【作者】 齐德广；

【导师】 秦银河；

【作者基本信息】 第三军医大学 ， 社会医学与卫生事业管理， 2011， 博士

【摘要】 改革开放以来,我国高等教育事业取得令世人瞩目的成绩,初步形成了适应国民经济建设和社会发展需要的多种层次、多种形式、学科门类基本齐全的社会主义高等教育体系,为社会主义现代化建设培养了大批人才,在国家经济建设、科技进步和社会发展中发挥了重要作用。提高人才培养质量是高等教育发展的核心任务和建设高等教育强国的基本要求,是国家经济社会发展战略需求赋予高等教育的新使命,是人民群众对高等教育的新期盼,是高等教育自身科学发展的新要求。新中国成立以来,我国高等医学教育飞速发展,逐步探索出符合我国国情和自身特点的医学教育发展规律,初步建立了包括学校医学基础教育、毕业后医学教育、继续医学教育的连续统一的医学教育体系,60多年来,为我国卫生事业战线输送了一大批合格的医药卫生人才,2010年,我国卫生队伍人员总数已超过600万,其中医师系列约200万人,护理系列约130万人,每千人口医师数从建国初期的0.1上升到1.3,达到了世界平均水平。但是,与西方发达国家相比,我国医学教育在教育思想和观念、医学教育终身化、人才培养方案的规范性、办学宗旨和培养目标定位的准确性、课程体系和教学内容的适宜性、教学方法和方式的先进性等方面还存在着不小的差距。当前,我国高等医学教育的发展面临着难得的机遇和严峻的挑战,我国经济体制和经济增长方式的两个根本转变,将进一步促使高等医学教育进行深层次改革。学校的生存与发展,很大程度上取决于学校办学的质量和效益适应社会需求的程度。2009年,国家教育部、国家卫生部联合下发了《关于加强医学教育工作提高医学教育质量的若干意见》,明确提出了统一认识、提高质量、加大投入、重视实践、强化措施、狠抓落实的13条进一步加强我国医学教育工作的意见,其中,把高等医学教育的质量,放在了一个举足轻重的战略位置。临床医学专业学员的培养是高等医学教育的核心组成部分,临床教学是其培养过程中最重要的培养阶段之一,临床教学质量的高低,对培养合格的、符合经济社会发展需要的临床医师起着十分关键的作用,为了持续提高临床教学质量,国内外医学教育专家一直在作大量、深入、持续的研究和探索。目前,军医大学临床教学任务主要由军医大学附属医院、教学医院和实习医院承担,他们是军医大学开展临床教学活动的重要平台,其教学质量的高低,直接影响着军医大学的人才培养质量,影响着我国军事医学发展的进程,秉承军队院校教学工作评价的基本理念,对军医大学附属医院、教学和实习医院定期进行临床教学质量的评价,对于推动军医大学各临床教学单位不断加大教学投入、改善教学条件、规范教学管理、提高教学质量,有着重要的现实意义,而建立一套科学合理的、适合常态化开展评价活动要求的、有较强针对性和较典型的简捷易操作特性的临床教学质量常态化评价指标体系,是实现教学评价常态化的首要条件。本研究旨在对相关文献进行充分调查研究的基础上,借鉴我国高等教育评估和军队院校教学工作评价过程中取得的经验,参考国内不同地区不同医学院校对临床教学基地开展评估的指标体系的设置,结合临床教学质量的影响因素,经过拟制指标体系框架、形成指标体系雏形、构建指标体系预案、通过多轮专家咨询确定指标体系内容、计算指标体系权重、明确指标体系应用方法和评价标准等一系列步骤,制定出一套适合军医大学实际的、适合常态化开展评价活动使用的临床教学质量评价指标体系,为军医大学临床教学评价的常态化开展提供基础条件和手段。本研究综合运用文献调研、专家访谈、问卷调查、层次分析法等多种研究方法和手段。全文共有七个部分:第一部分在系统回顾国际国内高等教育评估和部队院校开展教学工作评价情况的基础上,对我国下一步如何更加科学地开展教学评价工作进行了深入的思考;第二部分阐述了教学评价常态化的概念、内涵、类型、原则、方法及其意义等,对如何开展常态化教学评价提出了设想,对建立临床教学质量常态化评价指标体系的相关问题进行了探索;第三部分对高等教育评估、军队院校教学工作评价指标体系、临床教学基地建设标准、国内部分省市和医学院校开展临床教学基地评估所设置的指标体系进行系统的调查分析,以期在新的评价指标体系的研制过程中,充分吸收借鉴上述文献中对指标设置的好的经验和做法。第四部分经过对比分析、归纳提炼,对质量、教学质量及临床教学质量等相关概念进行了深入分析,界定了相关概念;通过对军医大学临床医学专业五年制本科人才培养目标、GMER、本科医学教育的国际国内标准等资料的分析,明确了新的评价指标体系应该能充分体现医学教育的国际和国内标准中规定的主要内容,还应该能体现“姓军为兵”的部队特色,同时,对构建新的指标体系的其他问题也进行了研究和探索。第五部分通过调查分析、查阅资料、因果分析等,制定了军医大学临床教学质量常态化评价的指标体系预案,对预案进行了期望调查,确定了评价指标体系的各级指标及评价标准;第六部分运用层次分析法计算出军医大学临床教学质量常态化评价指标体系各级指标的权重系数并对评价指标体系的应用方法进行了探讨。第七部分对本课题的创新点以及需进一步研究的内容进行了分析讨论。更多还原

