住院医师规范化培训管理现状调查与分析

目的 调查分析医院开展住院医师规范化培训现状。方法 选取2011—2013年进入医院住院医师规范化培训基地的住院医师,采用现场发放调查问卷方法进行无记名调查分析。将调查内容分为报名招录、轮转培训、各类考核、组织管理和其他板块。结果 96.7%认为医院招录过程合理或基本合理,92.6%认为培训计划制定具有一定的合理性,90.1%住院医师能够按照规定完成培训内容,各类考核内容基本能够反映住院医师的培训水平。在众多培训期间存在困难中,依次为收入偏低、个人婚恋生育计划难以实施以及工作和学习压力过大。结论 住院医师基本认同目前医院的培训管理制度和方法,逐步提高住院医师薪酬待遇,有效疏导培训压力和加强师资队伍建设是提高住院医师培训积极性和培训质量的保证。     

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。     

住院医师/专科医师对规范化培训带教师资和培训管理的满意度调查分析

目的 调查参加规范化培训的住院/专科医师对带教师资综合职业能力和培训管理的满意度,进一步了解不同医院开展毕业后医学教育所面临的问题和进行毕业后医学教育规范化培训异同。方法 采用自制问卷对成都市4所三级甲等医院598名住院/专科医师进行问卷调查,对收集的数据进行因子分析和方差分析。结果 受调查的598名住院/专科医师对带教师资的综合职业能力的满意度评分在3.83～4.11之间﹝满分为5分﹞,而对培训管理的满意度评分在2.91～3.75之间,且不同医院住院/专科医师的满意度有差异性﹝P﹤0.05﹞。结论 无论教学医院还是非教学医院,都应加强带教师资建设和培训管理,才能提高住院/专科医师对规范化培训的满意度,以促进住院/专科医师规范化培训的顺利开展。     

带教师资对规范化培训住院/专科医师综合职业能力的满意度调查分析

目的 调查带教师资对参加规范化培训的住院/专科医师综合职业能力的满意度。方法 采用自制问卷,对成都市4所三级甲等医院515名带教师资进行问卷调查,每项的满意度按5分记数,最高分5分,对收集的数据进行因子分析和方差分析。结果 受调查的515名师资对住院医师的综合职业能力的满意度评分均值为（3.48±0.58）分,不同医院的带教师资对住院/专科医师的满意度评价有差异性﹝P﹤0.05﹞。结论 人事关系类别是影响师资与学员相互之间的满意度因素之一,因此,无论教学医院还是非教学医院都应注意人事制度改革带来的多元化人力资源管理。

     

上海放射学住院医师规范化培训考核效果回顾性分析

目的 回顾性分析上海市放射学住院医师规范化培训技能考核的形式和内容,探讨影响规范化培训技能考核成绩的相关因素。方法 对2001—2009年,共计260名医学影像学住院医师参加规范化培训技能考核的理论题成绩以及技术操作成绩,运用描述性分析、秩和检验等方法对数据进行研究。结果 （1）放射学住院医师规范化培训CT基础理论题考核成绩的影响因素包括年龄（P=0.000）和毕业专业（P=0.012）;（2）MRI理论题考核成绩的影响因素为毕业院校类别（P=0.001）;（3）介入放射学理论题考核成绩的影响因素为服务医疗机构（P=0.042）;（4）CT操作技术考核成绩的影响因素为毕业院校类别（P=0.014）和服务医疗机构（P=0.015）,差异具有统计学意义。结论 住院医师规范化培训是医师成长的重要阶段。住院医师的学习经历和其所在医院工作情况直接影响其临床技能培训与考核的效果。     

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。方法 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。     

住院医师职业素养测评量表的信效度研究

目的 对住院医师职业素养量表进行信效度测评,为上海地区医疗机构提供住院医师职业素养的量化工具,并研究与职业素养相关的影响因素,对上海住院医师规范化培训现状提出一些建议。方法 针对上海交通大学医学院附属瑞金医院2012届住院医师规范化培训基地110学员进行职业素养调查,回收完整填写量表104份,回收率94.5%。运用主成分法、KMO检验和巴特利球体检验及因子分析对量表进行测评,以此获得量表的信效度。结果 住院医师职业素养量表Cronbach’s Alpha 系数为0.978,分半信度系数为0.864,CVI系数为0.884;KMO检验系数为0.916;职业素养量表由两个主要因子组成（内在因素、外在因素）。主成分分析出初始因子总方差解释率达78.86%。结论 量表具有较高的信度、可接受的结构效度,可广泛应用于上海市住院医师规范化培训的住院医师职业素养评估。     

