深圳市住院医师规范化培训实践

深圳市在多年的探索和试点工作基础上,从2010年开始面向全国各高等院校本科以上应届毕业生公开招考住院医师规范化培训学员,开始了新型住院医师规范化培训的实践.对住院医师规范化培训在政策、经费上予以大力支持,通过与全国多个医学院校附属医院建立委托培养关系,充分利用了国内优质资源,保证了深圳市住院医师规范化培训质量.作为我国住院医师规范化培训项目先行先试的城市之一,深圳市的住院医师规范化培训工作取得了一定的成绩,但仍需进一步完善住院医师规范化培训管理制度、积极探索各类医疗卫生人员的规范化培训模式、不断提高本市基地培养水平.     

北京:采用多元投入的经费保障机制

正原北京市卫生局、市教委、市财政局、市人力社保局和市中医管理局联合印发了《关于推进北京市住院医师规范化培训制度建设的意见》,自2012年起在北京地区全面建立住院医师规范化培训制度。建立会商制度,加强组织协调为全面推进住院医师规范化培训,首先,在首都医药卫生协调委员会层面实施住院医师规范化培训会商制度,由市级卫生计生行政部门负责住院医师规范化培训的组织领导和政策协调。其次,成立住院医师规范化培训工作指导委员会和专科委员会,负责提出     

对住院医师规范化培训与专业型硕士培养并轨的探讨

在阐述住院医师规范化培训与专业硕士培养并轨必要性的基础上,分析住院医师规范化培训与专业硕士培养并轨的现状.结合国内外住院医师规范化培训经验,探索完善住院医师规范化培训制度.提出住院医师规范化培训与专业硕士培养并轨尚需解决的问题,提示应进一步完善住院医师规范化培训与专业硕士培养并轨机制.     

住院医师规范化培训临床教学查房的实践与体会

在国家住院医师规范化培训持续深入推进的背景下,以医院加强住院医师规范化培训临床教学查房为基础,分析了住院医师规范化培训临床教学查房的内涵及特点,提出了组织临床教学查房的实施方案,并就如何实现住院医师规范化培训临床与教学有机融合提出了意见、建议。     

培训规范化的住院医=￥？--上海：保障待遇 吸引优秀学员

2014年1月17日,国家卫生计生委发布了《国家卫生计生委等7部门关于建立住院医师规范化培训制度的指导意见》,提出到2015年,各省（区、市）全面启动住院医师规范化培训工作,到2020年,基本建立住院医师规范化培训制度,所有新进医疗岗位的本科以上学历临床医师均接受住院医师规范化培训。住院医师规范化培训制度在全国的推行不仅有了明确的时间表,     

培训规范化的住院医=￥■

正2014年1月17日,国家卫生计生委发布了《国家卫生计生委等7部门关于建立住院医师规范化培训制度的指导意见》,提出到2015年,各省(区、市)全面启动住院医师规范化培训工作,到2020年,基本建立住院医师规范化培训制度,所有新进医疗岗位的本科以上学历临床医师均接受住院医师规范化培训。住院医师规范化培训制度在全国的推行不仅有了明确的时间表,而且     

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。     

住院医师规范化培训考核体系改革的探索

目的:在上海市推行新的住院医师规范化培训制度之际,东方医院对原有的住院医师考核体系进行改革,探索住院医师规范化培训过程中更合理的考核体系。方法:对住院医师考核体系的主旨、内容、流程、方法及与绩效挂钩等方面进行改革。结果:改革后的考核体系有利于提高住院医师培训的积极性,提高对住院医师培训的管理效率。结论:探索建立一套适合于住院医师规范化培训的考核体系,可有效提高住院医师规范化培训质量。     

住院医师规范化培训中的人文思想

本文论述在现代医学模式指导下,加强人文思想在住院医师规范化培训中的渗透,以促进住院医师规范化培训人员人文素养的提升。住院医师规范化培训中蕴含着许多人文思想因素,只要在教学中有意识地进行人文思想渗透,就可以有效地促成住院医师规范化培训人员人文思想的形成,进而提高住院医师规范化培训人员的人文素养。     

住院医师规范化培训教学查房的实践性探索

随着国家住院医师规范化培训的改革不断深入推进,住院医师规范化培训中的教学查房的作用变得越来越突出。笔者以住院医师规范化培训中的教学查房为基础,针对住院医师规范化培训中教学查房的现状,分析教学查房的特点,并就如何实现住院医师规范化培训临床与教学有机融合提出意见及建议,以促进教学质量和提高住院医师的临床诊疗思维能力、临床实践能力及自学能力等综合实力。     

