目的 探讨诊断学床旁见习教学中学患关系现状，为提高诊断学床旁教学质量提供应对策略。 方法 采用自行设计问卷，于2010年5月-2011年6月对80名临床医学专业三年级本科生以及同期在内科住院的100例患者分别进行不署名学患关系问卷调查（有效问卷率分别为91.3%和67%），同时对8名带教教师和7名临床主管医生进行个别访谈。 结果 学生问卷调查显示，79.5%的学生曾在床旁教学中遭遇患者不同程度的拒绝或不配合，大多数学生认为有被拒的心理准备和承受力。患者调查显示，82.1%的患者不愿意接受学生问诊查体，58.2%的患者表示即便给予一定经济补偿，也不愿配合教学。而对带教教师及临床主管医师访谈结果显示，当前床旁带教难度大大增加，学患关系紧张。 结论 现阶段学患关系紧张，根据其涉及原因，提出提升医务人员及医学生人文观念，推进医疗、教育体制改革，建立媒体监督机制，开展公众教育等多层面的应对策略，同时提出课程设置、教学模式、师资培养等具体教学应对举措。Objective To explore the present status of the relationship between students and patients in diagnostic bedside teaching, in order to promote the teaching quality. Methods From May 2010 to June 2011, self-made questionnaires were adopted to carry out an anonymous survey among 80 medical students in grade three or above and 100 inpatients to investigate the relationship between the students and the patients(with an effective questionnaire rate of 91.3% and 67% respectively). Eight tutors and 7 physicians concerned were taken in the individual interview. Results The survey showed that 79.5% of the students encountered refusal from patients in bedside teaching, and most of them believed that they had psychological preparation and endurance for the refusal. A total of 82.1% of the patients expressed their unwillingness to accept examination by clinical students, and 58.2% of the patients were unwilling to cooperate in the teaching even with an amount of economic compensation. The tutors and physicians concerned stated that the student-patient relationship was undesirable at present. Conclusions The relationship between students and patients in bedside teaching is strained at present. Based on the complicated reasons, we propose such coping strategies as promoting humanism among medical workers and students, pushing forward the medical and educational reform, building media supervision, developing public education, perfecting course design, teaching style, and cultivation of teachers, and so on.
Objective To investigate the decision-making situation of doctors in the township hospitals in Gaolan, Gansu province, and to discuss its scientificity and rationality. Methods Self-designed questionnaire was adopted to investigate the clinical decision-making situation of 108 doctors from 7 township hospitals in Gaolan county. The investigation contained three parts as follows: basic information of respondents, general information of clinical decision-making evidence, and comparison between respondents’ decision-making situation and current best clinical evidence. Results Among the total 108 questionnaires distributed, 89 valid were retrieved. The feedback showed that 79% of the doctors diagnosed and treated patients in accordance with medical textbooks; 53% took curative effect into consideration in the first place; 33% failed to consider patients’ willingness properly when making clinical decisions; and 52% made clinical therapy regimen for common diseases based on the evidence which was different from that in BMJ published Clinical Evidence. Conclusion While making clinical decisions, doctors in the township hospitals do not adequately refer to the best clinical evidence as their decision-making basis, and fail to take patients’ value and willingness into consideration properly. It is necessary to promote the concept of evidence-based medicine and spread the best evidence in the township health departments.
Objective By investigating the employment situation and intentions of medical students, to provide scientific evidence for guiding students’ employment by relevant departments, and to give references for formulating reasonable medical personnel training and distribution policy by health administrations. Methods The medical students of Grade 2005 in Lanzhou University were investigated by using a self-designed questionnaire. Results Among 397 questionnaires distributed, 337 were returned (84.8%). The analyses showed, when hunting a job, 45% of the respondents thought the “opportunities for personal development” was the most important factor, 61% thought the influence of parents’ or family’s desires was “greater” or “extremely greater”, 85% thought the job matching their majors was “important” or “very important”, 57% thought it is “easier” to get a content job by their majors, 51% held that the “fewer opportunities” were the most unfavorable conditions for working in township hospitals, 68% wouldn’t directly choose township hospitals after graduation, and 67% still gave up the choice even if an official position was provided. Conclusion The medical students attach great importance to the opportunities for their personal development, but they lack self-consciousness in choosing the occupation. They are optimistic about the employment but lack passion for primary hospitals. Meanwhile, they aren’t familiar with national policy guidance; their employment fields are narrow.