我院两类人员333制并轨培养效果评价

??目的 了解住院医师和专业学位研究生333制并轨培养的效果。方法 对实施333制管理模式前后的住院医师与专业学位研究生进行年度考核,比较考核成绩。结果 实施333制管理模式前,专业学位研究生考核成绩与住院医师有统计学差异,经过一年的并轨培养,专业学位研究生考核成绩显著提高,与同年住院医师考核结果无统计学差异。结论 专业学位研究生在住院医师规范化培训基地与住院医师进行并轨培养,能够提高专业学位研究生的临床能力。     

儿科临床路径管理引导住院医师规范化培训的探讨

?????? 目的 研究应用儿科临床路径管理的方法对住院医师规范化培训管理的价值。方法 采用对照研究的方法,用SPSS10.0软件计算χ²,确定统计学意义。结果 新方法的应用儿科理论成绩明显提高,住院医师定专业成功率提高,住院医师被患者投诉明显减少。结论 儿科临床路径管理应用于住院医师规范化培训管理,管理流程化,充分调动了培训医师的积极性和创新性,提高了学习效率和效果。     

基于品管圈活动的骨科护理带教质量效果分析

目的 探讨品管圈活动对骨科实习护生护理带教质量的影响。方法 选择2014年4至2014年12月骨科实习护生76名为观察组,2013年4至2013年12月骨外科实习护生64名为对照组,对照组实施传统式的灌输教学方法,观察组在对照组的基础上成立品管圈活动小组。比较培训后两组实习护生的综合能力、带教对护士工作的满意度及护士对带教工作的满意度。结果 两组实习护生对带教的自身素质评价一致,差异无统计学意义（P＞0.05）;在护理教学活动、业务教学能力、教学态度及合计总分上差异有统计学意义（P＜0.05）。结论 品管圈活动能提高骨科实习护生的实践操作能力和综合能力,提高了带教对护士工作的满意度,同时加强了带教老师的培养,也提高了带教老师的带教能力。     

Management of Inpatient Hyperglycemia: Assessing Perceptions and Barriers to Care Among Resident Physicians

Objective:To develop insight into resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal management.Methods:As part of a planned educational program, a questionnaire was designed and administered to determine the opinions of residents about the importance o inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in hospitalized patients.ResultsOf 70 resident physicians from various services, 52 completed the survey (mean age, 31 years; 48% men; 37% in first year of residency training). Most respondents indicated that glucose control was “very important” in critically ill and perioperative patients but only “somewhat important” in non-critically ill patients. Most residents indicated that they would target a therapeutic glucose range within the recommended levels in published guidelines. Most residents also said they felt “somewhat comfortable” managing hyperglycemia and hypoglycemia and using subcutaneous insulin therapy. whereas most residents (48%) were “not at all comfortable” with use of intravenous administration of insulin. In general, respondents were not very familiar with existing institutional policies and preprinted order sets relating to glucose management. The most commonly reported barrier to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and how to use them. Anxiety about hypoglycemia was only the third most frequent concern.ConclusionMost residents acknowledged the importance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guidelines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal management. Educational programs should emphasize inpatient treatment strategies for glycemic control. (Endocr Pract. 2007;13:117-125)     

Dietary Patterns,Metabolic Markers and Subjective Sleep Measures in Resident Physicians

