Regional Hospital Viborg, Heiberg Alle 4, DK-8800 Viborg, Denmark.
BMC Med Educ. 2010 Jun 18;10:46. doi: 10.1186/1472-6920-10-46.
Many countries have recently reformed their postgraduate medical education (PGME). New pedagogic initiatives and blueprints have been introduced to improve quality and effectiveness of the education. Yet it is unknown whether these changes improved the daily clinical training. The purpose was to examine the impact of a national PGME reform on the daily clinical training practice.
The Danish reform included change of content and format of specialist education in line with outcome-based education using the CanMEDS framework. We performed a questionnaire survey among all hospital doctors in the North Denmark Region. The questionnaire included items on educational appraisal meetings, individual learning plans, incorporating training issues into work routines, supervision and feedback, and interpersonal acquaintance. Data were collected before start and 31/2 years later. Mean score values were compared, and response variables were analysed by multiple regression to explore the relation between the ratings and seniority, type of hospital, type of specialty, and effect of attendance to courses in learning and teaching among respondents.
Response rates were 2105/2817 (75%) and 1888/3284 (58%), respectively. We found limited impact on clinical training practice and learning environment. Variances in ratings were hardly affected by type of hospital, whereas belonging to the laboratory specialities compared to other specialties was related to higher ratings concerning all aspects.
The impact on daily clinical training practice of a national PGME reform was limited after 31/2 years. Future initiatives must focus on changing the pedagogical competences of the doctors participating in daily clinical training and on implementation strategies for changing educational culture.
最近，许多国家改革了其研究生医学教育（PGME）。为了提高教育质量和效果，已经引入了新的教学举措和蓝图。然而，尚不清楚这些变化是否改善了日常临床培训。本研究旨在考察国家 PGME 改革对日常临床培训实践的影响。
丹麦的改革包括根据以能力为基础的教育原则（CanMEDS 框架）改变专科教育的内容和形式。我们对北丹麦地区的所有医院医生进行了问卷调查。问卷包括教育评估会议、个人学习计划、将培训问题纳入工作常规、监督和反馈以及人际关系等项目。在改革开始前和 31/2 年后收集数据。比较平均得分值，并通过多元回归分析响应变量，以探讨评分与资历、医院类型、专科类型以及受访者参加学习和教学课程的效果之间的关系。
响应率分别为 2105/2817（75%）和 1888/3284（58%）。我们发现对临床培训实践和学习环境的影响有限。评分的差异几乎不受医院类型的影响，而与其他专科相比，属于实验室专科与所有方面的评分较高有关。
在 31/2 年后，国家 PGME 改革对日常临床培训实践的影响有限。未来的举措必须侧重于改变参与日常临床培训的医生的教学能力，并实施改变教育文化的策略。
