The clinical medical postdoctoral project is a complex elite national project of post-graduation supported by the Ministry of Human Resources and Social Security. Since the 2016 academic year, the department of internal medicine at Peking Union Medical College Hospital has launched, modified and developed this project on multiple aspects, including the stratified training mode, 360 degree evaluating system, system of evaluation and feedback for progressive training, and program of simulation. During the process of implementing this project, we continued the improving process according to the feedback from multiple aspects. In this article, we demonstrated the innovation of this project and summarized our experience during the implementing process, hopefully to provide reference for cultivating a complex medical elite with international vision.

阿尔茨海默病(AD)是痴呆的主要原因,约占痴呆发病人数的60％～70％.约90％的AD患者在65岁以后发病,60岁以前发病者在临床上非常少见,称为早发AD(EOAD)[1],一般与家族遗传有关.本文报道1例散发性EOAD.

Objective To investigate the current situation, motivation, difficulties and needs of young physicians participating in teaching activities in internal medicine department at PUMCH. Methods We surveyed young attendings and residents who worked at internal medicine wards of Peking Union Medical College Hospital from November 2018 to October 2019 about their current tasks, motivation, difficulties and needs in terms of teaching. Results Based on visual Analog Scale, the mean score of attendings'interest in teaching is 8.0±1.8, and teaching work accounted for 25.3%±14.1% of all working hours. The most important motivation for teaching is self-improvement via teaching. The biggest difficulty faced by attendings is high pressure on clinical and research work (72.4%, 42/58). The most voted need is to increase the impact of teaching on promotion (48.3%, 28/58). The mean score of residents'interest in teaching is 7.5±1.8,and teaching work accounted for 24.8%±15.2% of all working hours. The most important motivation for teaching is self-improvement via teaching. The biggest difficulties faced by residents include high pressure on clinical and research work (50.6%, 41/81) and lack of teaching skills (25.9%, 21/81), etc. The most voted need is teaching skill trainings (42%, 34/81). Conclusions Young physicians are highly motivated to teaching with self-improvement as the main driving force. Measures should be taken to support young physicians to better balance clinical, research and teaching, and to improve their teaching results.

Objective The purpose of this study is to explore the establishment of an evaluation system that is more suitable for the training of high-level and compound medical personnel. Methods The framework of 360° evaluation system for core competency was built on the theoretical basis of 360°evaluation method through literature review and consultation of experts, or with other methods. Results We described and analyzed the components of the system and discussed the preliminary practice process in the postdoctoral training project of clinical medicine. Conclusions The 360°evaluation system based on core competence can comprehensively and intuitively reflect the development of clinical postdoctoral trainees' competence, and help students improve their ability in a targeted way, which lays a foundation for further exploration and improvement of the evaluation system for medical talents.

Objective To establish a duty competency evaluation system in Peking Union Medical College Hospital (PUMCH) which can stratify residents based on their performance and authenticate the ability to practice medicine independently on duty. Methods Residents enrolled from PUMCH Internal Medicine Training program in 2017 and 2018 were evaluated for duty competency, the number of test and time needed to pass the test were analyzed. Results The numbers of tests needed to pass were not statistically significant(χ2=9.12,P＞0.05)in postdoctoral residents, undergraduate residents and residents from Beijing training base. Time needed to pass exam showed difference(χ2=96.27,P＜0.05) in the three resident groups. The results showed that this exam helped to stratify residents. Most residents passed exam after 6 months' internship and was competent for independ practice on duty. Conclusions In standardized training of residents, duty competency evaluation system can help to assess their capability on duty, and stratified training will help residents fulfill improvement and assure clinical safety. Residents from Beijing training base needed more clinical teaching based on their performance on the exam. Most residents passed the exam after training.

为了给住院医师提供更立体、进阶式的培养,北京协和医院内科自2017年起在病房开始推行分层小组培养模式.本文对分层小组培养模式的具体运行情况进行了调研,反馈结果 提示分层小组培养模式获得了带教主治医师和分层小组组长的普遍认可,是一种可行、有效、符合住院医师成长规律的培养模式.但主治医师与组长在实施过程中也存在部分担忧,其中教学双方如何把握临床带教中的自主性和监督性的平衡问题最为突出,提示资质分层准入原则、有针对性的组长岗前培训等可能是下一步推动制度细化的重点.

目的:探析口腔种植牙术后肿胀疼痛采取新癀片进行治疗的效果及对炎性因子的影响.方法:选取2015年1月至2019年12月北京中医药大学东直门医院收治的口腔种植牙术后肿胀疼痛患者300例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组150例,对照组采用红霉素治疗,观察组采用新癀片联合红霉素治疗,比较2组患者术后肿胀和术后疼痛持续时间、牙槽骨吸收量、种植牙功能、种植体唇侧骨厚度、周围边缘骨吸收量、炎性反应因子水平、治疗优良率等指标.结果:与对照组比较,观察组术后肿胀持续时间、术后疼痛持续时间明显较短(P<0.05);观察组种植牙功能评分等明显高于对照组(P<0.05);观察组种植体唇侧骨厚度、周围边缘骨吸收量与对照组比较有明显差别(P<0.05);观察组CPR、IL-6、PCT等炎性反应因子水平明显较低(P<0.05);观察组治疗总有效率明显高于对照组(P<0.05).结论:口腔种植牙术后肿胀疼痛应用新癀片进行治疗,能获得较为理想的效果,改善炎性反应因子水平,有着极大的推广价值.

