住院医师规范化全纬度督导体系的构建和应用研究

目的探讨标准化全纬度督导体系在住院医师规范化培训中的应用与效果。方法构建全纬度督导体系改进住培督导工作。结果全纬度督导体系建立并实施后,临床教师查房考核评分由实施前的(79.10分±2.972)提高到(82.84分±3.659),且差异具有统计学意义(P<0.05);近3年学员结业考试通过率也由实施前的88.70%上升到95.45%;培训基地通过了检查并获得好评。结论构建全纬度督导体系解决了当前督导工作面临的主要问题,有效提高了管理人员的管理能力、临床教师的教学水平、住培学员的知识水平和成绩,有助于住培工作的顺利开展。     

超声科住院医师规范化培训教学实践及探索

超声科住院医师规范化培训(以下简称住培)存在专业性强、技术依赖性高等问题,本文结合超声专业及本基地特点,探索出个性化培训方案和导师负责制、理论授课、疑难病例讨论及病例回访相结合的模式,注重规范化临床实践能力培养,并充分利用微信平台互动教学,最后进行合理考核评价等,使住培学员在临床知识和超声技能操作掌握上取得较大进步,切实提升住培教学质量和效果。     

A randomized controlled trial of an online immunization curriculum

IntroductionImmunization education for physicians-in-training is crucial to address vaccine concerns in clinical practice. Vaccine education is not standardized across residency programs. The Collaboration for Vaccination Education and Research (CoVER) team developed an online curriculum for pediatric (Peds) and family medicine (FM) residents.MethodsA cluster randomized controlled trial (RCT) was performed during the 2017–2018 academic year to evaluate the CoVER curriculum. A convenience sample of residency institutions were randomly allocated to the intervention or control group, with stratification by residency type. The intervention, the CoVER curriculum, consisted of four online modules and an in-person training guide. Control sites continued with their standard vaccine education. Pre-intervention and post-intervention surveys were emailed to residents in both groups. The primary outcomes compared between groups were changes in “vaccine knowledge,” “vaccine attitudes/hesitancy,” and “self-confidence” in immunization communication. The team assessing outcomes was unblinded to assignments. Hierarchical general linear model was used to adjust for residency type and residency year; residency site was modeled as a random effect.ResultsOverall, 1444 residents from 31 residency programs were eligible to participate (734 intervention, 710 control). The pre-intervention response rate was 730 (51%) and post-intervention was 526 (36%). Average knowledge scores increased from pre-intervention (control 53%; CoVER 53%) to post-intervention (control 58%; CoVER 60%). Increases in vaccine knowledge among FM residents were greater for CoVER compared to controls (p = 0.041). Vaccine hesitancy was more common among FM (23%) than Peds (10%) residents. In all three residency years, residents in the CoVER group showed greater increases in self-confidence in ability to discuss vaccines with parents/patients (p < 0.03) compared to control group.ConclusionThe CoVER curriculum is an effective model to standardize immunization education of physicians-in-training. This RCT demonstrated the effectiveness of the CoVER curriculum to improve resident confidence in their ability to discuss vaccines with parents and patients.     

2007年长治市居民户食盐碘含量监测结果分析

目的：了解长治市实现消除碘缺乏病阶段目标后，长治市各县（市、区）居民户食用盐盐碘含量情况及存在问题。方法：根据《山西省2007年碘盐监测方案》进行监测。结果：居民户食用盐盐碘中位数为31．05mg／kg，碘盐合格率为99．18％，碘盐覆盖率为99．76％。盐碘含量以长治县、潞城市最高（中位数分别为37．10mg／kg、34．50mg／kg）。结论：长治市碘盐供应稳定，居民食用碘盐合格率达到国家标准（90％以上），但在部分县（市、区）仍然存在非碘盐冲销现象，个别地区盐碘仍有偏高趋势，部分地区的加碘盐质量有待提高。     

丽水市城乡居民健康素养水平及相关因素研究

目的了解丽水市居民健康素养水平,从不同人口学特征分析健康素养的影响因素。方法使用分层多阶段整群抽样法调查2 813名15~69岁人群健康素养水平,采用Logistic回归分析其影响因素。结果有效问卷2 701份;具备健康素养的占15.25%,标化率为16.26%;基本知识和理念、健康生活方式与行为和健康技能3个维度健康素养分别为19.33%、8.63%和22.99%,科学健康观、传染病预防、慢性病预防、安全与急救、基本医疗和信息获取6类健康问题具备比例分别是42.69%、29.43%、9.11%、53.31%、18.29%和24.81%。Logistic回归分析显示,影响健康素养水平的主要因素有文化程度、职业和年收入水平。结论丽水市居民健康素养水平有待提高,文化程度、职业和年收入水平是影响居民健康素养水平的相关因素。     

2011年天津市河北区居民死亡监测资料分析

目的了解天津市河北区2011年居民的死亡水平与死亡原因,为制定慢性病综合防治策略和措施提供依据。方法对河北区2011年居民死因监测资料进行分析。结果2011年河北区居民死亡5311人,死亡率为840．99／10万。居民死亡率,男性为904．35／10万,女性为776．59／10万;0岁为669．77／10万,1～4岁为37．93／10万,5～9岁为0．oo／10万,10～19岁为15．88／10万,此后逐渐上升,60～69岁迅速上升为1053．19／10万,≥80岁最高为7286．06／10万。居民死亡率最高的前5位死因,依次是心脏病、恶性肿瘤、脑血管病、呼吸系统疾病和内分泌疾病,合计死亡数占全部死亡数的92．39％。各种死因的合计减寿率为83．11‰,减寿率最高的是恶性肿瘤（28．17‰）、心脏病（20．28％o）、脑血管病（13．92％。）。结论2011年河北区居民死亡率较高,心脏病、恶性肿瘤、脑血管病为主要死因。     

