Reform direction of medical education in China： implementing ＂competency-based＂ medical education

For over 100 years, medical education has achieved continuous development and progress all over theworld. Flexner＇s report in 1910 brought modern science into the curricula of medical schools. In the 1960s, problem-based learning （PBL） was born in Canada and quickly achieved wide use. From the beginning of the 21 st century, with increasing specialization in medicine, the ＂silo effect＂ has become more apparent. The inequality in healthcare and low efficiency of the entire health system has become prominent problems. These have brought about new challenges for medical education--how to implement accountable medical education so as to rectify the current situation. Therefore, ＂competency-based＂ medical education, as an important feature of the third generation medical education reform, has gradually become the trend. J However, currently in most medical schools in China, PBL is still flourishing, which indicates that we are still at the second generation of medical education reform.

AB038.Assessing a novel approach to teaching ophthalmoscopy to medical student

Background:To determine if practice using an online fundus photograph program results in a long-term increase in proficiency with the direct ophthalmoscope in medical students.Methods:This study was a prospective medical education trial.Students were enrolled to participate in an objective structured clinical examination(OSCE)using five patients with ocular findings.Students who matched a minimum of 6 discs 17 months prior to the study were assigned to the intervention group and were compared to students who did not participate in the exercise.Participants:46 second-year medical students at Queen’s University:15 in the intervention group,31 in the control group.Students were evaluated using the Queen’s University Ophthalmoscopy OSCE Checklist(QUOOC).Students were asked to calculate the cup-to-disc ratio,comment on disc margins and if there was any macular pathology.Students participated in a summative OSCE as part of the curriculum in which all students attempted to match fundus photographs.Results:Students in the intervention group performed significantly better on the QUOOC with a mean score of 78.3%(+/−4.2%)compared to the control who had a mean score of 69.4%[+/−4.2%(P=0.007)].The intervention group was significantly more accurate at matching optic nerve photographs with 100%(15/15)of the students correctly identifying the correct optic nerve on first attempt compared to 53.3%(16/30)in the control group(P=0.0014).Conclusions:The use of an online peer fundus photograph program leads to a long-term increase in examination technique,proficiency in ophthalmoscopy and accuracy at matching optic nerve photographs.

Emerging Themes in Medical Education Research

Purpose: We aim to provide a broad overview of emerging themes in medical education, with recommendations for future research. Following a brief overview of recent changes in medical education and their implications, we focus on suggestions and examples for making progress in this field. Principal findings: In this article, we briefly review the context that has led to the emergence of the competency-based model of medical education. A critical implication is that medical educators must now focus on the development and maintenance of high quality assessment instruments to support valid decisions around advancement and promotion of learners. Rater cognition and "collective competence" are emerging issues that may have profound implications for the identification and assessment of competencies. Conclusions: While competency-based education represents the future, larger systemic effects must be identified and monitored to effect meaningful change in medical education.The authors conclude with a call for increased support for research in medical education and argue that the most promising and fruitful area of medical education scholarship for the future lies in the field of assessment of individual competence.

澳大利亚悉尼大学内科学PBL教学模式介绍及借鉴

以"基于问题的学习(problem-based learning,PBL)"的教育学模式目前在医学院校中广泛应用,成为发达国家医学教育的重要模式。本文介绍了澳大利亚悉尼大学《内科学》课程的PBL教学模式。通过与其成熟的PBL教学模式进行对比,我国医学院校《内科学》PBL教学的问题存在于问题设计、教员培训、教学组织以及能力评估等各个环节。针对这些环节的问题,本文提出了一些相应的对策。如果我们要将其应用于《内科学》教学,必须改变模糊认识,进行较大改良才能真正达到好的效果。