Objective To identify the correlation of medical residency evaluations and Objective structured clinical examination (OSCE) scores. Methods In 2015, 53 participants for standardized medical residency training at Peking Union Medical College Hospital were included. Before entering the program, every participant took a multi-station OSCE. Each month during training, they were given a comprehensive assessment from their supervisors. An annual score was calculated at the end of the first year. The correlation between two abovementioned scores was examined. Results Participants with longer medical education tended to score higher in OSCE. The correlation coefficient between OSCE and annual evaluation score is 0.68(P＜0.01), showing high correlation. In each station, the correlation coefficient between the annual evaluation score and that of computer-based examination, history taking, medical record writing was greater than 0.4. Conclusions OSCE before entering training may predict performance during the residency training thus can be used as an important indicator for residents' stratification and multilevel training.

目的 在住院医师规范化培训广泛开展的大环境下,北京协和医院内科采取模拟教学模式进行新的探索.方法 在内科规培住院医师中进行了问卷调查,并设计模拟教学针对部分学员进行了重症病例模拟培训.结果 内科规培学员重症病例暴露较少,对提高值班能力的教学内容较为期待.目前已建立内科重症病例模拟教学机制,初步运行效果良好.结论 在内科住院医师规培中应用模拟教学将有助于提高培训水平.

目的 进一步改进和完善北京协和医院内科临床博士后课程设置.方法 参加2017年内科临床博士后课程的学员对课程进行反馈;参加学期中和学期末的多次考核;收集和分析考核与反馈结果.结果 共50名学员参加博士后课程,包括博士后学员14人,非博士后学员36人.学员类型是影响历次考核的主要因素,出勤率也对部分阶段考核产生显著影响.博士后课程整体设置合理,根据学员反馈的意见进行相应调整和完善.结论 内科临床博士后课程的授课、考核和反馈过程,可有效了解学员对医学知识技能的掌握情况.通过反馈改善课程设置、提高教学质量,保证临床博士后项目及住院医师规范化培训项目顺利进行.

The clinical medical post-doctoral project is an elite post-graduation national project supported by Min-istry of Human Resources and Social Security and Health and Family Planning Commission .It is a new investiga-tion for elite medical education in new era.During the first academic year of launching this project in Peking Union Medical College Hospital ( PUMCH) , the department of internal medicine has continuously modified and developed the implementation of this project, including the setting of courses, teaching process, evaluation and feedback, basing on the feedback collecting from multiple dimensions during the process .These actions have boosted this project to be outstanding on the basis of the regular training program of residents , which has been es-tablished in the internal medicine department of PUMCH , and made it as an elite post-graduation medical educa-tion project.The process and experience of this project could provide reference for the implementation of similar projects in other teaching hospitals .

为深化内科住院医师规范化培训(住培),对不同教育背景的住院医师均有针对性的培训要求和计划,并达到分层培养的目的,北京协和医院内科创新尝试了在病房轮转时开展病房分层培养小组模式,并对初步试点结果进行了汇总、分析和思考.初步结果显示:病房分层培养小组具有一定的有效性和灵活性,病房带教主治医师多数持肯定态度,小组组长均认为个人能力得到更进一步的提升,尤其是临床决策能力、协调领导能力和统筹规划能力,而小组组员也均认为在小组中可以进一步的学习并在管理患者的能力方面取得了明显的提升.北京协和医院内科分层培养小组模式为住院医师提供更全面、更立体化的培训,为进一步提高住培质量提供借鉴,但在运行过程中还存在一些问题,运行规则也需要进一步探索.

Objective To investigate the current situation of empathy and self-efficacy, and relation with perform-ance of objective structured clinical examination in residents of standardized training. Methods Questionnaire sur-veys with Jefferson scale of empathy health professionals and general self-efficacy scale were conducted among resi-dents of grade 2015 and grade 2016 from department of internal medicine of Peking Union Medical College Hospital (PUMCH). Results Totally 101 questionnaires were delivered,and 99 were collected back. The average empathy score was 111.3±1.2,with that of grade 2015 slightly higher than that of grade 2016. The empathy score from resi-dents of different degree and different sources showed no significant difference. The average self-efficacy score was 22.77±0.50. The score of residents of grade 2015 was significantly higher than that of grade 2016. The score was higher in residents with higher degree. The score of residents from PUMCH was higher than the other subgroups. The score of empathy showed no significant correlation with OSCE scores, while the score of self-efficacy of resi-dents of grade 2015 significantly positively correlated with scores of medical recording (R=0.35,P<0.05),case analyzing (R=0.31,P<0.05) and average score(R=0.33,P<0.05) of OSCE. Conclusions The empathy and self-efficacy of residents remained to be improved, and could be improved through clinical training. Psychological evaluation could be inducted into standardized resident training system,and provide helpful supplementary to OSCE with more comprehensive evaluation of residents.

