基于Milestones系统的糖尿病联络护士培训体系构建与应用

目的 构建基于Milestones系统的糖尿病联络护士培训体系,并评价实施效果。方法 于2021年7~12月采用德尔菲法构建基于Milestones系统的糖尿病联络护士培训体系;2022年1~3月采用构建的培训体系对蚌埠医学院第一附属医院76名糖尿病联络护士进行培训。比较培训体系实施后和前期常规方法培训后糖尿病联络护士岗位胜任力各维度得分、糖尿病患者对有关糖尿病健康教育内容知晓度及对联络护士的满意度。结果 基于Milestones系统的培训体系实施后,糖尿病联络护士岗位胜任力各维度得分,包括理论、技能(胰岛素笔注射、指尖血糖检测、胰岛素泵植入与维护、健康教育)、态度(自评、护士长评价),患者对健康教育内容知晓得分和对联络护士满意度均高于常规培训,差异有统计学意义(P<0.001)。结论 构建并实施基于Milestones系统的培训体系,可提高糖尿病联络护士的岗位胜任力,为全院糖尿病患者提供专业同质化的护理;能提升患者对健康教育内容的知晓度,进而提高自我管理能力,改善患者就医感受。

运用Milestones评价体系评估肾内科住院医师为主的临床小讲课的分层效果分析

目的运用Milestones评价体系探讨住院医师为主的临床小讲课在肾内科住院医师规范化培训(以下简称住陪)中的分层应用效果。方法选择2020年9月~2021年8月在肾内科进行为期2个月住陪轮转的住院医师45人作为对照组,采用传统临床小讲课模式;选择2021年9月~2022年8月在肾内科进行为期2个月住陪轮转的住院医师36人作为研究组,采用住院医师为主的临床小讲课模式。对第1~3年住院医师(resident one-three,R1~3)轮转前后Milestones评价体系得分进行住院医师自评与主治医师评分,比较两组R1~3轮转前后Milestones得分变化,另外采用理论考核、实践技能考核及对住培满意度问卷调查评价两组R1~3的教学效果。结果轮转前两组Milestones评分比较,差异无统计学意义(P>0.05),两组主治医师评分均低于住院医师自评(P<0.05);研究组R1~3轮转后Milestones评分均高于轮转前(P<0.05),对照组R1~3轮转前后Milestones评分比较,差异无统计学意义(P>0.05);研究组R1~3理论考核成绩高于对照组,差异有统计学意义(P<0.05),研究组与对照组R1~3之间实践技能考核成绩比较,差异无统计学意义(P>0.05),研究组对住培满意度得分高于对照组(P<0.05)。结论住院医师为主的临床小讲课可以提高住院医师的患者照护能力、理论知识水平及从工作中学习与进步的能力,能改善住院医师住陪满意度。

Simulation-based assessment for the emergency medicine milestones: a national survey of simulation experts and program directors

The focus of outcome-based education has shifted from the process of training to the end“product”of education.This has necessitated a reframing of the teaching,learning,and assessment.Therefore,in 2013,the Accreditation Council for Graduate Medical Education(ACGME)implemented the educational milestones for all accredited residencies and fellowship programs.[1]The milestones have been described as“developmentally based,specialty-specific achievements that residents are expected to demonstrate at established intervals as they progress through training.”[1]Milestones are based on the six core competencies established by the ACGME and American Board of Medical Specialties(ABMS),which consist of medical knowledge(MK),patient care(PC),interpersonal and communication skills(ICS),practice-based learning and improvement(PBLI),professionalism(PROF),and systems-based practice(SBP).[2,3]ACGME,in conjunction with the American Board of Emergency Medicine(ABEM),drafted 23 detailed subcompetencies relevant to emergency medicine(EM).[4]

Scheduling Model and Algorithm of Construction Equipment under Milestone Constraint

The scheduling of construction equipment is a means to realize network planning.With the large-scale and low-cost requirements of engineering construction,the cooperation among members of the engineering supply chain has become very important,and effective coordination of project plans at all levels to optimize the resource management and scheduling of a project is helpful to reduce project duration and cost.In this paper,under the milestone constraint conditions,the scheduling problems of multiple construction devices in the same sequence of operation were described and hypothesized mathematically,and the scheduling models of multiple equipment were established.The Palmer algorithm,CDS algorithm and Gupta algorithm were respectively used to solve the optimal scheduling of construction equipment to achieve the optimization of the construction period.The optimization scheduling of a single construction device and multiple construction devices was solved by using sequencing theory under milestone constraint,and these methods can obtain reasonable results,which has important guiding significance for the scheduling of construction equipment.

