三种学制医学研究生科研训练与临床实践现状分析

徐浩杰; 王璐; 刘明娟; 赵丽丹

doi:10.12290/xhyxzz.2021-0623

三种学制医学研究生科研训练与临床实践现状分析

Analysis of Integrating Training in Scientific Research and Clinical Practice among Current Medical Postgraduates of Three Academic Systems

摘要

摘要:
目的了解不同学制医学研究生的科研训练与临床实践情况，分析各学制在医学博士培养模式上的优势与不足，以期为未来医学教育规划、调整、改革提供参考。
方法采用问卷调查与个别访谈相结合的方法，收集北京协和医学院临床学院(北京协和医院)2021年临床医学专业高年级研究生，包括传统学制博士生(2018级博士生，2016级直博、转博生)，2013级临床医学八年制本-博连读博士生，2018年和2019年入学的“4+4”试点班博士生科研训练与临床实践相关资料，进行分析、总结。
结果共收集有效问卷55份，其中传统学制博士生33份(60.0%)，临床医学八年制本-博连读博士生15份(27.3%)，“4+4”试点班博士生7份(12.7%)。11人愿意接受访谈，包括6名传统学制博士生，3名临床医学八年制本-博连读博士生，2名“4+4”试点班博士生。传统学制博士生、临床医学八年制本-博连读博士生、“4+4”试点班博士生中毕业后拟投身于临床工作的比率分别为97.0%、93.3%、71.4%。关于科研动力，84.8%的传统学制博士生认为是源于事业发展需求，临床医学八年制本-博连读博士生持同样观点者占比53.3%，“4+4”试点班博士生为57.1%。科研训练中，传统学制博士生面临的最主要问题为研究设计能力弱(60.6%)，临床医学八年制本-博连读博士生(73.3%)与“4+4”试点班博士生(71.4%)则主要为缺乏充足的科研时间。对当前科研状态感到满意或享受者的占比在“4+4”试点班博士生中最高(57.1%)，其次为传统学制博士生(39.4%)，临床医学八年制本-博连读博士生最低(26.7%); 对科研产出满意者在传统学制博士生中占比最高(54.5%)，其次为“4+4”试点班博士生(42.9%)，临床医学八年制本-博连读博士生最低(33.3%)。传统学制博士生、临床医学八年制本-博连读博士生、“4+4”试点班博士生每周科研时间投入＞20 h者的比率分别是63.7%、26.7%和14.3%，每周临床实践时间＞40 h者比率分别为24.2%、20.0%和42.9%。84.8%的传统学制博士生、100%的临床医学八年制本-博连读博士生、85.7%的“4+4”试点班博士生的科研方向在导师指导下确立并开展; 在科研进展遭遇困难时，3种学制博士生中需有赖于导师帮助的比率分别为48.5%、53.3%和42.9%，但每周与导师接触时间＞8 h的比率分别为12.1%、20.0%和14.3%。3种学制博士生中，对当前临床实践感到满意或享受者的占比在“4+4”试点班博士生中最高(71.4%)，传统学制博士生(42.4%)和临床医学八年制本-博连读博士生(40.0%)相对较低。
结论科研思维和临床能力的培养是渐进的过程，需大量时间投入和导师引领。3种博士生培养学制互有优劣，应整合医院及医学院临床和科研资源，合理规划临床实践与科研训练时间分配，激发研究生能动性，以期培养出更多符合社会需求且具有国际视野的高层次拔尖创新型医学人才。

Abstract:
Objective To explore the situation of training in scientific research and clinical practice among medical postgraduates of different academic systems, analyze the advantages and shortcomings of each academic system in the mode of training medical postgraduates, and provide reference for future planning, adjustment and reform to medical education.
Methods Using the methods of questionnaires and individual interviews, information from senior graduate students in clinical medicine at the School of Clinical Medicine, Peking Union Medical College (Peking Union Medical College Hospital) in 2021 were collected. These participants included doctoral students in the traditional master-doctor system(TMD) from the 2018 doctoral class and 2016 direct and transfer class, graduates of class 2021 from eight-year program of clinical medicine (8YCM), and medical students from the new academic "4+4" pilot class (NAPC) entering in 2018 and 2019. Their information about research training and clinical practice was summarized and analyzed.
Results A total of 55 valid questionnaires were collected, including 33 (60.0%) from TMD, 15(27.3%) from 8YCM, and 7 (12.7%) from NAPC. Eleven people were willing to be interviewed, including 6 from TMD, 3 from 8YCM, and 2 from NAPC. 97.0%, 93.3%, and 71.4% of participants from TMD, 8YCM and NAPC respectively planned to commit to clinical work upon graduation. Regarding motivation for scientific research, 84.8% of TMD students believed that the drive was the needs of career development. 53.3% of 8YCM and 57.1% of NAPC students held the same view. During the training in scientific research, the main problem faced by TMD students was their weakness in scientific research design (60.6%) while 8YCM and NAPC students claimed that their main problem was the insufficiency of time for scientific research (73.3%, 71.4%). The proportion of those who were satisfied with or enjoyed the current status of scientific research was the highest among NAPC students (57.1%), followed by TMD students (39.4%) and 8YCM students(26.7%). The proportion of those who were satisfied with scientific research output was the highest among TMD students (54.5%), followed by NAPC (42.9%) and 8YCM students (33.3%). As for time committed to research, TMD, 8YCM and NAPC students who spent more than 20 hours per week accounted for 63.7%, 26.7% and 14.3%, respectively, and accounted for 24.2%, 20.0%, and 42.9%, respectively for clinical practice of over-20-hour's commitment. 84.8% of TMD, 100% of 8YCM, and 85.7% of NAPC students established their directions of scientific research under the guidance of their mentors. When the progress of scientific research encountered difficulties, 48.5%(TMD), 53.3%(8YCM), and 42.9%(NAPC) of the students of the three academic systems turned to their supervisors for help. The proportions of students who had more than 8 hours of contact with their supervisors each week were 12.1%(TMD), 20.0%(8YCM) and 14.3%(NAPC). Among the three educational systems, the proportion of postgraduates who were satisfied with or enjoyed current clinical practice was highest in NAPC (71.4%), followed by TMD(42.4%) and 8YCM (40.0%).
Conclusions The cultivation of scientific research thinking and clinical ability is a gradual process, requiring time investment and the guidance of tutors. The three systems of graduate education have their own advantages and disadvantages. The resources of clinical practice and scientific research of hospitals and medical schools should be integrated, and the time allocation for clinical practice and scientific research should be rationally planned to stimulate the initiative of graduate students, so as to cultivate more high-level and top-notch innovative medical talents with international perspectives that meet the needs of society.

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