? Personal summary of hospital doctors' further study

? Time flies, fleeting. In a blink of an eye, half a year's study and life in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine has come to a successful conclusion. I cherish the short time of this half year. Because I know that this time the hospital sent me out to study, not only because of the needs of hospital business development, but also because of the full trust and ardent hope of hospital leaders, and I also regarded this study as a rare learning opportunity. Through this half-year study, I not only improved my professional and technical level, but also broadened my horizons and ideas, which benefited me a lot for life, and at the same time clearly felt my own shortcomings. Take this opportunity for further study and talk about some of my own experiences.

? The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine is a third-class comprehensive Chinese medicine hospital with the most complete clinical disciplines and the highest comprehensive service level in Southwest China, a national model Chinese medicine hospital and a construction unit of a national Chinese medicine clinical research base. It is also the National Clinical Experimental Research Center of Traditional Chinese Medicine (gcp), the National Ophthalmology Medical Center of Traditional Chinese Medicine, the National Emergency Medical Center of Traditional Chinese Medicine, the first aid clinical base of traditional Chinese medicine and integrated traditional Chinese and western medicine in state administration of traditional chinese medicine, and the clinical base of infectious diseases. My cardiovascular department is the cardiovascular base of the National Center for Clinical Trials of New Drugs and a key specialty of Chinese medicine in Sichuan Province. This department mainly adopts the method of combining traditional Chinese and western medicine to diagnose and treat various cardiovascular diseases. At the same time, it also carries out interventional therapy for coronary heart disease and structural heart disease, cardiac electrophysiological examination and various pacemaker implantation.

? Over the past six months, under the careful guidance of substitute teachers, I have mastered the diagnosis and treatment of various common and frequently-occurring diseases of cardiovascular system, such as hypertension, coronary heart disease, arrhythmia, heart failure, myocarditis, cardiomyopathy and valvular disease. , and have a certain familiarity and mastery of the treatment and rescue process of various critical diseases in ccu Cardiovascular Department; He has also mastered the methods, skills, key points of physical examination and accurate and reasonable application of conventional drugs for cardiovascular diseases, and can independently complete the operation of ECG machine, master the key points of reading ECG and issue accurate reports; At the same time, coronary angiography and stent implantation, permanent pacemaker implantation, cardiac electrophysiological examination, radiofrequency ablation and other interventional treatments were also observed and studied.

? In the process of further study, I was not only impressed by their superb medical technology, but also deeply moved by their scientific and standardized department management, especially in the implementation of their core medical system. As the top three Chinese medicine teaching hospitals in southwest China, their three-level doctor rounds system is vividly reflected. My cardiovascular department is divided into three medical groups, all residents are attending above titles, and each medical group has a doctor with deputy director or above to make rounds every day, and the department director and deputy director make regular business rounds every Monday and Thursday; In addition to routine morning rounds, medical groups often organize afternoon rounds by themselves; In the process of rounds, they made a detailed analysis and comment on each patient's condition from the perspective of evidence-based medicine, so that every doctor who participated in rounds could "know why and why"; If the patient has other symptoms during the treatment, he will immediately invite the relevant departments for consultation; Every Monday, Wednesday and Friday is the time for them to carry out interventional therapy, and preoperative discussion is held on Tuesday and Thursday afternoon; Every Monday afternoon is the discussion time of death, and Wednesday afternoon is the discussion time of difficult and critical cases; Friday afternoon is the business study lecture time; They also pay special attention to the doctor-patient communication system. After each patient is admitted to the hospital, the attending doctor will personally write a doctor-patient communication record, recording the patient's condition and diagnosis, the proposed treatment plan and some possible complications during the treatment. Repeated communication with family members of critically ill patients during treatment; In addition to the routine consent form, patients treated by interventional surgery also have preoperative conversation record; In addition, the department also has a medical teaching secretary who is responsible for the quality of medical records and teaching arrangements.

