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中国误诊学杂志 2008年第35期8卷 8649-8650页

作者：李红王琳李培杰青岛大学医学院附属青岛市市立医院山东青岛266011

我院是一所集医疗、教学、科研工作力一体的三级甲等医院。自1998年始施行住院医师培训工作并参加了山东省一、二阶段住院医师规范化培训考试,成立了12学科山东省住院医师培训基地。近10a内已完成200名住院医师规范化培训。2003年青岛... 详细信息

我院是一所集医疗、教学、科研工作力一体的三级甲等医院。自1998年始施行住院医师培训工作并参加了山东省一、二阶段住院医师规范化培训考试,成立了12学科山东省住院医师培训基地。近10a内已完成200名住院医师规范化培训。2003年青岛市卫生局正式公布《青岛市社会化身份住院医师培训制度试行条例》后,我院进一步加强和规范了这项工作,开创了青岛市社会化住院医师培训的新局面。现就如何建立完善的管理制度保障培训工作质量的实践体会总结如下。[第一段]

关键词：实习医师和住院医师职务在职培训

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Competency-based resident education

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OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA 2007年第6期40卷 1215-+页

作者： Marple, Bradley F. Univ Texas SW Med Ctr Dept Otolaryngol Head & Neck Surg Dallas TX 75390 USA

Over the course of the last decade fundamental changes have occurred in residency training. The basis of these changes has been rooted in the desire to simultaneously improve the quality of the learning experience while decreasing the demands of training on resident lifestyle. The ACGME Outcomes Project was initiated in 1999 with the intent of facilitating such change in medical education. Before its introduction, assessment of residency training sites focused on the processes, resources, and reputation of an individual program, but failed to assess how effectively a program used those assets. The stated goal of the ACGME Outcomes Project has been to drive an evolution of this process-oriented form of education to one that is based on outcomes that measure the effect of the educational experience. This article is a brief overview of current efforts to achieve this goal.

关键词： Accreditation Clinical Competence Competency-Based Education Curriculum 聘任鉴定临床工作能力基于能力的教育课程预测实习医师和住院医师职务 Clinical Competence Accreditation Reputation Competency-Based Education Residency Medical Education Curriculum

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The evolution of surgical training: Perspectives on educational models from the past to the future

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OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA 2007年第6期40卷 1227-+页

作者： Franzese, Christine B. Stringer, Scott P. Univ Mississippi Med Ctr Dept Otolaryngol & Commun Sci Jackson MS 39216 USA

Surgical education and training have progressed through the centuries, with the most commonly used model being the apprentice model. With advances in medical knowledge and practice, the apprentice model has evolved and competing models have arisen. However, the apprentice model remains the gold standard today, but for future use, further evolutionary changes will need to be made to the apprentice model if it is to continue to remain an effective education paradigm.

关键词： Accreditation Forecasting France Germany Great Britain History 19th Century 聘任鉴定预测法国德国大不列颠实习医师和住院医师职务导师外科学 Accreditation Educational Models surgical training France apprentice Great Britain

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Ease of tying arthroscopic knots

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JOURNAL OF SHOULDER AND ELBOW SURGERY 2007年第4期16卷 438-442页

作者： Baumgarten, Keith M. Wright, Rick W. Univ Washington Sch Med Dept Orthopaed Surg Seattle WA 98195 USA

To date, there is no comprehensive study that determines which arthroscopic knots are easiest to learn to tie. In this study, 23 surgeons in training graded 10 orthroscopic knots with regard to ease of learning and tying using a 10-cm visual analog scale for No. 2 Ethibond and No. I polydioxanone (PDS) II suture. Statistical analysis was performed with analysis of variance and the Tukey Studentized range (HSD) test for post hoc analysis with a significant value of P < .05. The Tennessee slider, Duncan loop, Revo knot, and Nicky's knot were the easiest knots to tie by use of both Ethibond and PDS suture. The Field knot and double-twist knot were consistently the hardest knots to tie. Knots tied with Ethibond were easier to tie than knots tied with PDS. Novice surgeons should consider using the Revo knot when developing their arthroscopic knot-tying skills. Once they have mastered this knot, they can consider adding more difficult knots to their repertoire.

