内镜专科医师培养与准入制度的实施研究
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摘要
专科医师规范化培训是国际上公认的临床医学专家成长的必由之路,对保证临床医师的专业水准、加强卫生人才队伍建设和提供高质量的医疗服务具有重要的、不可替代的作用。但是,迄今为止,我国尚未在全国范围内建立统一的、规范的、科学的专科医师制度,在一定程度上影响了我国临床医疗整体服务水平,难以满足人民医疗保健需求,因此,专科医师培训已成为我国医疗卫生事业改革和发展的一项重要课题。
内镜技术学是实践性技能性很强的一门专业技术,由于内镜技术在外科手术的进展操作越来越复杂、风险越来越大,对于内镜培训规范化的要求越来迫切和越来越严格。建立规范化的培训中心是开展规范化教学和培训的基础,是内镜技术这门毕业后教育的学科发展的必经之路。
内镜医师的成长要有扎实熟练的内镜技能。医师培训是医师提高诊断和治疗能力的必要阶段,也是医学人才成长的特有阶段。建立和完善符合我国国情的内镜医师培养制度,是提高内镜医师素质,保障医疗质量的根本措施,也是实现医疗卫生事业可持续发展的根本保证,制定不同学历层次的内镜医师培训计划能提高医师参加培训的积极性,而考核考试的目的在于客观地评价内镜医师培训结果,了解不足之处,将考核中发现的普遍不足的问题,作为今后在培训工作中需进一步强化的培训内容。
本研究立足于我国现实国情,着眼于医学教育发展趋势。首先回顾了我国住院医师培养的历史演变,并对我国目前住院医师培养的情况进行了总结分析。比较研究了美国、英国、加拿大等五个主要发达国家专科医师培养中所共有的特征,为建立我国专科医师培训基地培训考核体系提供有益借鉴,并明确了专科医师培训考核体系建设过程中所需要关注的几个主要问题。
结合课题需要,对中国内镜医疗资源分布、医师队伍构成、知识结构、培训机制调研；研究中国医师协会内镜医师分会在内镜专科医师培训和准入制度建设方面所做的工作；分析影响中国建立内镜技术培训和准入的影响因素及主要困难,同时借鉴了国际毕业后医学教育标准,为构建我国内镜专科医师培训和准入制度寻求理论基础、国际标准、国家政策等方面的支撑。在历史研究、比较研究、理论研究的基础上,借鉴国际毕业后医学教育标准,通过专家访谈的方法,提出了内镜专科医师培训和准入制度的构想。应用Delphi法,通过两轮专家咨询,逐步修改和完善,形成了比较科学、合理、可行的内镜专科医师规范化培训考核体系。最后,针对本课题研究,探讨了为促进我国内镜专科医师培养持续、科学发展,确保培训质量所需要进一步探索的问题以及应该关注的重点工作。
Standardized training of physicians is internationally recognized as the only way the growth of clinical experts. It plays an important and irreplaceable role in ensuring the clinician's professional standards strengthening the building of health personnel, providing high-quality medical services. However, to date, China has not yet set up a nationwide unified, standardized and scientific specialist system, to a certain extent, affected the whole of our clinical services, health care is difficult to meet the needs of the people. Therefore specialist training has become an important topic of China's reform and development of health.
Demanding superb practical skills, endoscopy technology need more complex operation, and the risk of being a endoscopist is rising. Therefore endoscopist training has become an important topic of China's reform and development of health.Establish standardized training center is the basis of standard teaching and training.The endoscopic technique is the only way for the development of education in the discipline.
Endoscopists have a solid growth of endoscopic skills. Physician training is the necessary stage to improve diagnosis and treatment ability, and is specific growth stage of Eodoscopists. Establish and improve China's national conditions endoscopists training system, which is proper to China's national conditions, isfundamental measures of improving the quality of endoscopic physician, ensuring the quality of medical, and is fundamental guarantee for the sustainable development of medical and health. Different academic levels of endoscopic physician training program can improve the training initiative. The purpose of assessment tests can objectively evaluate the results of endoscopic physician training.
