Residency Training

住院医师培训
  • 文章类型: Journal Article
    目的:当前的研究重点是通过检查产科医生对需要特殊经验的特定挑战性阴道分娩的方法来预测产科的未来趋势,如臀位介绍,大体胎儿,双胎妊娠,和真空使用,与他们的住院医师培训经验相比。
    方法:横断面研究分两个阶段进行。第一阶段是定性的,第二阶段是定量的。“访谈”和“调查”技术作为数据收集工具。总的来说,20名产科医生参加了面试,400名产科医生参加了调查。访谈数据使用Maxqda2020定性数据分析程序进行了分析,并使用SPSS25.0版对调查数据进行分析。
    结果:在过去的20年里,在涉及臀位的情况下,从阴道分娩逐渐转向剖宫产,大体胎儿,双胎妊娠,和真空使用。虽然法医学的担忧是不可否认的,产科医生普遍认为剖宫产分娩比阴道分娩更安全,这显著影响了这一趋势.相对而言,年轻的产科医生通常在没有获得足够的阴道分娩知识和技能的情况下完成住院医师培训.
    结论:年轻的产科医生目前在处理臀位的阴道分娩方面缺乏足够的经验,大体胎儿,双胎妊娠,和真空使用。随着高级产科医生退休,这种经验有可能在未来十年内完全消失。政策制定者在制定未来的医疗保健政策时应该考虑到这一点。
    OBJECTIVE: The current study focused on predicting future trends in obstetrics by examining obstetricians\' approaches to specific challenging vaginal delivery that require special experience, such as breech presentation, macrosomic fetus, twin pregnancy, and vacuum use, compared with their residency training experience.
    METHODS: The cross-sectional study was conducted in two phases. The first phase was qualitative and the second phase was quantitative. The \"interview\" and \"survey\" techniques served as data collection tools. In total, 20 obstetricians participated in the interviews, and 400 obstetricians took part in the survey. Data from the interviews were analyzed using the Maxqda 2020 qualitative data analysis program, and survey data were analyzed using SPSS version 25.0.
    RESULTS: Over the past 2 decades, there has been a gradual shift from vaginal deliveries to cesarean deliveries in cases involving breech presentation, macrosomic fetus, twin pregnancy, and vacuum use. While medicolegal concerns are undeniable, the prevalent belief among obstetricians that cesarean delivery is safer than vaginal delivery significantly influences this trend. Comparatively, young obstetricians often complete their residency training without acquiring sufficient knowledge and skills in vaginal delivery.
    CONCLUSIONS: Young obstetricians currently lack adequate experience in managing vaginal deliveries for breech presentation, macrosomic fetus, twin pregnancy, and vacuum use. This experience is at risk of disappearing entirely within the next decade as senior obstetricians retire. Policymakers should take this into consideration when shaping future healthcare policies.
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  • 文章类型: Journal Article
    虽然没有一个伟大的放射科住院医师的精确公式,某些属性和成就可能预示着训练中的成功。我们简要回顾了先前的工作,探索了顶级居民绩效的预测因素和评估指标,注意到那些专注于非认知属性的人已经二十多岁了。随着放射学实践和教育的实质性发展,我们从当代的角度重新审视这个话题。受到文学和我们个人经验的启发,我们建议以下非认知特征对放射学学员来说是无价的:沟通专业知识,工作场所适应性,自我意识,精通技术,对个人工作和更大的社区有真正的兴趣。申请人应突出这些特点,由甄选委员会寻求,由导师培养,由项目评估,并由同事重视。
    While there is no precise formula for a great radiology resident, certain attributes and achievements may herald success during training. We briefly review prior works exploring predictive factors and evaluation metrics of top resident performance, noting that those focusing on non-cognitive attributes are over twenty years old. As radiology practice and education has substantially evolved in the interim, we revisit this topic from a contemporary perspective. Inspired by the literature and our own personal experiences, we suggest that the following non-cognitive traits are invaluable for radiology trainees: communication expertise, workplace adaptability, self-awareness, tech savvy and genuine interest in one\'s individual work and greater community. These characteristics should be highlighted by applicants, sought by selection committees, cultivated by mentors, evaluated by programs and valued by colleagues.