? As a hospital of traditional Chinese medicine, the characteristic treatment of traditional Chinese medicine is one of their major characteristics. Chinese medicine treatment projects carried out by cardiovascular department generally include moxibustion, auricular point treatment, Chinese medicine foot bath, Chinese medicine collapse, acupuncture and other Chinese medicine treatment projects, the first three are mostly; Moxibustion treatment is to use the bought crown heart moxibustion, kidney-tonifying moxibustion, pain-relieving moxibustion and so on. Each patient was given a course of treatment (7 days) after admission; Auricular point therapy is your own. Their traditional Chinese medicine foot bath is the most common, and almost every patient will use it. This is because they have a strict proportion of Chinese herbal medicine decoction pieces (25% medicine), so they not only prescribe oral Chinese medicine to patients, but also carry out Chinese herbal medicine foot bath to improve the proportion of Chinese herbal medicine decoction pieces.

? As a department specializing in cardiovascular diseases, the high utilization rate of equipment in the department is another major feature of this department. Cardiovascular department has 80 beds, but there are more than 40 ECG monitors. Patients with heart failure and arrhythmia are routinely monitored by ECG, and patients are also routinely monitored by ECG for 2-3 days after interventional therapy. There is also a bedside Doppler ultrasound instrument in the department to carry out routine Doppler echocardiography examination on patients admitted to the hospital. In addition, the department also has a cardiac function examination room, which routinely carries out 24-hour ambulatory electrocardiogram, heart rate variability analysis and ambulatory blood pressure examination for patients with arrhythmia and hypertension. Every day, the 24-hour ambulatory ECG detector and ambulatory blood pressure monitor equipped in the department will be in short supply.

? Cardiac intervention and non-drug instrument therapy are the main trends in the treatment of modern cardiovascular diseases. The department has an interventional catheter room, equipped with advanced equipment such as digital subtraction angiography and Doppler echocardiography, which mainly carries out left and right cardiac catheterization and monitoring, coronary angiography, percutaneous coronary angioplasty and stent implantation, balloon dilatation of heart valves, and radiofrequency ablation of tachycardia (supraventricular tachycardia, atrial fibrillation, ventricular tachycardia, etc.). ), the placement of various pacemakers and interventional therapy of congenital heart disease have created considerable achievements for this technological innovation.

? In the performance appraisal of departments, taking the medical business income created by individuals as the standard, the principle of more work and more pay according to work is adopted to mobilize the enthusiasm of department personnel. At the same time, they take giving full play to the characteristics and advantages of traditional Chinese medicine and medical quality indicators as the main content, taking the quality of medical record writing, the implementation of core medical system, the qualified rate of TCM syndrome differentiation and treatment, the proportion of Chinese and western medicine, the rational use of four, the incidence of medical errors and participation in teaching activities as the assessment basis, and formulate comprehensive assessment rules for department personnel. The medical teaching secretary of the department evaluates the staff (doctors) of the department every month, which fully reflects the transparency and openness of the department management.

? In nursing work, they divided the nursing staff into two working groups, each with 1 nursing team leader. Each working group is divided into treatment group, office group, inspection group and mobile group. Qi Xin, from all groups, made concerted efforts to make the complicated nursing work go on in an orderly way.

? Through this half-year study, my professional and technical level has been greatly improved, but at the same time, I have deeply realized my own shortcomings and felt the obvious gap between primary hospitals and tertiary hospitals in software and hardware facilities. At that time, our hospital was establishing a second-class Chinese medicine hospital. I put forward the following humble opinions based on what I saw, felt and thought in the process of further study and the actual situation of inpatient internal medicine, hoping to promote the development of the department.

? 1, strictly implement the core medical system.

? Implementing the core medical system is an important measure to improve medical quality and ensure medical safety. In the process of routine business, we should strictly implement the core medical system such as ward round system, consultation system, discussion system of difficult and critical cases and discussion system of death cases. As far as the title structure of our hospital is concerned, the inpatient internal medicine department is fully capable of implementing the three-level doctor rounds system. However, it is difficult to implement the system of three-level doctor rounds because there are staff with the title of deputy director or above who undertake outpatient medical tasks every day. It is suggested to designate one morning every week as the rounds time of the deputy chief physician in the internal medicine business, and the deputy chief physician designated for rounds this morning should not undertake outpatient medical tasks.

