Self-evaluation of Orthopedic Continuing Education (Ⅰ)
September 20XX? In March, 20XX, with the arrangement of the department and the approval of the hospital leaders, I studied in Shanghai Sixth People's Hospital, majoring in trauma orthopedics, joint replacement surgery and spinal surgery. Shanghai Sixth Hospital is a famous orthopedic hospital in China. Its technology and concept are in line with international standards and have been at the forefront of the world. It is also the Shanghai Orthopedic Trauma Center, known as:? Shanghai Orthopedic Aircraft Carrier? . Every year, about1.5000 orthopedic operations are completed (excluding emergency operations), including 6500 cases of traumatic orthopedics, 20XX cases of spinal surgery, 5000 cases of joint replacement1.5000 cases of arthroscopy, 65438 cases of orthopedic surgery and bone tumor, and 2300 cases of rehabilitation and amputation wards, with an average daily operation. After nearly half a year's study, I have learned a lot of advanced techniques and concepts, which have greatly improved the diagnosis and treatment of common traumatic diseases, especially the diagnosis and treatment of fractures around joints and surgical skills. Have a full understanding of hip and knee replacement. It will have a positive and far-reaching impact on my future work and make me more confident in my future work. During my further study, I strictly abided by the rules and regulations of the Sixth Hospital, listened to the arrangement of the department leaders, actively completed the tasks assigned by the department, studied my business seriously, and successfully completed the further study task. The work in the past six months is summarized as follows:
A, limb microsurgery
From March of/kloc-0 to March of 1 6, I participated in the course of limb microsurgery according to the arrangement of further study in Shanghai Sixth Hospital, mainly to improve the microscopic technology and theoretical knowledge of senior doctors. Through teachers' lectures, I further consolidated and enriched my theoretical knowledge of microsurgery. In addition, the teachers' specimen teaching and operation demonstration also let them have a deeper understanding of some key steps of operation. Director Li Yanjie has always emphasized that microsurgery is the basic skill of orthopedic surgeons. Through the study of microsurgery, I deeply understand its true connotation and profound knowledge.
Second, AO technology
AO technology course is another required course before this study. This course is very formal. The lecturers are Professor Wu Zongjian from South Korea, Professor SuthornB from Thailand, Professor Luo Congfeng from Shanghai Sixth Hospital, Secretary General of AO Asia-Pacific Region, and some famous orthopedic experts in China. High quality and strict requirements. This course focuses on the principles of AO fracture treatment, covering the basic theory and clinical treatment of basic fractures. First of all, the course arrangement is about the basic principle of fracture treatment and its biological effect on fracture healing. This paper expounds soft tissue related injuries, introduces the influences of direct reduction and indirect reduction on fracture healing, discusses the scientific principles of rigid fixation and stable fixation, expounds the development of bone plate technology, and emphatically introduces the concept of locking plate internal fixation. Another important content in the class is the operation of grouping specimens. Professor SuthornB and Professor Wu Zongjian taught in person, which enabled me to master the basic fixation techniques of fractures, such as tension band fixation, compression screw fixation and external fixation bracket fixation. At the same time, through the study of the basic course of AO, I have a higher understanding of the principles of AO: anatomical reduction, firm fixation, protection of blood supply to soft tissues, and early functional exercise. Finally, I obtained the certificate of AO basic study class issued by the international AO organization, which laid the foundation for becoming Aofellow in the future.
Third, the study of trauma orthopedics
The Department of Traumatic Orthopaedics in Shanghai Sixth Hospital is divided into three wards, and I have gained a lot from studying in these three wards. There are many trauma patients in the Sixth Hospital, almost all kinds of patients and cases can be seen, and patients with the same fracture can also be seen many times in the operating room. Through the operation of the operation, the patient explanation of the teaching teacher, careful postoperative summary and professional study, and consulting a large number of medical literature in the library, I have mastered the following skills:
1 and the application of minimally invasive technology
After the teacher's lecture and operation, reading and summarizing after the operation, I have a thorough understanding of Mippo technology, mastered this technology and mastered the essence of the technology. It is a relatively stable fracture technique, which is suitable for shaft fractures that are out of joint, severely comminuted and soft tissue conditions do not allow open reduction, such as supracondylar fracture of femur and distal tibial fracture. Mippo technology is not equal to small incision technology. Whether it is a large incision or a small incision, the blood supply of bone should be preserved as much as possible, and anatomical reduction should not be based on destroying the local and bone blood supply. But sometimes patients don't understand the significance of functional reduction, and whether the fracture is anatomical reduction is the standard to measure the success or failure of the operation. The application of this technology requires good communication with patients before operation.
