住院医师规范化培训职业导师模式的探索——以学习者为中心的综合素质培养新尝试

Exploration of professional mentorship in standardized residency training--new attempts to learner-centered residency training in comprehensive quality of professionalism and humanistic nurturing

目的如何实现以学习者为中心的综合素质培养是住院医师规范化培训的重点与难点,目前尚无成熟的培养模式。本研究尝试引入职业导师制,探索其在规范化培训素质教育中的应用价值。方法选取武汉普爱医院中美全科医师培训基地有教学热情、临床能力过硬、乐观积极的中级以上职称的17名临床骨干医师作为住院医师的职业导师,在3年培训期间对住院医师持续跟踪指导,包括跟踪反馈360度评估、阶段考试、执业医师考试结果,提出改进意见并予以监督;帮助选定选修轮转科室;帮助遴选科研课题和病例讨论;对住院医师提供必要的心理支持和生活上的关怀与帮助;介绍从业经验,为住院医师未来的职业规划提供参考意见等。通过对相关参与者的问卷调查,分析职业导师制在以学习者为中心的住院医师综合素质培养方面的可行性与初步效果。结果调查结果显示:住院医师最期望导师在职业经验和未来职业规划、分析指导病例讨论、指导阅读文献、科研方面提供帮助,同时也希望在生活关怀和心理支持上提供帮助。目前阻碍职业导师制落实的主要因素有:导师日常工作繁重、时间保护不足、相关财务及人事激励不足、无定期的导师工作会议、导师工作没有评价指标、基地未定期反馈等。问卷调查了63名教学相关人员,相关人员倾向于认为住院医师的多项与职业素养相关指标经过两年培训有了明显改善,对全科医学的执业信心得到明显提高。结论职业导师持续跟踪住院医师的培训进展,提供一对一有针对性的职业指导、身心关怀和职业素养示范,初步结果显示职业导师制有助于实现以学习者为中心的素质化职业培养,这种培养模式值得进一步观察与实践。

Objective Learner-centered comprehensive quality training is still the focus and difficulty of standardized training for residents.At present,there is no established model recognized nationwide.This study attempts to introduce a mentoring modle and explore its application value in the quality training of standardized residency programs.Methods 17 teaching physicians with intermediate or senior titles,who are optinistic,enthusiastic for teaching and with excellent clinical skills were selected as mentors for residents in the Sino-US pilot standardized GP residency training program,Wuhan Puai Hospital,China.Three years of continuous designated follow-up and guidance are adopted.They include tracking the results of 360-degree evaluations,training tests/assessments,and national physician examinations;supervision and providing suggestions for improvement;advising to choose elective specialty rotation;helping to set up scientific research topics and case presentation;providing necessary psychological care and daily life support;sharing professional experience and guiding for career planming,etc.Through a battety of questionnaire sunveys of relevant participants,the feasibility and effect of this mentorship system on the comprehensive quality residency training are preliminarily analyzed.Results The surveys reveal that the areas where residents most expect to receive assistance from mentors are professional experience and future career planning;guidance of case analyzation and guidance of scientific research.In the meantime,residents also appreciate mentors to reach out for daily life and psychological support.Surveys also show that the main barriers hindering the implementation of this system are:busy schedule of mentors;insufficient time secured;no related financial and personnel incentives;lack of regular mentor training and evaluation for self-improvement and lack of regular feedback from the residency program adninistration.63 teaching-related personnel,who are surveyed in another questionnaire tended to believe that a number of professionalism-related indicators of residents had significantly improved after two years of training,and their confidence in the practice of medicine had been significantly improved.Conclusion Professional mentors continue to track the training progress of residents,provide one-to-one targeted career guidance,physical and mental care and role model of professional literacy.The prelininary observations indicate that the professional mentorship helps to achieve a learner-centered and qualitative residency training,which is worthy of further observation and examed.