,P=0.002）。在门诊接诊站、急诊处理站、临床思维站①、临床思维站②、专科技能站、辅助检查站、病例书写站方面,试验组不同阶段客观结构化考试各站点成绩均高于对照组;且在临床思维站①方面,实验组得分明显高于对照组,差异有统计学意义（F=6.51,P=0.012）。试验组对课程方面满意率,除有助于未来职业发展项外,其他项目满意率均高于对照组;且在提高逻辑思维能力方面,试验组得分明显高于对照组,差异有统计学意义（χ²=19.18,P<0.001）。结论　"贯穿临床诊疗流程"的临床思维课程能增强并轨研究生的临床实践能力,使其尽快达到住院医师标准,有效促进并轨研究生培养质量。     

临床医学专业学位硕士研究生学位论文质量评价体系的构建

目的：构建一套科学、客观、合理的临床医学硕士专业学位研究生学位论文质量评价体系,为衡量临床医学硕士专业学位研究生科研水平及整体培养质量提供依据。方法：在查阅文献、小组讨论、专家访谈的基础上初步建立临床医学硕士专业学位研究生学位论文质量评价体系,采用德尔菲法对指标体系进行２轮专家咨询。结果：确定了包含6个一级指标,18个二级指标,42个三级指标在内的临床医学硕士专业学位研究生学位论文质量评价体系。结论：构建的临床医学硕士专业学位研究生学位论文质量评价体系具有较高的科学性和可靠性,能作为评价临床医学硕士专业学位研究生学位论文质量的标准。     

研究生学位课程改革研究

目前研究生教育还没有摆脱应试教育的模式,研究生的科研、创新能力不高,一个重要原因是研究生学位课程教学比较僵化。为整体提升研究生课程的教学水平,培养研究生的科研、创新能力,本文从课程目标、课程结构、课程形式和课程内容、课程管理等五个方面着手,对研究生课程进行了改革。