Training Physicians for Primary Care: Trends and Hazards

Programs to train physicians more effectively for careers in primary care are being organized within academic departments in internal medicine and pediatrics, while the number of training programs in family practice continues to grow rapidly. However, the field of primary care training is expanding without a common vocabulary and with inadequate communication between the specialties involved.If decisions concerning health care policy are to be made rationally, the development of multiple distinct models for primary health care delivery must be encouraged and these models must then be evaluated.The distinction between family practice and family medicine must be made clear if the latter discipline is to realize its potential application to all specialties.The relative exclusion of family practice from universities and the absence of experienced practitioners in university primary care programs are conditions that threaten the future of both types of programs and deserve thoughtful attention from medical educators.     

The hospital component of vocational training for general practice.

Trainees and educationalists in general practice have some grounds for suggesting that the hospital component of vocational training should be restructured and teaching improved. However, the implications for other trainees and secondary care have to be considered. Changes that are needed include a curriculum for senior house officers in each specialty; appointment of training consultants with the necessary skills; and a different attitude by everyone towards study leave, including arrangements for funding. The optimum duration of hospital posts for trainees in general practice might be shorter than now, but the effects on others must be considered and competencies guaranteed in a briefer training period. Changes in the regulations for vocational training could help to improve specialist experience if trainees in general practice were allowed to be supernumerary. Alternatively, senior house officer posts for trainees in general practice could be split between secondary and primary care, thus encouraging a broader perspective.     

免疫治疗背景下提高临床肿瘤教学水平的探讨

肿瘤发病率的日益攀升以及临床肿瘤学的迅速发展,对培养专业的临床肿瘤学人才提出了更高的要求。随着第一个细胞免疫治疗药物Sipuleucel-T被美国FDA批准用于晚期前列腺癌的治疗,肿瘤治疗进入免疫治疗的新时代,现有传统临床肿瘤学教学方法及观念已经不能适应目前的要求,因此必须提高临床教学水平。本文在肿瘤免疫治疗迅速发展背景下,对如何提高临床肿瘤教学水平进行思考与探讨,通过加强肿瘤分子生物学及细胞分子免疫学理论教学,以及在教学过程中贯穿循证医学与个体化治疗相结合的理念、引入多学科参与的肿瘤综合治疗模式,并强调心理干预和人文关怀的重要性,兼顾教学理论和临床实践最新进展及趋势,有效地帮助学生树立全面、科学的临床肿瘤治疗理念,掌握改善临床肿瘤治疗的有效方法,切实提升临床肿瘤学的教学质量和水平,培养出能胜任现代临床肿瘤学实践需求的专业人才。     

脊椎动物学野外实习教学改革与实践

随着人们对自然资源保护意识的提高以及高校课程改革的发展,传统的脊椎动物学野外实习模式已经不能适应新形势下的教学要求。如何在不破坏自然资源和有限的实习时间内取得令人满意的野外实习效果,是很多高校生物学教师面临的挑战。基于作者自身的教学实践,对山地脊椎动物学野外实习教学方式、教学内容以及考核方式的改革进行了探讨。     

产学结合培养模式在生化工艺教学中的体现

在高职教育教学改革中,大家已经认同了产学结合的人才培养模式,目前非常核心的关键问题是如何在日常课程教学中实现产学结合、校企合作。结合长期的教学实践,提出在生化工艺课程教学中产学结合培养模式的实施方式,即教学内容与就业面向相结合,学校课堂与生产车间相结合,学校教师与企业工人相结合,教学过程与生产过程相结合,学校科研与工厂研发相结合,为产学结合培养模式在课程教学中的实施探索一条新的道路。     

General practitioner training in paediatrics in the Trent region.

A total of 259 postal questionnaires were sent to all final year vocational trainees and new principals in general practice in the Trent region to find out how much training in paediatrics they had had. Questionnaires were returned by 105 trainees and 139 principals (244; 94%). Overall 72% (175) had taken up a hospital post in paediatrics during training, but among the 138 doctors who were on or had completed a three year vocational training scheme the proportion was slightly higher (82%; 115) (p = 0.01). Among the 175 who had had a post in paediatrics 108 (62%) had been given teaching sessions every week, and for half of these doctors the sessions lasted over one hour a week. Seventy five (54%) of the 139 principals reported that in their training in a general practice they had received no teaching about child health and a fifth said that they had not attended a clinic for children; 47 (34%) had received no training on procedures for dealing with cases of child abuse. The doctors who had held posts as senior house officers in paediatrics were more likely to report that they had adequate skills in paediatrics than those who had not, but overall only 62 (44%) reported that they could run a preschool child health surveillance programme. Extra paediatric posts in hospital are needed, but in the mean time improvements can be made to the teaching content in hospital and in the general practice attachment and postgraduate training in paediatrics provided for all general practitioners.     