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  • 文章类型: Journal Article
    背景:住院医师计划需要将模拟纳入其培训计划。理想情况下,模拟为受训者提供了一个安全的环境来暴露于常见和具有挑战性的临床场景。这篇综述的目的是详细介绍最常用的腹腔镜,内窥镜,和普外科住院医师教育中的机器人手术模拟程序,包括成功实施所需的资源和评价基准。
    方法:美国胃肠和内镜外科医师协会(SAGES)居民和研究员工作组(RAFT)委员会成员使用PubMed和培训网站进行了文献综述。关于最常用的腹腔镜组件的信息,内窥镜,和/或机器人模拟课程,包括评估培训能力的正式和非正式基准,被收集。
    结果:腹腔镜模拟围绕腹腔镜手术基础(FLS)。FLS培训课程已使用基于技能的仿真和虚拟仿真。挑战包括对腹腔镜手术中可能出现的技术复杂性的直接转化。内窥镜模拟侧重于内窥镜手术的基本原理。有虚拟现实仿真平台可用于技能评估和培训。挑战包括模拟器类型和访问,以及结构化的指导和反馈。机器人模拟训练课程尚未标准化。模拟包括一项主要技术,根据入职的成本和要求,这可能是令人望而却步的。
    结论:虽然手术模拟似乎是手术训练的基本组成部分,它需要大量的资源,这对住院医师培训计划来说可能是令人生畏的。不管勾勒出的障碍是什么,腹腔镜手术模拟的需要,内窥镜检查,手术教育培训计划中的机器人技术很明显。
    BACKGROUND: Residency programs are required to incorporate simulation into their training program. Ideally, simulation provides a safe environment for a trainee to be exposed to both common and challenging clinical scenarios. The purpose of this review is to detail the current state of the most commonly used laparoscopic, endoscopic, and robotic surgery simulation programs in general surgery residency education, including resources required for successful implementation and benchmarks for evaluation.
    METHODS: Members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Resident and Fellow Task Force (RAFT) Committee performed a literature review using PubMed and training websites. Information regarding the components of the most commonly used laparoscopic, endoscopic, and/or robotic simulation curriculum, including both formal and informal benchmarks for evaluating training competence, were collected.
    RESULTS: Laparoscopic simulation revolves around the Fundamentals of Laparoscopic Surgery (FLS). Proficiency-based as well as virtual simulation have been utilized for FLS training curricula. Challenges include less direct translation to the technical complexities that can arise in laparoscopic surgery. Endoscopic simulation focuses on the Fundamentals of Endoscopic Surgery. There are virtual reality simulation platforms that can be used for skills assessment and training. Challenges include simulator types and access, as well as structured mentoring and feedback. Robotic simulation training curricula have not been standardized. Simulation includes one primary technology, which can be prohibitive based on cost and requirements for onboarding.
    CONCLUSIONS: While surgical simulation seems to be a fundamental and integrated part of surgical training, it requires a significant number of resources, which can be daunting for residency training programs. Regardless of the barriers outlined, the need for surgical simulation in laparoscopy, endoscopy, and robotics at surgical education training programs is clear.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    目标:德国神经外科住院医师面临着许多挑战,包括接受全面的外科培训并有足够的学习机会,实现平衡的工作生活平衡,保持一个积极的工作环境和导航的职业前景。这项研究的目的是评估对培训计划的总体满意度,找出导致不满的因素,探索培训计划的各个方面,评估居民的心理健康,并确定他们对未来亚专业的偏好。
    方法:对各培训医院神经外科住院医师进行匿名问卷调查,全国范围内。调查利用定量问卷作为数据收集工具。数据收集时间为2021年6月至2023年1月。
    结果:该调查涵盖了120名神经外科住院医师,性别分布为55%男性和45%女性。受访者主要来自大学医院(53%),其次是社区医院(38%)和私立医院(9%)。在培训项目满意度方面,37%报告中等满意度,39%表示满意度低于中度,28%的人满意度高于中等。确定的不满意的主要原因是手术暴露不足(39%的受访者报告),次优教育内容(38%),研究机会不足(32%)。此外,24%的受访者强调心理压力,36%的人报告频繁的职业倦怠经历。大多数(63%)表示每周60-80小时的工作量。大约一半的居民表示未来对神经外科肿瘤学有专业兴趣。
    结论:调查结果为德国神经外科受训人员的挑战和愿望提供了有价值的见解。这些结果作为完善培训体系的依据,改善工作环境,并指导该领域的未来规划。优化住院医师培训,重要的是要解决有限的手术和研究机会以及心理健康等问题。对专业的兴趣为塑造培训计划的未来方向提供了指导。
    OBJECTIVE: Neurosurgery residents in Germany face numerous challenges including receiving comprehensive surgical training with adequate learning opportunities, achieving balanced work life equilibrium, maintaining a positive work environment and navigating career prospects. The objectives of this study are to assess overall satisfaction with the training program, identify factors contributing to dissatisfaction, explore various dimensions of the training program, evaluate the psychological well-being of residents, and ascertain their preferences for future subspecialties.
