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海外进修:究竟学什么,怎么学?

2015-08-06 许茂怡整理 中国医学论坛报

对国内大部分医生来说,在职业生涯中书写一笔海外进修经历早已不再是难事。那么应该如何规划与准备,以最大化海外进修的收获呢?本报邀请6位中美心脏科专家和相关领域人士畅谈这一话题,看看“过来人”的经验能否为我们提供一些借鉴。 医生海外进修:中国医疗发展之必然 从事中美医生进修和交流工作已超过15年的蓝莉女士指出,21世纪生命科学以惊人速度向前发展,医学专业已是人才需求量最大的10大行业之一。我国医疗

对国内大部分医生来说,在职业生涯中书写一笔海外进修经历早已不再是难事。那么应该如何规划与准备,以最大化海外进修的收获呢?本报邀请6位中美心脏科专家和相关领域人士畅谈这一话题,看看“过来人”的经验能否为我们提供一些借鉴。

医生海外进修:中国医疗发展之必然

从事中美医生进修和交流工作已超过15年的蓝莉女士指出,21世纪生命科学以惊人速度向前发展,医学专业已是人才需求量最大的10大行业之一。我国医疗卫生事业近年来发生巨大变化:新政策方针相继出台;国内外医院合纵连横;新医疗技术、理论方法层出不穷。

为适应变化,医院发展必须依赖高素质、高质量专业技术人才,才能综合提升医院核心竞争力和可持续发展潜力,最终造福患者。因此,高层次临床和管理人才的重点培养是中国医院未来发展重要之策。医生个人也只有抓住机遇不断突破自我,才能拥有更广阔职业发展空间。

在此背景下,医生海外进修成为医疗发展之必然。成功的海外进修还将拓展海内外医院交流与合作。

进修途径各取所需

高磊医生总结,目前中国医生海外进修一般有3种方式,可各取所需。

参加国际会议对高水平医生来说,一周左右的国际会议是很好的交流学习机会。医生可在浓缩的会议日程中亲身感受国际顶尖医学概念与技术,接触最前沿医学发展,与来自全球各地的同道,甚至领域内巨擘面对面交流。但这种进修方式可能被很多国内医生忽略了。

在国外实验室进行基础研究以“访问学者”身份短期就职于国外研究机构是较为常见的海外进修方式,占70%~80%。

这种方式的“流行”存在客观因素。一方面,中国医生在国外一般没有直接接触患者的权利,做基础研究则限制较少。另一方面,在国外实验室的科研经历对国内医生职业发展非常有利。中国医生晋升体制对科研产出有硬性要求,在国外进行1年左右基础研究的医生一般可以成功发表1~2篇学术论文,这是授之以“鱼”;在国外实验室学到的科研方法、技术、英文论文写作与发表技巧,对回国之后开展科研工作也非常有利,这是授之以“渔”。

在国外医院观摩学习通过这种方式,进修医生可进入国外医院科室,参与其所有会议、学术交流,观摩手术全过程等等。这有助于医生掌握一门实实在在的临床技术。在国外医院的耳濡目染也有利于先进医学思维的培养。

蓝莉女士补充,无论选择哪种途径都要把握最佳时机。访问学者项目最好在40岁之前完成。3~6月短期进修最佳时机为35~40岁、副高级别阶段,因为该阶段医生从业经验成熟,需要更多机会、更优质环境实现自我突破。

进修内容有的放矢

诊疗规范化高磊医生指出,中国医院间实力悬殊,诊疗规范化程度不一,因此国内医生发展可谓“多大的庙,多大的佛”。而美国医生无论在培训还是临床诊疗方面都已“标准化”,因此很少参与以缩短专业差距为目的的进修,其继续教育一般针对前沿技术,以取得使用新技术的资格为目的。

但高端技术绝非中国医生海外进修重点。首先,新技术学无止境。其次,国内三甲医院与美国医院在医疗技术和硬件设施方面差距并不大,并且目前国内设有不少前沿技术临床试验点,中国医生无需远赴海外就可学习。