? 2. Increase the hardware input of the department.

? The development of modern diagnosis and treatment technology not only needs excellent professional technical level, but also needs the investment of hardware facilities. Through the experience of further study, I deeply realized that in our hospital, due to the lack of equipment, sometimes there will be embarrassment and helplessness of "a clever woman can't cook without rice", and the low proportion of acute and critical diseases in the department is also related to the lack of hardware facilities. As far as in-patient internal medicine business is concerned, it is suggested that the hospital laboratory should carry out tests such as natriuretic peptide, N-terminal pro-natriuretic peptide and blood gas analysis, and purchase equipment such as brain function therapeutic instrument and internal medicine rheoencephalogram detector. At the same time, painless gastroscopy is recommended. In addition, there is an idle ventilator in the department, so it is recommended to send someone to study and use it.

? 3. Fully display the characteristics of traditional Chinese medicine.

? Since the establishment of the second-class Chinese medicine hospital in our hospital, the internal medicine department has carried out appropriate technical treatment of Chinese medicine. Before, the appropriate techniques of Chinese medicine included acupuncture, auricular points, acupoint application, moxibustion, scraping, bloodletting at the tip of the ear, cupping and enema. Due to the restriction of the new rural cooperative medical system, there are only three kinds of treatment items in the department at present: acupuncture, acupoint application and moxibustion. However, no matter what kind of Chinese medicine treatment project, the concept of "Chinese medicine characteristic treatment" in our hospital has not been formed in patients' minds, and even some patients are very resistant to invasive operations such as acupuncture. In my opinion, in terms of appropriate technical treatment of traditional Chinese medicine, we can learn from the practice of Cardiovascular Department of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine and treat most patients with foot bath of traditional Chinese medicine. Investigate its reason, first of all, everyone should wash their feet every day, and when they wash their feet, they will add some Chinese medicine decoction, which everyone is happy to accept; Secondly, some patients who reject oral drugs (especially oral Chinese medicine) are willing to accept this Chinese medicine treatment; Third, the treatment method is non-invasive; Fourth, while increasing the income from treatment, the proportion of Chinese herbal pieces can be increased. In addition, all departments should develop their own hospital preparations as soon as possible, such as widely used Yinjia Qingfei oral liquid and Zhongfengxingnao injection.

? 4. Refine the department staff's specialty.

? In-patient internal medicine belongs to the category of large internal medicine, and the patients admitted are all over the internal medicine system. Due to the limitation of hospital conditions and patient resources, it is impossible to divide detailed secondary departments like tertiary hospitals, and it is impossible for department staff to meet the requirements of subject proficiency. Therefore, to refine the professional direction of department staff, it is not required that the professional direction of each system should be refined, at least the specialties of cardiovascular system, respiratory system, digestive system, nervous system and endocrine system should be refined to the heads of department staff, so as to achieve "a hundred schools of thought contend, and one end is leading". At present, some internal medicine personnel have completed advanced studies in cardiovascular and digestive medicine, so it is suggested to arrange personnel to study in respiratory, endocrine and neurology departments as a whole.

? Personal summary of hospital doctors' further study

? 1 year has just ended, and I have returned to my familiar job. First of all, I want to thank the hospital and the leaders for giving me this precious opportunity, and I also want to thank my colleagues, because their hard work allows me to finish my studies with peace of mind.

? I studied in the Department of Respiratory Medicine, Tang Dou Hospital, Fourth Military Medical University of PLA. It is the first master's degree-granting discipline in China, the superior medical discipline in Shaanxi Province, the national drug clinical trial institution, the grass-roots construction demonstration department of the Fourth Military Medical University, the training center for bronchoscopy diagnosis and treatment in northwest China and the ventilator training base. Chairman of the respiratory tuberculosis branch of Shaanxi Medical Association and vice chairman of the respiratory discipline of the whole army. There are two wards and 80 beds in respiratory medicine, as well as allergic disease research room, lung function blood gas room, bronchoscopy room, respiratory medicine intensive care unit and respiratory medicine laboratory. It is the most advanced unit of respiratory medicine technology and equipment in Shaanxi Province and Northwest China. The teachers here are noble in medical ethics, knowledgeable and approachable. Not only is the level of diagnosis and treatment among the best in China, but they attach great importance to the training of the younger generation, and maintain a strong talent echelon, which is popular all over the world.