关键词： Arthroscopy Humans Internship and Residency Orthopedics Polydioxanone 关节镜检查实习医师和住院医师职务矫形外科学聚二恶烷酮聚对苯二甲酸乙酯类 Polydioxanone Ethibond Arthroscopy Tie Internship and Residency Orthopedics virtual value

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Interactive instruction in otolaryngology resident education

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OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA 2007年第6期40卷 1203-+页

作者： Schweinfurth, John M. Dept Otolaryngol & Commun Sci Jackson MS 39216 USA

Today's academic faculty was typically trained under an education system based entirely on didactic lectures. However, if the aim is to teach thinking or change attitudes beyond the simple transmission of factual knowledge, then lectures alone, without active involvement of the students, are not the most effective method of teaching. If the goals of teaching are to arouse and keep students' interest, give facts and details, to make students think critically about the subject, and to prepare for independent studies by demonstration of problem solving and professional reasoning, then only two of these purposes are suited to didactic lectures. The problem then is how to organize lecture material so that individual student's learning needs are better addressed. The education literature suggests that instruction include a variety of activities designed to stimulate individual thought. These activities include small group discussion, working problems during lecture time, questions included in the lecture, and quizzes at the end of lecture, among others. The current study was undertaken to examine the feasibility of using these types of interactive learning techniques in an otolaryngology residency program. Possibilities considered in the current study include standard interactive lecturing, facilitated discussion, brainstorming, small group activities, problem solving, competitive large group exercises, and the use of illustrative cliff hanger and incident cases. The feasibility of these methodologies being effectively incorporated into a residency curriculum is discussed.

关键词： Curriculum Feasibility Studies Humans Internship and Residency Learning 课程可行性研究实习医师和住院医师职务学习动机耳鼻咽喉科学问题解决 education policy Group Discussion Internship and Residency Learning Residency Declarative Knowledge Students instruction Problem solving Curriculum Laryngology

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Application of distance learning to interactive seminar instruction in orthodontic residency programs

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AMERICAN JOURNAL OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS 2007年第5期132卷 586-594页

作者： Bednar, Eric D. Hannum, Wallace M. Firestone, Allen Silveira, Anibal M. Cox, Thomas D. Proffit, William R. Univ N Carolina Sch Dent Dept Orthodont Chapel Hill NC 27599 USA Univ N Carolina Sch Educ Chapel Hill NC 27599 USA Ohio State Univ Coll Dent Dept Orthodont Columbus OH 43210 USA Univ Louisville Sch Dent Dept Orthodont Louisville KY 40292 USA Univ N Carolina Informat Technol Serv Chapel Hill NC USA

A series of experiments involving 3 orthodontic departments has shown that distance learning can be acceptable to residents and effective in teaching concepts that are fundamental to orthodontic practice. Methods: Residents in each department participated in distance seminars, clinical conferences, and clinical seminars via high-speed Internet connections. The acceptability of this form of instruction was judged from evaluation forms completed by the residents. Its effectiveness was judged from pretests and posttests on the seminar topics. Results: The improvement from pretest to posttest scores after observing a sequence of distance seminars was similar to that with direct instruction. Orthodontic residents rated the educational experiences positively. Live participation in seminars via video conferencing was preferred to live observation or later observation of a recording, but observation provided similar improvement in test scores. Conclusions: The acceptability of the distance seminars appeared to be influenced by the instructor's personality and teaching style in facilitating interaction, the seminar subject, the residents' comfort level in dealing with this technology, and the sequence for interaction vs observation. Further development of recorded seminars with live follow-up discussions has the potential to supplement instruction in graduate orthodontic programs and help with the impending shortage of experienced full-time orthodontic faculty.

