临床医学专业学位研究生专科化培训的研究

发布时间：2017-12-31 10:12

本文关键词：临床医学专业学位研究生专科化培训的研究　出处：《复旦大学》2011年硕士论文　论文类型：学位论文

【摘要】：[背景]我国的医学教育制度与西方教育制度存在很大差异。目前,我国正在积极探索建立适应我国特点的医学教育体系,逐步完善“三阶段”医学教育模式。研究生教育和住院医师培养是毕业后医学教育的两条途径,对培养高层次医学人才、联接医学终身教育,有着重要作用。若能结合两种培养模式,对于医学人才培养的连贯性具有现实意义。另外,科学学位和专业学位的界限定位模糊,使住院医师培训与临床专业学位研究生培养存在重叠现象。但鉴于毕业的临床专业学位研究生缺乏足够的临床能力,仍需进入住院医师规范化培训项目,进行临床专科培训。 [研究目的]通过研究,探讨临床医学专业学位研究生与住院医师规范化培训结合的可能性,为临床医学硕士专业学位研究生教育改革试点提供参考依据。 [研究内容与方法]本研究采取对临床医学专业学位研究生相关政策分析,对上海市某三级甲等医院临床型研究生培养现状分析及对专科化培训的利益相关者评价分析,通过文献查阅、医院调查、问卷调查和专家访谈,收集相关数据,并采用了方差分析、非参数检验、x2检验、Logistic回归分析等统计方法。 [研究结果]通过研究发现,1998年国务院学位委员会正式颁发的《临床医学专业学位试行办法》,明确规定了临床医学专业学位旨在培养具有较强的临床分析和思维能力,并能较熟练地掌握该专业临床技能和临床科研方法的临床型人才。医学专业学位制度成为我国培养高层次临床医师的主要途径。但是,随着我国医疗事业快速发展,政府对医疗卫生问题日益重视,并且尝试把专业学位培养与住院医师培训有机结合起来。当前,建立全国性的住院医师规范化培训制度已有可能。上海市某三级甲等医院的在读专业学位研究生和临床带教老师的问卷调查显示,把研究生临床轮转培训和住院医师培训结合起来是可行的。技术层面上,两者轮转科室与轮转要求基本相同,带教老师基本相似；社会层面上,临床型研究生的临床能力培养与住院医师培训的方式是趋同的,两者互认只是形式问题；经济层面上,把临床型研究生培养纳入住院医师培训,可以充分利用国家给予研究生的补贴优势,减少重复的教育经费投入。研究显示,学生和带教老师对目前的临床专业学位研究生的临床能力培养成果表示肯定,81.7%学生认为临床型研究生能够达到或者大部分能够达到住院医师规范化培训的要求,68.4%的带教老师表示基本满意临床型研究生的临床能力,73.7%的老师认为其能够达到或者大部分能够达到住院医师规范化培训的要求。研究还显示,专业学位培养与住院医师培训结合的难点是：1、研究生的执业医师资格：46.2%的学生和42.2%的带教老师认为临床专业学位研究生没有执业医师资格是不能参加科室诊疗操作的主要原因,研究生只有在毕业当年才能参加执业医师资格考试；2、临床能力：临床型研究生轮转时间能否算作住院医师培训时间,49.77%的学生希望对临床型研究生按达到培训阶段水平给予证明,由开展住院医师规范化培训的医院直接认定,而目前临床型学生轮转水平认定方式并不赞同,84.2%的带教老师认为有必要把临床专业学位研究生培养纳入住院医师培训中,而只有51.7%的学生认为有必要,其中77.8%的临床型博士认为没有必要。 [讨论与建议]根据研究结果,作者建议：①完善我国住院医师规范化培训的模式,规范专科医师准入制度,尽快建立临床专业学位与住院医师规范化培训相结合的学位授予制度；②简化临床专业研究生培养层次,改革我国的医学教育制度；③建立统一、严格而具体的考核和考试制度,建立全国性的住院医师培训资格认证标准和认证体系；④允许经过一定时间轮转实践的专业学位研究生提前参加医师资格考试,配合建立和完善与临床医疗教学工作相关的法律法规；⑤不断完善上海市的临床医学硕士专业学位研究生教育综合改革试点项目。
[Abstract]:There is a big difference [background] our medical education system and western education system. At present, China is actively exploring the establishment of China's characteristics of the medical education system to gradually improve the medical education three stage "mode. The postgraduate education and residency training are two ways for graduate medical education, to cultivate the high level of medical personnel, medical connection of lifelong education, plays an important role. If we can combine the two kinds of training mode, it has practical significance for the training of medical personnel continuity. In addition, the fuzzy boundary location of scientific degree and professional degree, the residency training and clinical professional postgraduates training are overlapped. But in view of the clinical professional degree graduate students lack clinical ability enough, still need to be in the program of residency training, clinical specialty training.
[Objective] the purpose of this study is to explore the possibility of combination of clinical medicine professional degree graduate and resident resident standardized training, so as to provide reference for the pilot program of clinical medicine master degree graduate education reform.
[] the research contents and methods adopted in this study on the clinical medical professional degree graduate related policy analysis, the clinical research of a Shanghai City three Jiadeng hospital training present situation analysis and stakeholder analysis of specialized training evaluation, through literature review, hospital survey, questionnaire survey and expert interview, collect relevant data. Using variance analysis, nonparametric test, x2 test, Logistic regression analysis and other statistical methods.