Occupational medicine residency graduate survey: assessment of training programs and core competencies

OBJECTIVE: This study provides insight into Occupational Medicine (OM) residency graduates and how residency programs are meeting their education goals. METHODS: A survey of graduates from nine OM residency program was performed to evaluate the effectiveness of OM residency training in the United States and Canada. RESULTS: Eighty percent of the OM residency graduates were currently practicing OM. Three-quarters worked in clinical practice for a mean of 20 hr/wk. Other activities varied and included management, teaching and consulting. Ninety-five percent were satisfied with their OM residency training. The competencies acquired were mostly ranked highly as practice requisites, although preparation in clinical OM might be better emphasized in training. Recent OM residency graduates were more likely to be board-certified in OM than other American College of Occupational and Environmental Medicine physician members (73% vs 41%). CONCLUSIONS: OM residency graduates over the past 10 years were highly satisfied with OM residency training, with the training generally meeting practice needs.     

Components of effective clinical-nutrition training: a national survey of graduate medical education (residency) programs

A national survey was conducted by The American Society for Clinical Nutrition's Committee on Medical/Dental School and Residency Nutrition Education to assess the context in which nutrition training is provided in medical residency programs. Accreditation guidelines for residency programs suggested eight nutrition components that were endorsed by content experts for inclusion in residency training. Directors and nutrition educators from all accredited residencies in the United States were surveyed to determine the perceived importance of the components and the extent to which the components were actually present. The eight components appear to be relevant for exemplary nutrition training at the residency level. An important identified need is to train and involve more clinical-nutrition faculty members in residency programs.     

刍议临床住院医师规范化培训中责任导师的作用

本文通过全方位的剖析临床住院医师责任导师的工作内容探究责任导师在临床住院医师规范化培训中的作用。临床住院医师通过责任导师的培养和教育,不仅掌握了很巩固的专业知识还增强了职业素养和临床技能,积累了很多宝贵的工作经验,在遇到突发疾病时,不慌不乱,能够快速的展开救治工作。责任导师能够言传身教,使得临床住院医师掌握了良好的专业治疗技能,还使得临床住院医师的职业素质得以大大提高,有利于规范临床住院医师的医疗行为,适用于临床住院医师的规范化培训。     

Family medicine residency training--three or four years?

Opinions about a four-year family practice residency were elicited from a nationally representative sample of three groups of family physicians. Questionnaires were mailed to a random sample of 308 residency graduates aged 30 to 35 years, all 383 residency directors, and a random sample of 319 third-year residents. Two mailings produced an 82 percent response rate. A four-year residency was favored by 32 percent of recent graduates, 20 percent of program directors, and 34 percent of third-year residents. Over 60 percent of residents and recent graduates would have entered a family practice program had the residency been of four years' duration. Perceived barriers to a four-year residency included lack of resources, loss of appeal, and the additional time commitment. Respondents were most willing to complete a fourth year of residency to receive additional training in orthopedics, obstetrics, gynecology, and pediatrics. Many respondents believed that the additional year would be helpful in obtaining hospital privileges in obstetrics and in coronary care and intensive care units. This study provides information useful in discussions regarding extending residency training.     

Outpatient consultations from a family practice residency program: nine years' experience

Previous reports of consultation rates from family practice physicians have included small sample sizes and have suggested higher rates in residency training programs. This report summarizes 9 years of data involving 161 family practice physicians in a residency training program and shows an overall rate of 1.4 percent for outpatient consultations. Otolaryngology, orthopedics, obstetrics/gynecology, and general surgery were the most frequent disciplines consulted. These data are helpful in designing health care systems that include family practice residency programs.     

Training in Firearm Safety Counseling in Family Practice Residency Programs

The purpose of this study was to establish a national baseline regarding the prevalence of training of family practice residents regarding firearm safety counseling. A national survey of the residency directors at the 420 accredited family practice residency programs in the coterminous United States was used to assess the prevalance of training in firearm safety counseling, perceived effectiveness of such training, and perceived barriers to such counseling in residency programs. Program directors were sent a two-page questionnaire on firearm safety counseling activity in their programs and 71% responded. Few residencies (16%) had formal training in firearm safety counseling. The most common perceived barriers were no trained personnel (31%), too many other important issues (31%), not enough time (30%), and lack of educational resources (28%). Patient education materials (57%), video training programs (49%), and a curriculum guide (46%) were identified as resources, that would be most helpful in implementing a firearm safety counseling program. The results showed that formal training in firearm safety counseling is virtually absent from family practice residency training programs. This finding is not surprising given that less than 14% of the directors perceived firearm safety counseling would be effective in reducing firearm-related injuries or deaths and that research on effectiveness of such counseling is very limited.     

