DxR Clinician教学在全科专业规培学员临床思维能力培养中的作用

于2022年1月31日至2023年2月28日,将同济大学附属同济医院的30名全科专业住院医师规范化培训学员以随机数字表法分为试验组和对照组,每组均为15人。试验组应用DxR Clinician(简称DxR)系统进行9次虚拟诊疗课程;对照组以CBL(基于病例的学习)病例讨论形式进行9次相应主题的讨论课。应用满意度调查表了解两组规培学员对各自授课方式的满意度情况,同时应用年度考核成绩评估教学效果。实践表明,应用DxR系统的教学形式有助于提高全科规培学员的临床思维能力和自主学习能力,值得在全科医师规范化培训中广泛推广。

DxR clinicians在三年级本科生问诊及临床思维训练方面的应用与探索

利用DxR clinicians软件对三年级本科生进行问诊及临床思维训练课程,学生普遍认为该课程有利于提高学生问诊思路及临床思维的培养,有利于临床岗位胜任力及医患沟通能力、职业道德培养,有利于提高学生分析问题、解决问题的能力。该软件应用可在其他年级教学、培训及考试中适当推广.

虚拟病例教学软件PUMC-DxR Clinician的初步试用和评估

目的探索虚拟病例教学软件在国内医学教育中的应用。方法在医学生中募集志愿试用者41名(见习生23名和实习生18名),对PUMC-DxR Clinician软件进行为期5周的试用,共10份虚拟病例。试用结束后,填写软件试用评估问卷。结果试用者总体评价(3.71±0.72)分,新颖性(4.66±0.62)分,易用性(3.51±0.87)分,实用性(4.00±0.87)分,各项得分均显著大于3分。适用场景及人群方面,95.1%的试用者赞成用于见习、实习或初年住院医生;80.5%赞成用于教学。结论 PUMC DxR Clinician虚拟病例教学软件在本次试用中体现了较好的实用性和易用性,其价值主要体现在临床思维的培养。

DxR Clinician模拟教学在血液科临床实践中的应用初探

通过在血液科实施DxR Clinician(简称:DxR)模拟教学,了解医学生对其认可程度,评价其在血液内科实习中的教学效果。选择在同济大学附属同济医院的14级和15级74名实习学生为研究对象,该研究为前瞻性研究,从初期结果看,大部分学生对DxR模拟教学给予了肯定的评价,其作为一种教学方法的补充是可行的,但仍需要干预性验证。

Use of Chinese Herbal Medicine Therapies in Comprehensive Hospitals in Central China: A Parallel Survey in Cancer Patients and Clinicians

Summary： Chinese herbal medicine （CHM）, as the largest application category of traditional Chinese medicine （TCM）, is widely accepted among cancer patients in China. Herbal slice （HS） and Chinese patent drug （CPD） are commonly used CHM in China. This study aimed to investigate the utilization of CHM among clinicians and cancer patients in central China. Five hundred and twenty-five patients and 165 clinicians in 35 comprehensive hospitals in central China were asked to complete an anonymous questionnaire that was designed to evaluate the use of CHM. The results showed that 90.74% clinicians and 72.24% cancer patients used CHM during cancer treatment. The educational backgrounds of the clinicians and the age, education level, annual income, and cancer stage of the cancer patients were re- lated to use of CHM. More than 90% clinicians and cancer patients had used CPD. Comparatively, the percentage of HS use was 10% lower than that of CPD use among clinicians and cancer patients. More clinicians preferred to use CHM after surgery than cancer patients did （20.41% vs. 5.37%）. Enhancing physical fitness and improving performance status were regarded as the most potential effect of CHM on cancer treatment （85.71% among clinicians and 94.07% among cancer patients）, in comparison with directly killing tumor cells （24.49% among clinicians and 31.36% among patients）. As for refusal rea- sons, imprecise efficacy was the unanimous （100%） reason for clinicians＇ rejection of CHM, and 95.58% patients objected to using CHM also for this reason. Furthermore, the side effects of CHM were more concerned by clinicians than by patients （33.33% vs. 15.81%）. In conclusion, our survey revealed that CHM was popularly accepted by clinicians and cancer patients in central China. The reasons of use and rejection of CHM were different between clinicians and cancer patients.

