眼科住院医师规范化培训(以下简称“规培”)是培养眼科医师的必要环节。我国规培模式日臻成熟，但眼科规培过程管理中仍存在诸多问题，包括专科医院和综合医院的规培协调问题、师资激励、规培学员类型多样、研究生和规培“双轨制”、如何开展显微手术技能培训等，很多具体方案和措施仍在摸索中。眼科专科医院学科体系建设相对完善，配备更充足的教学资源，有一定的规培经验，是眼科规培的主力军。汕头国际眼科中心结合国家要求创建了一套规培模式，注重规范化、标准化和个性化相结合，并通过借鉴香港及海外住院医师培训经验，丰富理论培训形式，优化操作培训环境，突出外语和科研能力训练，强调系统性临床思维。本文基于汕头国际眼科中心五年来开展眼科规培的实践经验与思考，总结当前眼科专科医院规培现状，并提出对策和建议。
Standardized training for ophthalmology residents is an essential stage during the development of ophthalmologists. The standardized training system has become more and more mature, while problems still exist in the aspects of coordination between specialized hospitals and general hospitals, teacher resources, unevenness of trainees, combination of postgraduate education and residency standardized training, microsurgical skills training, and so on. Therefore, programs and strategies of standardized training are still under exploration. Eye hospitals, with the excellent disciplinary system, adequate resources, and advanced experience, play a key role in standardized training for ophthalmology residents. Joint Shantou International Eye Center has set up a training model in accordance with national requirements, focusing on the combination of standardization, normalization, and individuation. Besides, by learning from the oversea experience of residents training, Joint Shantou International Eye Center has enriched the training forms, optimized the skill training environment, and highlighted the training of foreign language, scientific research, and systematic clinical thinking. This paper, based on the 5-year experience and reflection on standardized training for ophthalmology residents in Joint Shantou International Eye Center, summarizes the current status of standardized training and put forward some measures and suggestions.
眼科住院医师规范化培训(住培)是眼科后备医疗人才培养中极其重要的环节，但反观目前我国眼科住培体系，尚存诸多不足。笔者以所在眼科住培专业基地运行为例，拟评估住院医师临床带教内容、带教模式和带教效果，以及加强规培学员思政教育及对带教老师授课能力的培训等方面进行较为全面的改革，并对此项改革所取得的成效进行报告，以期对我国眼科住院医师规范化培训模式的探索和完善提供帮助，提高我国眼科规培基地质量，为眼科发展培养更多优秀的后备人才。
The standardized residency training is the essential prerequisite for the training of ophthalmologists in the health system. Based on the emerging problems of standardized residency training in the Department of Ophthalmology in Wuhan Union Hospital, attempts have been made to explore the effectiveness of a comprehensive reform of clinical instruction in areas of content, mode and learning evaluation for residents, as well as incorporating ideological and political elements in the instructional process and faculty training to enhance teaching skills for instructors, which has achieved good results. We hope that the dissemination of such efforts could provoke thoughts on improving the training model for ophthalmological residents and to improve the quality of the ophthalmological training programs in China, and to eventually lead to accumulation of better ophthalmologists in China.
