海外實習(xí)大綱(外科部分)

1、畢業(yè)實習(xí)規(guī)定1. 畢業(yè)實習(xí)為50周。其中崗前培訓(xùn)2周、內(nèi)科16周、外科實習(xí)16周、婦產(chǎn)科實習(xí)6周、兒科實習(xí)6周、急救2周護理1周。實習(xí)時間為在本年7月開始至次年6月完成。實習(xí)安排在本校的附屬醫(yī)院和教學(xué)醫(yī)院中進行。2. 醫(yī)院對學(xué)生實習(xí)采取三級管理方式，即：教學(xué)辦教研室?guī)Ы探處?。教學(xué)辦在各教研室均聘請一名主治醫(yī)師以上的人員為班主任導(dǎo)師負責(zé)學(xué)生的實習(xí)管理工作。3. 入科教育：學(xué)生分組入科學(xué)習(xí)，第一天由該教研室常務(wù)副主任及教學(xué)班主任進行入科教育，介紹本科的基本情況、規(guī)章制度，輪轉(zhuǎn)科室和值班次序，安排帶教教師及實習(xí)醫(yī)生實習(xí)工作程序，教學(xué)查房和實習(xí)期間小講課的時間安排等。4. 出科考核：每科輪轉(zhuǎn)結(jié)束后，由

2、帶教教師及班主任共同組成考評小組，對實習(xí)生按照八項考核評定標(biāo)準(zhǔn)，進行口試、筆試、技能操作等考核，綜合實習(xí)生的平時操作、實習(xí)表現(xiàn)及考核成績按照客觀定量，計算在該科實習(xí)的分數(shù)。（見“八項指標(biāo)綜合評定標(biāo)準(zhǔn)”）5. 按照實習(xí)大綱要求，教學(xué)辦組織教學(xué)督導(dǎo)組專家于學(xué)年內(nèi)對每個學(xué)科進行教學(xué)查房督導(dǎo)評價，教學(xué)辦隨機到各教研室檢查實習(xí)帶教及學(xué)生實習(xí)情況，征求并反饋教師和學(xué)生意見，據(jù)此每月進行綜合評價。6. 實習(xí)生要遵守醫(yī)院的考勤管理制度。在實習(xí)期間，實習(xí)醫(yī)生一般不得請事假，如特殊情況，一日以內(nèi)者，向帶教老師請假；二日以內(nèi)向教研室請假，三天以內(nèi)者，向教研室主任及實習(xí)醫(yī)院教學(xué)辦請假；二周以上，報學(xué)校學(xué)生主管部門批準(zhǔn)

3、，違者按曠課處理。因病休假者必須出示就診醫(yī)院診斷證明書，并經(jīng)實習(xí)醫(yī)院的教學(xué)主管部門批準(zhǔn)后方可休假。如病情嚴重需長期休養(yǎng)者，應(yīng)經(jīng)學(xué)校學(xué)生主管部門批準(zhǔn)并按規(guī)定辦理休學(xué)。7. 實習(xí)醫(yī)生在內(nèi)、外科實習(xí)期間，病、事假不得超過該科實習(xí)期間的1/4，其他各科不得超過該科實習(xí)期的1/3，超過者應(yīng)按該科規(guī)定的實習(xí)時間補實習(xí)。實習(xí)期間病、事假累計超過全部實習(xí)時間的1/3，應(yīng)隨下一屆學(xué)生重新參加畢業(yè)實習(xí)。8. 學(xué)生如要求在校外或國外醫(yī)院實習(xí)，應(yīng)選擇在大學(xué)教學(xué)醫(yī)院或醫(yī)療中心級醫(yī)院、規(guī)模須具備500張床位以上，具有較強教學(xué)能力的綜合性醫(yī)院中進行。須本人提出申請并有接收醫(yī)院開具同意接受該生實習(xí)的證明，同時出具該醫(yī)院具備接

4、受能力的資質(zhì)證明。9. 無論在本校進行畢業(yè)實習(xí)還是在校外或國外醫(yī)院進行畢業(yè)實習(xí)，學(xué)生在完成各科實習(xí)后須回本校參加畢業(yè)實習(xí)綜合能力考試。（考試內(nèi)容為內(nèi)科、外科、婦科、兒科的臨床理論部分和實際操作能力部分）考試合格者方能準(zhǔn)予畢業(yè)?？荚嚂r間安排在次年的6月份進行。附：實習(xí)考核標(biāo)準(zhǔn)Internship Regulations1. The Internship in Clinical Medicine is 48 weeks from July in any year to June of the following year, in which there are 12 weeks for Inter