【Abstract】 Since the reforming and opening policy was carried out,the higher education in China has gained an outstanding achievement and has basically formed a socialism higher education system with complete disciplines and various levels and teaching methods. The education system also has cultured a great number of advanced talents and experts who play a great role in the economical construction,scientific advancement and social development in China.The quality enhancement is one of the core tasks of higher education and a basic requirement for building a strong country of higher education development.It is a new mission of state social and economic development,a new hope of Chinese people and new requirement of the self-development of higher education in a scientific way.Since liberation of China,the medical education has been developed in high speed and gained an outstanding achievement in practice. Based on the particular feature of the medical education and the development law,a complete education system,which includes basic education,post-graduate education and further education,has been built and a management and operation system for medical education has been formed. Since 1960, a great number of qualified medical and healthcare talents have been cultured and in 2010 there were altogether 600 million of the healthcare troop with 200 million of physicians and nurses. The rate of physicians per 1000 people rose to 1.3 from 0.1 in the time of founding of P R China and reached the average level of the world.However,compared with the level in advanced countries,the medical education has a great deal of problems in education idea and concept,the life long education,the regulation of programs,the curriculum system with accurate setting of the principles and objectives, the suitability of contents,teaching methods and ways and so on. At present,there are great chances and challenges facing by medical higher education in China for the complete changes in economical system and ways of development would further intensify the reforming of the medical higher education. The living and development of schools depends highly on their suitability to market economy and more importantly on the quality and effectiveness of the operation of the school. In 2009,the National Education Ministry and the Ministry of Health jointly promulgated the Suggestions on Enhancing the Medical Education quality by Improving Medical Education Work.which put forwards 13 suggestions that unifying the ideas, enhancing quality, increasing input,strenthening practice,intensifying programs and gaining sound effects, and the“enhancing quality”was put as the top priority.The culture of the clinic students is the core part the higher education and the clinical teaching is most important stage in the process. The quality of clinical teaching is key to culture qualified physicians who may meet the needs of economical and social development. To continuously improve the clinical teaching quality,the education experts worldwide are carrying on great deal of reseach consisiently and thoroughly.A teaching hospital is an important platform for clinical medicine teaching in military medical universities and its quality affects the quality the talent directly and the process of military medicine in China. It is significant in stimulating the teaching input,condition improvement,teaching quality regulation and quality enhancement in teaching hospital affiliated to the military medical universities if we inherit the basic idea of assessment in teaching work in militay schools to evaluate periodically the clinical teaching quality in military medical universities.To realize the envison and practice teaching assessment regularly, the first thing is construct a scientific and feasible evaluation indicator system.The clinical teaching quality belongs to the field of education quality which is affected by many factors. At present,there is various understanding on the definition and connotation of the education and clinical teaching quality. In this study, we reviewed a great deal of literature and summed up the conception of clinical teaching quality. On the basis of that,we constructed an evaluation indicator system with high reliability and validity which is also feasible in teaching hospital affiliated to military medical universities to provide basic condition and tools for regular clinical teaching evaluation in military medical universities and improve the mordenization of the healthcare course of national defence and military medicine.In this study, we applied the methods and tools such as literature review, expert interview, questionnaire investigation, Delphi survey and the analytic hierarchy process (AHP) and conducted the theoretical research on the clinical teaching quality and made interpretation of objectives of training medical students of military medical university and reviewed the literature on evaluation of clinical teaching quality wordwide. By conducting questionnaire investigation and Delphi survey on evaluation of clinical teaching quality in military medical university, we have constructed the indicator system for evaluating the clinical teaching quality in teaching hospital affiliated to military medical universities. The whole study falls into six parts:In the first part,we made a systematical review on the education evaluation worldwide and medical schools and thought deeply about to more effectively carry out a more scientific assessment conducted in-depth teaching next step.In the second part,We explained the concept of normalization of teaching evaluation,content,types,principles and methods and instruction on how to carry out evaluation of the normalization of the ideas put forward. Explored the establishment of evaluation index system of clinical teaching quality related issues.In the third part,we reviewed a great deal of literaure and deeply analyzed the conception of education assessment,quality,teaching quality and clinical teaching quality so as to gain the definition and connotation of the indicator system for evaluating clinical teaching quality.In the forth part,we expounded the GMER,the MER for the college stage in China,the training objectives of medical talents in military medical university.In the fifth part,by survy analysis,literaure review and causality analysis,we constructed an elementary indicator system for evaluating the clinical teaching quality in teaching hospital affiliated to military medical universities and identifed the indicators and standards of all level by Delphi survey. In the sixth part,we used the the analytic hierarchy process (AHP) to get the weight of the indicators of all level of the indicator system for evaluating the clinical teaching quality in teaching hospital affiliated to military medical universities. In the seventh part,we made the discussion on the reliability and validity of the indicator system for evaluating the clinical teaching quality in teaching hospital affiliated to military medical universities,the difficulties,the innovation and the contents needed to furth study.更多还原