目的：探讨标准操作程序在玻璃体腔内注药术护理中的应用效果。方法：选择2018年9至12月中山大学中山眼科中心眼底专科门诊504例玻璃体腔内注药术患者作为研究对象，对护理人力资源的整合、患者等待手术时间、患者和家属的满意度、医护人员满意度进行评价。结果：标准操作程序后明确护士岗位职责，护士操作水平和综合能力有效提升，患者手术等待时间由原来的预约2周缩短为2 d。患者和家属的满意度分别由92.0%和91.0%提高到98.5%和97.0%。医护人员满意度的评价由95%提到至98.4%。结论：玻璃体腔内注药术标准操作程序不仅提升了工作效率，更提升了患者和家属、医务人员的满意度，规范化的标准操作程序是玻璃体腔内注药的安全保障。
Objective: To investigate the effect of standard operation procedure in the intravitreal injection. Methods: A total of 504 patients visiting the fundus clinics of our hospital from September to December 2018 were selected in this study. The integration of nursing human resources, patient waiting time, patient and family satisfaction,and medical staff satisfaction were evaluated. Results: The nurses’ job responsibilities were clarified, and the nurses’ operation level and comprehensive ability were improved. The patients’ waiting time for surgery was shortened from 2 weeks to 2 days. Patient and family satisfaction increased from 92.0% and 91.0% to 98.5% and 97.0%, respectively. The evaluation of the satisfaction of medical staff was elevated from 95% to 98.4%.Conclusion: The standard operation procedure of intravitreal injection not only improves the work efficiency, but also significantly increases the satisfaction of patients and their families and medical staffs. Therefore, the standard operation procedure can guarantee the safety of intravitreal injection.
目的：在推广护理标准预防操作流程(standard operation procedure，SOP)前后对护理人员进行操作情况和针刺伤职业暴露水平对比，探索护理SOP的实用性和有效性。方法：在中山大学中山眼科中心推广护理SOP前后，分别对14名责任护士进行操作考核，并对推广护理SOP前后收治的传染病患者数量和针刺伤职业暴露事件数量进行对比。结果：推行护理SOP前后操作考核平均分分别为82.31分、88.23分，差异有统计学意义(P<0.001)。初高级责任护士考核结果差异无统计学意义。推行护理SOP前后病房收治血液传染性疾病患者总数分别为32例、51例，针刺伤职业暴露事件分别为4例、0例，差异有统计学意义(χ2 =6.698，P=0.020)。结论：护理SOP的推广可使护理人员加强自我防护，减少针刺伤职业暴露，有效降低医源性感染率。
Objective: To compare the operation status and occupational exposure to needle stick injuries level of nursing staff before and after the promotion of nursing standard prevention operation procedure (SOP), and to explore the practicability and effectiveness of nursing SOP. Methods: Before and after the promotion of nursing SOPs at Zhongshan Ophthalmology Center of Sun Yat-sen University, 14 responsible nurses were assessed for operation,and the number of infectious diseases and occupational exposures to needle stick injuries before and after the promotion of nursing SOPs were compared. Results: The average scores of operation and evaluation before and after the implementation of nursing SOP were 82.31 points and 88.23 points, with significant statistical difference(P<0.001). There was no statistical difference in the results of the initial senior responsible nurses. The total number of patients with blood infectious diseases before and after the implementation of nursing SOP was 32 cases and 51 cases. The occupational exposure to needle stick injuries events were 4 cases and 0 and the difference was statistically significant (χ2 =6.698, P=0.020). Conclusion: The promotion of standard preventive procedures can enable caregivers to strengthen self-protection, reduce occupational exposure, and effectively reduce the rate of iatrogenic infection.