美国骨科住院医师胜任力评价系统Milestones2.0的解读与思考

评估骨科住院医师核心胜任力对促进骨科住院医师规范化培训至关重要。骨科住院医师胜任力评价系统Milestones2.0是由美国毕业后医学教育认证委员会发布,针对骨科住院医师胜任力进行评价的系统,该系统的核心目的是评估参加ACGME培训项目骨科医师的核心胜任力。本文谨以该系统为例,围绕ACGME提出的六项胜任力,即患者照护、医学知识、基于系统的实践、基于实践的学习、职业素养和人际沟通技巧,介绍分阶段目标胜任力评价系统的主要内容、评价表主要结构及使用方法,以期为借鉴骨科住院医师核心胜任力的评估手段,起到促进作用。

Role Dynamic Allocation of Human-Robot Cooperation Based on Reinforcement Learning in an Installation of Curtain Wall

A real-time adaptive roles allocation method based on reinforcement learning is proposed to improve humanrobot cooperation performance for a curtain wall installation task.This method breaks the traditional idea that the robot is regarded as the follower or only adjusts the leader and the follower in cooperation.In this paper,a self-learning method is proposed which can dynamically adapt and continuously adjust the initiative weight of the robot according to the change of the task.Firstly,the physical human-robot cooperation model,including the role factor is built.Then,a reinforcement learningmodel that can adjust the role factor in real time is established,and a reward and actionmodel is designed.The role factor can be adjusted continuously according to the comprehensive performance of the human-robot interaction force and the robot’s Jerk during the repeated installation.Finally,the roles adjustment rule established above continuously improves the comprehensive performance.Experiments of the dynamic roles allocation and the effect of the performance weighting coefficient on the result have been verified.The results show that the proposed method can realize the role adaptation and achieve the dual optimization goal of reducing the sum of the cooperator force and the robot’s Jerk.

The Influence of Academic Self-Efficacy on Learning Engagement in Online Education in China:The Mediating Role of Effort

The shift towards online intelligent learning has become the norm in education and is now a fundamental part of modern educational activities.However,this new model can influence students’learning behavior and lead to changes in their approach to learning.Based on online intelligent learning,we investigated how the academic self-efficacy of nursing students affects their engagement with learning and explored the role of academic attribution as a mediator.Five hundred fifty-three nursing college students from Hebei and Hunan provinces in China participated in the online questionnaire.The results revealed that effort plays a mediating role in the relationship between academic self-efficacy and learning engagement.

Associations between residence and cognitive function among Chinese older adults: the mediating role of leisure activity

Background:Cognitive function is a current research hotspot,residence may be related to differences in cognitive function,and the mediating role of leisure activities are limited in Chinese research.This study used leisure activities as a mediating variable to investigate the mediating role of leisure activity between place of residence(city-town-rural)and cognitive function among Chinese older,this is where the innovation of the article comes in.Methods:Using cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey,Pearson correlation analyses were employed to examine the relationships among various indicators.Mediation analyses were conducted using the SPSS PROCESS macro program,version 3.5,written by Hayes,to explore the mediating effects of leisure activity between place of residence and cognitive function in older adults.Results:A total of 10955 older adults were included in this study,with a mean age of(84.23±11.57)years.Among them,2739(24.8%)lived in the city,3627(33.1%)in town,and 4615(42.1%)in rural areas;their leisure activity score was(5.34±3.77),and their cognitive function score was(24.69±6.65).Place of residence,leisure activities,and cognitive function were significantly correlated(P<0.01).Using city as a reference,place of residence is negatively associated with cognitive function,and place of residence not only had a direct effect on cognitive function in older adults:town-cognitive function(effect=–0.399;95%confidence interval(CI)=(–0.685,–0.113));rural-cognitive function(effect=–0.42;95%CI=(–0.698,–0.141)).There were also indirect effects on cognitive function through the pathway of leisure activity:town-leisure activity-cognitive function(effect=–0.17;95%CI=(–0.246,–0.1)),rural-leisure activity-cognitive function(effect=–0.199;95%CI=(–0.272,–0.13)).Conclusion:Leisure activities play a partially mediating role between the impact of place of residence and cognitive function in Chinese older adults,and it is vital to pay attention to the impact of place of residence on the cognitive function of older adults in various aspects,and to increase the participation rate of older adults in leisure activities,which is beneficial to the prevention of cognitive decline and the protection of older adult’s physical and mental health.

