精神科住院医师规范化培训的发展摭谈

精神科住院医师培训的核心目标是培养合格的临床医生,基本目标是通过为期3年的标准统一的规范化培训,使受训者具备良好的职业态度,掌握足够的理论知识和临床技能,达到独立从事精神科普通临床工作的基本要求。     

住院医师规范化培训将有“国标”

国家卫生和计划生育委员会网站发布《住院医师规范化培训标准（试行）》草案,向社会公开征求意见。《标准》提出,住院医师规范化培训是培养合格临床医师必经的毕业后医学教育阶段,为期3年的住院医师规范化培训以临床实践培训为重点,取得培训合格证书将逐步作为临床医师在医疗机构独立从事诊疗工作和进入专科医师培训以及中级职称晋升的必备条件。为尽快全面建立和实施住院医师规范化培训制度,进而为建立实施专科医师培训制度奠定基础,国家卫生计生委委托中国医师协会组织专家制定了《住院医师规范化培训标准（试行）》。该《标准》包括培训总则和内科、外科、妇产科、儿科等18个专科细则,其中《全科医生规范化培养标准（试行）》已于2012年7月印发实施。各专科细则根据本专科住院医师规范化要求,对本学科有关科室轮转时间的分配、应掌握的内容及程度、病例病种数量等具体内容作出明确规定,并妥善处理“宽基础”与“精专科”的关系,注重统筹做好本专科及相关专科知识技能的学习掌握。同时,各专科细则对参考书刊作了统一规定,均采用最新版本,有利于住院医师了解最新的知识进展。《标准》提出,在3年培训周期中,住院医师在省级及以上卫生计生行政部门认定的住院医师规范化培训基地选择相关专科进行培训,按照《标准》完成规定的专业理论学习和临床实践技能培训。通过培训能够掌握本学科常见病和多发病的诊断、处理;要掌握危重病症的识别与紧急处理等,在轮转每个必选科室时,必须手写完成2份反映疾病诊断治疗全过程的系统病历;要掌握心肺复苏技术、突发性疾病院前急救等临床医师实践技能。有关实施住院医师规范化培训工作所涉及的编制、人事、发展改革、财政及教育培训管理等相关配套政策,国家卫生计生委将会同国务院有关部门另行规定。     

以胜任力为导向住院医师人文教育

住院医师规范化培训是毕业后医学教育的重要组成部分,住院医师不仅需要掌握扎实的医学专业知识和临床技能, 而且应具备良好的职业素养以及合格的岗位胜任力.在知识与技能培训中融入医学人文精髓,培养在医疗工作中的胜任力是医学教育工作者应考虑的问题.分析住院医师医学人文教育的现实意义和存在问题,并提出加强人文素质培养、提升岗位胜任力的策略.     

加强住院医师规范化培训的几点建议

住院医师培训是毕业后医学教育的重要组成部分,本文主要介绍我院住院医师规范化培训现状,为确保住院医师规范化培训工作的顺利开展,促进住院医师职业道德和临床技能的双向提高提出建议,从而完善住院医师规范化培训体系建设。     

上海市住院医师规范化培训十年评估

搜集了上海市住院医师规范化培训的有关文件与资料,并对该项培训的市级管理者进行了访谈,在此基础上对上海市16所二级医院与16所三级医院住院医师和管理人员进行了问卷式调查,对上海市住院医师规范化培训进行了十年评估。上海市十年间住院医师规范化培训重在规范、重在能力培训、重在实效、重在低成本高效果,取得了一定的成效。但上海市住院医师规范化培训还需进一步加强临床能力的培训和考核;进一步研究二级医院二级学科住院医师赴三级医院培训的合理性;政策仍需配套,以全力推进育人工程;并应开展对临床研究生进行临床技能规范化培训的研究。     

国外住院医师教学能力培训的借鉴及探讨

住院医师规范化培训的目标是将住院医师培养成工作认真负责、掌握临床专业理论知识和诊疗技能，具有独立临床工作能力及有一定教学、科研能力及严谨的、实事求是的科学态度的临床医学人才。作为医院医疗、教学、科研的骨干力量的培养对象，如何围绕思想品德、知识结构、能力结构及外语程度进一步解决住院医师规范化培训的问题，任务仍很艰巨。     

住院医师临床技能培训在SARS防治中的应用调查分析

目的　评价住院医师临床技能培训在SARS防治中的应用效果 ,制定医师应急技能培训计划。方法　采用问卷调查的方法对本院进入SARS病区的 10 1名住院医师进行调查。结果　通过对住院医师进行临床各项技能的培训 ,使住院医师在SARS治疗中得到了不同程度的帮助。调查中住院医师认为有帮助、能解决问题达 10 0 % ,认为培训有益处达 10 0 %。结论　技能培训使住院医师较熟练地掌握了基本技能 ,提高了在临床应用中的操作能力 ,并在SARS治疗工作中增强了应对突发事件的能力[1] 。     