    METHODS: A questionnaire-based survey was conducted anonymously among neurosurgery residents from various training hospitals, nationwide. The survey utilized a quantitative questionnaire as data collection tool. The data collection took place from June 2021 to January 2023.
    RESULTS: The survey encompassed 120 neurosurgery residents, with a gender distribution of 55 % male and 45 % female. The respondents were primarily from university hospitals (53 %), followed by community hospitals (38 %) and private hospitals (9 %). In terms of training program satisfaction, 37 % reported moderate satisfaction, 39 % indicated below-moderate satisfaction, and 28 % experienced above-moderate satisfaction. The predominant causes of dissatisfaction identified were insufficient surgical exposure (reported by 39 % of respondents), suboptimal educational content (38 %), and inadequate research opportunities (32 %). Additionally, 24 % of respondents highlighted psychological stress, and 36 % reported frequent experiences of burnout. A majority (63 %) indicated a workload of 60-80 h weekly. About half of the residents indicated a future specialization interest in neurosurgical oncology.
    CONCLUSIONS: The results of the survey findings provide valuable insights into the challenges and aspirations of neurosurgery trainees in Germany. These results serve as a basis for improving the training system, enhancing the working environment, and guiding future planning in this field. To optimize the training of residents, it is important to address issues such as limited surgical and research opportunities and psychological well-being. The expressed interest in subspecializing offers guidance for shaping the training program\'s future direction.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
    评估是所有教育计划的重要组成部分,必须检查能力的获得,同时促进和促进学习。进度测试(PT)是公认的评估认知知识,临床背景下的临床推理和决策,提供有关个人表现和节目质量的重要信息。它在巴西和国际医学院广泛使用;然而,它在评估巴西的医疗居民方面仍然没有什么作用。我们介绍了两年来在传染病居住计划中实施PT试点的经验。第一,二年级和三年级居民进行了四次连续考试,每次40道多项选择题(项目)。对受体进行了项目写作最佳实践培训。所有项目都由专家小组审查,批准后,包含在项目库中。所有参与者都回答了他们对体验的看法的调查。在所有考试申请中,三年级居民的最终分数更高。参与者的满意度很高,他在考试和反馈中提到了学习机会。PT可以在培训期间改善居民的评估,居民的表现应指导计划的审查和改进。
    Assessment is an essential component for all educational programs and must check competence acquirement while foster and promote learning. Progress Test (PT) is well recognized to assess cognitive knowledge, clinical reasoning and decision making in the clinical context, offering important information about the individual performance and program quality. It is widely used in Brazilian and international medical schools; however, it still has little role in assessing medical residents in Brazil. We present the experience of a PT pilot implementation in an Infectious Diseases residency program over two years. The first, second and third-year residents did four serial exams with 40 multiple choice questions (item)/each. Preceptors were trained on best practices on item writing. All the items were reviewed by a panel of experts and, after approval, included in the item bank. All participants answered a survey on their perceptions about the experience. The final score was higher for the third-year residents in all exam applications. The level of satisfaction was high among the participants, who mentioned the learning opportunity with the exam and the feedback. PT can improve residents\' assessment along the training period and residents\' performance should guide review and improvement of the programs.
