不同层次实习护生实习初期的职业认同感调查分析

文章通过对不同层次实习护生在实习初期的专业满意度、择业依据、就业期望和职业认同感的调查及分析,指出在培养不同层次护生时应有规范化、针对性的护理教育,应创造有利于职业认同感培养的环境,以提高实习护生的职业认同感.     

主线融合教学模式在神经外科见习教学中的应用

主线融合教学模式是一种新的神经外科临床见习教学模式,是以神经系统血管供应、脑脊液营养循环、神经胶质纤维等结构整体为主线条,融合多学科知识剖析神经系统的相关疾病,并按神经系统“疾病群”来归纳和记忆知识.该模式有助于增强学生思考问题和解决问题能力.     

临床实习培训与考核初探

临床实习是培养合格临床医师的关键阶段。在此,从实习培训、考核和质量监控3方面探讨,医院如何加强临床实习管理、提高教学质量。     

Factor instability of clinical teaching assessment scores among general internists and cardiologists

CONTEXT: We are unaware of studies examining the stability of teaching assessment scores across different medical specialties. A recent study showed that clinical teaching assessments of general internists reduced to interpersonal, clinical teaching and efficiency domains. We sought to determine the factor stability of this 3-dimensional model among cardiologists and to compare domain-specific scores between general internists and cardiologists. METHODS: A total of 2000 general internal medicine and cardiology hospital teaching assessments carried out from January 2000 to March 2004 were analysed using principal factor analysis. Internal consistency and inter-rater reliability were calculated. Mean item scores were compared between general internists and cardiologists. RESULTS: The interpersonal and clinical teaching domains previously demonstrated among general internists collapsed into 1 domain among cardiologists, whereas the efficiency domain remained stable. Internal consistency of domains (Cronbach's alpha range 0.89-0.93) and inter-rater reliability of items (range 0.65-0.87) were good to excellent for both specialties. General internists scored significantly higher (P<0.05) than cardiologists on most items except for 4 items that more accurately assessed the cardiology teaching environment. CONCLUSIONS: We observed factor instability of clinical teaching assessment scores from the same instrument administered to general internists and cardiologists. This finding was attributed to salient differences between these specialties' educational environments and highlights the importance of validating assessments for the specific contexts in which they are to be used. Future research should determine whether interpersonal domain scores identify superior teachers and study the reasons why interpersonal and clinical teaching domains are unstable across different educational settings.     

Disentangling clinical learning experiences: an exploratory study on the dynamic tensions in internship

Clinical practice is an essential component of medical training, but not all internships yield the appropriate and expected learning results. We report on an exploratory study of the learning process during internship in undergraduate medical education. We hypothesised that learning experiences in clinical practice are determined by characteristics of the interns, characteristics of the training setting and the meaningful interactions between them. As the study focused on the perceptions and interpretations of both interns and their supervisors of interns' experiences in practical training, qualitative research methods were used for data collection and analysis. This consisted of student shadowing, complemented by informal and semistructured interviews with both interns and supervisors. Analysis revealed 5 components that constitute learning experiences in clinical internship. These components represent dynamics in the clinical environment that constantly require students to (re-)define and (re-)position themselves: the agenda of the internship (working versus learning); the attitude of the supervisor (evaluator versus coach); the culture of the training setting (work-orientated versus training-orientated); the intern's learning attitude (passive versus proactive), and the nature of the learning process (informal versus formal). The model of components and tensions offers a conceptual framework to analyse and understand students' learning during internship. It not only contributes to a grounded theoretical conceptualisation of clinical learning, but may also be used in efforts to improve the quality of learning during internship, as well as the level of support and supervision.     

Validity of index of learning styles scores: multitrait-multimethod comparison with three cognitive/learning style instruments

Cognitive and learning styles research is limited by the lack of evidence supporting valid interpretations of style assessment scores. We sought evidence to support the validity of scores from 4 instruments: the Index of Learning Styles (ILS); the Learning Style Inventory (LSI); the Cognitive Styles Analysis (CSA), and the Learning Style Type Indicator (LSTI). The ILS assesses 4 domains: sensing-intuitive (SensInt), active-reflective (ActRefl), sequential-global (SeqGlob) and visual-verbal (VisVerb), each of which parallel a similar domain in at least 1 of the other instruments. We administered the ILS, LSI and CSA to family medicine and internal medicine residents and Year 1 and 3 medical students and applied the multitrait-multimethod matrix to evaluate convergence and discrimination. After 3 months participants repeated the ILS and completed the LSTI. A total of 89 residents and medical students participated. Multitrait-multimethod analysis showed evidence of both convergence and discrimination for ActRefl (ILS, LSI and LSTI) and SensInt (ILS and LSTI) scores. ILS SeqGlob and SensInt scores showed unanticipated correlation. No other domains met the criteria for convergence or discrimination. Test-retest reliabilities for ILS scores were 0.856 for SensInt, 0.809 for ActRefl, 0.703 for SeqGlob and 0.684 for VisVerb. Cronbach's alpha values were > or = 0.810 for LSI and 0.237-0.758 for LSTI. At least 9 participants misinterpreted the LSI instructions. These data support the validity of ILS active-reflective and sensing-intuitive scores, LSI active-reflective scores and LSTI sensing-intuitive scores for determining learning styles in this population. Cognitive style and learning style scores may not be interchangeable, even for constructs with similar definitions.     