Study on the Promoting Role of Animating Zhuang Non-Heritage Folktales in the Ethnic Culture Industry

This study aims to explore the role of animating Zhuang non-heritage folktales in promoting the national culture industry.Using literature research,case studies,and comparative research methods,the positive impacts are analyzed in depth across four dimensions:cultural value inheritance,market demand,dissemination channels,and industrial innovation.The results show that animating Zhuang non-heritage folktales can help inherit national culture,meet market demand,broaden communication channels,and promote industrial innovation.Finally,this paper proposes corresponding policy suggestions and implementation paths to provide references for the sustainable development of the ethnic culture industry.

Theoretical Analysis and Practical Reflection on the Role Conflict of Double-Qualified Teachers in University-Affiliated Hospitals

Taking role conflict as the starting point,this article examines and reflects on the development of clinical teachers.In the process of the occurrence,development,and resolution of role conflicts among clinical teachers,there are many hidden issues related to the development of clinical teachers.The development of clinical teacher teaching and role conflict management contain similar educational philosophies and practical issues.This study draws on classic theories and research achievements in the development of university teachers and conducts theoretical analysis and practical reflection on the development of clinical teachers in medical colleges from the perspective of role conflict in social psychology.Policy recommendations are proposed,including strengthening the construction of teaching systems at the hospital organizational environment level,enhancing the role identity and teacher beliefs of clinical teachers,promoting their teaching development and academic learning,and ensuring their normal teaching investment;promoting leadership support at the level of interpersonal interaction and leveraging the role of colleague support in alleviating role conflicts;enhancing individual teacher beliefs,teacher role learning,and role skills.

Exploration of the Evolution of Teacher Roles and Professional Development Needs Among University English Instructors

The role of university English instructors has evolved significantly over the years,encompassing various aspects.This paper explores the evolution of the role of university English instructors and examines the current challenges and opportunities they face in today’s educational landscape.It delves into the multifaceted nature of their responsibilities and discusses the importance of continuous professional development to meet the evolving needs of students and the demands of the profession.

Exploration of Teaching Development Strategies for Double-Qualified Teachers in University- Affiliated Hospitals Based on Role Conflict Theory

This study draws on the classic theories and research achievements of university teacher development,and from the perspective of role conflict in social psychology,proposes policy recommendations for the development of clinical teachers in medical colleges,including following different stages of teacher development and designing teaching development strategies at different levels;designing the content and form of teaching development activities to meet the temporal and spatial needs of clinical teachers;and building an academic community for clinical teachers to promote the creation of teaching development behaviors.

Role-play联合翻转课堂教学法对护理实习生新生儿复苏知信行的影响

目的分析角色扮演(Role-play)联合翻转课堂教学法对护理实习生新生儿复苏知信行的影响。方法选取2022年10月1日至2023年8月1日在我院产科及儿科实习的80名本科段护理实习生进行前瞻性研究,将其随机分为试验组(采用Role-play联合翻转课堂教学法进行新生儿复苏技能培训)和对照组(采用传统临床教学法进行新生儿复苏技能培训),各40名。比较两组的教学效果。结果试验组的理论知识、态度信念得分高于对照组,差异具有统计学意义(P<0.05)。试验组的复苏操作得分高于对照组,差异具有统计学意义(P<0.05)。试验组的灵活应变能力、资源利用能力及沟通协作能力得分均高于对照组,差异具有统计学意义(P<0.05)。试验组的教学满意度高于对照组,差异具有统计学意义(P<0.05)。结论Role-play联合翻转课堂教学法在护理实习生新生儿复苏教学中的效果优于传统临床教学法。

美国放射科住院医师胜任力评价系统解读与思考(四):腹部放射学Milestone

腹部放射学分阶段目标胜任力评价系统(The Abdominal Radiology Milestone Project),是由美国毕业后医学教育认证委员会(The Accreditation Council for Graduate Medical Education,ACGME)与美国放射学会(The American Board of Radiology,ABR)联合倡议发起的用于评价放射学专科医师培训考核系统的一部分,该考核评价体系考核并记录腹部放射学专科医师在培训过程中所须具备六项胜任力,包括病患关切(Patient Care,PC),医学知识(Medical Knowledge,MK),基于系统的实践(Systems-based Practice,SBP),基于实践的学习(Practice-based Learning,PBL)、职业素养(Professionalism,PROF),人际关系和沟通技巧(Interpersonal and Communication Skills,ICS)。另外,评价系统指出了多种放射亚专业评估工具,对于完善国内培训机构考核方式与内容,有着积极的指导价值。