5、nal Medicine, 12 weeks for Surgery, 6 weeks for Gynecology & Obstetrics, 6 weeks for Pediatrics，4 weeks for Neurology，2 weeks for Radiology, 2 weeks for Ophthalmology, 2 weeks for Otorhinolaryngology and 2 weeks for Dermatology. The internship is arranged at the teaching hospitals of Tianjin Med

6、ical University according to the internship schedule.2. The students are under the supervision of the Teaching Affairs Department, Teaching and Research Office and the tutors. One attending or senior level doctor from each Teaching and Research Office will be put in charge of internship management r

7、espectively.3. Students should be arranged to do the internship in groups. On the first day of the internship, the vice director and the teacher in charge will give the students the basic introduction to the sectors, the regulations, the sequence of working in different sectors, the programme for in

8、ternship, schedule for going around the ward for inquiry and the arrangements for internship instruction.4. The interns shall be given an assessment after internship in each sector by an evaluation team formed by the tutors and the teacher in charge. The eight assessment results are based on both or

9、al and written tests, operation skills, comprehensive operations, overall behavior of the intern and evaluation result.5. The internship should be carried out strictly according to Internship Outline. Experts from the supervision team will give an evaluation and instructions for each subject and the

10、 teaching office will also ask for advice and feedback from the tutors and students. In accordance with the above, a comprehensive evaluation will be performed monthly.6. Students must abide by the regulations of the internship and they are not allowed to take a leave without special permission. If

11、they wish to have one day off, they should ask their tutors for permission; two days, ask the teaching and research office of the department; three days, ask the director of the department and the teaching office of hospital. For more than two weeks leave, they have to report to the students managem

12、ent department for authorization. Anyone will be regarded as absent if they take a leave without permission from the relevant department. If students ask for sick leave, they need to present the medical diagnosis record from the hospital and get the permission of the internship hospital. If the stud

13、ents suffer from a serious sickness, they need to get the approval of the university authorities and then go through the probation procedure.7. The students will be subject to make up for the lost period if his absence accounts for one fourth of the internal medicine or surgical internship, and one

14、third in the other subjects. A student needs to repeat the internship with the next grade if he is absent from the practice for over one third because of illness or for any other reason. 8. Students who want to do the internship aboard or out of our university should select a comprehensive hospital

15、or medical center, with over 500 patient beds and with medical teaching competence. The student is also required to submit an admission letter from the hospital and a certification showing the qualification of the hospital.9. Wherever the students perform internship work, at our university or aboard

16、, they must return to the university to attend the general examination after the internship. The examination involves clinical theory and clinical practice of Internal Medicine, Surgery, Gynecology and Paediatrics. Those who pass the exam are qualified to graduate and obtain diplomas. The examinatio

17、n is scheduled to be held next June. Encls: Evaluation Criteria for internship實習(xí)病種記錄表（外科學(xué)）Record of Diseases for Internship (Surgery)基本掌握疾病 Diseases to be mastered 例數(shù)Amount 參加手術(shù)Operation淺部組織的化膿性感染Acute pyogenic infection of soft tissue手部急性化膿性感染Acute pyogenic infection of the hand一般外傷Common trauma熱力燒

18、傷Burns甲狀腺疾病Diseases of the thyroid gland 乳腺疾病Diseases of the breast 腹外疝Abdominal hernia急性化膿性腹膜炎Acute pyogenic peritonitis胃、十二指腸潰瘍并發(fā)癥Complications of peptic ulcer腸梗阻Intestinal obstruction闌尾炎Appendicitis膽囊結(jié)石、膽囊炎Cholecystitis & cholecystolithiasis胰腺疾病Diseases of the pancreas原發(fā)性下肢靜脈曲張Varicose vein o