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。     

GP registrars as teachers: a survey of their level of involvement and training

The role of general practice in medical education is increasing both at the undergraduate and postgraduate level. There is a paucity of evidence as to the level of involvement of GP registrars and their training to teach. Two hundred and forty one GP trainees in the Peninsula Deanery were surveyed as to their current level of involvement in teaching and their training to provide it. Seventy eight completed surveys were returned and these revealed that 62% were regularly involved in teaching but only 41% had ever received any training in this area. There was a strong feeling that teaching was an important skill for GPs with 92% of trainees wanting further training in this area. There is clearly a need for further research in this area both to identity whether this sample is representative of the situation nationally and to determine how best to equip trainees in their roles as educators now and in the future.     

Residency training in plastic surgery: a survey of educational goals

With the advent of integrative plastic surgical training programs, requirements for earlier specialization decisions, and an increasing subspecialization within the practice of plastic surgery, the educational goals of residency training may have changed. The duration and extent of training required are also currently being questioned. This study was performed to better understand the necessary roles of plastic surgery residencies and to determine how these demands might optimally be met. Of 151 practicing plastic surgeons in the Ontario, Canada, region, 81 (53.6 percent) responded to a survey. General agreement was that 2 years was an optimal length of time for core surgical training, which should then be followed by at least 3 years of plastic surgical training. Opinions on the ideal length of time training in specific medical and surgical disciplines are discussed. Overall, respondents thought that two thirds of training should occur in tertiary care centers, with the remaining time spent at smaller community centers and private clinics. Nearly half of respondents thought that research training should be a mandatory part of the residency, although the amount of protected time for this activity varied substantially. Most thought that unrestricted elective time should also be available. Academic plastic surgeons rated the importance of research training (p < 0.01), critical appraisal skills (p < 0.05), and teaching skills (p < 0.05) as significantly more important than did their nonacademic colleagues. The authors present results from the Ontario region and a template for determining optimal characteristics for training programs. Further investigation may be of timely importance during a foreseeable future transition from traditional to integrative plastic surgery residency training.     

A Concept of a Pathology Institute

Scholarly achievement is the aim of a pathology institute. In a medical faculty it serves undergraduate, postgraduate teaching, practice and research. Historically, scholarly achievement in these fields has been promoted through the teaching responsibility of the university and hospital. With the increasing volume of work, knowledge and complexity of research, adequate performance in these fields is best obtained by limiting the volume of fixed duties for each individual. At the same time, depth of knowledge is gained by encouraging specialization to complement clinical specialties. This arrangement will guarantee that the teaching and research of the department are disease-oriented, which is the central theme of pathology. With a highly specialized staff there must be a core of intradepartmental conferences common to all staff and those in training. With this form of organization dedicated to the undergraduate and postgraduate teaching, the objectives of scholarly achievement in teaching practice and research will be obtained.     

Teaching Medical Ethics to Meet the Realities of a Changing Health Care System

The changing context of medical practice—bureaucratic, political, or economic—demands that doctors have the knowledge and skills to face these new realities. Such changes impose obstacles on doctors delivering ethical care to vulnerable patient populations. Modern medical ethics education requires a focus upon the knowledge and skills necessary to close the gap between the theory and practice of ethical care. Physicians and doctors-in-training must learn to be morally sensitive to ethical dilemmas on the wards, learn how to make professionally grounded decisions with their patients and other medical providers, and develop the leadership, dedication, and courage to fulfill ethical values in the face of disincentives and bureaucratic challenges. A new core focus of medical ethics education must turn to learning how to put ethics into practice by teaching physicians to realistically negotiate the new institutional maze of 21st-century medicine.     

口腔颌面外科住院医师规范化培训中临床能力培养初探

住院医师规范化培训是培养具有独立执业能力和高超临床技能的专业医学人才的重要环节。通过对3年来口腔颌面外科住院医师规范化培训教学工作经验的总结,根据现代医学素质教育理念,结合口腔颌面外科的学科特点,探讨更加适合口腔住院医师规范化受训人员的教学方法,以促进受训住院医师临床实践综合能力的提高。我们在规范化培训中按纲施训,从转变临床思维模式、强调学习自主性、加强临床基本技能训练、注重人文思想的渗透等多方面入手,针对临床实践中的薄弱环节进行培训,为培养高素质医学人才奠定了基础,取得了教与培的满意效果。     

Hands-on training about overfitting

Overfitting is one of the critical problems in developing models by machine learning. With machine learning becoming an essential technology in computational biology, we must include training about overfitting in all courses that introduce this technology to students and practitioners. We here propose a hands-on training for overfitting that is suitable for introductory level courses and can be carried out on its own or embedded within any data science course. We use workflow-based design of machine learning pipelines, experimentation-based teaching, and hands-on approach that focuses on concepts rather than underlying mathematics. We here detail the data analysis workflows we use in training and motivate them from the viewpoint of teaching goals. Our proposed approach relies on Orange, an open-source data science toolbox that combines data visualization and machine learning, and that is tailored for education in machine learning and explorative data analysis.     

多渠道建立生物化学综合实验,增强学生科研能力

生物化学实验教学体系中,"综合性实验"在训练学生实验设计思路、引导学生掌握生物化学基本实验技术的综合运用中,起着举足轻重的作用。为推进综合实验内容改革,充分发挥其功能,我们借助本科生百项工程、生物实验教学中心仪器平台、以及高层次科研项目等不同途径,建立了多层面的生物化学综合实验,并在教学实践中进行了有益的尝试。     

Increasing the effectiveness of clinical supervision.

