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Exploration and Practice of the Collaborative Program in Postdoctoral Trainees of Clinical Anesthesiology
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摘要:
目的 以北京协和医院临床医学博士后培养项目为依托，探索综合医院与专科医院协作的联合培养方案在麻醉科临床医学博士后培养中的优势和可行性。 方法 综合分析北京协和医院手术平台麻醉亚专科手术量及北京市各专科医院的临床专业特色和教学资源优势，建立综合医院与专科医院相结合的北京协和医学院麻醉学系联合基地，并制订临床医学博士后联合培养方案。比较联合培养方案实施前后，参与规范化培训的住院医师与临床医学博士后学员的麻醉亚专科病例培训数量及核心胜任力考核成绩差异。 结果 联合培养方案实施后，在临床麻醉总病例数不变的前提下，小儿外科麻醉、产科麻醉、心血管外科麻醉的培训病例数量和规范化培训要求完成率均显著提高(P均＜0.01);临床医学博士后学员的“知识技能”“沟通合作”“病人照护”3项核心胜任力成绩显著提升(P均＜0.05)。 结论 联合培养方案可优化麻醉科的病例资源，提高临床医学博士后的核心胜任力，对麻醉科临床医学博士后的规范化培训切实可行。 Abstract:Objective To explore the advantage and feasibility of the program of training anesthesiologists that is based on the clinical postdoctoral program of Peking Union Medical College Hospital (PUMCH) with collaboration between general hospitals and specialized hospitals. Methods We analyzed the operational volume of the operation platform in PUMCH and the clinical characteristics of the specialized hospitals in Beijing, and built a collaborative standardized training base that combines general hospitals with specialized hospitals. Before and after the implementation of the collaborative training program, the number of training cases of each sub-specialty and the trainees' scores of the assessment of clinical abilities were compared. Results After implementation of the collaborative standardized training program, the number of training cases of pediatric anesthesia, obstetrics anesthesia, and cardiovascular surgery anesthesia were significantly increased (all P < 0.01) with the total number of clinical anesthetic cases unchanged. Meanwhile, the scores of medical knowledge and skills, communication and collaboration, and patient care of the trainees were significantly improved (all P < 0.05). Conclusion The collaborative standardized training program can optimize the disease resources and improve the core competency of trainees, and is feasible for standardized postdoctoral training of clinical anesthesiology. 作者贡献：阮侠负责数据收集、分析与文章撰写; 谭刚、王琳、蔡晶晶、薛庆华负责项目实施; 徐铭军、张建敏、晏馥霞、郑晖、邓晓明负责培训方案的讨论、制订及修改; 申乐负责文章修订; 黄宇光负责项目整体策划及文章修订。利益冲突：所有作者均声明不存在利益冲突 -
表 1 联合培养方案实施前后麻醉亚专科培训病例数量及培训要求完成率比较(x±s)
组别 3年培训病例总数(n) 小儿外科麻醉 产科麻醉 心血管外科麻醉 病例数(n) 完成率(%) 病例数(n) 完成率(%) 病例数(n) 完成率(%) 联合培养组(n=9) 1367.8±27.0 115.9±7.0 96.6±5.8 132.7±14.8 88.4±9.9 78.8±10.3 393.9±51.5 单一基地培养组(n=12) 1370.9±71.5 78.1±20.0 65.1±16.6 78.5±22.0 52.3±14.7 45.7±19.9 228.3±99.6 P值 0.902 0.000 0.000 0.000 
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表 2 联合培养方案实施前后学员的核心胜任力成绩比较(x±s，分)
组别 知识技能 职业素养 沟通合作 终生学习 病人照护 联合培养组(n=9) 90.5±3.3 93.2±3.6 93.0±3.9 87.5±3.9 88.9±3.9 单一基地培养组(n=12) 84.8±5.0 89.7±5.2 87.1±5.6 84.5±3.5 81.2±4.8 P值 0.005 0.083 0.010 0.086 0.001
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表 3 临床医学博士后学员对联合培养方案的满意度评价(n=9)
内容 满意度[n(%)] 非常满意 满意 一般 不满意 非常不满意 开拓临床视野 6(66.7) 2(22.2) 1(11.1) 0(0) 0(0) 丰富医学知识 5(55.6) 2(22.2) 1(11.1) 1(11.1) 0(0) 提高操作技能 9(100) 0(0) 0(0) 0(0) 0(0) 改善沟通能力 2(22.2) 3(33.3) 3(33.3) 1(11.1) 0(0) 提高科研能力 1(11.1) 1(11.1) 3(33.3) 4(44.4) 0(0) 提升教学能力 2(22.2) 1(11.1) 5(55.6) 1(11.1) 0(0) 总体满意度 9(100) 0(0) 0(0) 0(0) 0(0)
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