药学实习生在门诊中药房的实践教学及管理体会

目的总结实习带教工作经验,巩固实习质量,为药学实习生将来的工作打下坚实的基础。方法根据中药房的实习内容,并结合药学部的实际情况,提出实习内容和带教模式。结果药学实习生通过实习前动员和岗前培训,对不同层次的学生采用不同的带教方式,药学实习生掌握了更多的中药学知识,同时带教老师也不断提高了自身素质。结论通过药学实习生中药房的实习带教,提高了药学实习生的专业知识水平,培养了新时代高素质的专业人才,同时也提高了教学质量。     

临床实习生对非直属附属医院教学管理满意度调查

目的 通过分析高校非直属附属医院本科实习生对医院教学管理的满意度,为完善医院临床本科实习生教学和管理工作提供参考。方法 制定临床本科实习生对医院管理、科室管理及带教老师教学满意度调查问卷,对河北省人民医院130名临床本科实习生进行现场的问卷调查,结果 学生的总体满意度较高,但医院的教学设备、学生管理、带教教师教学水平还有待完善。结论 应加强医院的教学设备建设、临床实习生管理和改善带教教师的教学方法。     

东南亚留学生急诊科临床实习带教体会

目的探讨急诊科东南亚医学留学生临床实习带教方法 ,提高临床实习带教效果。方法回顾性分析我院急诊科在东南亚医学留学生临床实习带教中存在的问题,总结经验教训。结果我院急诊科在东南亚医学留学生临床实习带教实践中积累了丰富的教学经验,但同时也存在诸多不足。结论提升带教老师的英语水准,采用PBL教学模式,合理安排实习内容,切实强化临床基本技能训练及临床思维能力的培养,可提高我院急诊科东南亚医学留学生临床实习带教效果。     

呼吸公众号结合PBL法在呼吸内科临床实习教学中的应用

目的探讨呼吸公众号结合PBL法在呼吸内科临床实习教学中的作用。方法选择我校2017级三年制临床医学专业学生100名,随机分成两组各50名。对照组给予常规呼吸内科临床带教;实验组采用呼吸公众号结合PBL法进行教学,即学生关注呼吸公众号,并参与呼吸公众号内容推送,以PBL模式即问题加答案的形式进行教学。两组学生均选用同一教材,由同一临床老师带教,实习结束同时测试并评价教学效果。结果采用呼吸公众号结合PBL法教学的实验组学生在评判性思维能力方面及呼吸内科临床实践能力方面均优于对照组,差异均有统计学意义(P0.05)。结论呼吸公众号结合PBL法进行临床实习教学,能显著提高学生对呼吸内科临床实习知识的掌握水平,激发学生自主学习兴趣,提高了学生解决临床实践问题的能力。     

高等医学教育中临床实习工作的几点思考

临床实习是医学院校学生走向临床工作不可逾越的阶段,是高等医学教育的重要组成部分,是医学生成长为合格的临床医生的必经之路。然而,目前临床实习过程中存在着带教教员任务繁重,缺乏教学热情;实习学生面临就业、考研等多重压力以及临床教学模式单一、临床实习考核流于形式等问题。针对这些问题所导致的医学生临床实习质量下降的现象,探讨提高实习质量的方法,以保证高等医学人才培养的质量。     

临床医学本科生实习质量的影响因素及对策

医学是一门实践性、社会性、应用性及责任性都非常强的学科。临床实习是医学生从理论学习到临床实践的重要阶段．是从单纯学习书本知识的学生成长为具有临床思维和技能的医生的重要环节。作者经过几年的带教经历,发现影响临床本科实习质量的因素主要为学生自身因素、带教老师因素和社会因素。现就这些影响因素及对策作一探讨。     

一对一规范带教法在检验科实习带教中的应用

目的探讨一对一规范带教法在检验科实习中的带教效果。方法选择2012年6月~2013年6月在我院检验科实习的学生60名,随机分为对照组和实验组,对照组应用常规传统带教法,实验组采取一对一规范带教法。比较两组实习生的考试成绩及实习生对教学方法的评价。结果实验组理论知识和临床技能考试成绩均优于对照组,差异有统计学意义(P0.05);实习生评价结果显示,实验组实习生总体工作情况较好,对自身职业素质的提升认同度也较高。结论检验科实习生一对一带教法的应用有积极效果,能显著提升实习生专业素质,值得推广应用。     