目的：探索翻转课堂联合改良的迷你临床演练评估(mini-clinical evaluation exercise，Mini-CEX)在眼科住院医师规范化培训中的应用可行性及效果。方法：回顾性分析上海交通大学医学院附属第九人民医院眼科在2018—2021年所有参加规范化培训结业考核的住院医师，共计39人。比较翻转课堂教学方法实施前后，包括改良Mini-CEX在内的综合能力考核、毕业合格率、课程出勤率及学员对教学模式的满意度。结果：实验组20人(2020及2021年毕业)，对照组19人(2018及2019年毕业)。两组间的性别比例、学历或学制构成差异无统计学意义(P>0.05)。实验组的毕业合格率明显高于对照组(100.00% vs 68.42%，P=0.008)；改良Mini-CEX(P=0.011)及放射诊断(P=0.025)平均成绩也显著高于对照组。两组的理论考核及心电图诊断的平均成绩无统计学差异。4年间的比较发现，学员的改良Mini-CEX平均成绩(P=0.006)及线下课出勤率(P=0.025)出现显著提升。实验组对教学模式的满意度显著高于对照组。结论：翻转课堂联合改良Mini-CEX应用于眼科住院医师规范化培训教学可获得良好效果，提示了积极的深入研究及拓展应用前景。
Objective: To evaluate the application of flipped classroom combined with revised mini-clinical evaluation exercise (Mini-CEX) in standardized training for ophthalmology residents. Methods: A retrospective analysis was performed on 39 residents who participated in the standardized training graduation examination during 2018 to 2021 in ophthalmology department of Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The comprehensive ability assessment including the improved Mini-CEX, pass rate of program completion, course attendance rate, and students’ satisfaction with the teaching mode were compared before and after the implementation of the flipped classroom teaching method. Results: There are no significant difference of sex or educational level was found between the experimental group (20 people graduated in year 2020 and 2021) and the control group (19 people graduated in year 2018 and 2019). Compared with the controls, the pass rate (100.00% vs 68.42%, P=0.008) and the average scores of revised Mini-CEX (P=0.011) and radiology (P=0.025) were significantly higher in the experimental group, while the average scores of basics and electrocardiograph were almost the same. Among the 4 years, the average revised Mini-CEX scores (P=0.006) and attendance rate of off-line courses (P=0.025) significantly progressed. Surveys of satisfaction degree suggested that the experimental group were significantly more satisfied with the education they accepted during their residency training program. Conclusion: It is effective to apply flipped classroom combined with revised Mini-CEX in residency training program of ophthalmology. Further study and development on this teaching pattern is encouraged.
目的：了解眼科住院医师在规范化培训期间的科研培训现状及需求，为今后开展住院医师科研能力相关课程提供科学依据。方法：采用横断面调查的方式，在2021年7月间对北京大学第三医院眼科中心42名住院医师进行问卷调查，对结果进行数据分析。从科研现状、科研能力及科研需求3个方面来进行分析，其中科研能力通过常规科研技能掌握程度和软件的使用情况来评分，最后将各项得分汇总得到的分数为科研能力得分。对科研现状及可能能力得分进行了相关分析，其他数据按数据类型选择对应的分析方法。结果：共42名北京大学第三医院住院医师参与了问卷调查，其中男20名，女22名，平均年龄25岁。有90.5%的住院医师参与过科研工作，而科研内容主要来自及导师布置(90.5%)。只有14.3%的住院医师具备良好的科研能力(科研能力得分在18分及以上)。此外，有92.9%的住院医师认为临床研究有助于临床技能的理解，97.6%的参与者认为非常有必要进行临床研究方法的继续教育培训。结论：眼科住院医师科研能力普遍偏低，目前的规范化培训不能满足住院医师科研能力培养的需求，在课程设计及内容安排上需要更广泛更具实际意义的拓展。
Objective: To understand the current situation and needs of scientific research training for ophthalmologists in general hospitals during standardized training, and to provide scientific basis for the future development of courses to improve the scientific research capabilities of residents. Methods: A cross-sectional survey was used to conduct a questionnaire survey among 42 residents in the Eye Center of Peking University Third Hospital in July 2021, and the results were analyzed. We conduct research from three aspects: scientific research status, scientific research ability and scientific research needs. The scientific research ability is scored by the mastery of conventional scientific research skills and the use of software. Finally, the score obtained by summarizing the various scores is the scientific research ability score. Correlation analysis is carried out on the status of scientific research and possible ability scores, and the corresponding analysis methods are selected according to the data type for other data. Results: A total of 42 residents of Peking University Third Hospital participated in the questionnaire survey, including 20 males and 22 females, with an average age of 25 years. 90.5% of residents have participated in scientific research, and the content of scientific research mainly comes from the arrangement of supervisors (90.5%). Only 14.3% of residents have good scientific research capabilities (research ability scores of18 points and above). In addition, 92.9% of residents believe that clinical research is helpful to the understanding of clinical skills, and 97.6% of participants believe that it is necessary to conduct continuing education and training on clinical research methods. Conclusion: The scientific research ability of ophthalmology residents is generally low. The current standardized training cannot meet the needs of the residents’ scientific research ability training. The curriculum design and content arrangement need more extensive and practical expansion.