关键词： Computer-Assisted Instruction Education Dental Graduate Distance 计算机辅助教学教育牙科研究生远程教育考核因特网实习医师和住院医师职务 Videoconferencing PRETEST graduate Residency Dentistry Distance learning instruction

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A theory-based curriculum for enhancing surgical skillfulness

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2007年第3期205卷 492-497页

作者： Boehler, Margaret L. Schwind, Cathy J. Rogers, David A. Ketchum, Janet O'Sullivan, Erin Mayforth, Ruth Quin, Jacquelyn Wohltman, Chris Johnson, Colleen Williams, Reed G. Dunnington, Gary So Illinois Univ Sch Med Dept Surg Springfield IL 62794 USA

BACKGROUND: Curricula for surgical technical skills laboratories have traditionally been designed to accommodate the clinical activities of residents, so they typically consist of individual, episodic training sessions. We believe that the skills laboratory offers an opportunity to design a surgical skills curriculum based on the fundamental elements known to be important for motor skill instruction. We hypothesized that training novices with such a curriculum for a 1-month period would yield skills performance levels equivalent to those of second year surgery residents who had trained in a traditional program. STUDY DESIGN: Fourth-year medical students served as study subjects (novice group) during a 4-week senior elective. They were taught each skill during a 1-week period. Subjects received instruction by a content expert followed by a 1-week period of deliberate practice with feedback. The novice performances were videotaped both before and after the intervention, and each videotape was evaluated in a blinded fashion by experts using a validated evaluation instrument. These results were compared with skill performance ratings of first- and second-year surgery residents that had been accumulated over the previous 3 years. RESULTS: Average performance ratings for the novices substantially improved for all four skills after training. There was no marked difference between average performance ratings of postintervention novice scores when compared with the average scores in the resident group. Inter-rater agreement in scoring for the videotaped novice performances exceeded 0.87 (intraclass correlation) for all ratings of pre- and posttraining. CONCLUSIONS: These results demonstrate the effectiveness of a laboratory-based training program that includes fundamentals of motor skills acquisition.

关键词： Adult Clinical Competence Curriculum Education Medical Graduate Educational Measurement 成年人临床工作能力课程教育医学研究生教育考核实习医师和住院医师职务 Clinical Competence Rating Medical graduate Educational Measurement Motor Skills average performance Curriculum Surgery

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The effect of dual training in internal medicine and Pediatrics on the career path and job search experience of pediatric graduates

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JOURNAL OF PEDIATRICS 2007年第4期151卷 419-424页

作者： Chamberlain, John K. Cull, William L. Melgar, Tom Kaelber, David C. Kan, Brian D. Univ Rochester Dept Internal Med Rochester NY USA Univ Rochester Dept Pediat Rochester NY USA Amer Acad Pediat Div Hlth Serv Res Elk Grove Village IL USA Michigan State Univ Kalamazoo Ctr Med Studies Dept Internal Med Kalamazoo MI USA Michigan State Univ Kalamazoo Ctr Med Studies Dept Pediat & Human Dev Kalamazoo MI USA Harvard Univ Dept Internal Med Cambridge MA 02138 USA Harvard Univ Dept Pediat Cambridge MA 02138 USA Cedars Sinai Med Ctr Dept Internal Med Los Angeles CA 90048 USA Cedars Sinai Med Ctr Dept Pediat Los Angeles CA 90048 USA

Objective To compare the job search experience and career plans of medicine-pediatrics (med-peds) and pediatric residents. Study design Annual surveys of graduating med-peds and pediatric residents were compared from 2003 and 2004. Results The survey response rates were 58% for med-peds residents (n = 427) and 61% for pediatric residents (n = 611). Pediatric residents were more likely to be female or an International Medical Graduate. The groups were equally satisfied with their career choice and had equivalent debt. Med-peds residents were more likely to seek and accept generalist and hospitalist positions. Pediatric residents were more likely to seek subspecialty careers and research opportunities. More than 94% of med-peds residents expected to care for pediatric patients. Among residents seeking generalist positions, med-peds residents sent half as many applications to get the same number of interviews and offers as pediatric residents, were more likely to be offered their most desired position, and were more likely to accept a position in a rural area/small town. Med-peds residents had substantially greater starting salaries as hospitalists or generalists compared with pediatric residents. Conclusion Med-peds and pediatric trainees differ in their career plans, although primary care is their most popular choice. Med-peds-trained physicians have an easier job search experience and greater market valuation.