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  • 文章类型: Journal Article
    描述研究表明,当教育领导者支持他们的学习者的自主性时,对双方都有积极影响。这在研究生医学教育(GME)中尤为重要,鉴于强调驻地表现,评估,和发展。不幸的是,GME教师经常将自治误解为居民对独立或“自由”的渴望,“事实上,它指的是核心心理需要感到意志和代理人。区别很重要,因为意志不是独立的同义词,提供自由可能与提供真正自治支持的策略背道而驰。这个,反过来,会增加压力,不适应,以及已经在医学中普遍存在的居民倦怠。为了帮助解决这个问题,本文为医学教育工作者区分自主性和独立性提供了一个循证指南,具体的例子,以帮助将理论转化为实践,以更好地支持医学界的福祉。
    Description Research shows that when educational leaders support their learners\' autonomy, it positively impacts both parties. This is particularly important in graduate medical education (GME), given that there is a strong emphasis on resident performance, evaluation, and development. Unfortunately, GME faculty often misunderstand autonomy as the resident\'s desire for independence or \"freedom,\" when in fact it refers to the core psychological need to feel volitional and agentic. The distinction is important because volition is not synonymous with independence, and providing freedom can be at odds with strategies that provide true autonomy support. This, in turn, can contribute to the stress, maladjustment, and resident burnout that are already prevalent in medicine. To help remedy this issue, this paper provides an evidence-based guide for medical educators to distinguish autonomy from independence, with specific examples to help translate theory into practice to better support the well-being of the medical community.
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  • 文章类型: Journal Article
    本研究的目的是评估ChatGPT产生的信息对中国居民教育的效用。
    我们设计了一项三步调查,以评估ChatGPT在中国住院医师培训教育中的表现,包括住院医师期末考试问题,患者病例,和居民满意度得分。首先,在ChatGPT的界面中输入了来自住院医师期末考试的204个问题,以获得正确答案的百分比。接下来,ChatGPT被要求产生20个临床病例,随后由三名讲师使用预先设计的5分Likert量表进行评估。根据包括清晰度在内的标准评估案件的质量,相关性,逻辑性,信誉,和全面性。最后,进行了31名三年级居民和ChatGPT之间的互动会议。居民对ChatGPT反馈的看法是使用李克特量表进行评估的,专注于易用性等方面,回答的准确性和完整性,及其在增强对医学知识的理解方面的有效性。
    我们的结果显示ChatGPT-3.5正确回答了45.1%的考试问题。在虚拟病人病例中,ChatGPT的平均评分为4.57±0.50、4.68±0.47、4.77±0.46、4.60±0.53和3.95±0.59分,相关性,逻辑性,信誉,和临床指导员的全面性,分别。在培训住院医师中,ChatGPT得分为4.48±0.70、4.00±0.82和4.61±0.50分,便于使用,准确性和完整性,和有用性,分别。
    我们的研究结果证明了ChatGPT在个性化中国医学教育方面的巨大潜力。
    UNASSIGNED: The purpose of this study was to assess the utility of information generated by ChatGPT for residency education in China.
    UNASSIGNED: We designed a three-step survey to evaluate the performance of ChatGPT in China\'s residency training education including residency final examination questions, patient cases, and resident satisfaction scores. First, 204 questions from the residency final exam were input into ChatGPT\'s interface to obtain the percentage of correct answers. Next, ChatGPT was asked to generate 20 clinical cases, which were subsequently evaluated by three instructors using a pre-designed Likert scale with 5 points. The quality of the cases was assessed based on criteria including clarity, relevance, logicality, credibility, and comprehensiveness. Finally, interaction sessions between 31 third-year residents and ChatGPT were conducted. Residents\' perceptions of ChatGPT\'s feedback were assessed using a Likert scale, focusing on aspects such as ease of use, accuracy and completeness of responses, and its effectiveness in enhancing understanding of medical knowledge.
    UNASSIGNED: Our results showed ChatGPT-3.5 correctly answered 45.1% of exam questions. In the virtual patient cases, ChatGPT received mean ratings of 4.57 ± 0.50, 4.68 ± 0.47, 4.77 ± 0.46, 4.60 ± 0.53, and 3.95 ± 0.59 points for clarity, relevance, logicality, credibility, and comprehensiveness from clinical instructors, respectively. Among training residents, ChatGPT scored 4.48 ± 0.70, 4.00 ± 0.82 and 4.61 ± 0.50 points for ease of use, accuracy and completeness, and usefulness, respectively.
    UNASSIGNED: Our findings demonstrate ChatGPT\'s immense potential for personalized Chinese medical education.
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