19、f the lower extremity腰椎間盤突出癥Lumbar protrusion常見骨折、脫位Common fracture and dislocation軟組織扭傷、勞損Injury and strain of soft tissue泌尿系感染Infection of the urinary system前列腺炎Prostatitis泌尿系結(jié)石Urinary system calculus尿路梗阻Urinary tract obstruction食管癌Esophageal cancer肺癌Lung cancer心臟疾病Diseases of the heart胸外傷Chest tr

20、auma麻醉前處理Evaluation before anesthesia麻醉前對病人的用藥Administration before anesthesia一般了解疾病 Diseases to be understood 例數(shù)Amount全身外科感染General surgical infection膽管結(jié)石、膽管炎Calculus of bile duct & cholangitis膽管結(jié)石、膽管炎Diseases of the anus腹部閉合性損傷Abdominal closed injury胃癌Gastric carcinoma肝癌Hepatic carcinoma結(jié)、直腸癌

21、Colorectal carcinoma下肢動脈硬化閉塞癥Arteriosclerosis obliterans of the lower extremity深靜脈血栓形成Deep vein thrombosis門脈高壓癥Portal hypertension關(guān)節(jié)結(jié)核Tuberculosis of the joint泌尿系損傷Injury of the urinary system附睪炎Epididymitis急性腎衰Acute renal failure頸肩痛、腰腿痛Cervix and shoulder pain & low back pain脊柱結(jié)核Tuberculosis of

22、 the spinal column教師簽字Teachers Signature: 日期Date： 實習(xí)操作技能記錄表（外科學(xué)）Record of Practice for Internship (Surgery)基本掌握Procedures to be mastered 數(shù)目Amount病歷書寫Medical documentation 中文in Chinese (for Chinese group) 英文in English (for Chinese / English group)外科查體Physical examination of surgery刷手戴手套穿手術(shù)衣Scrub, wea

23、r gloves and gown消毒皮膚Skin disinfection鋪消毒單Sterile drape of the operative site直腸指診Digital examination of the rectum切皮Incision止血Haemostasis縫合Suture打結(jié)Make knots胃腸減壓Nasogastric suction換藥Dressing change拆線Remove the suture導(dǎo)尿Urethral catheterization參加麻醉例數(shù)Participation in anesthesia麻醉記錄單書寫Anesthesia record

24、writing一般了解Procedures to be understood 數(shù)目Amount透光試驗Penetrating test透光試驗Anoscopy閱片X-ray interpretation局麻Local anesthesia傷口引流Wound drainage傷口包扎Wound dressing靜脈切開Venous cutdown皮膚牽引 骨牽引Skin traction and bone traction夾板Splint石膏繃帶Plaster bandage灌腸Enemas搬運病人Transporting patients全麻General anesthesia腰麻Subara

25、chnoid space block for anesthesia氣管內(nèi)插管Endotracheal intubation全麻、椎管內(nèi)麻醉Intervertebral anesthesia平均分管床位數(shù)The number of responsible for inpatient-bed (on average)教師簽字Teachers Signature: 日期Date：外科學(xué) Surgery實習(xí)醫(yī)院名稱The Name of the Teaching Hospital:實習(xí)時間Time of internship 自From(y/m/d)_ 至to(y/m/d)_ 實習(xí)小結(jié)：Interns

26、hip Report 年Y / 月M / 日D 實習(xí)成績考核記錄（外科學(xué)）GRADE RECORD OF INTERNSHIP (Surgery) 考核項目要求標(biāo)準(zhǔn)扣分標(biāo)準(zhǔn) statement得分教師簽字itemsrequirementstandardmarksignature病歷書寫字跡清楚 語言通順 層次分明 重點突出10字跡不清楚扣1-5分;語言不通扣1-5分;層次不分,重點不突出扣1-5分. clarity:1-5; fluency:1-5; emphases:1-5writing medical record clear, fluent, make the key points st

27、and out查體姿勢正確 順序正規(guī) 手法熟練 完整準(zhǔn)確15姿勢不正規(guī)扣1-5分;無順序,手法不熟練扣1-5分;有遺漏不準(zhǔn)確扣1-5分. posture:1-5; sequence:1-5; correct:1-5physical examinationcorrect posture, regular sequence, skillful performance病歷分析表達清楚 分析有序 抓住重點 診斷處理正確15表達分析層次不清扣1-8分;抓不住重點扣1-8分;診斷處理欠正確扣2-10分.perspicuity:1-8; emphases:1-8; diagnosis and treatme