Promoting Clinician Well-Being and Patient Safety Using Human Factors Science: Reducing Unnecessary Occupational Stress

Our healthcare delivery system has accumulated complexity of payment, regulation systems, expectations and requirements. Often these are not designed to align with clinical thinking process flow of patient care. As a result, clinicians are utilizing enormous mental (cognitive) resource to comply with these complexities, over and above the baseline mental effort required to give good care to the patient. Recent studies suggest a significant number of physicians, advanced practice providers and nurses no longer want to stay in healthcare due to difficult work expectations and conditions that have become unreasonable. Technology has benefitted healthcare delivery, but also is a conduit of many expectations that have been grafted upon clinician workloads, exceeding the resources provided to accomplish them. Cognitive load is a measure of mental effort and is divided into Intrinsic, Germane and Extraneous Cognitive Load. Extraneous Cognitive Load (ECL) is what is not necessary and can be removed by better design. High cognitive load is associated with increased risk of both medical error and clinician burnout. Chronic high level occupational stress occurs from dealing with this job/resource imbalance and is showing serious personal health impact upon clinicians and the quality of the work they can provide for patients. Since organizational systems have become more complex, leadership methods, clinician wellbeing and patient safety efforts need to adjust to adapt and succeed. Safety efforts have tended to predominantly follow methods of a few decades ago with predominant focus upon how things go wrong (Safety I) but are now being encouraged to include more of the study of how things go right (Safety II). Human Factors/Ergonomics (HFE) science has been used in many industries to preserve worker wellbeing and improve system performance. Patient safety is a product of good system performance. HFE science helps inform mechanisms behind Safety I and II approach. HFE concepts augment existing burnout and safety interventions by providing a conceptual roadmap to follow that can inform how to improve the multiple human/technology, human/system, and human/work environment interfaces that comprise healthcare delivery. Healthcare leaders, by their influence over culture, resource allocation, and implementation of requirements and workflows are uniquely poised to be effective mitigators of the conditions leading to clinician burnout and latent medical error. Basic knowledge of HFE science is a strategic advantage to leaders and individuals tasked with achieving quality of care, controlling costs, and improving the experiences of receiving and providing care.

Nobel clinician软件引导上颌窦内提升术在磨牙缺失修复中的应用研究

目的:研究Nobelclinician软件引导上颌窦内提升术在磨牙缺失的应用效果,为临床应用提供指导。方法:选择2016年10月-2018年10月在笔者医院进行手术的86例上颌磨牙缺失患者为研究对象,按照随机数表法分为观察组和对照组,每组43例。对照组:采用常规上颔窦内提升术;观察组:在Nobelclinician软件引导下进行上颌窦内提升术,两组均使用nobelreplace种植体种植。比较两组患者的种植体存留率及种植体周围组织情况[包括术前上颌窦底距牙槽嵴骨高度(Bone height of the maxillary sinus floor from the alveolar ridge,RBH)、术后6个月新骨获得量、术后1年垂直骨丧失、牙周探诊深度(Periodontal probing depth,PPD)];比较两组患者治疗后的X片检查结果及治疗满意度。结果:观察组的RBH、PPD及术后1年垂直骨丧失均显著小于对照组,术后6个月新骨获得量显著大于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后随访6个月,观察组的种植体存留率(100.00%)与对照组(94.55%)相比,差异不具有统计学意义(P>0.05),X片检查结果显示,两组患者的种植体及周围骨组织均结合良好,术后1年均已生成新的上颌窦底壁。观察组患者的满意度(100.00%)显著高于对照组(90.70%),差异具有统计学意义(P<0.05)。结论:Nobelclinician软件引导上颌窦内提升术能够降低垂直骨丧失量,增加新骨获得量,有助于提高磨牙缺失修复的美学效果,提高患者满意度。

使用DxR Clinician软件对内科住院医师规范化培训临床思维能力评估初探

目的通过临床思维训练软件DxR Clinician的训练及考核,培养住院医师正确的临床思维。方法选择在杭州市第一人民医院经过临床轮转2年或2年以上的内科住院医师25人,采用DxR Clinician软件,选择软件平台内符合该院实际情况的内科5大亚专科病例进行为期5个周期的考核,对得分情况进行统计分析;在首次考核前和末次考核后进行相关问卷调查。结果该院住院医师临床思维能力评估不理想,尤其是正确决策方面(包括诊断表现、临床思维表现)欠佳;问卷调查结果显示,使用DxR Clinician软件考核后,住院医师对临床思维能力训练的重要性认知有所提高。结论使用DxR Clinician软件对住院医师进行临床思维能力的训练及考核能反映住院医师在正确决策(包括诊断表现和临床思维表现)存在不足,可结合该软件开发住院医师规范化培训新的教学模式。