The deficiencies founding in the test need to be given further attetion in the training.
This research is based on the reality of our country and aims at the developing trend of international medical education. First reviewed the historical evolution of Resident Training in China, and China's current situation of training residents were analyzed. Comparison of the United States, Britain, Canada, the five major developed countries such as specialist training in the common feature, for the establishment of specialist training base our training and examination system to provide useful reference, and clearly the subject of specialist training in the construction process of evaluation system The main issues of concern. Combination of institutional change, educational evaluation theory, drawing on international standards for graduate medical education, specialist training base for the training proposed assessment system design framework, through expert interview, initially built "A Implementation of Training and Access System of Endoscopy Specialist".Application of Delphi method, by two rounds of expert advice, and gradually modify and improve to form a more scientific, reasonable and feasible evaluation system for standardized training of endoscopy specialist doctors. Finally, the subject of study for the promotion of our endoscopy specialist training continued, scientific development, to ensure the quality of training needed to further explore the issues and should be the focus of the work.
内镜技术学是实践性技能性很强的一门专业技术,由于内镜技术在外科手术的进展操作越来越复杂、风险越来越大,对于内镜培训规范化的要求越来迫切和越来越严格。建立规范化的培训中心是开展规范化教学和培训的基础,是内镜技术这门毕业后教育的学科发展的必经之路。
内镜医师的成长要有扎实熟练的内镜技能。医师培训是医师提高诊断和治疗能力的必要阶段,也是医学人才成长的特有阶段。建立和完善符合我国国情的内镜医师培养制度,是提高内镜医师素质,保障医疗质量的根本措施,也是实现医疗卫生事业可持续发展的根本保证,制定不同学历层次的内镜医师培训计划能提高医师参加培训的积极性,而考核考试的目的在于客观地评价内镜医师培训结果,了解不足之处,将考核中发现的普遍不足的问题,作为今后在培训工作中需进一步强化的培训内容。
本研究立足于我国现实国情,着眼于医学教育发展趋势。首先回顾了我国住院医师培养的历史演变,并对我国目前住院医师培养的情况进行了总结分析。比较研究了美国、英国、加拿大等五个主要发达国家专科医师培养中所共有的特征,为建立我国专科医师培训基地培训考核体系提供有益借鉴,并明确了专科医师培训考核体系建设过程中所需要关注的几个主要问题。
结合课题需要,对中国内镜医疗资源分布、医师队伍构成、知识结构、培训机制调研；研究中国医师协会内镜医师分会在内镜专科医师培训和准入制度建设方面所做的工作；分析影响中国建立内镜技术培训和准入的影响因素及主要困难,同时借鉴了国际毕业后医学教育标准,为构建我国内镜专科医师培训和准入制度寻求理论基础、国际标准、国家政策等方面的支撑。在历史研究、比较研究、理论研究的基础上,借鉴国际毕业后医学教育标准,通过专家访谈的方法,提出了内镜专科医师培训和准入制度的构想。应用Delphi法,通过两轮专家咨询,逐步修改和完善,形成了比较科学、合理、可行的内镜专科医师规范化培训考核体系。最后,针对本课题研究,探讨了为促进我国内镜专科医师培养持续、科学发展,确保培训质量所需要进一步探索的问题以及应该关注的重点工作。
Standardized training of physicians is internationally recognized as the only way the growth of clinical experts. It plays an important and irreplaceable role in ensuring the clinician's professional standards strengthening the building of health personnel, providing high-quality medical services. However, to date, China has not yet set up a nationwide unified, standardized and scientific specialist system, to a certain extent, affected the whole of our clinical services, health care is difficult to meet the needs of the people. Therefore specialist training has become an important topic of China's reform and development of health.
