住院医师规范化培训轮转计划与课程设置现状研究
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摘要
住院医师规范化培训是新时代临床医学人才培养的创新模式,是解决我国目前临床医师队伍水平参差不齐的重要举措,培训质量是提高医疗水平和医疗服务质量的重要保障。学员的轮转管理和课程建设是质量控制的一部分,是影响培训效果的重要因素。目前中国住院医师规范化培训政策得到医院和学员的重视及支持,但存在学员轮转计划执行程度不一、轮转的规范性有待提升、培训过程中工学矛盾突出、临床实践教学机会不足、医学职业道德、医事法学、医院经济运行管理等方面训练薄弱的问题,这些问题影响了培训的整体质量和学员的医学素养的提升。建议制定科学合理的培训轮转计划、建立严格的管理和监督体系、认真落实管理制度、将住培政策的宣传工作贯穿在院校教育和毕业后教育整个过程中、优化课程设置、合理安排临床工作时间与技能学习的时间。通过对国内外住院医师规范化培训轮转计划与课程设置进行研究,借鉴国外成功经验,为我国住院医师规范化培训工作提供参考。
Standardized residency training is an innovative model for the cultivation of clinical medical talents in the new era, which is an important measure to solve the issue of uneven levels of clinical physicians in China. Quality control in training is significant guarantee to improve the medical level and quality of medical services. The rotation management and curriculum settings of the residents is part of quality control and an important factor affecting the training effect. At present, standardized residency training in China has received support and attention of hospitals and trainees. However, there are some problems, such as varied degrees of implementation of the rotation plans of trainees, lack of rotation standardization, the prominent contradiction of working and learning during the training process, lack of opportunities for clinical practice and the insufficient training of medical laws, hospital economic operations and medical ethics. These programs affect the overall quality of standardized residency training and improvement of students. It is recommended to formulate scientific and reasonable training rotation plans, establish a strict management and supervision system, conscientiously implement the management system, the publicity of this policy should be carried out throughout the whole educational institution and hospitals. Curriculum settings should be optimized, and clinical working hours and skills learning time should be rationally arranged. This paper researched on the domestic and foreign standardized residency training rotation plans and curriculum provision of resident doctors, and provided the reference for standardized residency training system in China by learning from the advanced experience of those foreign countries.
Standardized residency training is an innovative model for the cultivation of clinical medical talents in the new era, which is an important measure to solve the issue of uneven levels of clinical physicians in China. Quality control in training is significant guarantee to improve the medical level and quality of medical services. The rotation management and curriculum settings of the residents is part of quality control and an important factor affecting the training effect. At present, standardized residency training in China has received support and attention of hospitals and trainees. However, there are some problems, such as varied degrees of implementation of the rotation plans of trainees, lack of rotation standardization, the prominent contradiction of working and learning during the training process, lack of opportunities for clinical practice and the insufficient training of medical laws, hospital economic operations and medical ethics. These programs affect the overall quality of standardized residency training and improvement of students. It is recommended to formulate scientific and reasonable training rotation plans, establish a strict management and supervision system, conscientiously implement the management system, the publicity of this policy should be carried out throughout the whole educational institution and hospitals. Curriculum settings should be optimized, and clinical working hours and skills learning time should be rationally arranged. This paper researched on the domestic and foreign standardized residency training rotation plans and curriculum provision of resident doctors, and provided the reference for standardized residency training system in China by learning from the advanced experience of those foreign countries.
引文
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[16]王梅.重庆市住院医师规范化培训现状调查及影响因素分析[D].重庆医科大学,2016.
[17]祁敏,陈华江,魏显招,等.我国住院医师规范化培训现状分析与展望[J].中国高等医学教育,2013,(4):7-8.
[18]张秀巧.我国住院医师人才规范化培训改革探讨[J].中国人才,2010,11X(22):267-268.
[19]蔡晨,董勤.浅谈美国住院医师培训制度对我国高学历青年医师培训的启示[J].西北医学教育,2013,21(4):635-637,641.
[20]刘思辰,史婧,顾亚律,等.住院医师规范化培训学员科研能力现状及存在问题分析--以云南省某国家级住培基地为例[J].卫生软科学,2018,32(2):55-57.
[21]倪平,赵坤,王丽华,等.临床医学专业学位研究生培养与住院医师规范化培训并轨的实践与思考[J].中国高等医学教育,2015,(12):118-119.
[2]黄发云.构建福建省住院医师规范化培训质量控制体系研究[D].福建师范大学,2013.
[3]叶晶晶.福建省住院医师规范化培训制度实施现况及效果的综合评价研究[D].福建医科大学,2016.
[4]张俊华.住院医师同质化培养与考核体系建设培训团,美国住院医师培养制度与管理体系镜鉴[J].中国卫生人才,2018(1):54-59.
[5]张文刚.借鉴美国医学教育经验促进中国住院医师培训[J].医学教育,2005,(1):77-80.
[6]孟群.中外住院医师/专科医师培训制度概况[M].北京:中国协和医科大学出版社,2010.
[7]Grant JR.Changing postgraduate medical education:acommentary from the United Kingdom[J].MJA,2007,186(7):9-13.
[8]GMC.Principles of Good Medical Education and Training[EB/OL].(2013-3-14)[2018-10-12].http://www.gmc-uk.org.
[9]武玉欣,张训巍.日本医师临床研修制度的现状及特色分析[J].日本医学介绍,2006,27(3):140-141.
[10]许丽莉,姜林娣,陈世耀,等.分层次课程设置在内科住院医师规范化培训中的应用[J].中国毕业后医学教育,2018,2(3):173-175.
[11]姜艳红,姚晨姣,黄穰浪,等.耶鲁-湘雅住院医师规范化培训模式的探索与实践[J].中国毕业后医学教育,2017,1(1):77-80.
[12]王鹏鹏,仰曙芬,韩冰,等.以胜任力为导向住院医师培训课程体系的构建[J].中国高等医学教育,2017,(5):69-70.
[13]孙加强.广东省住院医师规范化培训现状调查研究[D].南方医科大学,2016.
[14]陈艾艾.贵州省“医学规培生”培养现状调查研究[D].遵义医学院,2016.
[15]赵伟.山西省住院医师规范化培训现状调查研究[D].山西医科大学,2017.
[16]王梅.重庆市住院医师规范化培训现状调查及影响因素分析[D].重庆医科大学,2016.
[17]祁敏,陈华江,魏显招,等.我国住院医师规范化培训现状分析与展望[J].中国高等医学教育,2013,(4):7-8.
[18]张秀巧.我国住院医师人才规范化培训改革探讨[J].中国人才,2010,11X(22):267-268.
[19]蔡晨,董勤.浅谈美国住院医师培训制度对我国高学历青年医师培训的启示[J].西北医学教育,2013,21(4):635-637,641.
[20]刘思辰,史婧,顾亚律,等.住院医师规范化培训学员科研能力现状及存在问题分析--以云南省某国家级住培基地为例[J].卫生软科学,2018,32(2):55-57.
[21]倪平,赵坤,王丽华,等.临床医学专业学位研究生培养与住院医师规范化培训并轨的实践与思考[J].中国高等医学教育,2015,(12):118-119.