目的：探讨眼科住院医师规范化培训中睑板腺囊肿诊疗的培训效果及存在的问题，以期改进培训方式。方法：以2020年4月在中山大学中山眼科中心培训的154名学员为对象，进行问卷调查，采用SPSS 20.0统计学软件进行数据分析。结果：共76名专业型硕士(专硕)、78名住院医师培训(住培)学员完成了问卷调查。专硕具有睑板腺囊肿诊断、保守治疗及手术主刀经验的比例分别为40.8%、11.8%、7.9%；住培则显著高于前者，分别为79.5%(P<0.001)、60.3%(P<0.001)和21.8%(P=0.016)。对于关键诊疗环节的判断，90.8%的专硕选择了临床诊断(P=0.007)，94.9%的住培则选择治疗方案(P<0.001)。去除囊壁、术中意外与破溃皮肤的处理是专硕难以掌握的手术步骤(P<0.001)；而住培仅为去除囊壁(P<0.001)。结论：睑板腺囊肿诊疗水平在眼科住院医师规范化培训中亟待提高，并根据各类型学员的临床能力和认知差异，进行分级分类培训。
Objective: To explore the teaching effect of diagnosis and treatment on chalazion in the standardized training of ophthalmology residents and its existing problems, in order to improve the quality of the training systems. Methods: A self-designed questionnaire survey was conducted with 154 ophthalmology residents in Zhongshan Ophthalmic Center in April 2020, and the investigative data was analyzed using SPSS 20.0. Results: Totally 76 medical postgraduates and 78 ophthalmology residents completed the questionnaire survey. The proportions of medical postgraduates who had individual experience on diagnosis, conservative and surgical treatment of chalazion were 40.8%, 11.8%, and 7.9%. Compared to the former, ophthalmology residents had significantly higher proportion, with 79.5% (P<0.001), 60.3% (P<0.001), and 21.8% (P=0.016), respectively. For judging the important aspect of diagnosis and treatment process, the medical postgraduates chose the clinical diagnosis (90.8%) (P=0.007), while the ophthalmology residents paid more attention on treatment options (94.9%) (P<0.001). In the surgical procedures, removal of cyst wall, management of intraoperative accidents and skin ulcers are all their difficult skills to master for medical postgraduates (P<0.001), while only removal of cyst wall for residents (P<0.001). Conclusion: The training level of diagnosis and treatment of chalazion still needs to be improved in the standardized training of ophthalmology residents. The training should be carried out according to the clinical competence and cognition differences of various types of students.
目的：探讨急救护理技能规范化培训考核在眼科护士中的应用效果。方法：对暨南大学附属深圳眼科医院142名眼科护士实施急救护理技能的规范化培训考核，比较培训前后急救理论考核成绩及急救技能操作考核成绩的差异，并采用自制调查问卷进行培训评价的调查。结果：在实施急救护理技能规范化培训后，眼科护士的急救理论与技能操作考核成绩均高于培训前，差异有统计学意义(P<0.05)；90%以上的眼科护士对急救培训持肯定意见。结论：急救护理技能规范化培训考核提高了眼科护士的临床急救护理水平，培养了良好的急救护理意识和团队协作精神，同时增加了护士的自我价值及职业认同感，获得了较好的培训效果。
Objective: To explore the application effect of standardized training and assessment of emergency nursing skills in ophthalmology nurses. Methods: We implemented standardized training and assessment of emergency nursing skills for 142 ophthalmology nurses in our hospital, compared the difference between the first aid theory and the first aid skill operation before and after the training, and used a self-made questionnaire to conduct training evaluation surveys. Results: After implementing the standardized training of emergency nursing skills, the assessment scores of first aid theory and skill operation of ophthalmology nurses were higher than those of the pre-training assessment. And the difference was statistically significant (P<0.05). More than 90% of ophthalmology nurses had a positive opinion on first aid training. Conclusion: Standardized training and assessment of emergency nursing skills have improved the clinical emergency nursing level of ophthalmology nurses and cultivated a good emergency nursing awareness and teamwork spirit. At the same time, they have strengthened nurses’ self-worth and professional identity, and achieved better training results.
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
