专科医生在全科医学培训基地建设中的作用探讨

目的 探讨在三级综合医院全科医学培训基地的建设中，专科医生采取哪些措施和方式，能对全科医学培训基地建设起到积极的作用。方法 首先通过专科医生对全科医学培训基地建设提高思想认识，积极热情和主动带教，转变服务理念和模式，并在带教中要以常见病和多发病为主，在与患者沟通方面要体现全面的人文精神。结果 通过临床实践教学，加深对全科医学理论的认识，使专科医生在全科医学培训基地的建设中，真正起到关键性作用。结论 经过几年的全科医学培训，不断加强和提高专科医生的全科医学素质,使三级综合医院的全科医学培训基地建设的速度和质量大大提高。     

构建医患和谐：大型医院图书馆的医学信息服务的“三个面向”

针对临床医疗引发的医患矛盾,从医学信息服务角度提出了以面向医院管理层、临床医务人员和患者的医学信息服务来化解矛盾,阐述了大型医院图书馆以医学信息服务为纽带,构建医患和谐的工作要点。     

基于“以学为中心”的医学微生物学课程教学改革与实践

“医学微生物学”是临床医学专业的核心课程,理论性和实践性较强。面向国家对医学人才培养目标的变化、如何在教学过程中以学为中心,以及注重学生能力素质的培养是本课程教学改革的重要环节。我们依据学情分析结果,通过翻转课堂、挖掘课程思政元素、基于问题的学习(problem-based learning,PBL)讨论课、虚拟仿真实验及临床见习课、开放性实验等教学手段综合运用进行课程的教学改革。实践证明,该教学改革体系使课程教学与医学人才培养挂钩,能够充分调动学生积极性、提高创新能力及服务意识,实现了师生共赢,圆满完成教学目标。     

英国初级卫生保健质量与结果框架解析

目的 了解英国初级卫生保健质量与结果框架,为改善我国全科服务质量提供经验借鉴。 方法 文献综述与定性访谈。 结果 质量与结果框架作为全科服务合同的一部分,目的是通过引进激励机制改进服务质量,制定一套反映全科医疗服务质量的指标和评分体系,通过综合打分对全科医生的服务进行衡量。结论 在完善的组织管理、疾病登记体系和信息系统的支撑下,质量与结果框架有利于对全科服务进行标准化,统一的定价和支付体系有利于降低不同地区初级卫生保健的服务差异,激励了全科诊所服务的积极性。但也有专家学者指出了其中的一些弊端,有待进一步修正和完善。     

虚拟仿真教学在社区全科教学基地中的应用思考

随着信息技术的普及与传播,将网络多媒体技术应用于教学已成为各大院校教学改革的重要方向。本文拟阐述虚拟仿真教学在社区全科教学基地中的应用思考,以期提高教学质量,为今后全科医学教学改革提供理论参考。     

综合性大学附属医院在卓越医师培养中的主体作用

“卓越医师教育培养计划”的提出为我国医学人才培养提出新要求。经过我国高等医学教育管理体制近20年的改革与发展,培养高素质医学人才已成为综合性大学发展的必然要求,大学附属医院成为卓越医师培养主体。应进一步明确大学附属医院人才培养理念,理顺人才培养教育管理体制机制,充分发挥综合性大学的学科优势,实现临床医学人才培养科学发展。     

PBL联合翻转课堂在社区全科医学教学中的应用

目的探讨PBL联合翻转课堂在社区全科医学教学中的应用效果。方法将我院2014级临床医学专业本科实习生作为研究对象,随机分成实验组(n=32)和对照组(n=32)。由共同教师授予相同主题内容的课程,对照组采用传统教学法,实验组采用PBL联合翻转课堂教学法。课程结束后对学生进行基础理论知识、病史采集、病例分析及临床技能考核,并对学生进行教学效果的评价问卷调查。采用SPSS 25.0软件分析处理所有数据。结果实验组的各项考核成绩、对教学效果的主观评价均优于对照组,差异均有统计学意义(均P0.05)。结论 PBL联合翻转课堂教学优于传统教学模式,有助于提高学生综合能力,提高社区全科医学教学质量。     

