影像本科生实习教学模式的探索

从影像本科生实习管理、PACS系统的应用学习、多媒体教学应用、横向和纵向诊断思维培养四个方面对影像本科生实习教学模式进行了有益的实践探索,以期培养合格的影像医学人才。     

临床实习生常见问题与对策

临床实习是医学教育的重要组成部分,是培养学生理论联系实际的能力及临床操作技能的最佳方法之一,也是培养临床医学生向一名合格医生转变的重要教育过程。但医学生临床实习正面临着一些挑战和冲击,也是我们临床带教老师需要关注及期待解决的问题。     

模拟临床思维在儿科见习课教学中的应用

见习课是理论与实践相结合的重要过度桥梁,由于儿科的特殊性,传统的示教方式已不能适用于现在儿科见习课教学需要。为了提高学生的见习教学质量,作者所在教学团队对无典型病人的见习课采取了模拟临床思维方式的病例讨论法进行教学,取得了良好的教学效果。     

口腔实习生操作技能培养存在的困难及对策

通过总结口腔医学生临床实习中操作技能培养存在的困难,并对其进行分析,针对现存的问题提出解决方法,旨在提高口腔临床实习的操作技能,为培养实用性口腔医学人才提供指导。     

护理专业学生实习后期心理一致感现状及影响因素研究

目的:调查护理专业学生(护生)实习后期心理一致感现状,并分析其影响因素,以期为制定有针对性的相关措施提供参考。方法:采用便利抽样的方法选取河南省两所三级甲等医院147名实习护生作为研究对象,采用一般资料调查表、心理一致感量表(SOC-13)、大学生元认知能力量表对其进行问卷调查。结果:实习护生心理一致感总分为(53.23±9.05)分、元认知能力总分为(83.65±14.07)分,心理一致感总分与元认知能力总分及各维度得分呈正相关(P<0.05)。多重线性回归分析结果显示,性别、父母是否为医务人员、元认知能力是影响护生实习后期心理一致感的主要因素(P<0.05)。结论:性别、父母是否为医务人员、元认知能力影响护生实习后期心理一致感,护理管理者及临床带教老师应根据护生实习后期的心理一致感现状制订带教计划,提高其心理一致感。     

The effects of examination stress on the performance of emergency medicine residents

CONTEXT: Despite the finding that residents are exposed to significant stressors during their training, little is known about the impact of these stressors on performance. The objectives of this project were to measure the subjective anxiety felt by emergency medicine (EM) residents during in-training examinations, and to determine the effect of this anxiety on their ability to diagnose visual stimuli such as X-rays, photographs and electrocardiographs. METHODS: Two examinations, matched for difficulty and length, were constructed based on the performance of 23 residents in 2 Royal College of Physicians and Surgeons of Canada (RCPSC) EM residency programmes. These examinations were then administered at 2-week intervals to another 24 residents in 2 additional RCPSC EM programmes. One examination was administered under high-stress conditions (in-training examination) and the other under low-stress (control) conditions. Perceived anxiety was measured using the state scale of the State-Trait Anxiety Inventory before and after each iteration of the examination. RESULTS: Residents reported higher levels of anxiety in the high-stress condition (41.5 versus 35.9, P < 0.05). Examination scores were higher in the high-stress condition (70.4 versus 64.4, P < 0.01). The scores of junior residents improved in the high-stress condition, whereas those of intermediate and senior residents did not change. CONCLUSIONS: Emergency medicine residents report higher anxiety during in-training examinations compared with control conditions. Residents at all levels exhibited similar perceptions of anxiety. Junior residents performed better under stress, achieving higher scores during the in-training examination than during the control condition. The performance of more experienced residents was not affected by the stress condition.     