目的：宏观了解2015—2020年中国眼科药物临床试验情况，为我国眼科药物的研发和临床研究提供最新数据参考，为相关决策提供依据。方法：自国家药品监督管理总局药物临床试验登记与信息公示平台登记数据库提取2015—2020年登记的眼科药物临床试验和相关试验药物信息，汇总分析眼科药物临床试验数量、试验分期、试验范围、适应证、药物类型等。结果：2015年1月1日至2020年12月31日共登记98项眼科临床试验。统计每年眼科药物临床试验登记数量，2020年登记的数量最多(28项，占28.57%)；申办方类型中，国内制药企业(75项，占76.53%)发起的眼科药物临床试验数量远高于外资制药企业(23项，占23.47%)；试验分期中，I期临床试验最多(35项，占35.71%)，III期次之(30项，占30.61%)；药物类型中，生物制品数量最多(55项，占56.12%)，化学药物次之(36项，占36.73%)。结论：近6年来，我国眼科药物临床试验进入蓬勃发展时期，尤其是眼底科领域，近2年发展迅速。在创新药领域，国内制药企业已成为眼科新药研发的中坚力量。但创新药大部分集中在眼底科领域，在青光眼、干眼等领域仍需要继续创新。
Objective: To get a macro understanding of the clinical trials of ophthalmic drugs in China from 2015 to 2020, provide the latest data reference for development of ophthalmic drugs and clinical research in China, and provide the basis for relevant decision-making. Methods: The number of clinical trials and related investigational products from 2015 to 2020 were acquired in the China Food and Drug Administration Registration and Information Disclosure Platform for Drug Clinical Studies. Characteristics on number, stage, scope, indications, type were summarized and depicted. Results: There were 98 ophthalmic clinical trials registered in China from January 1, 2015 and December 31, 2020. The year of 2020 hit the highest record of registered ophthalmic clinical trials for 28, accounting for 28.57%. Among sponsor, 75 (accounting for 76.53%) were initiated by domestic pharmaceutical enterprises, much higher than initiated by foreign pharmaceutical enterprises (23, accounting for 23.47%). Among stage, the quantity of phase I (35, accounting for 35.71%) was the largest, followed by phase III (30, accounting for 30.61%). Among type, the quantity of biological product was the largest (55, accounting for 56.12%), followed by chemical product (36, accounting for 36.73%). Conclusion: The past 6 years have seen vigorous growth of ophthalmic clinical trials, particularly in the last 2 years in the field of fundus. Domestic pharmaceutical enterprises have become the central pillar of ophthalmic drugs renovation. However, their focus is limited to fundus, innovation is still needed in areas such as glaucoma xerophthalmia.
目的：探讨多元化宣教在提高眼科日间手术患者眼部用药正确率及满意度的应用效果。方法：采用便利抽样的方法，选取中山大学中山眼科中心2020年10至12月收治的200例眼科日间手术患者眼部用药的执行者为对象，将10至11月收治的100例日间手术患者眼部用药的执行者纳入对照组，将12月收治的100例日间手术患者眼部用药的执行者纳入试验组。对照组采取传统宣教方式，试验组应用多元化宣教模式进行健康教育。采用自制的健康教育需求调查表调查眼部用药执行者的健康教育需求，采用眼部用药执行评价表、健康宣教满意度调查表评价干预效果。结果：采用多元化宣教方式干预后，试验组患者眼部用药正确率(94%)高于对照组(35%)，差异具有统计学意义(P<0.05)。试验组对多元化宣教满意度得分明显高于对照组，差异具有统计学意义(P<0.05)。结论：多元化宣教模式可提高眼科日间手术患者眼部用药正确率，提高患者及家属的满意度，值得临床推广应用。
Objective: To explore the effect of diversified education on improving the accuracy and satisfaction of eye medication in patients undergoing ophthalmic ambulatory surgery. Methods: A total of 200 practitioners of administering eye medication after undergoing ambulatory surgery in Zhongshan Ophthalmic Center, Sun Yat-sen University from October to December 2020 were investigated by convenience sampling, 100 practitioners admitted from October to November were included in the control group, and 100 practitioners were included in the experimental group. The control group adopted the traditional method of education, while the experimental group applied diversified education mode to carry out health education. The health education needs of the patients were investigated by the self-made health education needs questionnaire, and the effect of intervention wasevaluated by the eye medication implementation evaluation form and health education satisfaction questionnaire. Results: After the intervention, the correct rate of eye medication in experimental group (94%) was higher than the control group (35%) with a statistical difference (P<0.05). The satisfaction score about diversified education in experimental group was significantly higher than the control group with a statistical difference (P<0.05).Conclusion: Diversified education model can improve the accuracy of administering eye medication in patientsundergoing ophthalmic ambulatory surgery, and the satisfaction in patients and their families is significantly improved. It is worthy of clinical application.