临床医师基本技能考核分析

现代医学是一门综合分析、交叉性强的学科,是关系人体生命科学的重要组成部分,不论从预防医学、社会医学;还是从治疗、康复、保健医学出发,卫生人才是需要量大、专科性强、技术性要求高、素质要现代化的全科性、复合性人才。基本技能是临床医师最重要的专业技能和临床基本功之一。体检技能的水平高低一定程度上反映了临床医师实际工作能力。直接影响医疗质量状况,成为各级医疗机构考核临床医师“三基”水平的重要内容。近年来,国家、军队卫生行政部门构建制定了临床医师规范化培训方法,将体检技能培训纳入了相继医学教育范畴。我部根据上级规定和临床工作实际,有计划、有步骤地对临床医师体检技能进行了规范化培训,在此基础上进行认真考核,现将考核中发现的问题分析如下：     

全科医学专业班级实行临床班级导师的实践与思考

目的总结全科医学专业班级实行临床班级导师的实践体会。方法对我校全科医学专业班级学生(2014级)实行临床班级导师制的教学模式进行分析。结果实行临床班级导师制教学对学生提前了解本专业的现状、强化专业思想及关注学科发展动态有促进作用,同时也提高了教师自身素质、沟通能力和亲和力,提高了教学质量。结论临床班级导师制是提高教师人才培养质量的有效途径,同时也让学生早期接触临床、将基础与临床科学有机整合,提高教学质量,值得推广应用。     

生物信息学本科人才培养的调研与思考

近年来,生物信息学已经逐步发展成为现代生物学和医学等领域的关键技术方法,社会对生物信息学专业人才的需求不断扩大,生物信息学的本科教育也受到了越来越多的关注和重视。为了探索更加合理的人才培养模式、完善课程设置和教学计划,本文以中美两国开设生物信息学本科专业的高校为对象,分别选取一些代表高校并进行深入调研,对比分析课程设置和人才培养现状。结果显示,生物信息学的跨学科性质在各高校中均得到一定体现,培养学生具有多元化的知识结构已经成为生物信息学人才培养的一项共识。同时,根据调研的结果,也对国内生物信息学本科教育提出一些启发与建议。     

PEDIATRICIAN'S POINT OF VIEW

Medical care for rural populations is an important problem facing the medical profession nationally and locally. The mechanism for solution lies in the existing American Medical Association and California Medical Association committees on rural medical service and further development of “local health councils.”Additional emphasis on training of physicians for general practice is essential through medical school graduate and postgraduate periods.The problem of providing additional adequately equipped and staffed hospitals must receive much consideration.Recognizing that passiveness invites aggressive non-medical agencies to foster bureaucratic dictation inimical to the practice of medicine, the rural physician must act through medical and community organizations to correct weaknesses in the structure of medical practice.     

PEDIATRICIAN'S POINT OF VIEW

Medical care for rural populations is an important problem facing the medical profession nationally and locally. The mechanism for solution lies in the existing American Medical Association and California Medical Association committees on rural medical service and further development of "local health councils."Additional emphasis on training of physicians for general practice is essential through medical school graduate and postgraduate periods. The problem of providing additional adequately equipped and staffed hospitals must receive much consideration.Recognizing that passiveness invites aggressive non-medical agencies to foster bureaucratic dictation inimical to the practice of medicine, the rural physician must act through medical and community organizations to correct weaknesses in the structure of medical practice.     

Medical and Health Care in State Residential Institutions for Children and Youths: A Report of Survey Findings in Five Hospitals

A survey of five Northern California state residential institutions showed considerable variation in the type and amount of medical services provided for children and youths. There was no standard policy for relationships with regional centers, use of community hospitals, vision and hearing assessments, speech and rehabilitation therapy, or genetic and maternal health services. Some hospitals had no staff members certified to carry out cardiopulmonary resuscitation (CPR). Not all staff physicians and other health professionals working in state hospitals had specific training in the areas of genetics, seizure control and physical rehabilitation medicine. While all five state hospitals are involved in training personnel, there is a need to develop a statewide plan for the better sharing of knowledge and expertise of the state hospital personnel in the training of pediatricians and others.     

Community medicine for clinicians in Canada: a recommendation for postgraduate training.