Objective To investigate the villagers’ cognitive degree of health knowledge in Gaolan county, Gansu province, so as to explore new methods to promote health education and spread health knowledge in rural areas. Methods Through non-random sampling methods, the questionnaires were distributed to the residents in Shagang village, Manwan village and Yanzi village, and the data were then statistically analyzed by using Epidata 3.1 and Excel 2003 softwares. Results A total of 290 questionnaires were distributed and retrieved with 100% valid rate. Only 23% of the surveyed had physical examination in the last one year; 75% thought they were lack of health knowledge; 92% would like to obtain health knowledge in regular; 86% thought lack of health knowledge was the reason of their or their relatives’ diseases; 74% obtained health knowledge by watching TV; 59% went to their village clinic first when suffering from mild symptoms of common diseases; and only 6% did exercises in their leisure time. Conclusion Most people in rural areas don’t pay enough attention to their health condition and are lack of high-quality health knowledge resources as well as consciousness of physical training. So it is not only necessary to strengthen health education, but also urgent to promote physical and mental health education in rural areas.
Objective To investigate the reading habits of authors of articles published in the Chinese Journal of Evidence-Based Medicine (CJEBM) and to compare the findings with those from other surveys. Methods A total of 512 questionnaires were sent to authors who had contributed to CJEBM over the past 7 years. Results A total of 129 questionnaires were returned (response rate 31.6%). The replies showed that the main purpose of reading literature was to keep up with the latest developments in medicine (94% of replies). The main reading material was medical journals (86%). Most respondents (57%) spent more than 3 hours a week reading journals. The biggest problem identified by authors was the lack of full text papers, but the first choice was the electronic versions of the literature. More than half of the authors (57%) said that they spent less time reading than in the past. Conclusion Effective reading of the medical literature is a basic requirement in the practice of evidence-based medicine. It is necessary and important for clinicians and healthcare providers to improve their reading skills and methods.
Objective To investigate the knowledge level about pulmonary rehabilitation in respiratory physicians in Shanghai. Methods A self-designed questionnaire about pulmonary rehabilitation was sent to respiratory physicians in 18 tertiary-care referral hospitals of Shanghai from June to September 2011. Results A total of 237 valid questionnaires were collected. Accuracy rate of single-answer questions was(62.1±18.3)% , while correct rate of multiple-answer questions ( more than one answer) was ( 35.5±15.6) % . Neither working years nor doctor rank had correlation with accuracy of questionnaires. Conclusion The knowledge about pulmonary rehabilitation in respiratory physicians of Shanghai was poor. We need to strengthen the relevant training and continuing education.
ObjectiveTo investigate primary healthcare workers' knowledge, attitude and behaviour, and explore the way of guidelines' popularization, application and surveillance mechanism in primary healthcare institutions. MethodsHealthcare workers in seven township hospitals in Gaolan county, Gansu province were given a questionnaire to test their knowledge, attitudes and behaviour regarding Clinical practice guidelines. ResultsAmong the 143 distributed questionnaires, 143 valid were retrieved. The results showed that 80% of respondents knew the guidelines and 51% had used guidelines in treatment, 32% obtained guidelines mainly through distribution by affiliations. The most popular type of guidelines was self-developed by native departments. Respondents (37%) considered difficult availability of guidelines major barriers to popularization, 74% failed to receive training about guidelines, 88% looked forward to special organizations in charge of disseminating guidelines and conducting related training on how to apply guidelines. ConclusionPrimary healthcare workers report low awareness of, attention to and compliance with clinical practice guidelines. The greatest challenge for guidelines' popularization in township hospitals is difficult availability and it is of vital importance for primary institutions to enhance guidelines' implementation and strengthen learning and conduct training.
