基于国际医学教育标准异同比较的岭南医学教育标准研究

发布时间：2018-06-10 20:39

本文选题：医学教育标准 + 比较研究　；参考：《南方医科大学》2012年硕士论文

【摘要】：研究背景目前国际上有代表性的医学教育标准有：由国际医学教育专门委员会2001年6月制定的IIME"标准”；由世界卫生组织西太平洋地区办事处于2001年7月制定的WHO西太区“标准”；由世界医学教育联合会于1999年10月制定的WFME“标准”和由中国医学教育质量保证体系研究课题组制定的中国本科医学教育标准。国内对于医学教育标准的研究大部分集中在两两研究上,如中美、中日、中欧等,针对的也仅仅只是一些方面,研究的很笼统,不够深入,而且大部分处于经验与体会层次,还没有系统性的理论成果。本课题是对中、美、日及全球医学教育最低基本要求的差异性研究。研究的更全面、系统。美国、日本在医学教育方面发展历史悠久,积累了很多成功的经验：中美医学教育标准的差异主要集中在人文素质、医德、医患沟通技巧的培养、课程设置、教学内容、考核、师资和临床实习课目设置方面；中日医学教育标准的差异主要集中在教学方法、医学生科研能力培养、医师素质、课程整合方面；中欧医学教育标准的差异主要集中在人文素质课程设置、教学方式、教学结果方面。岭南地区目前现状为经济发展不平衡,珠三角地区经济发展快,国际化程度高,人群的整体层次和要求也很高,人群对卫生保健的需求提出了更高的要求。不但要身体好,还要有良好的心理状态和社会活动能力,提高生活质量,延年益寿。地区人群需要精英式的医学教育人才,临床医学家；欠发达地区经济发展缓慢,人群的整体层次和要求不是很高,他们有最基本的卫生医疗保健需要,如社区医疗卫生保健服务,全科医生。新的医学模式为生物—环境—社会—心理—工程医学模式,医学模式的改变势在必行,即从“生物医学”模式转变为“生物—社会—心理—技术(工程)”模式。医学模式的转变,必将把医学引向更广泛、更深入和更复杂的研究层次。现在,人们对医学的要求不仅仅是提供医疗服务,还要提供与高质量生活相适应的服务,如心理咨询和治疗、劳动保护、营养咨询和特殊护理等,以增进健康。现行的中国医学教育标准是一个基于结果和过程评估的杂合体,岭南医学教育标准应倾向于对医学教育的产物—医学毕业生的评估(总结性评估),岭南地区医学教育标准应是在以中国医学教育标准为前提下的对岭南医学教育的侧重和补充。随着社会与公众对医疗服务质量和医学教育质量要求的不断提高及岭南地区医学教育的特殊性,人们对岭南地区医学教育标准的呼声和期待也在增高,岭南地区医学教育标准方面国内外至今无人研究,这就更加促使我们加快研究的步伐,制定出岭南地区医学教育标准,使岭南医学教育有准可依。研究目的 1、比较我国医学教育标准与美、日及全球医学教育最低基本要求的差异。 2、结合岭南地区医学教育特点及疾病谱制定岭南地区医学教育标准。研究意义本项目通过比较我国医学教育标准与美、日及全球医学教育最低基本要求的异同,找出美、日及全球医学教育最低基本要求中的先进理念,针对我国医学教育的现状,同时结合我国岭南地区独特的疾病谱和地域特点(岭南地区有其独特的气候特点,它南临南海北靠五岭,亚热带季风气候带来的湿热天气使山岚瘴气肆虐为害,潮湿的气候成为病菌很好的培养基,广东省是结核病疫情较为严重的省之一；独特的地理特点,岭南地区靠近香港澳门,国际化程度和人口密集度高,这也就带来了甲流、禽流感等传染病,也是乙肝的高发地；独特的饮食特点,岭南人民喜食海鲜鱼生,这也就是地区寄生虫病高居不下的原因之一：独特的地区遗传病特点,鼻咽癌和地中海贫血是地区典型遗传病。)以及岭南地区医学教育现状,制定岭南医学教育标准,使广东地区医学教育更有针对性,为有关部门制定相关政策提供理论依据。研究方法本课题采用了文献分析法、比较研究法、专家咨询法和统计分析法共四种研究方法。