Role of biomarkers for early detection of intra-abdominal sepsis: a clinician's perspective

Infection remains an universal important cause of morbidity and mortality,with the highest mortality rate for bloodstream infections（20%-70%）.[1,2]Fortunately,most community acquired infections,

Clinician Utilization of Best Practices for HIV Care and Status Disclosure: A Cross-Sectional Study

Determining the baseline utilization of best practices among clinicians, with regard to HIV care and disclosure of status to at-risk partners, is critical to addressing HIV prevention issues and disease transmission. In this study, we examined clinicians' utilization of best practices for HIV/AIDS care and the disclosure of HIV status to sexual and needle-sharing partners (HSSNSP). We conducted a cross-sectional survey of 100 clinicians to assess knowledge, attitude, and behavior towards best practices for HIV care and disclosure of HSSNSP. Multiple logistic regression analysis was used to determine factors associated with the utilization of clinical best practices for HIV care and disclosure of HSSNSP. Forty eight percent of the participants revealed poor behaviors. Fifty six percent showed less positive attitudes towards clinical best practices for HIV care and disclosure of status. Less than half (32%) of the participants had earned at least 1 HIV/AIDS CME credit in the past two years. Our study showed strong associations between the utilization of best practices for HIV care and the disclosure of status, and clinician attitudes and knowledge levels. Further research that aims to improve knowledge and attitudes on clinical best practices for providing HIV/AIDS care and the disclosure of status is needed. This improvement may lead to increase in the utilization of best practices for HIV care and disclosure of status, and contribute to decreases in disease transmission rates.

Hello,can you hear me?Orthopaedic clinic telephone consultations in the COVID-19 era-a patient and clinician perspective

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has resulted in seismic changes in healthcare delivery.As a result of this,hospital footfall required to be reduced due to increased risk of transmission of infection.To ensure patients can safely access healthcare,we introduced orthopaedic clinic telephone consultations in our busy district general hospital.AIM To investigate patients’and clinicians’perspective of telephone consultations during COVID-19,and whether this method of consultation could be a viable option in the post-pandemic future.METHODS This is a single centre,prospective study conducted in a busy National Health Service district general hospital.In May 2020,100 non-consecutive adult patients were contacted by independent investigators within 48 h of their orthopaedic clinic telephone consultation to complete a telephone satisfaction questionnaire.The questions assessed satisfaction regarding various aspects of the consultation including overall satisfaction and willingness to use this approach long term.Satisfaction and perspective of 25 clinicians conducting these telephone consultations was also assessed via an online survey tool.RESULTS 93%of patients were overall satisfied with telephone consultations and 79%were willing to continue this method of consultation post-pandemic.Patients found telephone consultations to reduce personal cost and inconvenience associated with attending a hospital appointment.72%of clinicians reported overall satisfaction with this service and 80%agreed that telephone consultations should be used in the future.The majority found it less laborious in time and administration in comparison to face to face consultations.Patients and clinicians expressed their desire for video consultations as a method of further improving their experience with remote consultations.CONCLUSION Our study has shown that telephone consultations are a safe and rapid method of adaptation to the COVID-19 pandemic,achieving the aim of reducing hospital footfall.This method of consultation has resulted in immense clinician and patient satisfaction.Our findings suggest that this tool has benefits in post pandemic healthcare delivery.It has also highlighted that telephone consultations can act as a steppingstone to the introduction of the more complex platform of video consulting.

The Eighth Working Meeting of Serial Periodicals of the People's Medical Publishing House and the Meeting of the Ninth Editorial Board of the Chinese Journal for Clinicians and the Second Editorial Board of Global Health Journal were successfully convened

On March 15,2019,in order to study and implement General Secretary Xi Jinping's speech on deepening reform and cultivating worldclass scientific and technological journals,the eighth working meeting of serial periodicals of the People's Medical Publishing House (PMPH),meeting of the ninth editorial board of the Chinese Journal for Clinicians,and the second editorial board of the Global Health Journal were held in Beijing.