Differences in preventive health quality by residency year

BACKGROUND: It is assumed that the performance of more senior residents is superior to that of interns, but this has not been assessed objectively. OBJECTIVE: To determine whether adherence to national guidelines for outpatient preventive health services differs by year of residency training. DESIGN: Cross-sectional study. PARTICIPANTS: One hundred twenty Internal Medicine residents, postgraduate year (PGY)- 1 and PGY -2, attending a University Internal Medicine teaching clinic between June 2000 and May 2003. MEASUREMENTS: We studied 6 preventive health care services offered or received by patients by abstracting data from 1,017 patient records. We examined the differences in performance between PGY-1 and PGY-2 residents. RESULTS: Postgraduate year-2 residents did not statistically outperform PGY-1 residents on any measure. The overall proportion of patients receiving appropriate preventive health services for pneumococcal vaccination, advising tobacco cessation, breast and colon cancer screening, and lipid screening was similar across levels of training. PGY-1s outperformed PGY-2s for tobacco use screening (58%, 51%, P = .03). These results were consistent after accounting for clustering of patients within provider and adjusting for patient age, gender, race and insurance, resident gender, and number of visits during the measurement year. CONCLUSIONS: Overall, patients cared for by PGY-2 residents did not receive more outpatient preventive health services than those cared for by PGY-1 residents. Efforts should be made to ensure quality patient care in the outpatient setting for all levels of training.     

Medicare financing of graduate medical education

The past decade has seen ongoing debate regarding federal support of graduate medical education, with numerous proposals for reform. Several critical problems with the current mechanism are evident on reviewing graduate medical education (GME) funding issues from the perspectives of key stakeholders. These problems include the following: substantial interinstitutional and interspecialty variations in per-resident payment amounts; teaching costs that have not been recalibrated since 1983; no consistent control by physician educators over direct medical education (DME) funds; and institutional DME payments unrelated to actual expenditures for resident education or to program outcomes. None of the current GME reform proposals adequately address all of these issues. Accordingly, we recommend several fundamental changes in Medicare GME support. We propose a re-analysis of the true direct costs of resident training (with appropriate adjustment for local market factors) to rectify the myriad problems with per-resident payments. We propose that Medicare DME funds go to the physician organization providing resident instruction, keeping DME payments separate from the operating revenues of teaching hospitals. To ensure financial accountability, we propose that institutions must maintain budgets and report expenditures for each GME program. To establish educational accountability, Residency Review Committees should establish objective, annually measurable standards for GME program performance; programs that consistently fail to meet these minimum standards should lose discretion over GME funds. These reforms will solve several long-standing, vexing problems in Medicare GME funding, but will also uncover the extent of undersupport of GME by most other health care payers. Ultimately, successful reform of GME financing will require "all-payer" support.     

Factors Associated With Interest in Subspecialty Training Among Neurology Residents

Phenomenon: Previous studies have not explored factors associated with decisions among neurology residents to pursue subspecialty training within neurology. Understanding career choices among neurology residents, particularly decisions regarding subspecialty training, is critical, as neurologists with specialized knowledge can help meet the needs of patients with specific disease conditions. This study addresses the knowledge gap about subspecialty training decisions by examining factors associated with neurology residents' interest in pursuing subspecialty training and the types of subspecialty training neurology residents consider. Approach: We surveyed a geographically stratified sample of neurology residents in U.S. training programs using a two-stage survey design. In Stage 1, we randomly sampled half of the accredited neurology residency programs stratified by U.S. census region; Stage 2 involved a survey of neurology residents within these programs. Findings: The majority (approximately 81%) of residents expressed interest in subspecialty training. Resident demographic characteristics and educational debt did not influence interest in pursuing subspecialty training. Residents were more likely to express interest in subspecialty training when they participated in any neurology research (odds ratio [OR] = 2.39), 95% confidence interval (CI) [1.13, 5.07], p = .02, and indicated more interest in careers involving teaching (OR = 8.33), 95% CI [1.64, 42.19], p = .01. Considering the “medical content of subspecialty” as a more important factor approached but did not reach statistical significance (OR = 3.12), 95% CI [0.97, 10.06], p = .06. Insights: Participation in any neurology research and interest in careers involving teaching are associated with interest in subspecialty training among neurology residents. Further research is needed to determine whether exposure to research and teaching stimulates interest in subspecialty training and whether residents believe that subspecialty training is instrumental in pursuing an academic career.