其中运用文献分析法来了解国内外相关研究现状：运用比较研究法来比较研究中、美、日及全球医学教育最低基本要求的差异；运用专家咨询法和统计分析法来论证通过比较研究中、美、日及全球医学教育最低基本要求差异的基础上得出岭南地区医学教育标准指标的权威性和可行性,从而制定出岭南地区医学教育标准。研究结果本课题采用了两轮德尔菲专家咨询法,第一轮指标经过专家咨询后进行均数、满分比、标准差、变异系数和肯德尔系数的检验,其中问卷中第一部分(美、日及全球医学教育最低基本要求的内容)当中的“课时”项目即医学生临床实习阶段课时大于医学院学习阶段课时,此项目均数(2.59最低)(满分4分)、满分比(0.17最低)、标准差(0.91最高)、变异系数(0.35最大),此项目各个统计指标均不理想,专家认为不重要,建议删除；问卷中第二部分(制定岭南地区医学教育标准所围绕指标)当中的“岭南地区特点方面”项目即掌握岭南中医学的基本特点,了解中医学诊疗基本原则,此项目均数(2.45、2.17最低)、满分比(0.07、0.03最低)、标准差(0.87、0.97最高)、变异系数(0.36、0.45)此项目各个统计指标均不理想,专家认为不重要,建议删除。根据专家意见和对问卷的补充,增加六个项目,分别在教学方面增加了“完善和细化教学质量保证体系”、教师方面增加了“具有丰富临床经验的教师应多参与教学及医学生课外科研活动”、“教师应具有能够将复杂问题简单说明的能力”和“本地区籍贯的教师比例应在较合理的范围”岭南地区特点方面增加了“掌握岭南地区特有的传染病(包括新发传染病)和地区性新发疾病的特点和诊疗原则”和“建立岭南地区不同院校学科优势相适应的特色专业培养模式”。回收修改后的第二轮指标,进行均数、满分比、标准差、变异系数和肯德尔系数的检验,将问卷中的两部分内容的肯德尔系数分别进行对比,第一轮第一部分内容的肯德尔系数为0.204,修改后第二轮第一部分内容的肯德尔系数为0.220,第二轮咨询的协调系数和第一轮相比有提高,证明专家在指标内容的认识上在逐步达到一致；第一轮第二部分内容的肯德尔系数为0.297,修改后第二轮第二部分内容的肯德尔系数为0.405,较第一轮有很大提高,专家的认识得以集中,专家认识趋于一致。两轮问卷协调系数的P值均小于0.05,表明在95%的置信度下,专家评估意见协调性好,第二轮两部分指标可取。专家一致认为制定岭南地区医学教育标准应该围绕第二轮问卷中指标,同时对美、日医学教育标准中的内容加以了肯定,认为制定岭南医学教育标准可以参考美、日及全球医学教育最低基本要求相关内容。研究结论根据美、日及全球医学教育最低基本要求中我们可以借鉴的内容以及制定岭南地区医学教育标准所围绕指标制定出岭南医学教育标准初稿。岭南医学教育标准初稿具有以下特点：(1)充分体现生物—社会—心理—技术(工程)医学模式的需要；(2)充分体现人文社会科学与自然科学的交融；(3)特别注重综合素质的教育与培养；(4)针对毕业生个体,以保证医学院校所培养出的毕业生质量为目的；(5)包含我国医学教育标准的方针政策；(6)包含我国医学教育的精华部分；(7)具有岭南地方特色；(8)包含美、日及全球医学教育最低基本要求中我们值得借鉴的地方。研究创新及特色 1、美国、日本在医学教育方面发展历史悠久,积累了较为丰富的经验,尤其是美国的医学教育是西方医学教育的典型代表,是一种比较成功和有特色的教育模式。2、目前在岭南医学教育方面研究的人很少,本课题更有地域性和指导价值。3、可以为有关部门借鉴和参考,提供研究依据。4、使更多的人关注医学教育标准,从而关注医学教育,进而推动医学教育发展。5、为培养优质的医药卫生人力资源提供标准依据,为加强医学教育质量保证工作添砖加瓦。
[Abstract]:Background of the study