A large gap presently exists between the predominantly biologic expertise of the medical profession and the complex mixture of biologic, behavioural and epidemiologic components of health problems today. Furthermore, the development of community medicine in Canada has been relatively separate from that of the clinical disciplines. To enable clinicians to acquire the knowledge and skills to manage these health problems, much more community-oriented research, applied behavioural science and clinical epidemiology is needed within the clinical sector of medicine. I have proposed a definition of clinical community medicine and presented a strategy for training clinicians in community medicine skills that calls for administrators of clinical postgraduate programs to develop training in clinical community medicine. Residency programs in community medicine cannot be expected to provide such training given their nonclinical priorities, which focus mainly on the training of public health physicians.     

Health sector response to security threats during the civil war in E1 Salvador.

During the recent civil war in E1 Salvador, as in other modern wars, human rights abuses adversely affected health workers, patients, and medical facilities. The abuses themselves have been described in reports of human rights advocacy organisations but health sector adaptations to a hostile wartime environment have not. Agencies engaged in health work during the civil war adapted parties such as training of community based lay health workers, use of simple technology, concealment of patients and medical supplies, denunciation of human rights abuses, and multilevel negotiations in order to continue providing services. The Salvadorean experience may serve as a helpful case study for medical personnel working in wars elsewhere.     

Simple training programme for ambulance personnel in the management of cardiac arrest in the community.

The extended training for ambulance personnel in Nottinghamshire includes a period of training in cardiac resuscitation by defibrillation, and defibrillators are now part of the standard equipment of vehicles used on the accident and emergency service. Comparison of recent results with previous attempts in the City of Nottingham to provide a service for out of hospital cardiac arrest has shown that an elementary training course and the provision of defibrillators on emergency vehicles enables the ambulance service to save the lives of a reasonable proportion of those who suffer sudden death in the community. The extended training programme as a whole has proved acceptable to ambulance personnel and we believe that this programme could be the basis for a more widespread introduction of post basic training.     

论首都农村卫生室乡村医生的未来??????? ——以政策与法律变迁为研究主线

???? 未来,随着国家乡村卫生服务一体化管理的推进,在首都农村卫生室执业的执业（助理）医师将最终汇入乡镇卫生院的体制之内,无论是合同聘用,还是正式编制,均将改变其现在以及之前的农民身份,从而进入公职人员的行列;其后续人员的选拔在当前遇到了一定的困难,需要作出针对性的改革;其培训将主要通过网络平台同时辅助于一部分面授等方式来完成,其待遇将与卫生院医务人员趋同,其向村民提供的服务将在现有基础上增加一部分卫生院的服务项目。

     

城市社区与乡镇卫生院医务人员工作倦怠情况分析

目的 分析基层医疗卫生机构中的城市社区卫生服务中心与乡镇卫生院医务人员的工作倦怠情况及影响因素,探讨两类机构中医务人员倦怠的水平差异。方法 采用Maslach职业倦怠普适量表（MBI-GS）对东北某地区城市社区卫生服务中心及乡镇卫生院进行问卷调查。结果 城市社区卫生服务中心医务人员工作倦怠检出率为27.8%,工作倦怠程度影响因素是学历、职称、工资收入和绩效方案合理性。乡镇卫生院工作倦怠检出率为34.1%,倦怠程度主要受性别、工作时间、工作量和工资收入影响。结论 乡镇卫生院较城市社区卫生服务中心医务人员的工作倦怠感严重,应引起有关管理部门的重视并采取相应的干预措施。     

The clinical psychologist in a health centre: one year's work.

The Livingston integrated health services project is an attempt to provide a fully integrated area health service with special emphasis on developing multidisciplinary community health teams. As part of this experiment a clinical psychologist was appointed to work in general practice. Ninety-four patients with behavioural, emotional, and cognitive problems were referred in the first year (1% of the 10 000 patients registered at the practice). The psychologist thus provided treatment for some patients who would otherwise have been seen by a general practitioner with neither the time nor the training to deal adequately with their problems.     

Northern Health Service in Canada

The current state and future development of Canada''s North present significant medical problems. The medical facilities available at present are inadequate and, although they are improving rapidly, they must keep pace with the coming expansion of the North. Arctic regions of other northern countries do not show the great discrepancies in health standards that Canada''s North does in comparison to her southern areas. To improve the situation adequate communication, transportation, personnel and facilities are needed. It is proposed that residents in hospital training programs work for a period in the North to supplement recommendations of the Hall Commission in this connection and to broaden their own training.