Tips for clinicians in selecting a research topic and getting it published

How to select a research topic that is appropriate for a clinician and that can lead to a peer-reviewed publication?In this essay,I will provide 5 tips:keep it interesting,keep it relevant,keep it inclusive,keep it simple,and keep it trying.Keep it

基于OBE理念的内科学课程考核评价模式探索

随着医学教育改革深入进展,传统的内科学课程考核方式已不能满足当前医学人才培养的需求。目前内科学课程考核模式存在考核内容与学习成果联系不紧密,考核模式相对单一的困境。为克服以上短板,文章设计基于成果导向教育(outcomes-based education,OBE)理念的内科学考核评价模式,融入“DxR Clinician临床思维训练测评”和“临床操作技能直接观察评估(direct observation of procedural skills,DOPS)”“客观结构化临床考试(objective structure clinical examination,OSCE)”“迷你临床演练评估(mini-clinical evaluation exercise,Mini-CEX)”等多种考核手段,建立考核标准化模块,这既符合新医科教学理念,又满足高层次临床医学教育特点,有利于加强理论与实践的结合,推进医学思维知识体系的构建,提升学生的综合素质,是一次对课程考核模式改革有益的教学尝试。

公立三甲医院医师继续医学教育现状及存在问题与对策

目的了解公立三甲医院医师继续医学教育的现状,探讨存在的问题以及对策,为后续制定针对性的继续教育项目,提升继续教育质量提供科学依据。方法选取百色市右江区三所公立三甲医院的220名医师作为研究对象,对其进行问卷调查,采集一般人口学资料、对开展继续教育的内容和形式需求,并分析影响参加继续教育的相关因素。此外,选取15人进行半结构式访谈,了解目前公立三甲医院医师继续医学教育存在的主要问题。结果共发出问卷220份,有效问卷208份,有效回收率94.5%。单因素分析结果显示,年龄、性别、职称和学历与公立三甲医院医师对继续教育必要性认知有关(P<0.05)。多因素logistic回归分析结果显示,年龄30~<40岁(β=1.704,P=0.033,OR=2.927,95%CI=1.092~7.845)、中级职称(β=1.211,P=0.029,OR=3.357,95%CI=1.133~9.943)以及单位认为继续教育必要的态度(β=1.369,P<0.001,OR=3.931,95%CI=2.390~6.468)是影响三甲医院医师参加继续教育的独立影响因素。公立三甲医院医师在继续教育的内容、形式、时长和费用分担上有一定的倾向。既往参加过继续教育的116名研究对象满意度仅为61.2%。研究对象认为目前继续教育存在的主要问题集中在科室支持力度不够、继续教育的内容和形式个性化不足、工作太忙没有时间、精力参与继续教育。结论公立三甲医院医师继续教育必要性的认知还有加强,医院以及科室也要积极主动地为其提供继续教育的条件和机会。此外,继续教育的管理部门应根据参与继续教育的学员特点,提供个性化、满足其需求的培训方案,优化全区的继续教育体系,更好地促进公立三甲医院医师继续教育的质量提升。

临床医生实践医患共同决策的思考

医患共同决策是继家长式决策模式和知情同意模式后,逐渐被大家认可的临床决策模式。在我国经历20多年的发展,逐渐被临床医生所认可并不断引入临床实践,但其发展并不如想象中那么乐观。虽然它可以改善医患关系、减少决策失误,但实际工作中仍存在缺乏政策指引、医患双方互不信任、医生没有实现共情等诸多实际问题,致使医患共同决策的推进并不顺畅。因此,医患共同决策模式作为理想的决策模式,在我国临床工作中仍需要不断探索与完善。

高质量发展视域下我国医院临床医生科研状况、影响因素及应对策略

目的了解我国医院临床医生群体的科研状况及影响因素,探讨高质量发展背景下临床科研人才的规划与建设。方法选取我国东部、中部、西部8个省/自治区/直辖市,采用分层整群抽样法纳入40家医院,医院类型涵盖省级/市级/县级公立综合医院、公立中医医院、民营医院。调查临床医生开展科研工作的状况,应用二元Logistic回归模型分析临床医生参与科研工作的影响因素,并分析临床医生对科研困难的认知情况。结果共纳入3274名临床医生,50.3%的临床医生参与科研工作,91.3%的临床医生有明确的职业发展规划,其中将参与科研工作作为职业发展首要选择的临床医生占47.2%。性别、年龄、技术职称、医院类型、医院级别、对卫生技术人员职称评审实行成果代表作制度的赞同度、职业发展机会和平台可影响临床医生的科研工作参与情况(P<0.05)。临床医生在开展科研工作过程中面临的难题主要是临床业务繁重(占86.9%),其次是缺乏研究团队(占56.4%)、科研与临床脱节(占55.4%)。结论我国临床医生群体有明确的职业发展规划,但科研工作参与度一般,且面临着“临床业务繁重”“缺乏研究团队”等限制因素。建议二/三级公立医院要将科技创新作为重点任务,注重发挥科研工作对医疗服务高质量发展的重要支撑作用,持续推进研究型医院建设;公立医院要建立健全科研人才规划,完善科技人才培养、使用、评价和激励机制。