At present , there is a representative medical education standard in the world : the IIME " standard " developed by the Special Committee of International Medical Education in June 2001 ;
WHO Western Pacific " Standard " established in July 2001 by the World Health Organization ' s Western Pacific Regional Office ;
The standard of WFME , developed by the World Medical Education Federation in October 1999 , and the Chinese undergraduate medical education standard developed by the research team of the quality assurance system of Chinese medical education . Most of the research focuses on the difference of the minimum basic requirements of medical education in China , America , Japan and the world . The research is more comprehensive and systematic . The differences between China and America , Japan and the global medical education have a long history and have accumulated a lot of successful experiences .
The differences between the standards of medical education in China and Japan mainly focus on the teaching methods , the cultivation of scientific research ability of medical students , the quality of doctors and the integration of curriculum ;
The difference of the standard of medical education in Central Europe is mainly focused on the course setting , teaching mode and teaching result of humanistic quality .

At present , the present situation of the Ling Nan region is unbalanced , the economic development of the Pearl River Delta region is rapid , the internationalization degree is high , the overall level and the requirement of the population are high , and the population has higher requirement on the demand of health care .
The development of medical science is slow , the overall level and requirement of the population are not very high , they have the most basic health and health care needs , such as the community medical health care service , the general practitioner . The new medical model is the biological - environment - society - psychology - engineering medical model . The transformation of the medical model will lead the medicine to the wider , deeper and more complex research hierarchy .

With the increasing demands of social and public health service and the quality of medical education and the particularity of medical education in Ling Nan region , there has been no research on the voice and expectation of medical education standard in Ling Nan region .

1 . To compare the differences between the standards of medical education in China and the minimum basic requirements of American , Japanese and global medical education .

2 . Combining with the characteristics of medical education and the development of medical education standards in Ling Nan region .

Through comparing the similarities and differences between Chinese medical education standards and the minimum basic requirements of American , Japanese and global medical education , we find out the advanced idea of the minimum basic requirements of American , Japanese and global medical education , aiming at the present situation of medical education in China .
The unique geographical features , the area close to Hong Kong Macao , the degree of internationalization and the population density are high , which also brings infectious diseases such as influenza A , avian influenza and other infectious diseases , and is also a high incidence of hepatitis B ;
The unique diet features that the people of the Ling Nan people eat seafood fish , which is one of the reasons why regional parasitic diseases are high . The unique regional genetic disease characteristics , nasopharyngeal carcinoma and thalassaemia are typical genetic diseases in the region . As well as the current situation of medical education in Lingan area , the author has formulated the standard of medical education of Ling Nan , which makes the medical education in Guangdong region more targeted and provides theoretical basis for relevant departments to formulate relevant policies .

Research Methods

There are four methods of literature analysis , comparative research , expert consultation and statistical analysis .
By using the expert consultation method and statistical analysis method , the authoritativeness and feasibility of the standard index of medical education in the Ling Nan region were obtained based on the difference of the minimum basic requirements of American , Japanese and global medical education .

Results of the study

The subject adopted two rounds of Delphi expert consultation method . The first round of indicators was examined by experts after consulting with experts . The first part of the questionnaire ( the contents of the minimum basic requirements for medical education in America , Japan and the global medical education ) , the total score ratio ( 2.59 min ) , the standard deviation ( highest ) , the coefficient of variation ( 0.35 largest ) , all the statistical indexes of the project were not ideal , and the experts thought it was not important and suggested deletion ;
In the second part of the questionnaire , the basic characteristics of the traditional Chinese medicine are mastered , and the basic principles of TCM diagnosis and treatment are known . The average number of this project ( 2.45 , 2.17 lowest ) , the full score ratio ( 0.07 , 0.03 lowest ) , the standard deviation ( 0.87 , 0.97 highest ) , the coefficient of variation ( 0.36 , 0.45 ) are not ideal , and the experts believe it is not important , and the suggestion is suggested to be deleted .

According to the experts ' opinions and the supplement to the questionnaire , six projects are added to improve the teaching quality assurance system .

The second round of indexes , the mean , the full - score ratio , the standard deviation , the coefficient of variation and the Kender coefficient of the second round of the questionnaire were compared . The coefficient of the first part of the first round was 0.204 , the coefficient of the first part of the second round was 0.220 , the coordination coefficient of the second round of consultation was improved compared with the first round , and it was proved that the experts had reached agreement in the understanding of the content of the index ;
The second part of the first round is 0.297 , the second part of the second part of the second part of the coefficient is 0.405 , the first round has a great improvement , the expert ' s understanding is concentrated , the expert understanding tends to be consistent .

The P value of the coordination coefficient of the two questionnaires is less than 0.05 , indicating that under 95 % confidence , the expert ' s assessment opinions are good and the second round is preferable . The experts agree that the development of the standard of medical education in the Ling Nan region should be around the index in the second round questionnaire , and the contents in the American and Japanese medical education standards are affirmed .

According to the minimum basic requirements of American , Japanese and global medical education , we can draw lessons from the contents and establish the first draft of Ling Nan Medical Education Standards .
( 2 ) fully reflect the blend of the humanities and social science and the natural science ;
( 3 ) Pay special attention to the education and cultivation of comprehensive quality ;
( 4 ) To ensure the quality of graduates in medical colleges for the purpose of ensuring the quality of graduates ;
( 5 ) Party ' s policy of medical education standard in China ;
( 6 ) Contains the essence of medical education in China ;
( 7 ) It has the local characteristics of Ling Nan ;
( 8 ) We are worthy of reference in the minimum basic requirements for medical education in the United States , Japan and the world .

Study innovation and characteristics

1 . In the United States , Japan has a long history and accumulated rich experience in medical education , especially the American medical education is a typical representative of western medical education . It is a comparatively successful and characteristic education model .
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：G642;R-4

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