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：探讨基于微信的图像存储和传输系统(picture archiving and communication system，PACS)教学在眼眶科规培医生中的教学效果及质量评价。方法：将中山眼科中心眼眶科轮训的66名规培医生分为A组(PACS组)与B组(微信+PACS组)。通过出科考核和问卷分析比较两组学生的教学效果及满意度。结果：B组学生的基础知识测试和阅片技能测试得分均显著高于A组(P<0.001，P=0.037)。教学效果自我评估量表显示B组学生对解剖结构位置的熟悉程度、影像学诊断、鉴别诊断能力、工作中解读CT或MRI图像的能力预判，以及对CT或MRI影像学的兴趣，明显优于A组(均P<0.001)。所有学生(100.00%)对这种教学模式感到非常满意。结论：在眼眶科住院医师规划化培训中应用基于微信的PACS教学模式能显著提高教学效果和满意度，提高教学质量。
Objective: To evaluate the application quality of picture archiving and communication system (PACS) based on WeChat in standardized resident training in orbital department. Methods: A total of 66 doctors trained in the Orbital Department of Zhongshan Ophthalmic Center were divided into group A (PACS group) and Group B (WeChat +PACS group). The quality and feedback of teaching of the two groups of students were compared through examination and questionnaire. Results: The scores of basic knowledges and reading skills of group B were significantly higher than those of group A (P<0.001, P=0.037). The self-assessment scale for teaching quality showed that the students in group B were superior to group A in understanding the position of anatomical structure, imaging diagnosis and differential diagnosis according to CT or MRI, interpreting CT or MRI images in the future, and interest in CT or MRI imaging (all P<0.001). All the students (100.00%) were very satisfied with this mode of teaching. Conclusion: The application of PACS based on WeChat in standardized resident training in orbital department can significantly improve the quality and satisfaction of ophthalmology teaching.
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
将课程思政理念融入专业课程是落实立德树人根本任务和全面推进课程育人的重要途径。本文根据课程思政的内涵要求和发展实际，结合实验室技能培训课程特点，从知识点、人与社会、故事、案例辨析、实验操作5个方面进行思政探索和实践。通过优化教学设计、创新教学方法和丰富教学内容，切实将社会主义核心价值观教育贯穿专业课教育全过程，为眼科学及分子医学专业课相关课程的思政教学和高质量人才培养提供了有价值的参考。
Integrating ideological and political concepts of the curriculum into the professional curricula is an important way to implement the fundamental task of cultivating people with morality and comprehensively promote the education of people through the curriculum. Based on the connotation requirements and actual development of the integration of ideological and political education throughout curriculum, considering the features of laboratory skills training courses, this paper explores ideological and political education in 5 aspects. The 5 aspects include knowledge points, humans and society, stories, case analysis, and experimental operation. By optimizing teaching design, innovating teaching methods, and enriching teaching contents, the education of socialist core values should be effectively carried out throughout the whole process of professional course education, which provides a valuable reference for the ideological and political teaching in ophthalmology and molecular medicine related courses and for the cultivation of high-quality talents.
目的：调查中山大学中山眼科中心参加分子医学实验技能培训课程的研究生学员上课前的实验基础，为研究生实验技术课程的备课提供参考。方法：对2020年及2021年参加分子医学实验技能培训课程的博士和硕士研究生进行课前问卷调查。从理论知识和操作经验两方面对15个专题课程进行分析。结果：共155名学生完成问卷调查。在全部专业研究生中，25%以上学生对理论知识不了解的专题有14个，而仅有10%以下学生熟练操作的专题有6个；分子医学专业的优于前者，不了解和熟练掌握的专题个数分别是9和12。理论掌握程度最低的4个专题是细胞增殖、流式细胞、图像采集和组学分析。15个小专题整合成7个大专题，操作熟练程度由低到高依次是：眼科实验数据收集、组学技术、数据分析、细胞技术、蛋白技术、组织分析、分子技术。结论：新入学研究生存在分子医学实验技能基础理论知识薄弱以及科研训练不足等问题，迫切需要改善实验技能培训制度，深化课程体系建设。
Objective: To conduct a pre-course survey on the graduate students who participated in the Molecular Medicine Laboratory Skills Training Course in the Zhongshan Ophthalmic Center of Sun Yat-sen University to provide a reference for the preparation of the course. Methods: We asked the doctoral and master’s students who participated in the training courses of molecular medical experimental skills in 2020 and 2021 to take a pre-course questionnaire survey and analyzed the results by the students’ pre-course command of theoretical knowledge and pre-training operational experience in 15 lessons of special topics or techniques. Results: A total of 155 students completed the pre-course questionnaire survey. Our results showed that there were 14 lessons in which more than 25% of the students were not familiar with the theoretical knowledge, whereas there were 6 lessons in which less than 10% of the students had high operational proficiency. The students majoring in the molecular medicine had better prior knowledge of the techniques: there were only 9 lessons in which more than 25% of the students were not familiar with the theoretical knowledge, whereas there were 12 lessons in which less than 10% of the students had high operational proficiency. The four lessons with worst prior knowledge were cell proliferation, flow cytometry, image acquisition, and omics analyses. We grouped the 15 lessons into 7 categories: the ophthalmic experimental data collection, the omics technology, the data analyses, the cell technology, the protein technology, the tissue analyses, and the molecular technology, presenting by the level of the students’ pre-training proficiency from low to high. Conclusion: The first-year graduate students were very weak in basic knowledge and had little experience in techniques before joining the molecular medicine training courses. It is urgent to improve the laboratory skills training system and strengthen the construction of the curriculum system.