28、nt;2-10analysis of medical recordclear expression, orderly analysis, correct treatment 臨床基本 技能操作熟練準(zhǔn)確 正規(guī)迅速15不熟練扣2-10分;欠準(zhǔn)確或不準(zhǔn)確扣4-15分;不迅速扣2-7分. skillness;2-10; correct:4-15; fast;2-7basic clinical performanceskillful, correct, regular, fast口試回答正確 概念清楚 表達有條理15回答不正確概念不清楚扣1-10分;表達能力差扣1-5分. correct:1-10; a

29、bility of expression:1-5oral testcorrect answer, clear concept, logistic expression理論考試選擇題,病歷討論題15按考卷評分及病歷分析結(jié)果計算.according to the papertest of theorymultiple choice, discussion record職業(yè)道德尊敬老師 愛護患者 文明禮貌 遵守紀律15不尊敬教師扣1-15分;對病人不關(guān)心不愛護扣1-15分；不遵守紀律不文明禮貌扣1-15分. respect teachers;1-15; care about patients:1-1

30、5; be polite and observe discipline:1-15medical ethicsrespect teachers, care about patients, civilized, be polite, observe discipline,總分 mark:教研室主任簽字 Signature of Director:科室意見Directors Review 主任簽字Directors Signature: 日期Date:_考勤情況（由帶教教師紀錄）Attendance Record (Record for Internship Teachers) 病假 事假 曠課 遲

31、到 早退sick leave absence leave truancy late leave early_外科學(xué)實習(xí)大綱總體要求實習(xí)生外科輪轉(zhuǎn)共16周。實習(xí)科室有, 普通外科8周, 骨科2周, 心胸外科2周，泌尿外科2周，神經(jīng)外科2周。通過上級醫(yī)師的傳, 幫, 帶以及實習(xí)醫(yī)師提問, 自學(xué)等方式，理論聯(lián)系實踐，熟悉外科常見病, 多發(fā)病的診斷和治療。學(xué)會閱讀胃腸道造影, 腹平片, CT, MR，及其在疾病診斷中的價值。掌握外科無菌術(shù)，換藥, 手術(shù)基本操作等技能。在外科實習(xí)過程中，要求實習(xí)生參加住院醫(yī)生24小時值班，對“醫(yī)師法”進行了解。書寫中文病歷6份，英文2份；英文班學(xué)生書寫英文病歷8份。在上

32、級醫(yī)師指導(dǎo)下分管6張床病人。實習(xí)期間，每周安排實習(xí)小講課一次，教學(xué)查房一次，要求應(yīng)用雙語教學(xué)和學(xué)習(xí)，安排主治醫(yī)師帶教。實習(xí)結(jié)束時進行口試, 理論考試, 病例分析及操作考試。實習(xí)醫(yī)生實習(xí)期間，要求參加學(xué)科組織的學(xué)術(shù)講座，病例討論等學(xué)術(shù)活動。Surgery Practice OutlineGeneral requirements: There are 12 weeks for the interns to accomplish the surgical rotation. The arrangements are as follows: department of general surgery

33、for 6 weeks, department of orthopedic for 2 weeks, either in the department of urinary surgery or department cardiothoracic surgery for 2 weeks. Through the senior doctors teaching and self-study by the intern, the student should integrate theory with practice and become acquainted with the diagnosi

34、s and treatment of common surgical diseases. The intern should learn how to read gastrointestinal contrast films, abdominal plain films, CT, MR, and know their use in the diagnosis of various diseases. The procedures of surgical asepsis, dressing changes, and some basic operation skills should be ma

35、stered.The intern should be engaged in 24-hour duty during the internship, and learn the basic principles of medical care. The intern should finish 8 medical records and manage at least 6 inpatients under the senior doctors instruction. There will be a short lecture once a week and instructional tea

36、ching rounds with the attending physican, once a week. There will be an attending physician serving as a teacher, and teaching will be both in English and Chinese. At the end of the internship, the intern will receive an oral examination, a written examination paper, a case analysis and a test of pr

