实习前后护生护理风险认知调查与分析

目的：调查分析实习前后护生对护理风险的认知情况,为学校护理风险教育提供参考。方法：自行设计问卷,调查实习前护生100名,实习后护生165名。结果：护生具有一定护理风险意识,实习后护生的风险意识高于实习前（X^2=23.80,P〈0.05）;但是护理风险知识均分不高,其中法律知识均分（2.23±0.639）、临床护理操作均分（2.39±0.577）、职业防护均分（2.53±0.544）;实习后护生的护理风险教育课程需求高于实习前（X^2=168.90,P〈0.05）。结论：学校可采取＂三段式＂护理风险教育模式,形成以医护法律、临床护理操作、职业防护等为主题的课程体系,着力提高护生对护理风险的识别、预测、处理能力。     

三年制医学生妇产科实习出科考核现状及方法探讨

目的 针对妇产科实习出科考核现状,探讨制定统一的考核方法.方法 通过访谈与查阅试卷的方式,调研重庆三峡医药高等专科学校36家综合性实习医院妇产科出科考核情况,其中三级甲等医院占33.33％（12/36）、二级甲等医院占52.78％（19/36）、二级乙等医院占13.89％（5/36）.选择4家教学条件相近的二级甲等县医院的临床医学专业实习学生137人为研究对象,随机抽取2家医院实习生作为研究组（72人）,另2家医院实习生作为对照组（65人）.结合执业助理医师资格考试大纲及人才培养方案要求,建立出科理论考试题库及技能考核项目、评价标准.研究组按学校实习大纲要求、技能考核项目及评价标准对实习学生进行培训,对照组未作相应要求,实习结束后由学校统一组织出科考核,理论考试与技能考核成绩总分各为50.出科考核调研结果采用确切概率法进行分析;2组学生出科考核成绩比较行t检验.结果 有出科考核的医院占80.56％（29/36）,按实习大纲要求出题者仅占20.69％（6/29）.经干预,研究组与对照组理论考试成绩分别为（40.31±3.47）分、（35.78±4.92）分,2组差异有统计学意义（t=6.26,P=0.000）;技能考核成绩为（40.42±3.02）分、（34.05±5.18）分,2组差异有统计学意义（t=8.90,P=0.000）.结论 实习医院出科考核随意性较大,建议统一出科考核方法.     

神经科总住院医师607例会诊病例分析

目的分析神经科总住院医师会诊病例的构成特点,从一个方面反映总住院医师的工作情况。方法统计北京协和医院神经科1名总住院医师在2003年8月1日至2004年1月31日会诊的病例。结果共新会诊患者607例,女性305例,男性302例,年龄5个月至92岁,平均年龄55·2岁,平均每周新会诊24例。急症会诊208例(34·3%),常规会诊399例(65·7%)。362例(59·6%)继发于系统性疾病;66例(10·9%)与医源性因素有关。急症会诊以代谢性脑病最多(92例),占急症会诊的44·2%,病因包括呼吸衰竭、肾功能衰竭、多器官功能衰竭等;其次为急性脑血管病51例;第三为癫发作23例。内科常规会诊病例以周围神经病最多(69例),占内科常规会诊的17·3%(69/398),病因包括糖尿病、血管炎/结缔组织病、肿瘤相关的周围神经病等。外科和妇科约请神经科常规会诊主要目的是围手术期的神经科疾病评估和预防。结论会诊工作具有特殊性和挑战性,神经科总住院医师应该了解会诊病例特点,在会诊中学习和积累经验。     

The educational value of being a house surgeon

A time and motion study has been performed with four house surgeons. The results suggest that modern pre-registration housemen spend over 75% of their time in a hospital service role. There is only a small amount of supervised teaching in what is regarded as an educational post.     

Patient management problems Issues of validity

Patient management problems (PMP) are being used in medical examinations with increasing frequency despite evidence which throws doubt on their validity as measures of clinical competence. This study investigated the construct validity of a PMP constructed in both written and interview formats. Each test was administered to groups of students of different seniorities and to two groups of Docotor, interns and post-interns. The pattern of scores for the different groups was not that expected of a valid test of competence. The most competent groups (the postinterns) generally scored less well on the calculated indices than the senior students and interns. These findings were similar for both formats of the test so cueing was not thought to be the major factor. It appears that the scoring system is at fault.
A comparison of performance on the written and interview (uncued) formats showed that many more options were chosen by all groups tested on the written PMP.
It was concluded that written PMPs cannot yet be regarded as a valid simulation of clinical performance. Although content validity is high this does not appear to be so for construct validity or concurrent validity.     