? The director of their department makes rounds once a week 1 time, and the third line makes rounds twice a week. I feel a harmonious atmosphere during rounds, emphasizing seeking truth from facts and attaching importance to evidence-based medical evidence. Many issues of principle have been recognized, but differences that do not violate principles are allowed. Tang Dou Hospital has always emphasized comprehensive treatment, and the comprehensive department organizes joint rounds of radiology diagnosis, pathology, surgery, internal medicine and radiotherapy from time to time. When making rounds, the first-line or senior doctors report the medical history; The superior doctor carefully reads the film, analyzes the possible diagnosis, further examination and treatment plan. In this way, patients can get reasonable treatment systematically and systematically, and young doctors know a lot about this. Reasonable comprehensive treatment is one of the important factors of high-level diagnosis and treatment in Tang Dou hospitals.

? To develop departments, we must attach importance to re-education, re-learning and the cultivation of reserve talents. The academic activities I participated in mainly include: theoretical study twice a week to make new progress in treatment; Weekly 1 departmental academic discussion; Irregular academic exchanges with foreign countries, including lectures by famous experts at home and abroad and academic conferences at home and abroad. Long-term intensive and conscious study and communication are also important factors for their longevity.

? I also found something. First of all, I systematically studied the relevant basic knowledge and the latest diagnosis and treatment technology, mastered the diagnosis and treatment of common and frequently-occurring diseases in respiratory department and related departments, mastered the routine operations of respiratory department such as closed thoracic drainage, pleural biopsy, ultrasound and ct-guided percutaneous lung puncture, and basically mastered the operating essentials of bronchoscope and thoracoscope.

? Thirdly, the cooperation of various disciplines is the guarantee to improve the level of diagnosis and treatment. Every department has technical expertise, and every doctor also has technical expertise to ensure the level of diagnosis and treatment in the department. It is not enough to have a good clinician. Only advanced equipment and perfect auxiliary examination can design an ideal treatment plan. At the same time, the cooperation between various departments of the hospital is also very important, such as surgery, pathology, diagnosis and so on. Outstanding comprehensive strength can bring a high level of diagnosis and treatment.

? Advanced equipment and technology also left a deep impression on me. In our primary hospitals, there are many problems that plague us. With advanced medical equipment and technology, we will be easily solved and suddenly enlightened. Nevertheless, routine treatment is still the most commonly used treatment. In my opinion, relying on the current technology and equipment in our hospital, as long as we can use conventional technology in a standardized and reasonable way and carry out new business and new technology within our power, most patients can also obtain satisfactory curative effect.

? Experiences and suggestions for further research:

? 1, departments should develop, hospitals should be strong, and be invincible in the highly competitive medical market. We should take the road of professional construction, complete disciplines, scientific development and academic specialization, and the disciplines are becoming more and more detailed. We must strengthen the cultivation of talents in various disciplines and attach importance to re-education, re-learning and the cultivation of reserve talents.

? 2. For the development of the hospital, it is necessary to strengthen the cooperation among various departments, such as internal medicine, surgery, pediatrics, obstetrics and gynecology, radiology, ct room, ultrasound room, electrocardiogram room, lung function room, etc. It is not enough to have a good clinician. Only advanced equipment and perfect auxiliary examination can design an ideal treatment plan. Only in this way can we have a higher level of diagnosis and treatment, benefit more patients, better improve the social and economic benefits of the hospital and enhance its popularity.