Shiftwork is common in medical training and is necessary for 24-h hospital coverage. Shiftwork poses difficulties not only because of the loss of actual sleep hours but also because it can affect other factors related to lifestyle, such as food intake, physical activity level, and, therefore, metabolic patterns. However, few studies have investigated the nutritional and metabolic profiles of medical personnel receiving training who are participating in shiftwork. The aim of the present study was to identify the possible negative effects of food intake, anthropometric variables, and metabolic and sleep patterns of resident physicians and establish the differences between genders. The study included 72 resident physicians (52 women and 20 men) who underwent the following assessments: nutritional assessment (3-day dietary recall evaluated by the Adapted Healthy Eating Index), anthropometric variables (height, weight, body mass index, and waist circumference), fasting metabolism (lipids, cortisol, high-sensitivity C-reactive protein [hs-CRP], glucose, and insulin), physical activity level (Baecke questionnaire), sleep quality (Pittsburgh Sleep Quality Index; PSQI), and sleepiness (Epworth Sleepiness Scale; ESS). We observed a high frequency of residents who were overweight or obese (65% for men and 21% for women; p?=?0.004). Men displayed significantly greater body mass index (BMI) values (p?=?0.002) and self-reported weight gain after the beginning of residency (p?=?0.008) than women. Poor diet was observed for both genders, including the low intake of vegetables and fruits and the high intake of sweets, saturated fat, cholesterol, and caffeine. The PSQI global scores indicated significant differences between genders (5.9 vs. 7.5 for women and men, respectively; p?=?0.01). Women had significantly higher mean high-density lipoprotein cholesterol (HDL-C; p?<?0.005), hs-CRP (p?=?0.04), and cortisol (p?=?0.009) values than men. The elevated prevalence of hypertriglyceridemia and abnormal values of low-density lipoprotein cholesterol (LDL-C; >100?mg/dL) were observed in most individuals. Higher than recommended hs-CRP levels were observed in 66% of the examined resident physicians. Based on current recommendations, a high prevalence of low sleep quality and excessive daytime sleepiness was identified. These observations indicate the need to monitor health status and develop actions to reassess the workload of medical residency and the need for permission to perform extra night shifts for medical residents to avoid worsening health problems in these individuals.     

住院医师规范化培训中的问题及国际经验启示

目的 梳理我国住院医师规范化培训存在的问题,借鉴国际经验,提出相关政策建议。方法 对现阶段我国住院医师规范化培训存在问题和典型国家住院医师培训开展文献调研和专家咨询。结果 我国 住院医师规范化培训存在管理制度不完善,培训过程和内容不合理,考核制度不健全,动员机制不顺畅等问题。结论 根据 国际经验,提出厘清各部门分工,充分发挥行业组织的桥梁和纽带作用;加强顶层设计和政策配套,保障培训制度的落实;拓宽培养内容,加强学员考核,提高培养质量等政策建议。     

医生与管理者对医院核心人力资源管理制度评价研究

目的 了解公立医院医生和管理者对薪酬、晋升与学习成长这医院3大核心人事制度的认知与评价。方法运用自行设计的人事制度管理状况调查表对我国东、中、西3省、直辖市9个地区的128所公立医院进行调查。结果 医院核心人事制度3个因子中,被调查者不清楚率最高的是“晋升”（5.21%）,不认同率最高的是“薪酬”（25.02%）。多元logistic分析显示,是否是管理者、院内工龄等与被调查者对3大医院核心人事制度的评价有显著关联（P<0.05）。结论 普通医生与管理者对医院核心人事制度的知晓度尚可,医院管理者对医院核心人事制度的评价均显著优于普通医生。     

An Assessment of Diversity,Inclusion, and Health Equity Training in Endocrinology Fellowship Programs in the United States

ContextThe Accreditation Council for Graduate Medical Education has instituted common program requirements related to diversity, equity, and inclusion (DEI) for postgraduate trainees in the United States; however, the extent to which DEI training is being incorporated across endocrinology fellowship programs is unknown.ObjectivesTo describe the sociodemographic representation and DEI training experiences within endocrinology fellowship programs.Design, setting, and participantsNational cross-sectional survey study of fellows and fellowship program leaders in the United States whose fellowships were members of the Association of Program Directors in Endocrinology and Metabolism.Main outcome measures(1) Demographics of fellows and program leaders and (2) programs’ experience, confidence, and interest in formal DEI training.ResultsA total of 108 and 106 fellow and faculty responded to the survey, respectively. The majority of fellows and faculty are female. Less than 3% of fellows and 3.7% of faculty identify as Black. More than 90% of fellows/faculty are heterosexual and no respondents identified as transgender/nonbinary; however, 5% and 2% of all respondents preferred not to disclose their sexual orientation and gender identity, respectively. While 85% of faculty received institutional diversity and inclusion training, 67.6% of fellows did. Fellows are more likely to have received training in health equity than program leaders. Both fellows and program leaders express a high interest in health equity curriculum.ConclusionsWithin the diversity of endocrinology training programs, Black physicians are underrepresented in medicine, which persists in endocrinology fellowships. Fellowship programs express enthusiasm for national diversity and health equity curricula, with the majority of programs reporting institutional DEI training.     