目的 将客观结构化临床考试(OSCE)应用于规范化培训住院医师的入科评估,全面评价住院医师的各项临床能力,以期发现弱点,利于后续开展针对性培训.方法 对2016年至2017年进入北京协和医院内科进行规范化培训的102名住院医师,在入科前设置6站式OSCE作为入科摸底考试,并对考试结果进行分析.结果 2016年至2017年OSCE总成绩均符合正态分布.在病史采集站及总成绩方面,2017年对比2016年考生成绩有显著提高(P<0.05).2017年基地规培住院医师在各考站及总成绩的平均分数均优于并轨硕士研究生,但除体格检查考站外.结论 将OSCE应用于规范化培训住院医师的入科考试的总体设计是成功的.该考试能够全面评估不同来源住院医师的临床能力及弱点,对于后续的规范化培训具有一定指导意义.

Objective: To assess the value of internal medicine residency training program at Peking Union Medical College Hospital (PUMCH), and the feasibility of applying revised Milestones evaluation system. Methods: Postgraduate-year-one to four (PGY-1 to PGY-4) residents in PUMCH finished the revised Milestones evaluation scales in September 2017. Residents' self-evaluation and faculty-evaluation scores were calculated. Statistical analysis was conducted on the data. Results: A total of 207 residents were enrolled in this cross-sectional study. Both self and faculty scores showed an increasing trend in senior residents. PGY-1 residents were assessed during their first month of residency with scores of 4 points or higher, suggesting that residents have a high starting level. More strikingly, the mean score in PGY-4 was 7 points or higher, proving the career development of residency training program. There was no statistically significant difference between total self- and faculty-evaluation scores. Evaluation scores of learning ability and communication ability were lower in faculty group (t=-2.627, -4.279, all P<0.05). The scores in graduate students were lower than those in standardized training residents. Conclusions: The goal of national standardized residency training is to improve the quality of healthcare and residents' career development. The evaluation results would guide curriculum design and emphasize the importance and necessity of multi-level teaching. Self-evaluation contributes to the understanding of training objectives and personal cognition.

住院医师规范化培训(简称住培)已在全国全面开展,我们注意到无论是全国还是北京市,内科住院医师规范化培训计划[1-2]均以病房为主要培训地点,门诊并未被纳入必须轮转计划中.北京协和医院内科作为我国住培的先行者,开展住培已有近百年历史[3],早年有相对完善的住院医师门诊,后来由于种种原因住院医师不再常规轮转门诊.由于门诊是临床教学不可缺少的场所,协和内科从2017年起努力恢复住院医师教学门诊,派专人作为指导老师带教教学门诊.

目的：使用文本挖掘方法分析医学生对临床带教老师开放式文本评价数据，建立新的教学评价方案。方法对1084份实（见）习学生对临床带教老师主观描述性评价资料，根据统计软件R中Rwordseg包进行分词，把文字转化成可以量化的指标，设计算法和程序，建立教学评价指标，对临床带教工作进行评分。结果有效评价的字数呈现幂律分布特征，评价用词反映了学生对教学指导的倾向性。综合得分≥6.82，6.82＞综合得分＞6.13，及综合得分≤6.13分别表示高质量、中等质量和低质量的临床带教工作。结论采用文本挖掘方法可以科学、准确评价临床带教工作，为临床带教老师考核提出新的方法。

Objective To establish a new competency based evaluation and feedback system, which can evaluate real-time how the residents perform and get feedbacks for improvement .Methods Based on the situation and re-quirements of standard resident training in China , and learn from experiences of other countries, we designed a new progressive evaluation and feedback system, and use the system to evaluation 6 clinic post-doctors in internal medicine department who graduate in 2016.Results This evaluation and feedback system not only reflect a total score of each resident evaluated, but also show advantages and weakness in each competency.Conclusions To implement this progressive evaluation and feedback system into the process of standard resident training can provide a feasible way to formatively and progressively evaluation residents and help them to improve , which is of critical importance.

总住院医师制度是医院人才培养的重要环节.内科总住院医师身处医疗、教学第一线,可以在医疗、教学、管理等方面全面促进住院医师的素质提高.坚持并加强总住院医师制度在内科住院医师规范化培训中的作用,对规范化培训的成功有重要意义.

Using objective structuned clinical exammation ,OSCE to access a new resident standardized training , analyze the result and perform stratifying management and teaching based on the result , which may improve the effi-ciency and effectiveness of resident standardized training .