? 3. It is suggested to set up specialized respiratory medicine and powerful thoracic surgery. At present, epidemiology shows that respiratory diseases (excluding lung cancer) rank fourth among the causes of death in cities and third in rural areas. The incidence rate of lung cancer (654.38+0.2 million years) and the mortality rate (654.38+0.65.438+0 million years) both rank first in the world, and have surpassed lung cancer in China. In order to win over these patients and create better social and economic benefits for the hospital, it is suggested to purchase advanced equipment such as bronchoscope and thoracoscope as soon as possible, speed up the training of personnel in this field and develop new business and technology. Thoracic surgery and respiratory department are inseparable from bronchoscopy, let alone development. Strengthening and strictly mastering the indications of using ventilator-assisted breathing to treat critically ill patients can save the lives of most respiratory patients, prolong their lives and improve their quality of life. It is suggested that critically ill patients (especially respiratory patients) routinely check arterial blood gas analysis, which can better judge the prognosis of patients and improve the utilization rate of equipment. For the time being, new services such as pleural biopsy and percutaneous lung puncture can be carried out, and comprehensive treatment such as pleural perfusion therapy for tumors can be carried out. Ventilator treatment can be performed.

? 4. It is suggested that the hospital set up a comprehensive emergency center, set up an emergency observation room, and merge and cancel the infusion room, which is also beneficial to the management and better treatment of patients in the observation room. It is suggested that patients who meet the hospitalization conditions should be hospitalized to create better economic income for the hospital. The medical staff in various departments of the hospital rotate, and the emergency doctors are not fixed, so that emergency doctors can also learn professional knowledge and apply what they have learned, so that the medical staff in the hospital can be fully developed, and the doctors in the inpatient department can get first aid training and master first aid knowledge and technology.

? The above is my little suggestion to the hospital. If there is anything wrong, I hope the leaders will understand me, because I am from a Chinese medicine hospital and I love hospitals.

? Personal summary of hospital doctors' further study

? One year's study in xxx Orthopaedics, one year's time, is not rich but very substantial. I really benefited from my personal experience and empathy.

? Looking back on my one-year study in xxx Orthopaedics, there are scenes of asking medical history, careful physical examination, quiet lectures, not taking the patient to a prenatal examination, standing on the operating table honestly for a day, reading books and reading documents, and so on, all of which are presented in my mind when I write a review summary. Although I am familiar with some work, I can rediscover my shortcomings in my daily clinical practice with Dr. xx, such as making rounds, asking about medical history, physical examination and so on. From the normative point of view, the difference is very far, so this year has not been wasted. From the most basic learning, I not only learned their profound spinal joint routines, but also standardized my behavior from the perspective of clinicians.

? Unremitting pursuit of career. Xx, as a national center for diagnosis and treatment of difficult diseases, often encounters many rare diseases in the field of orthopedics. When they encounter diseases that they have never seen before, they will consult a lot of literature, organize general practitioners to study the consulted literature and discuss treatment plans. Although medicine is an empirical science and it is important to accumulate experience, it is more important to respect the evidence of evidence-based medicine. They will keep all the treated cases in order to sum up the treatment experience.

? Clarify the concept of bed manager. In fact, the definition of the concept of bed management doctor is the best interpretation for clinicians. The bed management doctor should do a good job in writing the patient's medical records in this bed, complete relevant examinations and preoperative and postoperative consultations, deal with the common perioperative complications of patients, and report to the superior doctors in time when problems are found. Therefore, it is common for residents to stay and work overtime, because their work is complicated and heavy, and today's work will be left until tomorrow. Only by taking care of your bed every day can you become a real clinician. Doing a good job as a resident can lay a solid foundation for the future career.

? It is difficult to be a doctor with excellent skills, and it is even more difficult to be a doctor with both ability and political integrity. Orthopedics doctors mainly rely on surgery to treat diseases, so they will attach great importance to the improvement of surgical skills and abilities. However, an excellent doctor should not only have basic professional skills, but also have a sincere and responsible heart for patients. Although these reasons are understandable, how many doctors can really do it? At least that's what I did among the xx orthopedic professors I contacted. Therefore, it is very important to give me the feeling environment. Academic leaders are very important, and an excellent leader can bring out an excellent person.

? Although one year's study is short, xx's rigorous and refined academic spirit and diligent and dedicated work style will benefit me for life.