口腔医学技术专业顶岗实习管理存在的问题及对策

口腔医学技术专业学生顶岗实习的单位都是营利性的义齿公司,与其他临床医学类相关专业相比,在实习管理上有很大的不同。该文通过对某校8年来口腔医学技术专业实习管理的经验的总结,对该专业在顶岗实习中存在的问题进行分析,并提出解决的对策及建议,为今后该专业学生进行实习管理提供借鉴。     

Alcohol Expectancies and the Personal and Parental Drinking Patterns of Women

ABSTRACT

Background and objectives: Successful employment outcomes for pregnant women result from a complex interplay between the woman, her employer, her prenatal care provider, laws and other influences.

Methods: A mail survey about management of employment during pregnancy was sent to directors of US residency programs that train prenatal care providers. Each physician was randomly assigned one of 4 vignette patients whose job involved prolonged standing, rotating shifts and lifting 40 lbs. Half the vignette patients had risk factors for preterm birth and half would have financial difficulty if placed on an unpaid antenatal leave.

Results: The 301 respondents estimated that they provide a written job restriction for 20% of their employed pregnant patients, although in 6 clinics the job restriction rate was 100%. For vignettes with preterm birth risk factors, 62.5% of physicians would always recommend a job restriction, 35.6% would do so sometimes, and 2.2% would rarely do so. When the vignette did not have risk factors for preterm birth, 21.5% of the physicians would always recommend a job restriction, 51.3% would do so sometimes, 25.9% would do so rarely and 1.3% would never do so. Economic factors were not associated with prescribing job restrictions. One in 5 of the residency programs provides no teaching on occupational health issues in pregnancy, and 65.1% provide 2 hours or less.

Conclusions: Variability in employment recommendations suggests that some women may not obtain the job modifications that they need, whereas others may be restricted unnecessarily. The limited curriculum time devoted to this topic may make it difficult to train physicians about complex employment issues during pregnancy.     

临床医学生实习期间的压力及其对心理健康的影响分析

[目的]调查临床医学生在临床实习过程中的压力及其对心理健康状况的影响。[方法]使用自编的临床医学生实习期间的压力源量表和症状自评量表(SCL-90)进行测查。[结果]70.4%的临床医学生有中等程度以上的压力,26.6%的临床医学生有重度以上的压力。临床医学生的实习期间的压力水平存在性别差异。医学生实习期间的心理健康状况良好。但有10%左右的医学生表现出不健康或亚健康。临床医学生实习期间的压力源大多与心理健康的因子显著相关。[结论]临床医学生实习期间存在较大的压力,实习期间的压力是影响医学生心理健康状况的重要因素。     

Assessing cardiac physical examination skills using simulation technology and real patients: a comparison study

Objective High‐stakes assessments of doctors’ physical examination skills often employ standardised patients (SPs) who lack physical abnormalities. Simulation technology provides additional opportunities to assess these skills by mimicking physical abnormalities. The current study examined the relationship between internists’ cardiac physical examination competence as assessed with simulation technology compared with that assessed with real patients (RPs). Methods The cardiac physical examination skills and bedside diagnostic accuracy of 28 internists were assessed during an objective structured clinical examination (OSCE). The OSCE included 3 modalities of cardiac patients: RPs with cardiac abnormalities; SPs combined with computer‐based, audio‐video simulations of auscultatory abnormalities, and a cardiac patient simulator (CPS) manikin. Four cardiac diagnoses and their associated cardiac findings were matched across modalities. At each station, 2 examiners independently rated a participant’s physical examination technique and global clinical competence. Two investigators separately scored diagnostic accuracy. Results Inter‐rater reliability between examiners for global ratings (GRs) ranged from 0.75–0.78 for the different modalities. Although there was no significant difference between participants’ mean GRs for each modality, the correlations between participants’ performances on each modality were low to modest: RP versus SP, r = 0.19; RP versus CPS, r = 0.22; SP versus CPS, r = 0.57 (P < 0.01). Conclusions Methodological limitations included variability between modalities in the components contributing to examiners’ GRs, a paucity of objective outcome measures and restricted case sampling. No modality provided a clear ‘gold standard’ for the assessment of cardiac physical examination competence. These limitations need to be addressed before determining the optimal patient modality for high‐stakes assessment purposes.