骨科实习教学中的问题及对策

实习教学是培养医学生的重要环节,是理论教学与临床实践的桥梁。根据骨科专业性强、内容繁多,带教老师多肩负繁重临床工作等特点,我们通过加强师资队伍建设,落实带教责任制,明确学习目标,培养学习兴趣,注重基本功训练,规范实施问诊查体,养成独立的临床诊断与治疗思维,重视病历书写,培养临床思维,加强医患交流,掌握常见多发病的诊疗常规,注重动手能力培养,强化骨科影像教学等内容,提高实习生综合素质,达到提高骨科临床教学质量的目的。     

不同学历实习护生对带教老师素质能力期望现状调查

目的调查护生对临床带教老师素质能力期望现状,有针对性地加强护理临床带教教师队伍建设。方法采用吕岩编制的《护理本科生临床实习情况调查问卷》对龙岩市三甲医院实习的不同学历实习护生165名进行问卷调查,并对不同学历实习护生对带教老师素质能力期望现状调查的结果进行统计分析,从教学计划、带教教学能力、学生参与实践、带教监督管理、护生评价体系五个维度评价实习护生对带教老师的期望现状。结果不同学历实习护生在带教老师的教学能力、学生参与实践、带教监督管理、护生评价体系得分比较,差异具有统计学意义(均P0.05);教学计划得分比较差异无统计学意义(P0.05)。结论不同学历实习护生对带教老师素质能力期望具有差异性,护生实习管理体系尚未健全,需要进一步提升。     

评教评学对临床护理教学质量的影响

目的探讨分析评教评学对临床护理教学质量和学生学习质量的影响。方法以2009~2011学年在我科实习、见习护士、临床带教老师及护长的评教评学调查表作为研究对象,对评教表、评学表的每项指标的分值进行统计分析。结果评价表每项指标的分值逐年提高,差异具有统计学意义(P0.05)。结论评教评学有利于调动带教老师和学生双方的教与学的积极性,及时发现教与学中存在的问题,达到指导临床教学改革,督促学生自觉学习,在总体上提高临床护理教学质量。     

高等医学教育中临床实习工作的几点思考

临床实习是医学院校学生走向临床工作不可逾越的阶段,是高等医学教育的重要组成部分,是医学生成长为合格的临床医生的必经之路。然而,目前临床实习过程中存在着带教教员任务繁重,缺乏教学热情;实习学生面临就业、考研等多重压力以及临床教学模式单一、临床实习考核流于形式等问题。针对这些问题所导致的医学生临床实习质量下降的现象,探讨提高实习质量的方法,以保证高等医学人才培养的质量。     

PBL和TBL的双轨教学法在胸外科专业学位研究生教学中的应用

目的:研究PBL联合TBL的双轨教学法在胸外科专业学位研究生教学中的应用。方法:选取进入我院进入科室进行临床工作的硕士研究生及博士研究生共60人,随机分为教学改革组与传统教学组,每组30人,教学改革组采用PBL联合TBL教学法。在为期1年时间结束后,分别采用闭卷考试、小组成员互评及导师对学员的评价等多种评价模式比较教学改革组与传统教学组的学习效果。同时还采用闭卷考试与问卷调查方式评价教学效果。结果:教学改革组客观成绩与学习效果即出科考试成绩、增设考试成绩与对专业知识掌握程度的客观成绩优于传统教学组,差异具有统计学意义,并且PBL联合TBL的双轨教学法对于提高学生临床思维培养能力、表达能力、交流能力均优于传统教学组,并且提高了学生在实习期间的热情度。结论:联合PBL和TBL的双轨教学发在胸外科专业学位研究生教学中有较好的效果。     