Demanding superb practical skills, endoscopy technology need more complex operation, and the risk of being a endoscopist is rising. Therefore endoscopist training has become an important topic of China's reform and development of health.Establish standardized training center is the basis of standard teaching and training.The endoscopic technique is the only way for the development of education in the discipline.
Endoscopists have a solid growth of endoscopic skills. Physician training is the necessary stage to improve diagnosis and treatment ability, and is specific growth stage of Eodoscopists. Establish and improve China's national conditions endoscopists training system, which is proper to China's national conditions, isfundamental measures of improving the quality of endoscopic physician, ensuring the quality of medical, and is fundamental guarantee for the sustainable development of medical and health. Different academic levels of endoscopic physician training program can improve the training initiative. The purpose of assessment tests can objectively evaluate the results of endoscopic physician training.
The deficiencies founding in the test need to be given further attetion in the training.
This research is based on the reality of our country and aims at the developing trend of international medical education. First reviewed the historical evolution of Resident Training in China, and China's current situation of training residents were analyzed. Comparison of the United States, Britain, Canada, the five major developed countries such as specialist training in the common feature, for the establishment of specialist training base our training and examination system to provide useful reference, and clearly the subject of specialist training in the construction process of evaluation system The main issues of concern. Combination of institutional change, educational evaluation theory, drawing on international standards for graduate medical education, specialist training base for the training proposed assessment system design framework, through expert interview, initially built "A Implementation of Training and Access System of Endoscopy Specialist".Application of Delphi method, by two rounds of expert advice, and gradually modify and improve to form a more scientific, reasonable and feasible evaluation system for standardized training of endoscopy specialist doctors. Finally, the subject of study for the promotion of our endoscopy specialist training continued, scientific development, to ensure the quality of training needed to further explore the issues and should be the focus of the work.
引文
[1]佟维训.毕业后医学教育原则[J].继续医学教育,1992(1)：45-48.
[2]李幼平,陶铁军,孙丁等.我国专科医师分类研究初探[J].中国循证医学杂志,2004(3)：236-238.
[3]王锦倩,刘雁飞,祁国明.我国专科医师培养与准入的现状及对策.中国循证医学杂志,2004, (2)：9.
[4]金大鹏.建立专科医师制度的实践与探索.中华医院管理杂志,2006,22(10)：649-651.
[5]孟群主编.各国专科医师培训与准入制度.第一版北京：中国协和医科大学出版社,2004：8.
[6]梅人朗,陈刚,杨益等编译.医学教育全球标准.第一版上海：上海科学技术出版社,2004：1.
[7]刘淑兰.教育评估和督导.华东师范大学出版社,1999.
[8]陈永明主编.教育行政新论.第一版上海：华东师范大学出版社,2002.
[9]王德炳.住院医师规范化培训.北京：北京大学医学出版社,2002.12-16.
[10]张勤.建设亚洲医学中心城市的重要任务与挑战：上海专科医师培养的过去、现在、将来.上海医学,2007,30(10)：802-804.
[11]卫办科教发[2006]27号.卫生部办公厅关于开展专科医师培训试点工作的通知.
[12]唐国瑶,陈建俞.我国住院医师培训制度的历史演变.医学教育探索,2006,5(2)：99-101
[13]黄俊辉,刘保平,鲁燕平.我国专科医师培养制度与住院医师培训的联系和区别.中国医院管理.2005,25(9)：8-9.
[14]黄志,杨仕英,陈琼.加强临床住院医师规范化培训促进临床专业人才健康成长.中国高等医学教育.2006,(4)：60-62.
[15]威廉·维尔斯曼.教育研究方法导论.北京：教育科学出版社.1997.103-105.
[16]陆有铨,马和民.走向研究型教师之路——教育研究方法与应用.杭州：浙江电子音像出版社.2002：73-75.
[17]詹绍康.现场调查技术.上海.复旦大学出版社.2003：113-119.