美国放射科住院医师岗位胜任力评价系统:介入放射学Milestones 2.0解读与启示

美国放射科介入放射学新版住院医师胜任力评价系统Milestones 2.0发布于2019年12月,相对于第一版,新版以更广的考核视角,评估与记录放射介入方向住院医师的成长,其六大岗位胜任力包括医患照护、医学知识、基于医疗体系的实践、基于医疗实践的学习与提升、职业素养、人际沟通能力。介入放射学Milestones 2.0分为两个评价系统:融合版与独立版,分别对应放射学分支专业与放射学亚专业,分别涵盖31项、24项胜任力细则。其考核细则中的不少内容在国内放射科住培考核中尚未涉及,对于未来我国进一步完善放射科住院医师规范化培训(简称住培)内容,有重要的启示与指引作用。

基于Milestones的不同阶段医学人才岗位胜任力培养目标探讨

根据医学教育培养和医学人才成长规律的渐进性和连续性特征,以及我国《本科医学教育标准-临床医学专业(试行)》《住院医师规范化培训内容与标准(试行)》《关于印发临床医学、口腔医学和中医硕士专业学位研究生指导性培养方案的通知》等医学人才培养标准和目标,结合中国医师岗位胜任力8大核心要素,梳理并合理界定医学院校教育、毕业后医学教育和继续医学教育等不同培养阶段医学人才岗位胜任力培养内容和目标,以利于培养机构科学地制订、设计和实施不同培养阶段医学人才岗位胜任力培养方案,并通过基于Milestones(里程碑)评估系统的评价和促进作用确保和提高医学人才岗位胜任力培养质量。

适用于客户机/服务器系统的MILESTONE开发方法

传统的软件开发生存周期把软件开发过程划分成４个主要阶段．这种方法特别适合于单一的独立系统，但不适合客户机／服务器系统的开发．客户机／服务器系统由许多软部件组成，而且集成多个部门自己开发的软件，这些软部件特别适合采用并行且交互的实现方法．根据客户机／服务器系统开发的特点，文中介绍了一种基于ＭＩＬＥＳＴＯＮＥ的过程开发模型．

美国眼科学住院医师Milestones评价系统解读与思考

美国眼科学住院医师Milestones评价系统是由美国毕业后教育认证委员会(the accreditation council for graduate medical education,ACGME)和美国眼科委员会(the American board of ophthalmology,ABO)根据毕业后医生的核心能力评价教育质量所提出用于眼科学住院医师评价的评价系统,考核的六大核心竞争力包括患者照护、医学知识、职业素养、人际沟通、基于系统的实践和基于实践的学习,最终形成“以胜任力为基础的医学教育”。如何能够将基于培养临床胜任力的培训模式合理运用于我国眼科住院医师规范化培训体系中,并建立对眼科住院医师临床胜任力的评价与考核体系,需要进一步思考和实践。

美国传染病专科住院医师Milestones评价系统介绍与思考

20世纪90年代,我国就开始了住院医师规范化培训制度的探索,2014年原国家卫生与计划生育委员会发布的《住院医师规范化培训管理办法(试行)》正式全面启动实施,2015年底再次发布了《关于建立专科医师规范化培训制度试点的指导意见》,从制度上规范并完善了我国医学毕业后继续教育体系。传染病学专科医师培训是对参加内科住院医师规范化培训的医师或传染病学专业的临床型研究生开展传染病学专科阶段的培养,使其成长为能够独立、规范地从事传染性疾病专科诊疗工作的临床医师,以满足人民群众对高质量医疗卫生服务的需求。我国住院医师规范化培训制度尚在发展完善阶段,全程跟踪监管的科学的医师培养评价与反馈体系亟待完善。

美国放射科住院医师胜任力评价系统:肌骨放射学milestone解读与思考

美国毕业后医学教育认证委员会(ACGME)联合美国放射学会(ABR)倡议发布了针对放射科住院医师或专科医师的milestone胜任力评价系统,其主要目的是评估参加ACGME认可的放射科医师培训项目,为放射科住院医师或某个亚专业的专科医师核心胜任力的发展提供了一个评估框架。在此仅以肌骨放射学milestone为例,围绕ACGME提出的六项胜任力,即患者照护、医学知识、基于系统的实践、基于实践的学习、职业素养和人际沟通技巧,介绍分阶段目标胜任力评价系统的主要内容、评价表主要结构及使用方法。