Results of a psychosomatic training program in China, Vietnam and Laos

ABSTRACT: BACKGROUND: With the "ASIA-LINK" program, the European Community has supported the development and implementation of a curriculum of postgraduate psychosomatic training for medical doctors in China, Vietnam and Laos. Currently, these three countries are undergoing great social, economic and cultural changes. The associated psychosocial stress has led to increases in psychological and psychosomatic problems, as well as disorders for which no adequate medical or psychological care is available, even in cities. Health care in these three countries is characterized by the coexistence of Western medicine and traditional medicine. Psychological and psychosomatic disorders and problems are insufficiently recognized and treated, and there is a need for biopsychosocially orientated medical care. Little is known about the transferability of Western-oriented psychosomatic training programs in the Southeast Asian cultural context. METHODS: The curriculum was developed and implemented in three steps: 1) an experimental phase to build a future teacher group; 2) a joint training program for future teachers and German teachers; and 3) training by Asian trainers that was supervised by German teachers. The didactic elements included live patient interviews, lectures, communication skills training and Balint groups. The training was evaluated using questionnaires for the participants and interviews of the German teachers and the future teachers. RESULTS: Regional training centers were formed In China (Shanghai), Vietnam (Ho Chi Minh City and Hue) and Laos (Vientiane). A total of 200 physicians completed the training, and 30 physicians acquired the status of future teacher. The acceptance of the training was high, and feelings of competence increased during the courses. The interactive training methods were greatly appreciated, with the skills training and self-experience ranked as the most important topics. Adaptations to the cultural background of the participants were necessary for the topics of "breaking bad news," the handling of negative emotions, discontinuities in participation, the hierarchical doctor-patient relationship, culture-specific syndromes and language barriers. In addition to practical skills for daily clinical practice, the participants wanted to learn more about didactic teaching methods. Half a year after the completion of the training program, the participants stated that the program had a great impact on their daily medical practice. CONCLUSIONS: The training in psychosomatic medicine for postgraduate medical doctors resulted in a positive response and is an important step in addressing the barriers in providing psychosomatic primary care. The transferability of western concepts should be tested locally, and adaptations should be undertaken where necessary. The revised curriculum forms the basis of training in psychosomatic medicine and psychotherapy for medical students and postgraduate doctors in China, Vietnam and Laos.     

Residency training in internal medicine: program design in an era of constraint.

Directors of postgraduate internal medicine programs face many problems in program design, particularly when numbers of house staff continue to decrease. This paper examines the training requirements of a resident in internal medicine and proposes a curriculum based on set rotations in the three key areas of training--subspecialty services, critical care and the clinical teaching unit. The distribution of time in these three areas and the balance of exposure to inpatients and outpatients are discussed in detail. This program design ensures exposure to all the key elements of internal medicine in 3 years and should prevent significant gaps in knowledge at the time of certification. The implications for "service" in major teaching hospitals is discussed. Hospital departments and administrators must confront the prospect of hospital units without house staff. Most important, program directors must resist sacrificing the pedagogic essentials of a training program for service requirements.     

浅析基于PBL教学模式下的临床医学教学应用

目的:PBL是"基于问题式学习"的教学法,本文以PBL教学法内涵为理论基础,剖析了在临床医学教学过程中实施PBL教学法的必要性。PBL教学法可以顺应时代发展的要求提高学生的综合能力提升教师的教学水平增进和改善师生关系,并总结归纳出PBL教学法的一般模式和实施过程中常见的主要问题,主观上传统的教育观念根深蒂固,客观上存在师资力量不足、现有教学体系不科学的问题。提出了解决问题的策略:转变教学理念,不断完善教学环境;提高教师队伍素质建设,发挥教师导向作用;逐步建立科学的教育体系。PBL教学法有助于全面培养学习者的学习能力,提高学习者的综合素质,全面推行切合自身实际的PBL教学模式,逐步建立具有中国特色的临床医学教学模式,培养高素质临床医学人才,与现代社会对人才培养的要求基本一致,值得推广和应用。     

A systematic review of evidence-based practices for clinical education and health care delivery in the clinical teaching unit

Background:The clinical teaching unit is a widespread clinical training model that requires reform to prepare physicians for practice in the 21st century. In this systematic review, we aimed to identify evidence-based practices in internal medicine clinical teaching units that contribute to improved clinical education and health care delivery.Methods:We searched several databases from 1993 until Apr. 5, 2021, to identify published studies in inpatient clinical teaching units that involved medical trainees and reported outcomes related to trainee education or health care delivery. We identified emergent themes using a narrative approach and determined confidence in review findings using the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) methodology.Results:We included 107 studies of internal medicine clinical teaching units, of which 93 (87%) were conducted in North America. Surveys (n = 31, 29%), trials (n = 17, 16%) and narrative studies (n = 15, 14%) were the most prevalent study designs. Practices identified as contributing to improved clinical education or health care delivery included purposeful rounding (high confidence), bedside rounding (moderate confidence), resource stewardship interventions (high confidence), interprofessional rounds (moderate confidence), geographic wards (moderate confidence), allocating more trainee time to patient care or educational activities (moderate confidence), “drip” continuous models of admission (moderate confidence), limiting duty hours (moderate confidence) and limiting clinical workload (moderate confidence).Interpretation:In this review, we identified several evidence-based practices that may contribute to improved educational and health care outcomes in clinical teaching unit settings. These findings may offer guidance for policies, resource allocation and staffing of teaching hospitals.