Knowledge and clinical problem-solving

A consistent finding in the literature on measures of clinical problem-solving scores is that there are very low correlations across different problems. This phenomenon is commonly labelled 'content-specificity', implying that the scores differ because the content knowledge necessary to solve the problems differs. The present study tests this hypothesis by presenting groups of residents and clinical clerks with a series of simulated patient problems in which content was systematically varied. Each subject also completed a multiple choice test with questions linked to each diagnosis presented in the clinical problems. Three of the four problem-solving scores showed low correlations, even to two presentations of the same problem, and no relationship to content differences. None of the scores were related to performance on the multiple choice test. The results suggest that variability in problem-solving scores is related to factors other than content knowledge, and several possibilities are discussed.     

An analysis of interneship training in Sri Lanka

The interneship period is a critical phase in the continuum of training provided to medical students. An analysis was made of the tasks the interne medical officers in Sri Lanka are engaged in during their period of training in different clinical disciplines. Data was collected by direct observations by trained observers for a continuous period of 10 days and self-reporting by the internes at the two teaching hospitals and four of the provincial hospitals where internes are posted. The reliability of the data was high. The results indicated the wide differences in the learning experiences of the internes in important aspects of patient care in the different training situations. The non-availability of any guidelines to the consultants with respect to the training intended is another deficiency. The study shows an urgent need to implement a planned and monitored interneship programme in the country.     

Survey of hospital doctors'training goals in diagnosis and management of pulmonary diseases

Although subspecialty training goals for junior hospital doctors have not been evaluated, they are potentially useful for assessing clinical competence. A questionnaire was sent to medical residents, full-time pulmonary teaching staff, and community-based physicians who were asked to rate the importance of diagnosing and managing selected pulmonary diseases for the future practices of young hospital doctors. The latter also rated their perceived preparedness for the same training goals. Generally good intra- and intergroup agreement about the relevance of most of the training goals was observed, although the hospital doctors rated a greater number of items to be more important than did the two other groups. This finding may be attributed to institutional influences and to many clinical abilities expected of all physicians. Immunological or fibrotic and paediatric respiratory disorders were rated least important by most respondents. The hospital doctors disagreed on the basis of the distribution of their ratings about their preparedness for the same goals, which probably reflects varying training experiences and background. The process of developing general professional training goals in a subspecialty requires discussion, identification, and consensus to identify and potentially correct areas of weakness, with allowance for institutional training patterns. A survey such as described in this study can provide data that can help measure clinical competence and support or define curricular changes.     

护理临床实习环境评价量表的编制及信效度检测

目的结合临床护生实际实习状况研制科学、客观的护理临床实习环境评价量表,为评价护理临床实习环境提供量化工具。方法应用文献检索分析法、专题小组讨论法及专家咨询法制定量表;采取整群抽样法抽取某三级甲等综合性医院184名护理实习生进行问卷调查,检验量表的信度和效度。结果终量表包含教学方法、老师素质、学习机会、人际关系、工作氛围及组织支持6个维度共30个条目;量表6个维度内部一致性信度Cronbach′sα系数为0.83~0.91,量表总体Cronbach′sα系数为0.96;6个公因子累积贡献率达73.37%;各维度之间相关系数为0.48~0.66,各维度与总分之间相关系数为0.83~0.86;集合效度相关系数为0.56~0.84,区分效度相关系数为0~0.46。结论该量表具有较好的信度和效度,达到了量表编制要求,可以从整体上测评护理临床实习环境情况。     

实习生医德知行合一教育模式的探索

医德教育是医疗卫生领域精神文明建设的一个重要部分,实习是临床医学生认知医学专业技能的重要时期,是其医德形成的关键时期,也是医学教育的重要阶段.通过正式课程、课外教育、心理咨询、社会实践、卫生服务等医学职业道德教育环节,借鉴先进医德培育经验,提高实习医学生的职业道德素质.