临床医生营养风险筛查认知现状调查

目的:调查临床医生营养风险筛查的现状,为进一步规范住院患者营养管理提供参考依据。方法:采用便利抽样法,应用成人营养筛查认知度调查问卷对山西某三级甲等医院的临床医生进行调查。结果:244名医生中,233名(95.5%)医生知晓成人营养筛查表,89名(36.5%)医生能够亲自全程根据成人营养风险筛查表筛查患者,55名(22.5%)医生知晓营养风险筛查分值,160名(65.6%)医生知晓营养风险筛查评估频次,110名(45.1%)医生非常重视住院患者营养状况,44名(18.0%)医生通过培训获取营养知识。结论:临床医生对营养风险筛查认识不足,应开展系统规范的培训,完善临床营养专业队伍建设。

精神分裂症临床特征及影响因素

目的:探讨精神分裂症临床特征及其相关影响因素。方法:采用方便取样的方式招募铜陵市某二级甲等精神专科医院的精神分裂症患者630例,采用简明国际神经精神访谈(MINI)、精神症状维度评定量表(CRDPSS)和阳性与阴性症状量表(PANSS)进行诊断和评估,采用SAS 9.4进行方差分析、Pearson相关分析和多重线性回归等对数据进行统计分析。结果:不同病程特征的精神分裂症患者的CRDPSS(F=22.46,P<0.01)和PANSS(F=7.99,P<0.01)得分差异有统计学意义,其中持续恶化型患者的CRDPSS总分[(11.88±4.16)分]和PANSS总分[(75.63±23.95)分]均为最高。年龄、性别、受教育水平、家庭人口数、腰臀比、婚姻状况、工作状态、吸烟量、首次诊断年龄、首次治疗年龄、总发作次数、总住院次数、停药次数、起病形式和病程特征等因素与CRDPSS量表和PANSS量表总分及各维度得分有不同程度的关联。结论:持续恶化型精神分裂症患者的临床症状严重程度更高,腰臀比、平均每天吸烟量、停药次数、总住院次数、慢性起病是精神分裂症患者症状严重的危险因素。

DxR Clinician在国内医学模拟教学中的应用

目的 通过在国内医学生中实施DxR Clinician（简称：DxR）模拟教学,了解医学生对其认可程度,以及其在临床教学中的可行性和应用前景.方法 选择在上海交通大学附属第六人民医院学习的98位医学生为研究对象,对其进行DxR软件培训、操作练习和教学评估,并利用问卷调查及个别访谈评价教学效果.使用Excel 2007对问卷数据进行统计分析.结果 ①多数学生认为DxR使用范围广泛,超过70.00％的学生认为其可用于实习前培训、实习后出科考试以及住院医师规范化培训和考试.②71名（72.45％）学生认为其操作界面虽然有点复杂但容易掌握,也有19名（19.39％）学生觉得较难掌握,需要一定的培训时间.③对于DxR的版块设计,认为“体格检查”和“辅助检查”版块设计较为理想的分别有52、48名学生,分别占53.06％、48.98％,而被认为设计最不令人满意的是“处置”版块.④在DxR诸多优点中,37名（37.76％）学生认为实践性是其最突出的优点,而认为是灵活性的有28名（28.57％）.⑤总体而言,认同DxR软件适用于我国临床教学的学生有88名（88.78％）.⑥在对DxR的教学效果评价中,得分最高的项目是“DxR能够提高学生的推理分析能力”：8.87分,得分最低的是“DxR能够提高学习效果”：7.95分,总体平均得分为8.36.结论 从初期结果来看,大部分学生对DxR模拟教学给予了肯定的评价,认为其适用于我国的临床教学,DxR今后有望成为传统理论教学和临床实践教学的有效辅助手段.