ObjectivesTo investigate Chinese health practitioners’ usage and demand for clinical practice guidelines in general so as to improve the development and implementation of guidelines.MethodsWe conducted a cross-sectional questionnaire survey that covered health practitioners from different levels of medical institutions in 17 provinces in China. Attitudes, adherence, usage barriers and demands for clinical practice guidelines were investigated.ResultsA total of 953 health practitioners were involved in the survey in which 931 completed the questionnaires. Respondents generally held positive attitudes toward guidelines and agreed that they improved quality of care and standardized diagnosis and treatment. More than 80% of the respondents reported a fine adherence to guidelines. The most reported barriers to follow the guidelines were " several guidelines are competing” and " lack of facilities and medical resources”. Most respondents agreed that it was necessary to establish a national guideline database, appraise implementation effect of guidelines, develop evaluation tools for guidelines that are applicable for Chinese clinical practice, and provide guidelines training.ConclusionsThis study finds favorable attitudes and fine adherence towards clinical guidelines in general in China. However, internal barriers, such as authority of guidelines, and external barriers, such as supplying system and patients’ preference, can affect guideline dissemination and implementation. It is suggested that establishing a national guidelines database, developing evaluation tools for guidelines that fit for Chinese clinical practice, and provision of guideline training, would facilitate the use of guidelines.
ObjectiveTo investigate the problems in the use of quick-drying hand disinfectants and formulate intervention measures to improve the hand hygiene compliance of nursing staff.MethodsFrom February 2014 to June 2016, the hand hygiene compliance of nursing staff was continuously observed according to the hand hygiene observation table recommended by the World Health Organization. The questionnaire on the use of quick-drying hand disinfectants, which passed the reliability and validity test, was used to find out the reasons leading to the low compliance rate of hand hygiene among nurses, and pertinent interventions were formulated. From November 2016 to December 2017, intervention measures were gradually implemented throughout the hospital, and the hand hygiene compliance of nursing staff was continuously observed again. Then we compared the compliance rate of hand hygiene and the compliance rate of hygienic hand disinfection among nurses in the second quarter of 2016 (before intervention) with those in the last quarter of 2017 (after intervention).ResultsThe compliance rates of hand hygiene and hygienic hand disinfection among nurses before intervention were 62.15% and 49.77%, respectively, and those after intervention were 91.64% and 90.80%, respectively. The differences were statistically significant (P<0.05).ConclusionThe factors affecting the hand hygiene compliance of nursing staff are identified through questionnaires and targeted intervention measures have effectively improved the hand hygiene compliance rate of nursing staff.
ObjectiveTo explore the present national status of diagnostic teaching as well as to investigate the opinions on teaching operation such as overall course planning, so as to provide references for the formulation of national diagnostic teaching standard in the future.MethodsSelf-made questionnaires were adopted to carry out an anonymous survey among the teachers from 50 different medical colleges and universities who worked on diagnostic teaching throughout the country from October 2016 to September 2017.ResultsA total of 100 teachers were investigated. The diagnostic teaching departments where 59 respondents worked in were formed by a few fixed teachers plus teachers in rotation. The requirement of rotation time as well as the setting up of lecture-internship ratio in each school were quite various. Forty-seven respondents agreed that the ideal lecture-internship ratio should be internship more than lecture. As for the instruments of clinical skill room, only 40% of the respondents agreed that their diagnostic departments were equipped with a steady standardized patient (SP) team, which was also the reason why SP teaching was the least utilized teaching method during internship (47%). The respondents had various opinions on whether the final exam should weigh more than 50% in the subject score. Above these, the planning and expectations of the respondents on diagnostic course were mostly in consensus.ConclusionsThe development of diagnostic course including teaching staff, teaching content and teaching condition, etc. among each medical colleges and universities was not balanced. It’s quite necessary to formulate a unified and reasonable standard to normalize the teaching staff constitution, teaching planning and set-up as well as teaching condition so as to guarantee the teaching quality.