神经病学临床见习教学的思考

本文从多方面介绍了神经病学临床见习的教学方法,认为临床见习的重点是理论联系实际及学生临床思维能力的培养,促进医学生向医生的转变。     

精细化临床带教在儿科急诊实习生中的应用

目的分析精细化临床带教在儿科门急诊实习生临床带教中的应用价值。方法以2018年7—11月于医院儿科门急诊临床专业实习生48例为对照组,采用传统教学法,以2019年7—11月于本院儿科门急诊实习的52例临床专业实习生为试验组,采用精细化临床带教,包括一对一CBL带教和一对一日常考核,对比两组带教效果。结果试验组实习生实习结束后的理论成绩、实践成绩和案例临床诊疗思维能力,均明显高于对照组,组间差异具有统计学意义(P<0.05)。结论在儿科门急诊运用精细化临床带教,包括一对一CBL带教和一对一日常考核教学模式,能显著提高实习生理论、实践、病例综合分析能力以及对实习满意度,具有较好的教学效果。     

Could musculo-skeletal radiograph interpretation by radiographers be a source of support to Australian medical interns: A quantitative evaluation

IntroductionPublic expectations regarding access to the emergency department (ED) challenges providers and policy makers with finite resources being stretched beyond capacity. To enable education of a greater numbers of doctors the format of the medical internship in Australia has changed and assumes that sufficient supervision is provided to interns to enable image interpretation skills development. Furthermore this assumes that appropriate foundational skills are established during undergraduate education.MethodsA mixed methods approach using a convenience, self selecting sample population of radiographers and final year medical students was adopted. The study measured the interpretive ability of final year medical students and radiographers in musculo-skeletal trauma (MSK) plain radiographic images. An image test bank based upon radiologist consensual agreement was corrected for prevalence and bias. Performance across a range of measurements was completed and compared for statistical significance using Mann–Whitney U.ResultsResults were divided to enable analysis across age ranges and types of skeletal presentation. Radiographer performance was better numerically and demonstrated statistically significant difference in several areas.ConclusionRadiographers have the knowledge base to assist junior doctors to clinically interpret the musculo-skeletal radiographic image. To meet the requirements of AMC and the Medical Board of Australia (MBA), a tailored clinically based educational system could be developed and provided by an accredited radiographer. Australian radiographers could also be employed to provide a safety net to avoid misinterpretation, such as seen in the UK commenting system, operating as an interprofessional team.     

DOPS在外科实习医师技能操作考核中的应用探讨

目的探讨临床操作技能直接观察评估考核(DOPS)在外科实习医师"换药"操作考核中的应用价值。方法以徐州医科大学2017届和2018届在我院实习的临床医学专业46名本科实习医师为研究对象,将其随机分为研究组和对照组。研究组在第1周末、第2周末、第3周末、第4周末进行DOPS评估操作考核;对照组在第1周末、第2周末、第3周末进行传统操作考核,第4周末进行DOPS操作考核。比较研究组和对照组第4周末DOPS考核的平均分数及教师、实习医师对考核的满意度。结果研究组第4周末DOPS考核平均分高于对照组(85.25±2.57)分vs.(76.64±4.96)分;研究组教师满意度为高于对照组教师满意度(7.42±0.41)分vs.(5.76±1.12)分;研究组实习医师满意度为高于对照组实习医师满意度为(7.43±0.85)分vs.(6.17±1.26)分;差异均有统计学意义(P<0.05)。结论DOPS评价系统应用于外科实习医师的操作考核中,可有效提高实习医师的操作水平,增加教师与实习医师的满意度。     

加强医院实习生实习档案管理的分析

医学院的学生实习阶段是学生在教育中将理论与实践、基础知识与临床应用联系到一起的重要环节，是训练如何掌握专业的临床诊疗与各种医疗器械的操作技能不可缺少的阶段，是临床教育中重要的组成部分，同时也是医院选拔人才的一种重要的手段。因此许多医院在实习生参加实习的过程中都会建立实习档案对实习生进行系统的评价，档案不仅能反应一个学生的学习情况，增加考核临床带教的功能，还能够为用人单位提供一定参考价值的依据。     

A Pilot Study Using Nominal Group Technique to Assess Residents’ Perceptions of Successful Attending Rounds

BACKGROUND  Ward attending rounds are fundamental for internal medicine residency training. An improved understanding of interns’ and residents’ perceptions of attending rounds should inform training programs and attending physicians. OBJECTIVES  The aim of this study was to assess residents’ perceptions of successful attending rounds. DESIGN  We convened two groups of interns and two groups of residents, to elicit their perceptions on attending rounds. SUBJECTS  Participants were recruited by e-mail and conference announcements from the 49 interns and 80 residents in the internal medicine and medicine-pediatrics residency programs. MEASUREMENTS  The nominal group technique (NGT) uses a structured group process to elicit and prioritize answers to a carefully articulated question. MAIN RESULTS  Seven interns (14%) identified 27 success factors and ranked attending approachability and enthusiasm and high quality teaching as most important. A second group of six (12%) interns identified 40 detractors and ranked having “mean attendings,” receiving disrespectful comments, and too long or too short rounds as the most significant detractors. Nine (11%) residents identified 32 success factors and ranked attention to length of rounds, house staff autonomy, and establishing goals/expectations as the most important success factors. A second group of six (8%) residents identified 34 detractors and ranked very long rounds, interruptions and time constraints, and poor rapport between team members as the most significant detractors). CONCLUSIONS  Although there was some overlap in interns’ and residents’ perceptions of attending rounds, interns identified interpersonal factors as the most important factors; whereas residents viewed structural factors as most important. These findings should assist attending physicians improve the way they conduct rounds targeting both interns and residents needs. Presented in part at the Southern Regional Meeting of the Society of General Internal Medicine in New Orleans, LA, in February 2005 and the Society of General Internal Medicine Annual Meeting in New Orleans, LA, in May 2005.     