胜任力导向医学教育简介

胜任力导向医学教育已引起全球医学界的关注与投入,然而西方发展出的主流胜任力导向医学教育框架仍缺乏足够文献研究及其适用性的相关资料。本研究以系统方式检索相关西方文献,并分析整理予国内参考。针对胜任力导向医学教育领域探索,进行欧美文献研究,并系统检视整理此概念的执行、课程设计及评估工具等数据为关心毕业后医学教育的同仁提供参考,作为创新开发中国的胜任力训练指标及各种相关设计的建议基础。综述胜任力导向医学教育、核心胜任力领域、里程碑、可信赖专业活动的定义与等级及其相互关系,整理出评估核心胜任力领域的工具。系统梳理西方毕业后医学教育主流方式大纲,以便医学教育专家与临床教师提出融合国际方向,与国内各区历史、社会文化、医疗执业场所等背景的中国创新胜任力导向医学教育框架。本研究整理的细节规划,从建立指标、设计发展、成效评估等实际可执行工具,为国内同道应用与转化构建符合中国特色的胜任力导向医学教育提供参考,以呼应当前中国对于医学发展与医疗照护的社会需求。

Virtual reality simulation in endoscopy training:Current evidence and future directions

Virtual reality simulation is becoming the standard when beginning endoscopic training. It offers various benefits including learning in a low-stakes environment, improvement of patient safety and optimization of valuable endoscopy time. This is a review of the evidence surrounding virtual reality simulation and its efficacy in teaching endoscopic techniques. There have been 21 randomized controlled trials(RCTs) that have investigated virtual reality simulation as a teaching tool in endoscopy. 10 RCTs studied virtual reality in colonoscopy, 3 in flexible sigmoidoscopy, 5 in esophagogastroduodenoscopy, and 3 in endoscopic retrograde cholangiopancreatography. RCTs reported many outcomes including distance advanced in colonoscopy, comprehensive assessment of technical and non-technical skills, and patient comfort. Generally, these RCTs reveal that trainees with virtual reality simulation based learning improve in all of these areas in the beginning of the learning process. Virtual reality simulation was not effective as a replacement of conventional teaching methods. Additionally, feedback was shown to be an essential part of the learning process. Overall, virtual reality endoscopic simulation is emerging as a necessary augment to conventional learning given the ever increasing importance of patient safety and increasingly valuable endoscopy time; although work is still needed to study the nuances surrounding its integration into curriculum.

基于置信职业行为构建胜任力导向的急诊住院医师规范化培训课程

胜任力导向的医学教育(competency-based medical education,CBME)是医学教育改革的发展趋势,但是在实施层面仍然存在问题。本文以急诊医学为例、以置信职业行为(entrustable professional activities,EPA)为基础,构建了胜任力导向的急诊住院医师培训课程。该培训课程以信任决定为核心,参考美国医学教育专家David E Kern提出的课程开发六步法,从评估课程可行性和目标学员需求出发,筛选急诊专业核心EPA,确定教学目的及具体教学目标,基于知识、技能和态度选择合适的教学策略和评估方法,通过学习档案电子化、定期反馈和授权认证等确保课程实施并从课程和学员两方面评估教学效果等。本文详细阐述了该课程的准备和实施过程,以弥合住院医师抽象的胜任力能力评估与真实的临床工作之间的裂隙,提供了基于EPA的急诊住院医师规范化培训课程设计的具体模板。

国际置信职业行为研究在医学教育中的发展与启示

为了解国际置信职业行为(entrustable professional activities,EPAs)研究的发展历史与研究现状,于2020年采用HistCite文献计量分析软件,以Web of Science核心合集中的相关研究文献为对象,通过对2005年1月至2020年9月文章数量、作者分布、研究方向与热点等的分析,梳理EPAs研究总体态势。发现EPAs研究论文在数量上总体呈上升趋势,在文献发表、研究机构和期刊分布方面,美国遥遥领先。国际EPAs研究发展迅速,医学学科发展位于世界前沿的地区或高校,EPAs研究也位于前列。我国EPAs研究相对落后,需要加强相关研究。