目的：分析眼科超说明书用药使用情况，为眼科临床合理用药提供有效、安全的循证参考依据。方法：考察并收集21家爱尔眼科医院集团眼科中心城市及省会级医院备案的超说明书用药情况，同时抽查处方、医嘱用药，对超说明书用药情况进行充分论证评估，参考广东省、山东省等超说明书用药共识、文献，进行统计、分析和归纳，并征求相关眼科临床专家意见。结果：梳理指南、共识及期刊论文等循证医学证据，得出超说明书用药推荐级别1级8项、2级29项、3级24项，并编写了供集团内使用的《眼科医院眼科超药品说明书用药参考目录(2021年版)》，便于临床参考使用。在眼科常用有32种超说明书药品，61项超说明书用药，其中超给药途径32项(52.5%)、超适应证用药13项(21.3%)、超适应证合并超给药途径14项(23.0%)。超说明书品种及超说明用药项目数均以抗菌药物最多，分别为13个(40.6%)品种，26项(42.6%)。结论：眼科因特殊的给药途径，超说明书用药比较普遍，而如抗菌药物注射剂使用眼内注射或滴眼等超说明书用药方式对某些急性眼内感染性疾病起到了很好的治疗效果。规范眼科超说明书用药，是防范医疗风险的必要措施。
Objective: To investigate off-label ophthalmic medications, and provide an effective and safe evidence-based reference for the rational use of ophthalmic drugs. Methods: On the basis of collecting the off-label drug use recorded in 21 Aier Eye Hospital Group which including ophthalmic central cities and provincial capital level hospitals, and spot checking the prescription and doctor’s order drug use, this article conducted full demonstration and evaluation of off-label drug use which referred to the off-label drug used consensus of Guangdong and Shandong, and other literature on the off-label drug use in ophthalmology. The paper conducted statistics, analysis and induction, and solicited the opinions of relevant ophthalmology clinical experts. Results: Sorting out the evidence of the guides,consensus, journal papers and other evidence-based medicine in ophthalmic medication, recommending 8 items of level 1, 29 items of level 2, and 24 items of level 3, we compiled the “Reference catalogue for the off-label drug use in ophthalmic hospital (2021 edition)” within the group which can providing reference for clinical use. There were 61 off-label drugs commonly used in ophthalmology, involving 32 drugs. Among them, 32 items (52.5%) were used by over administration route, 13 items (21.3%) were used by over indication, and 14 items (23.0%) were used by over indication and administration route. Antibacterial drugs were the most frequently used in the varieties and items of off-label drug use, accounting for 13 (40.6%) and 26 (42.6%) respectively. Conclusion: Ophthalmic off-label medications are common owing to the special route of administration. Such as intraocular injection or eye drop have played a good role in the treatment of some ocular infectious diseases. Standardizing the off-label drug use of ophthalmology is an effective measure to reducing medical risks.