绩效考核在住院医师规范化培训中的作用

目的：探讨绩效考核在住院医师规范化培训中的作用。方法：以我院在培住院医师规范化培训学员66人为研究对象,比较绩效考核革新前后的学员绩效收入满意度、临床理论知识和技能操作考核评分、住院病历评分等。结果：绩效考核革新后,住培学员对学员收入满意度、临床理论知识和技能操作考核评分、住院病历评分显著高于绩效考核方案革新前,差异均具有统计学意义（p＜0.05）。结论：绩效考核有助于提高住院医师规范化培训学员工作积极性,提高住院医师规范化培训的质量,具有一定的推广价值。     

住院医师体检技能缺陷分析

体检技能是住院医师最重要的专业技能和临床基本功之一，体检技能水平高低一定程度上反映了住院医师实际工作能力，成为医院考核住院医师“三基”水平的重要内容。近年来，国家、军队卫生行政部门相继制定了住院医师规范化培训方法，将体检技能培训纳入了继续医学教育轨道...     

硕士研究生住院医师规范化培训的实践与成效分析

目的实施硕士研究生住院医师规范化的临床培训,提高住院医师的业务素质与临床技能。力弦探讨硕士研究生住院医师临床培训的运行机制与模式,利用统计描述法对培训成效进行分析。结果2006-2008年度,203位硕士研究生住院医师的阶段培训考核合格率高于80％：品德素质、理论知识、技能操作、病历质量、临床教学与科研能力等指标均达到培训要求。结论明确硕士研究生住院医师规范化培训的目标,探讨适宜的培训运行机制与模式,对实现住院医师规范化培训有积极意义。     

临床型研究生培养与住院医师培训相结合可行性研究

目的研究临床型研究生培养与住院医师培训相结合的可能性。方法对上海某三级甲等医院临床型研究生和部分临床带教老师进行问卷调查。结果对于临床型研究生培养纳入住院医师培训,对其临床能力培养是否有帮助和对就业是否有帮助,带教老师和学生之间看法具有显著差异(P<0.05);临床型研究生医师资格被带教老师和学生认为是存在的障碍第一位;带教老师认为临床型研究生培养纳入住院医师规范化培训有必要的比例明显高于学生。结论从经济上、技术上、组织管理和社会影响进行分析,临床型研究生培养与住院医师培训相结合有其可行性,两条途径的临床能力培训并轨后,将利于统一的专科医师准入制度的建立。     

Mentoring Early-Career Preventionists: Current Views from Mentors and Protégés

In prevention science, much of the training occurs outside of a formal graduate program and mentorship is invaluable to early-career individuals. A sample of the Society for Prevention Research (SPR) membership (N?=?97) from a wide range of career levels completed an online questionnaire in spring 2010. Almost 20% identified as mentors, 32% as protégés, and 49% as both a mentor and a protégé. Most mentoring relationships were established in graduate school, but professional organizations such as SPR facilitated nearly one in five mentoring relationships. Qualitative results suggested that participants value their professional organization's support of mentoring and would support initiatives to increase mentoring relationships specifically among SPR members. Although all mentor functions and protégé responsibilities were rated as important, professional support was the highest ranked mentor function and taking initiative the highest ranked protégé responsibility. Additionally, the qualitative results revealed that interpersonal skills and commitment to the mentoring process were seen as key to positive mentoring relationships. We also found that formal documentation of mentoring agreements was rare and a slight preference for a match on gender or ethnicity was observed for protégés from nondominant groups. The discussion includes implications for individuals and implications for promoting high-quality mentoring within professional organizations.     

Benefits of comprehensive reproductive health education in family medicine residency

Given the high prevalence of unintended pregnancy and early pregnancy failure, family physicians frequently encounter these clinical problems. Early abortion care and miscarriage management are within the scope of family medicine, yet few family medicine residency programs' curricula routinely include training in these skills. Comprehensive reproductive health education for family physicians could benefit patients by improving access to safe care for unintended pregnancy and early pregnancy loss and by improving continuity of care, especially for rural and low-income women. By promoting reflection on conflicts between personal beliefs and responsibility to patients, training in options counseling and abortion care fosters patient-centered care and informed decision making. Managing pregnancy loss and termination also improves skills in patient-centered counseling and primary care gynecology. Multiple studies document the feasibility and success of several training models for abortion and miscarriage management in family medicine. Incorporating comprehensive reproductive health care into family medicine residency training enables family physicians to provide a full range of reproductive health services.     

Influence of residency training on occupational medicine practice patterns

OBJECTIVES: A relatively high proportion of occupational medicine (OM) specialists have not had formal residency training in OM. Members of the Western Occupational and Environmental Medicine Association, a professional organization of OM specialists, completed a postal questionnaire (160 of 561 members). METHODS: Educational background, practice setting, practice activities, and skills considered relevant were compared between those with and without formal training. RESULTS: Both groups had considerable focus in clinical care, musculoskeletal medicine, and workers' compensation. However, those with formal training practice in a broader variety of settings were less likely to have practiced another specialty, and used additional skills (toxicology, industrial hygiene, and epidemiology) in their practices. Formal education appears to create a greater diversity of skills and opportunities, but it does not appear to create a group of physicians disinterested in "front-line" occupational medicine practice. CONCLUSIONS: The data support the need for formal residency programs but also highlight the importance of access to formal training for midcareer physicians.     