Medical education in North America is largely based on an educational model that is now more than a century old.¹ To keep pace with changing social, economic and health system circumstances, substantial educational reform is necessary to prepare physicians for practice in the 21st century. Over the past decade, numerous national organizations, including the Association of Faculties of Medicine in Canada and the American Medical Association, have echoed this call to action.^1,2The clinical teaching unit (CTU) provides a joint model of undergraduate and postgraduate clinical education in which trainees contribute to direct patient care, with graded levels of responsibility reflective of their level of training.³ The CTU describes an approach to delivering learner education and patient care in parallel, and since its inception in Canada in 1962, this model of care has become almost ubiquitous across clinical specialties in many countries. Although the use of CTUs is a common approach to organizing an inpatient teaching service, the implementation of CTUs is highly variable with regard to elements such as the number of learners and patients, and regionalization to specific hospital wards. Moreover, a systematic evaluation of practices that maximize the CTU’s effectiveness has not been conducted, meaning evidence to inform CTU design is lacking.The purpose of this systematic review was to identify practices in internal medicine CTUs that contribute to improved clinical education for resident physicians and medical students, as well as to health care delivery.     

新媒体在研究生教学中的应用

当今教育技术现代化高度发展的环境下,随着以计算机为核心的新媒体技术的迅速发展,计算机辅助教学工具和辅助教学媒体在教学中的应用已经日趋广泛和成熟,应用新媒体教学可以充分调动学生学习的积极性,可以有效培养学生的思辨性以及分析解决问题的能力,更可以根据每个学生的自身情况制定个性化学习方案。同时以微信,微博为代表的社交互动平台也愈发显示出其在教育教学中无可替代的作用。将这些社交互动平台与研究生教学相结合可以拓展师生之间的交流方式,可以帮助学生开阔眼界与视野并有助于其与行业顶尖人才直接交流心得体会,也可以帮助学生拉近与老师之间的距离并有助于学生自主学习。本文通过对新媒体,新技术的深入研究以及对微信,微博等社交互动平台与研究生教学相结合的密切关注探讨这些前沿科技在硕士研究生尤其是在临床医学类研究生教学领域的应用前景。     

Development and Validation of an Instrument for Measuring the Quality of Teamwork in Teaching Teams in Postgraduate Medical Training (TeamQ)

Background

Teamwork between clinical teachers is a challenge in postgraduate medical training. Although there are several instruments available for measuring teamwork in health care, none of them are appropriate for teaching teams. The aim of this study is to develop an instrument (TeamQ) for measuring teamwork, to investigate its psychometric properties and to explore how clinical teachers assess their teamwork.

Method

To select the items to be included in the TeamQ questionnaire, we conducted a content validation in 2011, using a Delphi procedure in which 40 experts were invited. Next, for pilot testing the preliminary tool, 1446 clinical teachers from 116 teaching teams were requested to complete the TeamQ questionnaire. For data analyses we used statistical strategies: principal component analysis, internal consistency reliability coefficient, and the number of evaluations needed to obtain reliable estimates. Lastly, the median TeamQ scores were calculated for teams to explore the levels of teamwork.

Results

In total, 31 experts participated in the Delphi study. In total, 114 teams participated in the TeamQ pilot. The median team response was 7 evaluations per team. The principal component analysis revealed 11 factors; 8 were included. The reliability coefficients of the TeamQ scales ranged from 0.75 to 0.93. The generalizability analysis revealed that 5 to 7 evaluations were needed to obtain internal reliability coefficients of 0.70. In terms of teamwork, the clinical teachers scored residents'' empowerment as the highest TeamQ scale and feedback culture as the area that would most benefit from improvement.

Conclusions

This study provides initial evidence of the validity of an instrument for measuring teamwork in teaching teams. The high response rates and the low number of evaluations needed for reliably measuring teamwork indicate that TeamQ is feasible for use by teaching teams. Future research could explore the effectiveness of feedback on teamwork in follow up measurements.     

Evolving residency requirements for ambulatory care training for five medical specialties, 1961 to 1989.

Recent changes in the patient population of teaching hospitals, spurred by technologic advances and economic forces, have jeopardized the traditional hospital-based model of residency training. In consequence, there has been increasing attention paid to the need for ambulatory care experience. A primary force in shaping the content of postgraduate medical education is "The Essentials of Accredited Residencies," published in the Directory of Graduate Medical Education Programs. We reviewed recommendations and requirements for ambulatory settings and outpatient experience as specified in the Directory during the years 1961 to 1988 and investigated pending changes in requirements for five major specialties: internal medicine, pediatrics, family practice, general surgery, and obstetrics and gynecology. Increases in the amount of time residents spend in ambulatory care training recently have been mandated in internal medicine and are under consideration in two other specialties, indicating probable major shifts in the locus of postgraduate medical training.