[18]江彦桥,赵伟建,付克阳.高等学校教学质量保证体系的研究与实践.第一版上海：上海外语教育出版社,2002：12.
[19]沈玉顺主编.现代教育评价.第一版上海：华东师范大学出版社,2002：3.
[20]韩映雄.高等教育质量研究.第一版上海：上海科技教育出版社,2003：7
[21]熊耕.美国高等教育认证制度的起源及其形成动力分析.外国教育研究,2004,31(6)：61-64.
[22]任佰玲,胡志,周新发.住院医师规范化培训基地评价指标体系的研究.继续医学教育,2004,24(9)：45-50.
[23]陈慧.高等教育引入2000版1509000族标准的研究.复旦教育论坛,2003,16(5)：70-73.
[24]Omer GEjr.The development of orthopedic certification in the United States.Clin Orthop.1990,(257):11-17.
[25]Council On Medical Education:Principles for graduate medical education.Acad Med,1990,65(9):545.
[26]Cooper V.Reforming higher specialist training in the UK. MedEduc,1999, 33(5):394.
[27]Cassie JM,Armbruster JS,Bowmer MI.Accreditation of postgraduate medical education in the United States and Canada:a comparison of two systems.Med Educ.1997,33(7):493.
[28]Lehmann KA,Schultz JH.Anesthesiology education and training in Germany. Results from a representative questionnaire.Anaesthesist.2001,50(4):248-261.
[29]WalshWJ.TheimPlieationsofsPeeializationinmedieine[J].CanVetJ,1975,16(10): 295-296.
[30]杨欣,李克敏.从妇产科住院医师培训看美国的毕业后医学教育.继续医学教育2001；15(4)：42-44.
[31]郝风节.德、美高等医学教育模式对我国的启示[J].医学与社会,2009,22(12)：70-71.
[32]吕一平,贾明艳,高坚.建立专科医师培训基地是实施专科医师培训制度的基本保障.中华医学管理杂志.2006,22(10)：652-654.
[33]蔡哲心,连庆泉,朱雪琼.依托基地建设完善专科医师培训工作.中国医院.2008,12(4)：30-32.
[34]王永光,何兴图,常大麟,等.微创体系中人文思想的探索[J].医学与哲学,2004,25(1)：28-31.
[35]王永光,裘法祖,何兴国,等.创新发展微创医学新体系[J].医学与哲学,2003,24(8)：27-28.
[36]张初民,韩盛玺,宋立.内镜直视下食道狭窄的水囊扩张治疗[J].中国内镜杂志,2004,10(1)：16-17.
[37]吴云林,张曙,褚晔,等.MAZ胶囊内镜在消化病诊断中的应用研究[J].中华消化内镜杂志,2003,20(4)：230-233.
[38]郭学刚,邓勇,孙安华,等.假性胰腺囊肿的内镜治疗[J].中华消化内镜杂志,2003,20(4)：256-259.
[39]KallooAN, SinghVK, Jagannath SB, et a.l Flexible transgastric peritoneoscopy; anovel approach to diagnostic and therapeutic interventions in the peritoneal cavity[J]. CastrointestEndosc,2004,60(1):114-117.
[40]RrttnerD,Kalloo A,ASGE/S AGES Working Group. SAGES/ASGE working group on naturalorifice translumenal endoscopic surgery[J]. Surg Endosc,2006, 20(2):329-333.
[41]刘辉,刘殿奎,汪建荣,等.以科学发展观指导内镜医师执业规范化的发展[J].中国内镜杂志,2010,16(4)：446-447.
[42]谢宗豹.我国专科医师培养模式与基地认证评审的研究[J].解放军医院管理杂志,2004,11(3)：276-277.
[43]CAO SJ, YANG XG, CHEN XY. Derivative effects of hospital culture under scientific development conception [J]. Chinese Hospitals,2009,13(10):45-46.