[results] the study found that the degree of Clinical Medicine Academic Degrees Committee of the State Council in 1998 officially issued "Interim Measures", defined the professional degree of clinical medicine to develop a strong analysis and clinical thinking ability, and can skillfully master the clinical talents in the professional clinical skills and clinical research methods of medical professional. The degree system has become the main way to cultivate high-level clinicians in our country. However, with the rapid development of medical industry in China, the government pay more attention to health problems, and try to put the professional degree training and residency training organically. At present, the establishment of a national standardized residency training system has been possible.
Shanghai City three hospitals in the study of reading professional degree students and clinical teachers with questionnaire survey showed that the postgraduate clinical rotation training and residency training combination is feasible. The technical level, the two departments and rotary rotary requirements are basically the same, teachers are similar; the social level, way the clinical ability of postgraduate training and clinical residency training is convergence, just two forms of mutual recognition; the economic level, the training in residency training clinical postgraduates, can make full use of the state to give Graduate Students Subsidy advantage, reduce duplication of education funding.
Research shows that students and teachers affirmed the clinical ability of clinical professional degree of current students' achievements, 81.7% of students think that clinical postgraduates can achieve or most can reach the residency training requirements, 68.4% clinical teachers expressed satisfaction of basic ability of clinical postgraduates, 73.7% the teacher thinks it can achieve or most can reach the residency training requirements.
The study also showed that the professional degree training difficulty and residency training combination: 1, graduate qualification: teachers think clinical professional postgraduates without qualification is the main reason not to participate in the Department of medical operation with 46.2% students and 42.2% graduate students, only in the year of graduation to participate in the practice the physician qualification examination; 2, clinical competence: clinical postgraduates training time cycle time can be counted in hospital physicians, 49.77% of the students hope for Clinical Postgraduate Certificate in accordance with the training to achieve level given, directly determined by the development of the standardized training of residents and hospital, the current clinical student level recognition does not agree with the rotation. Teachers think it is necessary to clinical professional degree graduate education into the training of residents in 84.2%, while only 51.7% of the students think it is necessary, the 77.8% of the clinical doctorates do not think it is necessary.
[] discussion and suggestions according to the research results, the author suggested: perfecting mode of our country of residency training, standardized specialist access system, the establishment of clinical professional degree as soon as possible with a combination of residency training degree granting institution; the reduced levels training of clinical postgraduates, the reform of China's medical education system the establishment of a unified,; strict and specific assessment and examination system, the establishment of a national residency training certification standards and certification system; the allowed after a certain time of professional degree rotation practice students to participate in pre qualification examination, establish and improve relevant laws and regulations of clinical teaching work and constantly improve the pilot; the comprehensive reform of Education Master's degree in clinical medicine graduate student in Shanghai city.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：G643;R-4

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