Interobserver Agreement between On-Call Radiology Resident and General Radiologist Interpretations of CT Pulmonary Angiograms and CT Venograms

ObjectivesTo evaluate the interobserver agreement (IOA) between the initial radiology resident and the final staff radiologist reports of combined computed tomographic pulmonary angiograms (CTPA) and computed tomographic venograms (CTV) performed during on-call hours.ResultsCTPAs were reported by staff radiologists as positive for pulmonary embolism (PE) in 18% (126/694), with a kappa of 0.81 (95% CI 0.77-0.86) with 3 outcomes (P, N, I), and a kappa of 0.89 (95% CI 0.85-0.94) with 2 outcomes (P, N). Regarding PE location, good concordance was observed for positive studies, with a kappa of 0.86 (95% CI 0.78 – 0.95). CTVs were reported as positive by staff radiologists in 8.5% (33/388), with a kappa of 0.66 (95% CI 0.55-0.77) with 3 outcomes (P, N, I), and a kappa of 0.89 (95% CI 0.8-1.0) with 2 outcomes (P, N). The IOA between residents and staff radiologists increased with increasing residency year level for CTPAs, but did not for CTVs.ConclusionsVery good and good IOA were observed between resident and staff radiologist interpretations for CTPA and CTV, respectively, with tendency towards improved IOA as residency level of training increased for CTPA, but not for CTV.     

Web-Based Training for Primary Healthcare Workers in Rural China: A Qualitative Exploration of Stakeholders’ Perceptions

BackgroundEquitable access to basic public health services is a priority in China. However, primary healthcare workers’ competence to deliver public health services is relatively poor because they lack professional training. Since the availability of web-based training has increased in China, the current study explored stakeholders’ perceptions of a web-based training program on basic public health services to understand their thoughts, experiences, and attitudes about it.MethodsSix focus group discussions with primary healthcare workers and three with directors of township hospitals, county-level Health Bureaus, and county-level Centers for Disease Control and Prevention were conducted in Yichang City during 2013. Semi-structured topic guides were used to facilitate qualitative data collection. Audio recordings of the sessions were transcribed verbatim and theme analysis was performed.ResultsMost of the study’s participants, especially the village doctors, had insufficient knowledge of basic public health services. The existing training program for primary healthcare workers consisted of ineffective traditional face-to-face sessions and often posed accessibility problems for the trainees. Most of the study’s participants had a positive attitude about web-based learning and expressed a strong desire to receive this novel training approach because of its flexibility and convenience. The perceived barriers to utilizing the web-based training method included poor computer literacy, lack of personal interaction, inadequate infrastructure, and lack of time and motivation. The facilitators of this approach included the training content applicability, the user-friendly and interactive learning format, and policy support.ConclusionsWeb-based training on basic public health services is a promising option in rural China. The findings of the study will contribute knowledge to implementation of web-based training in similar settings.     

Effects of One-Hour Training Course and Spirometry on the Ability of Physicians to Diagnose and Treat Chronic Obstructive Pulmonary Disease

BackgroundsIn China, the prevalence of chronic obstructive pulmonary disease (COPD) in persons 40 years of age or older is estimated at 8.2%, but this is likely a substantial underestimate.MethodsEight secondary hospitals which didn’t have spirometries were chosen randomly in Hunan province of central south China. Physician subjects at these hospitals underwent a one-hour training course on the Chinese COPD guidelines. Physicians answered questionnaires assessing their knowledge of the guidelines before and after the training session. The mean correct scores of questionnaires were compared before and after training. Four out of the eight hospitals were given access to spirometry. Eligible patient subjects underwent spirometry testing prior to the physician visit. After seeing the patient, physicians were asked to answer a questionnaire relating to the diagnosis and severity of COPD. Physicians were then given the results of the spirometry, and asked to answer the same questionnaire. Physicians’ responses before and after receiving the spirometry results were compared.Results225 physicians participated in the training session. 207 questionnaires were completed. Mean scores (out of 100) before and after the training were 53.1 ± 21.7 and 93.3 ± 9.8, respectively. 18 physicians and 307 patient subjects participated in the spirometry intervention. Based on spirometric results, the prevalence of COPD was 38.8%. Physicians correctly identified the presence of COPD without spirometric data in 85 cases (76.6%); this increased to 117 cases (97.4%) once spirometric data were available. Without spirometric data, physicians incorrectly diagnosed COPD in 38 patients; this decreased to 6 patients once spirometric data were available. Spirometric data also improved the ability of physicians to correctly grade COPD severity.ConclusionsSimple educational training can substantially improve physicians’ knowledge relating to COPD. Spirometry combined with education improves the ability of physicians to diagnose COPD and to assess its severity.