Effective use of preceptors in the clinical training and supervision of residents involves four essential steps: careful screening of the preceptor''s practice to ensure it reflects the goals of the residency program and teaching the preceptor about the goals; setting a realistic contract for learning between resident and preceptor; teaching the preceptor to use constructive feedback techniques in the day-to-day supervision of residents; and developing the preceptor''s skills in the reliable and valid evaluation of the resident''s performance. Clinical preceptors must be trained to become effective teachers and evaluators in residency programs.     

针灸推拿专业培养模式的改革与实践

随着经济的发展和社会的进步,针灸推拿学科近年来发展迅速。培养优秀的针灸推拿专业人才,必须深化教育改革。本文结合教学实践,着重从目标体系、课程体系、教育教学方法体系和考核评价体系等四个方面进行了讨论：（1）从确定人才培养目标,人才培养目标体系的建立,两方面探讨构建特色专业人才培养目标体系;（2）构建以传承、实践、创新、应用为主干的核心课程体系;（3）构建课程教学与课外实践紧密结合的教育教学方法体系主要分为以下三方面工作：①实施理论课程教学改革,优化学习过程②构建与培养目标相适应的实验教学体系,加强实践创新能力培养③优化校内实训和社会实践相结合的实践教学体系,强化课外实践效果;（4）构建校内培养过程与社会认同相结合的评价体系主要分以下两个方面：①完善校内培养过程评价制度建立②培养质量的社会认同评价。     

Vocational training for general practice in inner London. Is there a dearth? And if so what's to be done?

OBJECTIVE--To identify the nature and extent of any vocational training deficit within the London initiative zone and investigate the reasons. DESIGN--Collation of statistics and postal questionnaire surveys. SETTING--Thames regions inside and outside the London initiative zone. SUBJECTS--General practice registrars, trainers, principals from non-training practices, and vocational training course organisers. MAIN OUTCOME MEASURES--Trends in numbers of general practice registrars, proportions of trainers, views on current vocational training in inner London. RESULTS--Numbers of general practice registrars fell significantly between 1988 and 1993 within the London initiative zone and in England overall. The number of registrars within the zone fell by more than in the rest of the Thames regions, where the decline was not statistically significant. A lower proportion of principals were approved as trainers within the zone than in the rest of the Thames regions and England overall. In their responses to the survey (88% of inner London registrars responded and 81% of outer Thames registrars) registrars suggested that improving remuneration and personal safety would make training in London more attractive. Trainers and non-trainers (response rates 89% and 66% respectively) also suggested increasing remuneration for trainers together with more protected time for training. CONCLUSIONS--Less vocational training takes place within the London initiative zone than in the rest of the Thames regions and England overall, although there are discrepancies in official statistics. As well as specific recommendations for improving recruitment to vocational training in inner London, measures to tackle inner city deprivation should also remain high on the political agenda.     

Theatre programs in community colleges: A policy for equity

This piece presents a theoretical exploration of the potential for the creation of policy that would inform the inclusion of arts and particularly theater courses in all community colleges. In April 2017, Fong et al. released a comprehensive meta-analysis that explored the relationship between psychosocial factors of self-perception and motivation within 58 studies on student persistence and 186 studies on student achievement in U.S. community colleges. In the field of drama in and as education multiple studies have articulated a strong connection between positive self-perception, motivation, and involvement within drama-based experiences. My reflection emerges from four years service as the chair of the Arts and Humanities, and the sole theater professor at a leading campus within the largest community college in a Midwestern state. I share the ways in which the arts program, and particularly the theater program, were situated within the college's traditional vocational curriculum and theorize the ways in which a policy that secures the presence of the arts, drama, and theater in particular, within all community college curriculums may support positive self-perception and motivation and affect persistence and completion rates, particularly within terms of underrepresented and nontraditional communities.     

本科生物技术专业分子医学课程教学的探讨

分子医学时代的开启给生命科学领域的本科教学带来了新的挑战。在针对本科生物技术专业所开设的分子医学课程教学中,从授课内容与形式、教学手段与方法、教学考核等方面进行了相关的分析与实践,有效地提高了教学质量。     

Depth in Training in Academic Pathology Including Teaching and Research

Excellent training in academic pathology, including research, results when teaching becomes the prime function of the scholars in an academic department. Teaching of postgraduates requires research and practice and furthermore requires excellence in these fields. A program designed to teach the postgraduates orientates the research and practice to this end rather than making these ends in themselves. A major aim of pathology is to explain at the cell level the mechanism of interaction between intrinsic and extrinsic factors resulting in the abnormality of cell function in disease. The traditional core training in tissue diagnosis develops the interest and ability to analyze the cell and its intracellular activities. To realize the relation of structure and function as the ultimate aim of pathology an intensive study of some of the collateral fields of cell chemistry, physiology, immunology and genetics must become a major part of the organized program.