国内最需要的是“接地气”的诊疗规范化执行。目前国内不少医院已开始提倡针对不同疾病的规范化“临床路径”。高磊医生认为这是非常正面的进步,希望可以逐渐落实。

医疗思维医疗思维涉及方方面面内容,其培养需要潜移默化。高磊医生以“平等”思维为例,指出国内的三级医师查房制度对医生严格的等级划分扼杀了很多青年医生的主观能动性。“实际上,很多刚结束培训的医生也许在知识的更新上赶超高资历医生”。

蒲岷教授表示同意以上观点。虽然三级医师查房制度可以保证每位患者的治疗都有高资历的医生把关,但美国主治医生(attending physician)制度赋予年轻医生更多自主权,有助于激发其责任心、积极性、主动性、以及独立思考能力。

蒲岷教授还特别强调美国医疗思维中“创造性”思维。以科研为例,提出问题、设计课题、开展科研、提出见解都是比较高层次的能力,需要一定创造力和独立思考能力,而不仅仅是知识与技能上的积累。

这也许和中美整体科研环境有关系。美国学者一般手握一两个项目,基于小规模资料和数据,通过透彻思考,尝试理论建设,比较“敢想、敢做、敢思维”。中国研究者则倾向于收集大规模数据,加以统计分析,建立循证依据,但在理论建设方面则较弱。

探索更多可能高磊医生还指出,海外进修医生应充分利用好时间,最大化科研、临床和人脉三方面收获。

以访问学者项目为例,在基础研究之外,进修医生应尽量多参加学术会议,寻找临床观摩学习的机会、与当地医生学者建立合作关系。这为日后的交流合作、甚至下一代医生的联合培养,打开了无限可能。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1748901, encodeId=3c641e48901e0, content=<a href='/topic/show?id=e4d6655811a' target=_blank style='color:#2F92EE;'>#海外#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65581, encryptionId=e4d6655811a, topicName=海外)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82fd36209189, createdName=lishizhe, createdTime=Thu May 26 15:51:00 CST 2016, time=2016-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=38187, encodeId=4e273818e40, content=这篇文章写得很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Oct 08 16:34:00 CST 2015, time=2015-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35191, encodeId=36d83519110, content=扯淡的政策, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=126b110623, createdName=ndd99, createdTime=Fri Aug 07 09:55:00 CST 2015, time=2015-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34984, encodeId=e25934984a4, content=这篇文章很有价值, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34986, encodeId=de963498667, content=我从中学习到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34987, encodeId=4e5c3498ea8, content=看看“过来人”的经验能否为我们提供一些借鉴。, beContent=null, objectType=article, channel=null, level=null, likeNumber=141, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=)]
    2016-05-26 lishizhe
  2. [GetPortalCommentsPageByObjectIdResponse(id=1748901, encodeId=3c641e48901e0, content=<a href='/topic/show?id=e4d6655811a' target=_blank style='color:#2F92EE;'>#海外#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65581, encryptionId=e4d6655811a, topicName=海外)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82fd36209189, createdName=lishizhe, createdTime=Thu May 26 15:51:00 CST 2016, time=2016-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=38187, encodeId=4e273818e40, content=这篇文章写得很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Oct 08 16:34:00 CST 2015, time=2015-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35191, encodeId=36d83519110, content=扯淡的政策, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=126b110623, createdName=ndd99, createdTime=Fri Aug 07 09:55:00 CST 2015, time=2015-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34984, encodeId=e25934984a4, content=这篇文章很有价值, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34986, encodeId=de963498667, content=我从中学习到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34987, encodeId=4e5c3498ea8, content=看看“过来人”的经验能否为我们提供一些借鉴。, beContent=null, objectType=article, channel=null, level=null, likeNumber=141, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=)]
    2015-10-08 hlycom3356

