Innovation in Indigenous Health and Medical Education: The Leaders in Indigenous Medical Education (LIME) Network as a Community of Practice

Problem: The Leaders in Indigenous Medical Education (LIME) Network aims to improve the quality and effectiveness of Indigenous health in medical education as well as best practice in the recruitment, retention, and graduation of Indigenous medical students. Intervention: In this article we explore the utility of Etienne Wenger's “communities of practice” (CoP) concept in providing a theoretical framework to better understand the LIME Network as a form of social infrastructure to further knowledge and innovation in this important area of health care education reform. Context: The Network operates across all medical schools in Australia and New Zealand. Outcome: Utilizing a model of evaluation of communities of practice developed by Fung-Kee-Fung et al., we seek to analyze the outcomes of the LIME Network as a CoP and assess its approach and contribution to improving the implementation of Indigenous health in the medical curriculum and the graduation of Indigenous medical students. Lessons Learned: By reflecting on the Network through a community of practice lens, this article highlights the synthesis between the LIME Network and Wenger's theory and provides a framework with which to measure Network outputs. It also posits an opportunity to better capture the impact of Network activities into the future to ensure that it remains a relevant and sustainable entity.     

我国日间手术开展现状与前景展望

日间手术在国外已有上百年的发展历史，现已成为欧美国家重要手术模式。我国于20世纪初开始开展日间手术，但目前尚未普及，发展不平衡问题比较突出，存在认识不清、开展不规范、与医保支付对接不畅等问题。日间手术是一种使国家、医院和病人三方均受益的新型手术模式。近年来，国家相关管理部门积极引导，开展日间手术的医院明显增多，可以预见，我国日间手术即将进入快速发展的新阶段。因此，有条件的医院可以从简单、易操作的病种开始，落实临床路径，积累经验，再逐步稳妥展开。在保证质量的前提下，不断拓展日间手术范围，提高三、四级手术比例。同时，积极与医保支付政策对接，采取灵活的方式，获得医保的支持，更好地促进我国日间手术的快速发展。     

聚焦解决护理模式结合健康教育对银屑病患者心理状态、应对方式的影响

目的 探讨聚焦解决护理模式结合健康教育对银屑病患者心理状态、应对方式的影响。方法 选取2020年2月至2021年2月我院收治的100例银屑病患者,随机分为观察组(聚焦解决护理模式结合健康教育)与对照组(常规健康教育)。比较两组的心理状态及应对方式。结果 干预后,观察组的焦虑自评量表(SAS)、抑郁自评量表(SDS)评分低于对照组(P<0.05)。干预后,观察组的面对评分高于对照组,屈服、回避评分低于对照组(P<0.05)。干预后,观察组的病耻感评分低于对照组(P<0.05)。结论 聚焦解决护理模式结合健康教育可有效改善银屑病患者的不良情绪,减轻病耻感,转变疾病应对方式。     

贵州省"5+3"模式订单定向医学毕业生的离职意愿及影响因素研究

背景 我国基层全科医生的离职意愿较高，调查其离职意愿并分析影响因素，可以为减少基层卫生人才流失提供思路。目前，完成"5+3"模式（5年临床医学本科教育+3年住院医师规范化培训）培养的订单定向医学毕业生逐步履约进入基层工作，而针对该部分全科医生离职意向的研究相对较少。 目的 调查贵州省"5+3"模式订单定向医学毕业生回归基层工作后的离职意愿及影响因素，为完善吸引卫生人才留任、建设基层全科医生队伍相关政策提供依据。 方法 以贵州省截至2020年底已完成"5+3"模式培养并履约到基层医疗卫生机构工作的2015—2017级订单定向医学毕业生为研究对象。于2021-01-20至2021-02-10对其开展电子问卷调查，内容包括毕业生的一般情况、职业满意度、离职意愿、服务期满后职业方向。共回收问卷347份，其中有效问卷311份，问卷有效回收率为89.6%。采用单因素分析及多元逐步线性回归分析全科医生离职意愿的影响因素。 结果 贵州省"5+3"订单定向医学毕业生的整体离职意愿得分为（3.98±0.98）分，具有离职倾向者229例（73.6%）。不同性别、单位地理位置、每日工作量者的离职意愿得分比较，差异有统计学意义（P<0.05）。多元逐步线性回归分析显示，单位负责人对待下属的方式、在工作中获得的成就感、对当前收入满意程度、家人对工作的支持程度、当地激励政策执行程度是"5+3"订单定向医学毕业生离职意愿的影响因素（P<0.05）。服务期满后，计划留任原基层医疗卫生机构者12例（3.9%），计划去其他基层医疗卫生机构者21例（6.7%），计划离开基层去上级医院工作者196例（63.0%），计划攻读全日制硕士学位者60例（19.3%）。 结论 贵州省"5+3"模式订单定向医学毕业生的离职意愿较高，预计服务期满后基层全科人才流失较多，需从提高收入、重视全科医生心理需求、优化全科医生培养与使用、发展基层医疗卫生机构、加强全科宣传等方面着手改善。     

The scope of computerized simulation in competency-based maxillofacial training: a systematic review

Oral and maxillofacial surgery (OMS) teaching is set to undergo a paradigm shift towards competency-based training. With increasing focus on resident skill development and patient safety, computerized simulators are likely to play a more mainstream role in OMS training. A systematic review of the available literature was conducted, in accordance with the PRISMA guidelines, to highlight the scope of computerized simulation in OMS teaching. A PubMed search was performed by two independent reviewers, and 35 articles published in English between 2010 and 2021 that reported the use of computerized simulation for teaching maxillofacial procedures were included in the analysis. Eight articles on minor oral surgery, seven on orthognathic surgery, five on maxillofacial trauma, five on cleft lip and palate surgery, three articles each on nerve block techniques, endoscopic procedures, and reconstructive surgery, and one article on fibre-optic intubation reported the use of computerized simulation that can be applied to OMS training. Ten randomized controlled trials were identified in the search. However there was marked heterogeneity among the studies. Simulator training for skill acquisition mentored by an expert OMS educator could offer holistic resident training; however more studies that test common themes of resident training such as knowledge acquisition and skill development are necessary.     

Exploring the implementation of evidence-based optimisation strategies: A qualitative study of the experience of diagnostic radiographers

IntroductionRadiographers are responsible for ensuring safe and effective use of ionising radiation. Through evidence-based practice (EBP), valuable optimisation strategies can be implemented to fulfil these responsibilities. This study aimed to explore radiographers' attitudes, perceptions, and experience of using evidence-based optimisation strategies.MethodsA Grounded Theory approach using in-depth interviews. UK-based radiographers were recruited. Discussions focused on (1) the role of evidence-based optimisation strategies in daily practice, (2) assistance in implementing evidence-based optimisation strategies, and (3) the role of EBP and optimisation strategies in the future. Interviews were transcribed verbatim and analysed using open and axial coding.ResultsParticipants (n = 13) stated that EBP is not frequently used to implement optimisation strategies. Participants relied on the knowledge taught in education settings and their professional skills to optimise in daily practice, alongside departmental protocols. Barriers identified as affecting the implementation of optimisation strategies related to reluctance to change, a lack of support from superiors, and a lack of resources to engage with EBP. Some participants expected the use of optimisation strategies to become unnecessary due to technology advancements.ConclusionThe results indicate that effective operationalisation of EBP is not part of daily practice among radiographers to implement valuable optimisation strategies in daily practice.Implications for practiceThe potential barriers to implementing evidence-based optimisation strategies highlighted in this study suggest that improving access to resources and empowerment of individual radiographers is required to enable radiographers to implement optimisation strategies.