品管圈活动在提高超声医学科住院医师医疗质量中的作用

目的探讨品管圈活动在提高超声医学科住院医师医疗质量中的作用。 方法2020年11月至2021年3月由南昌大学第一附属医院超声医学科8个亚专业组组长组成品管圈小组，应用品管圈管理方法对10名住院医师在医疗活动中存在的问题进行分析，制订相应措施及实施方案，采用方差分析比较品管圈活动实施前（2020年11月）、实施中（2020年12月，2021年1、2月）及实施后（2021年3月）住院医师的工作终质量的差异，各个月份之间两两比较采用Bonfermoi检验。 结果实施品管圈活动后，住院医师的工作终质量有显著提高，各月之间差异具有统计学意义（F=135.047，P＜0.001）。品管圈活动实施后的工作终质量评分高于实施前［（64.38±2.54）分 vs（44.21±1.39）分］，差异具有统计学意义（校正P＜0.01）；品管圈活动实施中各月（2020年12月，2021年1、2月）的工作终质量持续上升［（52.20±1.71）分 vs（57.22±2.31）分 vs（62.35±2.24）分］，差异均具有统计学意义（校正P均＜0.01）；品管圈活动实施结束月（2021年2月）与实施后（2021年3月）的工作终质量［（62.35±2.24）分 vs（64.38±2.54）分］比较，差异无统计学意义（P=0.345）。 结论品管圈活动能有效提高住院医师工作终质量，改善医疗质量，提升住院医师的综合能力。     

Black clouds in surgery: A study of surgical resident workload and burnout

BackgroundThe concept of a ‘black cloud’ is a common unfounded perception in the healthcare workforce that attributes a heavier workload to specific individuals or teams. Prior studies in non-surgical disciplines have demonstrated that ‘black cloud’ perceptions are not associated with workload, albeit such perceptions may influence behavior. The influence of ‘black cloud’ perceptions on surgical resident workload and burnout remains to be investigated. This study assesses the associations between ‘black cloud’ self-perception with actual workload and burnout among surgical residents in different specialties.MethodsA cross-sectional survey study of postgraduate year (PGY) 2 and 3 residents enrolled in different surgical residencies at the Icahn School of Medicine at Mount Sinai was conducted between September–November 2021.ResultsThe survey response rate was 62.1% (41/66). 46.3% of respondents were female. The majority of subjects were single (61%) and PGY2 trainees (56.1%). In a multivariate regression analysis demographic factors and workload variables, such as the number of pages responded, notes, and amount of sleep, were not significant predictors of a ‘black cloud’-self-perception. A significantly lower Burnout Index Score (BIS) was observed among females (p< .001). A significantly higher BIS was observed among residents who are single (p = .003), training in general surgery (p = .02), and orthopedic surgery (p = .03). There was no significant association between ‘black cloud’ self-perception and BIS.DiscussionThe findings demonstrate that a ‘black cloud’ self-perception is not associated with a high workload and burnout among surgical residents. Gender, marriage/domestic partnership, and certain surgical specialties influenced burnout among the study cohort.     

Contemporary cardiovascular computed tomography (CCT) training: Serial surveys of the international CCT community by the Fellow and Resident Leaders of the Society of Cardiovascular Computed Tomography (SCCT) Committee (FiRST) and SCCT Future Leaders Program (FLP)

BackgroundAs cardiovascular computed tomography (CCT) practice evolves, the demand for specialists continues to increase. However, CCT training remains variable globally with limited contemporaneous data to understand this heterogeneity. We sought to understand the role of CCT globally and the training available to underpin its use.MethodsWe performed two consecutive surveys of cardiology and radiology physicians, two years apart, utilizing the Society of Cardiovascular Computed Tomography (SCCT) website, weblinks, social media platforms, and meeting handouts to maximize our response rate. We compared United States (US)-based vs. international responses to understand global similarities and differences in practice and training in the surveys.Results235 respondents (37% trainees and 63% educators/non-trainees) initiated the first survey with 174 (74%) completing the core survey, with 205 providing their work location (114 US and 91 international). Eighty-four percent (92/110) of educator respondents stated a need for increased training opportunities to meet growing demand. Dedicated training fellowships are heterogenous, with limited access to structural heart imaging training, despite structural scanning being performed within institutions. The lack of a standardized curriculum was identified as the main obstacle to effective CCT learning, particularly in the US, with web-based learning platforms being the most popular option for improving access to CCT training. 148 trainees initiated the second survey with 107 (72%) completing the core components (51% North America, 49% international). Only 68% said they would be able to meet their required CCT education needs via their training program. Obstacles in obtaining CCT training again included a lack of a developed curriculum (51%), a lack of dedicated training time (35%), and a lack of local faculty expertise (31%). There was regional variability in access to CCT training, and, in contrast to the first survey, most (89%) felt 1:1 live review of cases with trained/expert reader was most useful for improving CCT training alongside formal curriculum/live lectures (72%).ConclusionsThere is a need to expand dedicated CCT training globally to meet the demand for complex CCT practice. Access to CCT education (didactic and 1:1 case-based teaching from expert faculty), implementation of recently published global training curricula, and increased teaching resources (web-based) as an adjunct to existing experiential learning opportunities, are all deemed necessary to address current educational shortfalls.