关键词： Adult Career Choice Fellowships and Scholarships Female Health Care Surveys 成年人职业选择助学金和奖学金卫生保健调查内科学实习医师和住院医师职务 General Practitioners Hospitalists Job Application Occupational Choice career Pediatrics Adults Health Care Surveys Fellowships and Scholarships graduate Internal Medicine

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Teaching evidence-based medicine in otolaryngology

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OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA 2007年第6期40卷 1261-+页

作者： Liu, Jeffrey C. Stewart, Michael G. Weill Cornell Med Coll Dept Otorhinolaryngol New York NY 10021 USA

Learning to apply the ever-expanding volume of clinical literature to patient care is critical for the next generation of physicians. This evidence-based medicine (EBM) offers much to improve patient care and outcomes, but should enhance rather than restrict the practice of medicine. Although the barriers to the adoption and teaching of EBM lie on many fronts, including institutional and staff limitations, many examples of structured didactics-.from journal club to professor rounds-have been reported with good success. Published reviews and online evidence-based guidelines offer excellent synthesis of complex topics as a catalyst for understanding the clinical literature. Beyond academics, this article, in its discussion of what EBM is and how to practice it, presents information of value to practicing clinicians.

关键词： Curriculum Evidence-Based Medicine Humans Internship and Residency MEDLINE 课程证据医学实习医师和住院医师职务联机系统耳鼻咽喉科学教学 Pedagogy MEDLINE Patient Care Internship and Residency Curriculum Laryngology Teaching

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Discrepancies in interpretation of ED body computed tomographic scans by radiology residents

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AMERICAN JOURNAL OF EMERGENCY MEDICINE 2007年第1期25卷 45-48页

作者： Tieng, Nelson Grinberg, Diana Li, Siu Fai Jacobi Med Ctr Dept Emergency Med Bronx NY 10461 USA

Objective: In academic institutions, radiology residents are often relied oil for providing preliminary reports of imaging studies done in the ED. We examined the prevalence of discrepant interpretations of body computed tomographic (CT) scans in Our institution. Methods: We conducted a retrospective Study on a consecutive series of body CT scans at all urban ED. We compared the preliminary interpretation by radiology residents with the final interpretation by radiology attending physicians. An interpretation was characterized as having no discrepancy, minor discrepancy, or major discrepancy. A major discrepancy was defined as a discrepancy that resulted in a change in diagnosis, treatment, or disposition. Results: Two hundred three body CT scans were identified during the study period. Of these CT scans, 20 had major discrepancies (10%), 40 had minor discrepancies (20%), and 143 had no discrepancy (70%). Major discrepancies included missed appendicitis, normal appendix, missed bowel obstruction, and missed colon cancer. Computed tomographic scans with abnormal findings were more likely to contain major discrepancies (relative risk = 6.0;95% confidence interval - 1.8-20). Conclusion: Discrepancies between radiology residents and radiology attending physicians were common at our institution. Emergency department physicians Should exercise caution when relying on residents' interpretation of body CT scans. (c) 2007 Elsevier Inc. All rights reserved.

关键词： Abdominal Pain Diagnostic Errors Internship and Residency 腹痛误诊实习医师和住院医师职务 tomographic scanning Diagnostic Errors emergency room Radiology Tomography Abdominal Pain X-Ray Computed Tomography Internship and Residency interpretation

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