37、ocedural skills. You are also required to take part in academic activities organized by the department, such as lectures and case discussions. 各學(xué)科具體要求普外科普通外科輪轉(zhuǎn)8周，對實習(xí)醫(yī)師要求如下：1. 通過臨床診治工作，熟悉外科病人常見癥狀, 體征及其意義，掌握初步診斷疾病的輕重緩急及病態(tài)大致部位。2. 熟悉普外病人術(shù)前常規(guī)準(zhǔn)備方法以及術(shù)后飲食, 抗菌素, 胃腸減壓, 腹腔引流的處理及補液原則。3. 了解B超, X線檢查結(jié)果, 內(nèi)窺鏡檢查, 同位素

38、檢查以及各項常規(guī)化驗結(jié)果在臨床外科的診斷意義。4. 通過病房及急診實踐, 掌握抽血, 換藥, 膿腫切開, 導(dǎo)尿, 胃腸減壓, 掌握外科無菌概念。在上級醫(yī)師指導(dǎo)幫助下，學(xué)會外科手術(shù)的基本操作。5. 對闌尾炎, 疝, 大隱靜脈曲張, 甲狀腺瘤, 肛門疾病從診斷, 術(shù)前準(zhǔn)備, 手術(shù)治療原則到術(shù)后處理要求較全面的掌握,并參加這一類手術(shù)。 6. 對一般膽囊炎, 膽石癥, 消化道潰瘍, 消化道腫瘤，甲狀腺腫大, 甲亢，乳腺等疾病，要求掌握臨床表現(xiàn), 體征，輔助檢查方法選擇，特殊術(shù)前準(zhǔn)備以及手術(shù)原則。 7. 對直腸癌，門脈高壓，胰腺疾病，復(fù)雜膽道疾病等復(fù)雜的外科病，要求了解臨床表現(xiàn)和診斷方法的選擇，掌握治療

39、原則。8. 對搶救工作，尤其是外科較多見的出血及中毒性休克，了解補充血容量，糾正水電解質(zhì)紊亂和酸堿平衡失調(diào)的原則 。9. 熟悉外科營養(yǎng)的目的, 途徑, 需要量的計算, 并發(fā)癥的預(yù)防和處理。10. 書寫中文病歷3份，英文1份；英文班書寫英文病歷4份，熟悉普外科常見病術(shù)前, 術(shù)后的醫(yī)囑處理。Individual Department RequirementsGeneral Surgery Practice OutlineThe intern should work in the department of general surgery for 8 weeks. The requirements

40、are as follows:1. Become acquainted with common symptoms and signs of patients with general surgical diseases and know their significance by clinical work. Learn how to approximate the extent and location of the diseases.2. Be acquainted with routine preparation for preoperative patients and basic p

41、ostoperative management, such as diet, antibiotic treatment, principles of fluid replacement, nasogastric suction, and abdominal drainage.3. Understand the diagnostic significance of B-ultrasound, X-ray films, endoscopy, isotopic examinations and routine laboratory reports.4. Master some procedures

42、such as venipuncture for blood draws, dressing changes, abscess incision, urethral catheterization, nasogastric suction, and understand surgical aseptic technique. Master basic operation skills under the senior doctors instruction.5. Master the diagnosis, preoperative preparation, and operative prin

43、ciples for appendicitis, hernia, varicose great saphenous veins, thyroid tumor, and diseases of the anus. Participate in these operations.6. Master the clinical presentation, selection of accessory examinations, special prepoerative preparations, and operative principles for cholecystitis, cholecyst

44、olithiasis, peptic ulcers, digestive tract tumors, thyromegaly, hyperthyroidism, and diseases of the breast. 7. Understand the clinical presentation and selection of diagnostic methods, and master the treatment principles for some complicated surgical diseases, such as rectal cancer, portal hyperten

45、sion, diseases of the pancreas and complicated diseases of the biliary tract.8. Understand the principles of blood volume replacement, correction of water-electrolyte disturbances, and acid-base imbalance during emergencies, especially in hemorrhagic shock and toxic shock.9. Be acquainted with the p

46、urpose, route, calculation of requirements, and prevention and management of complications of surgical nutrition.10. Finish 4 English medical records and be acquainted with preoperative and postoperative physician orders for common diseases in general surgery.骨科骨科輪轉(zhuǎn)2周，對實習(xí)醫(yī)師要求如下：1. 通過骨科實習(xí)后，熟悉掌握骨科物理學(xué)診