2. Intramedullary nail technique
In recent years, with the improvement of life expectancy, China has entered an aging society, with more than 60 million osteoporosis patients. It is reported that there is a patient with hip fracture every five minutes in China. In the past six months, I have contacted many elderly patients with hip fractures. Fixation is no longer limited to hollow screws and DHS, but many international advanced intramedullary fixation systems, such as PFN, PFNA, Ganma nail, Ganma3, intertan, etc. Its advantages are short lever arm, small bending arm, less surgical trauma and less blood loss, which can relieve patients' pain and reduce surgical complications, and is especially suitable for patients with subtrochanteric fracture. At present, the treatment of hip fracture with intramedullary nail technology has become? Gold standard? It can be seen from international conferences, internal meetings and various magazine articles. However, most of these implants are imported materials, which are expensive, but I believe that with the emergence of a large number of domestic instruments, intramedullary nailing technology will inevitably become the mainstream in the treatment of hip fractures. So I also focused on this technique, including closed reduction to implantation. After repeated practice, I have mastered it.
3. Application of 3.Ilizarov external fixator
I have only heard of ilizarov external fixator in books and magazines before. This kind of scaffold is used in orthopedic surgery and the treatment of complex trauma, which solves many problems that can't be treated by orthopedic surgery in the past, especially in the treatment of bone defect, nonunion and bone joint deformity. Where did Yili Sarow's therapeutic principles come from? Traction osteogenesis? This fact. During my study in the Sixth Hospital, I had many operations with Professor Kang Qinglin and Professor Bao Kun and asked them about their main points. Have time to read related books, and take the opportunity of Yili Sarow External Fixation Support Exhibition to learn from the technical director of this support. The reason why I am interested in this technology is because there were cases of large bone defects in our department before, and finally the treatment was delayed because there was no good treatment. In my opinion, this technology can provide us with a method to treat nonunion, bone defect, tibialis anterior injury caused by high-energy violence, foot drop deformity and other injuries. At present, this technology is widely used by Professor Xia Hetao of Beijing Institute of External Fixation. I will continue to study this technology and hope to carry it out in our hospital one day.
In addition, I also witnessed the application of navigation technology by Professor Luo Congfeng in traumatic orthopedics research. Tibial plateau fracture? Three-column typing theory? Practical application of; Professor Shi, an expert in foot and ankle surgery, treats ankle fracture: Professor Chen Yunfeng, a shoulder expert, reconstructs acromioclavicular ligament and coracoclavicular ligament to treat acromioclavicular dislocation; Professor Zhong Biao, an elbow expert, is interested in elbow joint? Terror trio? The treatment of fracture around elbow joint has a deeper understanding of future trauma treatment.
Fourthly, the research of joint surgery.
After hard work, I was lucky enough to study in joint surgery. There are about 6,000 joint replacement patients in Shanghai every year, including 6 hospitals 1.500 cases, with an average of 6 joint replacement operations every day. My tutors are Dr. Wu Haishan and Dr. Dai Kerong, famous experts in joint surgery in China, both of whom are doctoral tutors. Its theory and technology are very strong. Through the study of joint surgery, I have mastered the basic surgical skills and the treatment of complications of hip and knee replacement.
Self-evaluation of the completion of the second part of orthopedic continuing education
From xx month in xx year to September in XX year, I studied in Beijing XX Orthopaedics for one year, which was not rich but very substantial, and really benefited from my personal experience and empathy.
Looking back on my one-year study in xx 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.
I remember the habit of patrolling twice a day. They have formed the habit of making rounds every morning and evening, and really observe the condition carefully. Check the patient's condition and check the results; Listen to patients' feelings and give priority to family members' opinions. Find problems in time and deal with them in time.
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 pre-operation and post-operation consultations, deal with 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.
Unremitting pursuit of career. As a national center for diagnosis and treatment of difficult diseases, xx 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.
Every Thursday morning reading meeting and big rounds are opportunities for general practice communication. The morning reading meeting of xx Orthopaedics every Thursday morning is actually a small lecture, which is taught by teachers above associate professor and uses their professional knowledge to explain a topic. After the lecture, you can ask questions and communicate. In xx Hospital, it has gained fame and has been well received by hospital leaders. General rounds are to summarize the surgical patients in the past week and discuss the surgical plan of the patients before surgery in the next week.