目的：测量医联体糖尿病患者眼科随访依从性及相关的健康信念，分析其影响因素。方法：采用便利抽样的方法，使用中文版糖尿病眼科随访依从性问卷对在广州医科大学附属第二医院所辖医联体内的334例糖尿病患者进行调查。结果：仅24.3%的受访者在过去的1年中接受过眼科散瞳检查，受访者眼科随访健康信念的总体评分为3.09±0.64，其中感知的益处和威胁维度评分最高，行为线索维度评分最低。糖尿病类型、就医倾向、合并其他糖尿病并发症、医联体相关知识和家庭类型是糖尿病患者眼科随访健康信念的主要影响因素。结论：医联体糖尿病患者眼科随访健康信念处于一般水平，缺乏行为线索支持，提示在糖尿病眼部并发症筛查和防治过程中，医联体应发挥下筛上转的功能，通过对障碍因素的干预，提高辖区糖尿病患者接受眼科随访的依从性。
Objective: To measure the adherence to ophthalmology follow-up and the related health belief of patients with diabetes in medical alliance, and analyze the influencing factors. Methods: Totally 334 community-dwelling patients with diabetes mellitus were recruited in a medical alliance in Guangzhou by convenient sampling method. They were investigated by the Chinese version of the Compliance with Annual Diabetic Eye Exams Survey (CADEES-C). Results: Dilated fundus examination within the last year were only reported by 24.3% of respondents. The mean score of the CADEES-C was 3.09±0.64, with the highest score in perceived benefit and threat dimensions and the lowest score in behavioral cue dimension. The factors that mainly influence the adherence to ophthalmology follow-up and their related health beliefs of patients with diabetes are types of diabetes, propensity to seek treatment, other complications of diabetes, knowledge of medical alliance and family pattern. Conclusion: The adherence to ophthalmology follow-up and the related health belief of patients with diabetes are at low level with the deficiency of behavioral cues. It is suggested that medical alliance should play a critical role to improve the status quo by developing more screening and referrals.
研究生导师的能力和水平是影响研究生教育质量的最关键因素之一。针对眼科学研究生专业基础 知识薄弱、动手实践机会缺乏、创新能力不足，导师队伍教学主动性不强、活力欠佳等问题，中 山眼科中心逐步建立了“行政+专家”的双重教学管理架构，引导激励教师积极主动参与、推动研 究生课程改革、科研创新能力培训、教学信息化建设、教学质控与学生管理等各项教学改革与决 策，通过不断完善教师参与教学改革共同治理的长效机制，打造高素质的教师队伍，实现高质量 的眼科学研究生培养。
The ability and level of postgraduate tutor is one of the key factors affecting the quality of graduate education. In view of the weak basic ophthalmic knowledge, lack of practical opportunities and the inefficiency in innovation ability among ophthalmology graduates, as well as the lack of initiative and vitality in teaching team, Zhongshan Ophthalmic Center, Sun Yat-Sen University has been gradually established the dual management structure of “administration and experts”. By guiding and encouraging the teachers participate in the curriculum reform of graduates, scientific research ability training, management informatization, the teaching quality control, student administration and so on. Through improving the long-term mechanism of teachers’ participation in teaching reform governance, the quality of teachers has been improved, which promote the high-quality development of ophthalmology graduate education.
住院医师规范化培训(简称“住培”)是我国新医改的一项重要举措，旨在通过住培来使我国临床 整体医疗水平同质化提高，解决民众日益增长的医疗需求和各地医疗发展不平衡之间的矛盾。我 国眼科住培改革经历十余年，在追求同质化的实践中发现一些值得重视的问题，如教学师资的选 拔和培训、临床操作类教学的落实、教学师资待遇的提升以及包括人文在内的住院医师诊疗能力 全面培养等。本文探讨了这些问题的根源和解决方法，希望通过改革将住培这一临床医学基础工 程更好的落到实处。
Standardized resident training (called ‘ZhuPei’ for short in Chinese) is an important measure of the New Healthcare Reform in China, aiming to promote the homogenization of clinical medicine level which tackles the constraints of unbalanced medical development so that people’s ever-growing medical demand can be supplied. With the reality of over 10 years’ ophthalmology standardized resident training experience in China, certain crucial issues are put forward, such as the selection and training of teachers, the implementation of clinical training course, the concern of teachers’ salary and promotion, the residents’ capabilities of diagnosis and treatment including humanistic care, etc. This article discusses the root causes of those issues and the solutions to them, intending to implement the standardized resident training as a basic clinic medical engineering through the New Healthcare Reform