新冠肺炎流行期间护理本科实习生职业认同现状及其对突发公共卫生事件应急态度的影响

目的:调查新冠肺炎流行期间护理本科实习生职业认同现状,并探讨其对突发公共卫生事件应急态度的影响。方法:采用一般资料调查表、护生职业认同量表和护士突发公共卫生事件应急态度量表对河南省某三级甲等综合医院的301名护理本科实习生进行调查。结果:护理本科实习生职业认同得分为(64.04±12.02)分,突发公共卫生事件应急态度条目均分为(3.95±0.54)分。职业认同和突发公共卫生事件应急态度呈正相关(r=0.588,P<0.01)。分层回归分析结果显示,职业认同独立解释突发公共卫生事件应急态度变异的24.8%。结论:新冠肺炎流行期间护理本科实习生职业认同良好,突发公共卫生事件应急态度处于中等水平,职业认同是突发公共卫生事件应急态度的重要影响因素。本科院校应为护理专业在读学生设置突发公共卫生事件应对相关课程,同时重视职业认同的培养,从而提高其突发公共卫生事件应急态度积极程度。     

A review of journal clubs in postgraduate medical education

OBJECTIVE: To review the goals, organization, and teaching methods of journal clubs, summarize elements of successful clubs, and evaluate their effect on reading habits, and effectiveness in meeting teaching goals. Examples of clubs that utilize principles of adult learning are reviewed. DATA SOURCES: English language articles identified through a MEDLINE search (1966–1997) using the MeSH terms “internship” and “residency,” and text words “journal club” and “critical appraisal.” STUDY SELECTION: Articles on learning goals and organization were included if they represented national or regional surveys with a response rate of 65% or greater. Articles that evaluated teaching effectiveness were included if they used a controlled, educational design, or if they exemplified important adult learning principles. DATA EXTRACTION: Data were manually extracted from selected studies and reviews. DATA SYNTHESIS: A major goal for most clubs is to teach critical appraisal skills. Clubs with high attendance and longevity are characterized by mandatory attendance, availability of food, and perceived importance by the program director. Residents who are taught critical appraisal report paying more attention to the methods and are more skeptical of the conclusions, and have increased knowledge of clinical epidemiology and biostatistics, but studies have failed to demonstrate that these residents read more, or read more critically. Reading guidelines may be useful for teaching critical appraisal skills, and may be associated with increased resident satisfaction. CONCLUSIONS: Journal club formats are educationally diverse, can incorporate adult learning principles, and are an adaptable format for teaching the “new basic sciences.” Received from the Department of Medicine, University of Florida, Gainesville.     

WPBA护理临床实习评价模式的初步构建

目的借鉴基于工作场所的评估(WPBA)实施的成功经验,结合护理专业自身的特点,构建WPBA护理临床实习评价模式,为护理临床实习教学质量评价提供参考。方法以WPBA评价模式为基础,通过文献回顾、小组讨论,初步拟定护理临床实习的WPBA各测评工具的评价项目和细则;釆用德尔菲(Delphi)法组织2轮专家函询,汇总专家意见,运用统计学方法分析有关资料,初步确定评价项目和细则。结果构建WPBA护理临床实习评价模式,包括Mini-cex(迷你临床演练评量)、DOPS(操作技能直接观察评估考核)和CbD(个案为基础的讨论)三种测评工具,分别包含了7、10和7个项目,对应34、10和7条评价细则。两轮专家咨询的积极系数均为100%,专家的权威系数0.812,两轮专家咨询后各条目重要性的变异系数为0.079~0.223,可操作性变异系数为0.048~0.223,均小于0.30。结论 WPBA护理临床实习评价模式适用于护生临床实习的过程性评价,具有一定的科学性,可为提高临床实习教学质量提供参考。     

护生共情能力与职业获益感的相关性研究

[目的]探讨护理实习生的共情能力、职业获益感水平及两者的关系。[方法]采用杰弗逊共情量表和职业获益感量表对福建省某三级甲等综合医院的201名护理实习生进行调查。[结果]护生的共情能力总分为(80.60±9.44)分,职业获益感总分为(59.95±16.27)分;共情能力与职业获益感呈正相关关系(r=0.395,P<0.01)。[结论]实习护生共情能力处于中等水平,职业获益感处于较低水平,两者存在正相关。护理教育者可根据两者现状及关系有针对性地制定提升共情能力和职业获益感的措施。