Pediatric Residency Training on Tobacco: Training Director Tobacco Survey

BACKGROUND: Statements from the American Academy of Pediatrics encourage pediatricians to address tobacco. However, most fail to do so and little is known about the preparation to intervene on tobacco they receive during residency training. METHODS: The Pediatric Residency Training Director Tobacco Survey was mailed to all pediatric residency training directors in the United States. The survey assessed the nature of training and supervision on tobacco, barriers to training, and factors that influence the inclusion of tobacco in the residency training curriculum. RESULTS: Seventy percent of the training directors returned the surveys. Relatively few offered training/supervision on tobacco on a formal basis. Training directors were reluctant to treat parents who smoke, were skeptical about third party payer reimbursement, and did not believe that office-based interventions for treating tobacco use among patients were effective. Key barriers to training were competing priorities, lack of training resources, and lack of faculty with expertise on tobacco. CONCLUSION: Residency training is an excellent time to train future pediatricians to intervene on tobacco, but too few pediatric training programs have taken up this charge. Much needs to be done to correct this situation and to prepare future pediatricians to meet the tobacco challenge.     

农村订单定向医学生就业与规培:两年跟踪分析

目的:跟踪分析两届订单定向医学生毕业后两年的就业与规培情况,探讨首届定向生规培结束后能否"回乡"履约,并提出政策建议。方法:选取中西部四所医学院校,分别对2015届305名和2016届435名订单定向生在毕业当年建立队列,随后连续两年开展随访调查和深入访谈。结果:当前订单定向毕业生履约率高于99%,工作落实率高于98%,2015届和2016届定向生编制落实的比例分别为86.7%和93. 8%,参加规培的比例分别为97. 4%和68. 3%,规培期间月总收入分别为3 879元和3 783元。结论:与首届定向生相比,2016届毕业生的工作及编制待遇落实更为顺畅,但是出现与家乡所在地签约率下降、定向工作地点限制过严、部分定向生参加规培未得到有效落实等问题。相关部门应尽早明确规培与"回乡"的转接办法,充分调动地方政府的积极性,促进定向生履约。     

美国住院医师科研能力培训的经验与启示

住院医师规范化培训的目的在于提高住院医师的综合素质,培养高质量医学人才.具有科研能力及创新精神的青年医师是医院学科建设得以持续发展的必备条件.本文介绍了美国住院医师规范化培训中加强科研训练的一些实践和探索,为解决我国住院医师规范化培训中所面临的问题提出了建议,以期为国内正在开展住院医师规范化培训的医学院校加强青年医师创新意识和科研能力的培养提供新的思路.     

Length and content of family practice residency training

BACKGROUND: Family practice residency programs are based largely on a model implemented more than 30 years ago. Substantial changes in medical practice, technology, and knowledge necessitate reassessment of how family physicians are prepared for practice. METHODS: We simultaneously surveyed samples of family practice residency directors, first-year residents, and family physicians due for their first board recertification examination to determine, using both quantitative and qualitative methods, their opinions about the length and content of family practice residencies in the United States. RESULTS: Twenty-seven percent of residency directors, 32% of residents, and 28% of family physicians favored extending family practice residency to 4 years; very few favored 2- or 5-year programs. There was dispersion of opinions about possible changes within each group and among the three groups. Most in all three groups would be willing to extend residency for more training in office-based procedures and sports medicine, but many were unwilling to extend residency for more training in surgery or hospital-based care. Residents expressed more willingness than program directors or family physicians to change training. Barriers to change included disagreement about the need to change; program financing and opportunity costs, such as loss of income and delay in debt repayment; and potential negative impact on student recruitment. CONCLUSION: Most respondents support the current 3-year model of training. There is considerable interest in changing both the length and content of family practice training. Lack of consensus suggests that a period of elective experimentation might be needed to assure family physicians are prepared to meet the needs and expectations of their patients.