目的：了解眼科住院医师规范化培训学员(规培生)的沟通技能态度和人际沟通能力现状。方法：对中山大学中山眼科中心三个年级规培生的沟通态度和人际沟通能力进行问卷调查，并进一步分析其沟通态度与沟通能力的相关性。结果：共纳入196名规培生，沟通积极态度量表总分为51.38±6.52，消极态度为36.80±5.70，人际沟通能力为2.41±0.40，辅导与咨询维度得分为2.50±0.64，提供有效的负面反馈维度得分为2.61±0.50，支持性沟通维度得分为2.29±0.44。沟通技能的积极态度与人际沟通能力和三维度之间显著相关(P<0.01)。人际沟通技能得分与性别、规培年级、喜欢眼科专业的程度、得到家庭的关爱程度、得到朋友的关爱程度等因素显著相关(P<0.05)。结论：眼科规培生对沟通技能的积极态度优秀，但是总体沟通能力较弱，并受到多种因素影响。应充分重视规培生人际沟通能力的培养，开展医患沟通的专业化培训。
Objective: To evaluate the current status and correlations between attitudes and competency for interpersonal communication in ophthalmology standardized training trainee. Methods: A questionnaire survey was conducted on the communication attitudes and interpersonal communication ability of standardized training trainees from three grades in Zhongshan Ophthalmic Center, affiliated to Sun Yat-sen University, and the correlation between communication attitude and communication ability was further analyzed. Results: A total of 196 trainees were included. The scores of positive attitude, negative attitude, and interpersonal communication skills were 51.38±6.52, 36.80±5.70, and 2.41±0.40, respectively. In addition, the dimension of coaching and counseling scores were 2.50±0.64, the dimension of providing effective and negative feedback scores were 2.61±0.50, and the dimension of supportive communication scores were 2.29±0.44. The positive attitudes of communication skills were significantly related to the interpersonal communication skills and three-dimensionality (P<0.01). The interpersonal communication skills were significantly associated with sex, grades, interest in ophthalmology, social support from the family and friends (P<0.05). Conclusion: Ophthalmology trainees have excellent positive attitudes toward communication skills, but the overall communication skills are weak and influenced by a variety of factors. More attention should be paid to the development of interpersonal communication skills of the trainees, and specialized training in doctor-patient communication is warranted.
全科医生对个人及其家庭所提供的基本、连续性、综合性及整体性的医疗服务。全科医生要求具备更为“广博”的知识结构。那么如何在有限的培训期内更好地完成亚专科的培训并获得社区卫生服务中切实需要的临床技能及知识储备，是目前亟待解决的问题。基于社区卫生服务的基本特点，全科医生规范化培训中培训眼科学的相关内容，强调重视眼与全身疾病、眼科急症及全身药物的眼部损害等，有助于全科医生迅速、准确地发现和判断在社区医疗机构就诊的各类眼部急危重症患者，及时向专业眼科机构转诊，避免延误诊治，为后续专业的眼科治疗赢得宝贵时间，从而使全科医生更好地胜任社区居民健康“守门人”的工作。
General practitioners provide basic, continuous, comprehensive and holistic medical services to individuals and their families, which requires them to have a more “extensive” knowledge structure. However, within the limited training period, how to successfully complete subspecialty training and acquire the clinical skills and knowledge needed in community health services is an urgent problem which need to be explored. Based on the basic characteristics of community health service, the ophthalmology training of the standardized training of general practitioners, focus on the eye and systemic diseases, ophthalmic emergency and side-effect of systemic drug on eye would help general practitioners rapidly and accurately find and diagnose all kinds of serious emergent ophthalmologic diseases, and then refer to professional eye institutions in time, which avoid delay in diagnosis and treatment and save more valuable time for subsequent professional treatment. It would make the general practitioners become good healthy gatekeepers for the local community residents.