Using longitudinal mixed methods to study the development of professional behaviours during pharmacy work‐based training

Recent longitudinal investigations of professional socialisation and development of professional behaviours during work‐based training are lacking. Using longitudinal mixed methods, this study aimed to explore the development of professional behaviours during a year of intensive work‐based (pre‐registration) training in pharmacy. Twenty trainee pharmacists and their tutors completed semi‐structured interview and professional behaviour questionnaires at four time points during 2011/2012: months 1, 4 and 9 during training and 4 months after registration; tutors participated in months 1 and 9. Interviews were analysed thematically using template analysis, and questionnaires were analysed using ANOVA and t‐tests. Self‐assessed (trainee) and tutor ratings of all elements of professional behaviours measured in questionnaires (appearance, interpersonal/social skills, responsibility, communication skills) increased significantly from the start of pre‐registration training to post‐registration. Some elements, for example, communication skills, showed more change over time compared with others, such as appearance, and continued to improve post‐registration. Qualitative findings highlighted the changing roles of trainees and learning experiences that appeared to facilitate the development of professional behaviours. Trainees’ colleagues, and particularly tutors, played an essential part in trainees’ development through offering support and role modelling. Trainees noted that they would have benefited from more responsibilities during training to ease the transition into practising as a responsible pharmacist. Longitudinal mixed methods can unpack the way in which professional behaviours develop during work‐based training and allow researchers to examine changes in the demonstration of professional behaviours and how they occur. Identifying areas less prone to change allows for more focus to be given to supporting trainees in areas where there is a development need, such as communication skills and holding increasing responsibility.     

临床专业学位研究生培养与住院/专科医师培训的比较研究

通过对临床专业学位研究生培养与住院/专科医师培训模式的比较研究,尝试对两者进行同一化管理,将利于量化临床型研究生临床能力培养情况,提高招生吸引力,利于挑选优秀临床型研究生,与住院医师规范化培训对象招录工作相衔接。     

Twenty Years of the Ryan Residency Training Program in Abortion and Family Planning

ObjectiveTo summarize the effects of routine, opt-out abortion and family planning residency training on obstetrics and gynecology (ob-gyn) residents’ clinical skills in uterine evacuation and intentions to provide abortion care after residency.MethodsData from ob-gyn residency programs supported during the first 20 years of the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning were analyzed. Postrotation surveys assessed residents’ training experiences and acquisition of abortion care skills. Residency program director surveys assessed benefits of the training to residents and the academic department from the educators’ perspectives.ResultsA total of 2775 residents in 89 ob-gyn programs completed postrotation surveys for a response rate of 72%. During the rotation, residents – including those who only partially participated – gained exposure to and skills in first- and second-trimester abortion care. Sixty-one percent intended to provide abortion care in their postresidency practice. More than 90% of residency program directors (97.5% response rate) reported that training improved resident competence in abortion and contraception care and 81.3% reported that the training increased their own program's appeal to residency applicants.ConclusionOver 20 years, the Ryan Program has supported programs to integrate abortion training to give ob-gyn residents the skills and inspiration to provide comprehensive reproductive health care, including uterine evacuation and abortion care, in future practice. Residency program directors noted that this integrated training meets resident applicants’ expectations.ImplicationsRyan Program residents are trained to competence and are prepared, both clinically and in their professional attitudes, to care for women's reproductive health.     

加拿大家庭医学教育强化技能培训对我国家庭医生培养和职业发展的启示

加拿大家庭医学教育目前已形成较完善的规范化教育和培养体系,强化技能训练是加拿大家庭医生规范化培训体系中作为通科培训后继续教育的一部分,家庭医生完成两年的通科培训后,可申请就重点关注的特殊领域进行额外专科培训,至少为期一年.通过强化技能训练的家庭医生在获得资质认证后可拥有重点执业领域执业资格,更好地完成家庭医生工作,同时...     

Family medicine and psychosocial knowledge: how many hats can the family doctor wear?

The paper examines the impact of teaching family physicians psychosocial skills and knowledge during their residency training in family medicine. The idea put forth by the family practice profession that family physicians are trained to treat their patients' biological, as well as psychosocial problems, is important to the social work profession since social workers have had primary responsibility in treating patients' psychosocial problems in the health care arena in the United States from 1904 until now. In order to learn about the effect of adding psychosocial knowledge to the family practitioner's training curricula, the author conducted an exploratory and comparative study to see if family practitioners had any more psychosocial knowledge than other primary care physicians. No significant differences were found. Implications of the study for family medicine and social work, primary health care, and social/health policy are discussed.