[44]陈璜,杨黎,杨宏伟.规范化的手术配合在腹腔镜胆囊切除术中的意义[J].中国内镜杂志,2009,15(8)：838-839.
[45]孙彬,张连云,杨文秀.坚持四个统筹推进新形势下专科医师制度的实施OJ].中国医院管理,2009,29(2)：12-13.
[46]吴长君,张春梅,张雪菊.以科学发展观指导超声医学的发展[J].医学教育探索,2007,6(3)：250-251.
[47]任国胜,陈鸿雁,罗天友.专科医师培训工程是21世纪医学人才的成长平台[J].医学教育探索,2009,8(2)：128-129.
[48]杨琦,杨晔,秦明,等.浅谈内镜微创技术的发展与内镜医师的培训[J].西北医学教育,2010,16(4)：446-447.
[49]刘辉,刘殿奎,汪建荣,等.建立我国内镜专科医师的培训机制[J].中国内镜杂志,2010,16(5)：557-558.
[2]李幼平,陶铁军,孙丁等.我国专科医师分类研究初探[J].中国循证医学杂志,2004(3)：236-238.
[3]王锦倩,刘雁飞,祁国明.我国专科医师培养与准入的现状及对策.中国循证医学杂志,2004, (2)：9.
[4]金大鹏.建立专科医师制度的实践与探索.中华医院管理杂志,2006,22(10)：649-651.
[5]孟群主编.各国专科医师培训与准入制度.第一版北京：中国协和医科大学出版社,2004：8.
[6]梅人朗,陈刚,杨益等编译.医学教育全球标准.第一版上海：上海科学技术出版社,2004：1.
[7]刘淑兰.教育评估和督导.华东师范大学出版社,1999.
[8]陈永明主编.教育行政新论.第一版上海：华东师范大学出版社,2002.
[9]王德炳.住院医师规范化培训.北京：北京大学医学出版社,2002.12-16.
[10]张勤.建设亚洲医学中心城市的重要任务与挑战：上海专科医师培养的过去、现在、将来.上海医学,2007,30(10)：802-804.
[11]卫办科教发[2006]27号.卫生部办公厅关于开展专科医师培训试点工作的通知.
[12]唐国瑶,陈建俞.我国住院医师培训制度的历史演变.医学教育探索,2006,5(2)：99-101
[13]黄俊辉,刘保平,鲁燕平.我国专科医师培养制度与住院医师培训的联系和区别.中国医院管理.2005,25(9)：8-9.
[14]黄志,杨仕英,陈琼.加强临床住院医师规范化培训促进临床专业人才健康成长.中国高等医学教育.2006,(4)：60-62.
[15]威廉·维尔斯曼.教育研究方法导论.北京：教育科学出版社.1997.103-105.
[16]陆有铨,马和民.走向研究型教师之路——教育研究方法与应用.杭州：浙江电子音像出版社.2002：73-75.
[17]詹绍康.现场调查技术.上海.复旦大学出版社.2003：113-119.
[18]江彦桥,赵伟建,付克阳.高等学校教学质量保证体系的研究与实践.第一版上海：上海外语教育出版社,2002：12.
[19]沈玉顺主编.现代教育评价.第一版上海：华东师范大学出版社,2002：3.
[20]韩映雄.高等教育质量研究.第一版上海：上海科技教育出版社,2003：7
[21]熊耕.美国高等教育认证制度的起源及其形成动力分析.外国教育研究,2004,31(6)：61-64.
[22]任佰玲,胡志,周新发.住院医师规范化培训基地评价指标体系的研究.继续医学教育,2004,24(9)：45-50.
[23]陈慧.高等教育引入2000版1509000族标准的研究.复旦教育论坛,2003,16(5)：70-73.
[24]Omer GEjr.The development of orthopedic certification in the United States.Clin Orthop.1990,(257):11-17.
[25]Council On Medical Education:Principles for graduate medical education.Acad Med,1990,65(9):545.
