发表病例报告对中国住院医师专业发展的价值:一项定性研究。
The value of publishing case reports for the professional development of Chinese residents: a qualitative study.
作者信息
Yang Zhihui, Chen Wen, Li Ruoyu, Wang Xiaowen, Yao Mi
机构信息
Department of Dermatology and Venerology, Peking University First Hospital, No.8 Xishiku Street, 100034, Beijing, China.
National Clinical Research Center for Skin and Immune Diseases, Beijing, China.
出版信息
BMC Med Educ. 2025 Jul 1;25(1):933. doi: 10.1186/s12909-025-07459-2.
BACKGROUND
In comparison with high-income countries, medical education resources in low- and middle-income countries (LMICs), such as China, are severely lacking. In China, residents' clinical work is characterized by extensive demands and mechanized approaches, resulting in a paucity of opportunities for active thinking and learning during clinical rotations. Moreover, these residents lack the time and experience necessary for scientific research training. However, these countries possess a wealth of case resources, including numerous classical and complex cases that hold significant teaching and publication value. The effective utilization of this advantage and the integration of case reporting as a distinctive graduate medical education (GME) platform remain to be explored.
METHODS
The study was conducted between September 2023 and March 2024 in Beijing, China. Purposive sampling was used to recruit 15 residents who were in the first or second stage of standardized residency training and had successful experience in publishing case reports. Semi-structured in-depth interviews were conducted on a one-on-one basis to explore the role of case reports in the professional development of residents in LMICs. Thematic analysis was employed to analyze the data.
RESULTS
Of the 15 participants, 3 were male and 12 were female, with an average age of 27.2±2.6 years. 12 subthemes were extracted, from which 5 themes were identified, including clinical professional competency, scientific research competency, collaborative and communicative competency, sources of pressure and implementation evaluation. In terms of clinical competency, publishing case reports can increase residents' basic medical knowledge reserve, practical ability of diagnosis and treatment, and self-learning in daily clinical practice. In terms of scientific research competency, the case report can guide young residents to commence their academic careers, improve academic writing skills and strengthen their initiative in scientific research. Furthermore, it has been demonstrated that case reports can enhance awareness and skills in multidisciplinary collaborations, as well as communication with patients, supervisors and journal editors/reviewers. Heavy clinical responsibilities during residency training are common external pressures while anxiety is a common internal pressure during case report writing. Feasible aspects of integrating case report training into GME in LMICs include the relatively low time commitment and abundant case resources. However, challenges include inconsistent training and assessment standards.
CONCLUSIONS
It is suggested that case report training be specially integrated into GME in LMICs with sufficient valuable case resources and capacity to manage complex cases, based on the value of case report experience in the career development of residents and the current situation of medical education in these countries.
背景
与高收入国家相比,中国等低收入和中等收入国家(LMICs)的医学教育资源严重匮乏。在中国,住院医师的临床工作特点是需求广泛且方式机械化,导致临床轮转期间积极思考和学习的机会匮乏。此外,这些住院医师缺乏科研培训所需的时间和经验。然而,这些国家拥有丰富的病例资源,包括众多具有重要教学和发表价值的经典和复杂病例。如何有效利用这一优势并将病例报告整合为一个独特的毕业后医学教育(GME)平台仍有待探索。
方法
该研究于2023年9月至2024年3月在中国北京进行。采用目的抽样法招募了15名处于标准化住院医师培训第一或第二阶段且有发表病例报告成功经验的住院医师。进行一对一的半结构化深入访谈,以探讨病例报告在低收入和中等收入国家住院医师专业发展中的作用。采用主题分析法对数据进行分析。
结果
15名参与者中,男性3名,女性12名,平均年龄27.2±2.6岁。提取了12个次主题,从中确定了5个主题,包括临床专业能力、科研能力、协作与沟通能力、压力来源及实施评估。在临床能力方面,发表病例报告可增加住院医师的基础医学知识储备、诊断和治疗实践能力以及日常临床实践中的自我学习能力。在科研能力方面,病例报告可引导年轻住院医师开启学术生涯,提高学术写作技能并增强其科研主动性。此外,已证明病例报告可提高多学科协作意识和技能,以及与患者、上级医师和期刊编辑/审稿人的沟通能力。住院医师培训期间繁重的临床职责是常见的外部压力,而撰写病例报告时的焦虑是常见的内部压力。在低收入和中等收入国家将病例报告培训整合到毕业后医学教育中的可行方面包括所需时间相对较少和病例资源丰富。然而,挑战包括培训和评估标准不一致。
结论
基于病例报告经验在住院医师职业发展中的价值以及这些国家的医学教育现状,建议在有足够宝贵病例资源和管理复杂病例能力的低收入和中等收入国家,将病例报告培训专门整合到毕业后医学教育中。
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