    这篇文章写得很好

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1748901, encodeId=3c641e48901e0, content=<a href='/topic/show?id=e4d6655811a' target=_blank style='color:#2F92EE;'>#海外#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65581, encryptionId=e4d6655811a, topicName=海外)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82fd36209189, createdName=lishizhe, createdTime=Thu May 26 15:51:00 CST 2016, time=2016-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=38187, encodeId=4e273818e40, content=这篇文章写得很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Oct 08 16:34:00 CST 2015, time=2015-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35191, encodeId=36d83519110, content=扯淡的政策, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=126b110623, createdName=ndd99, createdTime=Fri Aug 07 09:55:00 CST 2015, time=2015-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34984, encodeId=e25934984a4, content=这篇文章很有价值, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34986, encodeId=de963498667, content=我从中学习到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34987, encodeId=4e5c3498ea8, content=看看“过来人”的经验能否为我们提供一些借鉴。, beContent=null, objectType=article, channel=null, level=null, likeNumber=141, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=)]
    2015-08-07 ndd99

    扯淡的政策

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1748901, encodeId=3c641e48901e0, content=<a href='/topic/show?id=e4d6655811a' target=_blank style='color:#2F92EE;'>#海外#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65581, encryptionId=e4d6655811a, topicName=海外)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82fd36209189, createdName=lishizhe, createdTime=Thu May 26 15:51:00 CST 2016, time=2016-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=38187, encodeId=4e273818e40, content=这篇文章写得很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Oct 08 16:34:00 CST 2015, time=2015-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35191, encodeId=36d83519110, content=扯淡的政策, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=126b110623, createdName=ndd99, createdTime=Fri Aug 07 09:55:00 CST 2015, time=2015-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34984, encodeId=e25934984a4, content=这篇文章很有价值, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34986, encodeId=de963498667, content=我从中学习到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34987, encodeId=4e5c3498ea8, content=看看“过来人”的经验能否为我们提供一些借鉴。, beContent=null, objectType=article, channel=null, level=null, likeNumber=141, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=)]
    2015-08-06 hlycom3356

    这篇文章很有价值

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1748901, encodeId=3c641e48901e0, content=<a href='/topic/show?id=e4d6655811a' target=_blank style='color:#2F92EE;'>#海外#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65581, encryptionId=e4d6655811a, topicName=海外)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82fd36209189, createdName=lishizhe, createdTime=Thu May 26 15:51:00 CST 2016, time=2016-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=38187, encodeId=4e273818e40, content=这篇文章写得很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Oct 08 16:34:00 CST 2015, time=2015-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35191, encodeId=36d83519110, content=扯淡的政策, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=126b110623, createdName=ndd99, createdTime=Fri Aug 07 09:55:00 CST 2015, time=2015-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34984, encodeId=e25934984a4, content=这篇文章很有价值, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34986, encodeId=de963498667, content=我从中学习到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34987, encodeId=4e5c3498ea8, content=看看“过来人”的经验能否为我们提供一些借鉴。, beContent=null, objectType=article, channel=null, level=null, likeNumber=141, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=)]
    2015-08-06 hlycom3356

    我从中学习到很多

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1748901, encodeId=3c641e48901e0, content=<a href='/topic/show?id=e4d6655811a' target=_blank style='color:#2F92EE;'>#海外#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65581, encryptionId=e4d6655811a, topicName=海外)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82fd36209189, createdName=lishizhe, createdTime=Thu May 26 15:51:00 CST 2016, time=2016-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=38187, encodeId=4e273818e40, content=这篇文章写得很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Oct 08 16:34:00 CST 2015, time=2015-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=35191, encodeId=36d83519110, content=扯淡的政策, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=126b110623, createdName=ndd99, createdTime=Fri Aug 07 09:55:00 CST 2015, time=2015-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34984, encodeId=e25934984a4, content=这篇文章很有价值, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34986, encodeId=de963498667, content=我从中学习到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34987, encodeId=4e5c3498ea8, content=看看“过来人”的经验能否为我们提供一些借鉴。, beContent=null, objectType=article, channel=null, level=null, likeNumber=141, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 21:58:00 CST 2015, time=2015-08-06, status=1, ipAttribution=)]
    2015-08-06 hlycom3356

    看看“过来人”的经验能否为我们提供一些借鉴。

    0

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