[26]Cooper V.Reforming higher specialist training in the UK. MedEduc,1999, 33(5):394.
[27]Cassie JM,Armbruster JS,Bowmer MI.Accreditation of postgraduate medical education in the United States and Canada:a comparison of two systems.Med Educ.1997,33(7):493.
[28]Lehmann KA,Schultz JH.Anesthesiology education and training in Germany. Results from a representative questionnaire.Anaesthesist.2001,50(4):248-261.
[29]WalshWJ.TheimPlieationsofsPeeializationinmedieine[J].CanVetJ,1975,16(10): 295-296.
[30]杨欣,李克敏.从妇产科住院医师培训看美国的毕业后医学教育.继续医学教育2001；15(4)：42-44.
[31]郝风节.德、美高等医学教育模式对我国的启示[J].医学与社会,2009,22(12)：70-71.
[32]吕一平,贾明艳,高坚.建立专科医师培训基地是实施专科医师培训制度的基本保障.中华医学管理杂志.2006,22(10)：652-654.
[33]蔡哲心,连庆泉,朱雪琼.依托基地建设完善专科医师培训工作.中国医院.2008,12(4)：30-32.
[34]王永光,何兴图,常大麟,等.微创体系中人文思想的探索[J].医学与哲学,2004,25(1)：28-31.
[35]王永光,裘法祖,何兴国,等.创新发展微创医学新体系[J].医学与哲学,2003,24(8)：27-28.
[36]张初民,韩盛玺,宋立.内镜直视下食道狭窄的水囊扩张治疗[J].中国内镜杂志,2004,10(1)：16-17.
[37]吴云林,张曙,褚晔,等.MAZ胶囊内镜在消化病诊断中的应用研究[J].中华消化内镜杂志,2003,20(4)：230-233.
[38]郭学刚,邓勇,孙安华,等.假性胰腺囊肿的内镜治疗[J].中华消化内镜杂志,2003,20(4)：256-259.
[39]KallooAN, SinghVK, Jagannath SB, et a.l Flexible transgastric peritoneoscopy; anovel approach to diagnostic and therapeutic interventions in the peritoneal cavity[J]. CastrointestEndosc,2004,60(1):114-117.
[40]RrttnerD,Kalloo A,ASGE/S AGES Working Group. SAGES/ASGE working group on naturalorifice translumenal endoscopic surgery[J]. Surg Endosc,2006, 20(2):329-333.
[41]刘辉,刘殿奎,汪建荣,等.以科学发展观指导内镜医师执业规范化的发展[J].中国内镜杂志,2010,16(4)：446-447.
[42]谢宗豹.我国专科医师培养模式与基地认证评审的研究[J].解放军医院管理杂志,2004,11(3)：276-277.
[43]CAO SJ, YANG XG, CHEN XY. Derivative effects of hospital culture under scientific development conception [J]. Chinese Hospitals,2009,13(10):45-46.
[44]陈璜,杨黎,杨宏伟.规范化的手术配合在腹腔镜胆囊切除术中的意义[J].中国内镜杂志,2009,15(8)：838-839.
[45]孙彬,张连云,杨文秀.坚持四个统筹推进新形势下专科医师制度的实施OJ].中国医院管理,2009,29(2)：12-13.
[46]吴长君,张春梅,张雪菊.以科学发展观指导超声医学的发展[J].医学教育探索,2007,6(3)：250-251.
[47]任国胜,陈鸿雁,罗天友.专科医师培训工程是21世纪医学人才的成长平台[J].医学教育探索,2009,8(2)：128-129.
[48]杨琦,杨晔,秦明,等.浅谈内镜微创技术的发展与内镜医师的培训[J].西北医学教育,2010,16(4)：446-447.
[49]刘辉,刘殿奎,汪建荣,等.建立我国内镜专科医师的培训机制[J].中国内镜杂志,2010,16(5)：557-558.