【作者】 葛长青；

【导师】 胡铁辉；

【作者基本信息】 中南大学 ， 临床医学， 2013， 博士

【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。更多还原

【Abstract】 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.更多还原