47、斷方法，尤其掌握上, 下肢的肌力檢查方法, 脊柱及骨關(guān)節(jié)的檢查方法，并應(yīng)了解一些特殊的骨科物理診斷方法。2. 初步掌握骨科常見病的診斷及處理原則，如：創(chuàng)傷（骨折, 脫位）, 骨關(guān)節(jié)感染, 結(jié)核, 關(guān)節(jié)炎等常見病的診斷和處理方法。初步掌握一些常見的骨折, 脫位（如股骨頸骨折, COLLes骨折, 鎖骨骨折, 肩關(guān)節(jié)脫位等）的診斷和治療原則。3. 了解骨科的一些基本操作技術(shù)方法，如：皮牽引, 骨牽引固定, 小夾板應(yīng)用, 關(guān)節(jié)穿刺, 各種造影技術(shù), 局部封閉等技術(shù)。4. 了解嚴格的無菌概念對骨科的特殊重要性，必須掌握要求更高的無菌操作及消毒, 滅菌原則。5. 熟悉骨科常見病多發(fā)病，腰椎間盤突出癥的診

48、斷及鑒別診斷，脊柱結(jié)核的臨床表現(xiàn)，治療原則及手術(shù)指征，慢性化膿性骨髓炎的成因, 診斷及治療原則，骨腫瘤的分類, 良惡性骨腫瘤的鑒別和治療原則。了解腰腿痛及頸肩痛的病因, 發(fā)病機理, 診斷, 鑒別診斷及治療原則，髖及膝關(guān)節(jié)結(jié)核的臨床表現(xiàn)和治療原則。6. 正確開醫(yī)囑，掌握骨科常見病術(shù)前準(zhǔn)備及術(shù)后處理；常用藥物劑量, 給藥途徑及方法，掌握藥物的適應(yīng)癥, 禁忌癥和副作用。7. 掌握骨外科常見急重癥的搶救技術(shù)，如手外傷, 多發(fā)傷, 多發(fā)骨折, 創(chuàng)傷性失血性休克, 高位頸髓損傷等，參加心肺復(fù)蘇的搶救。8. 書寫中文病歷1份，英文1份；英文班書寫英文病歷1份，熟悉骨外科常見病術(shù)前, 術(shù)后的醫(yī)囑處理。Orth

49、opedic Surgery Practice OutlineGuidelines for 2 weeks of clinical practice in the Orthopedics Department1. Master the basic physical examination techniques required to make a diagnosis of diseases of the musculoskeletal system, for example the examination of muscle strength and motion of the spine o

50、r joints. Also try to obtain knowledge of some special physical examination techniques.2. Acquire an intimate knowledge of the principles of diagnosis and treatment for some common disorders of the bones and joints. Such as traumatic surgery (fracture and dislocation), infectious diseases, and asept

51、ic arthritis, etc.3. Learn some basic therapeutic techniques, such as traction, fixation with splint or cast, arthrocentesis, arthrography, and local injection techniques to treat joint pain. 4. Understand the special importance of aseptic technique during orthopedic surgery, and to learn more stric

52、t sterile techniques.5. Learn the basic knowledge of key points for some common disorders such as the diagnosis and differential diagnosis for lumbar disc herniation, the clinical manifestations and principles of treatment of tuberculosis of the spine, the classification, differential diagnosis, and

53、 principles of treatment of bone tumors. 6. Learn how to write the correct medical documentation and physician orders, to give a proper plan for preoperative and postoperative treatment, and to know the correct medications to prescribe, and their effects and side effects. 7. Take part in procedures

54、for the management of some emergency and critical cases, such as multiple injuries, compound fractures, traumatic and hemorrhagic shock, and cervical spinal cord injury.8. Complete at least 1 case records in English.心胸外科心胸外科輪轉(zhuǎn)2周，對實習(xí)醫(yī)師要求如下：1. 對一般胸部創(chuàng)傷能作出正確診斷及初步處理。2. 了解食管疾病，肺部疾病的檢查方法，能對食管癌, 肺癌做出診斷。3. 了解胸透, 胸穿操作方法及觀察胸腔引流在疾病診治中的作用。4. 了解低溫, 體外循環(huán)的機理。5. 根據(jù)心前區(qū)