Strict aseptic concept on operating table. Advanced laminar flow equipment and modern disinfection instruments in the operating room can provide a more sterile environment and tools for surgery, but if surgeons and nurses in the operating room don't know enough about the concept of sterility, the most advanced and modern ones are floating clouds. From the asepsis in the first class to the knowledge of the professors on the stage every time, it shows that asepsis has become a habit for them. To do the most successful operation, if infection will be a disaster, especially if implants are placed in orthopedics, infection will definitely lead to the failure of the operation.
Communication between doctors and patients. As we all know, the establishment of a good doctor-patient relationship requires good communication between doctors and patients and their families, but to get good communication, it is definitely not for you to operate on patients. Of course, this may be necessary. After xx orthopedic patients are admitted to the hospital, the doctor will introduce himself first, let the patient know that you are his bed-managing doctor, and you can find something during hospitalization. I think this is really important. Patiently listening to the patient's complaints, carefully explaining the illness, handling the illness in time, even taking care of the patient in life, personally accompanying the patient for examination, and often guiding the training and rehabilitation before and after surgery are all good ways to communicate with the patient. Doctors should gain the trust of patients in medical practice, which is the most effective way of communication.
Self-evaluation on the Completion of Orthopedic Continuing Education (Ⅲ)
What is my main direction for further study? Neck, shoulder, back and leg pain? Conservative treatment and? Broken limb? Surgical treatment. The further education departments are neck, shoulder, lumbocrural pain, upper limb injury and hand surgery. The treatment center for neck, shoulder, back and leg pain consists of four departments, with a total of 170 beds. It is the largest TCM treatment department for cervical and lumbar spondylosis in China. The department of upper limb injury and hand surgery are the departments for surgical treatment of limb fractures and vascular and nerve injuries.
I. Further study:
Go to the hospital for rounds at 7: 00 every morning, check the patient's treatment, ask the patient's feelings, and solicit the patient's opinions on treatment, focusing on the newly admitted patients and patients after surgery (or volume reduction). Answer the patient's questions and doubts, report the problems that you can't solve to the teacher in time, ask the teacher for advice, solve them with the teacher, and complete the patient's treatment (such as dressing change and doctor's advice, etc.) in time. ).
During my study in the department of neck, shoulder, back and leg pain, I mastered a set of effective non-surgical treatments for neck, shoulder, back and leg pain, namely Luoyang osteopathy.
Excellent traction method: the bedside multifunctional traction frame is adopted, and the corresponding traction angle, traction weight and traction time are adopted according to the different conditions of patients, so as to achieve the therapeutic effect of bone setting and tendon adjustment.
Traditional Chinese medicine treatment: Pingle bonesetting divides this disease into three types: one is qi stagnation and blood stasis, the other is cold and dampness stagnation, and the third is liver and kidney deficiency. Luoyang Orthopedic Hospital adopts self-developed Jingtongxiao Pill, Intervertebral Disc Pill and Zhongqishushu Pill, which are treated by stages according to three types, and adopts external traditional Chinese medicine such as fumigation and iontophoresis to warm meridians and dispel cold and dredge meridians, so that external therapy plays the role of internal treatment.
Zhanjindan rubbing medicine: Zhanjindan rubbing medicine method is based on acupuncture? The hole is wide open and unobstructed, causing evil spirits to fly? Principle: According to the specific situation of neck, shoulder, back and leg pain, select the corresponding acupoints or reaction points, apply Jinzhandan (powder) on it, and at the same time apply specific kneading and massage techniques to make the drugs and techniques work together to promote blood circulation and relieve pain, and dredge channels and collaterals.
Manipulation therapy: divided into tendon manipulation and bone manipulation. The main methods of tendon treatment are rational tendon, flexible tendon and relaxed tendon. Bone-setting manipulation is mainly a variety of joint movements, including lifting estimation, three-dimensional traction bed fixed-point rotation and so on. This manipulation can effectively adjust the position of spinal intervertebral disc and facet joints, and change the anatomical relationship between protrusion or osteophyte and stimulated nerve roots or spinal cord and blood vessels (that is, displacement theory), thus reducing the tension of nerve roots or the stimulation of osteophyte to nerves and blood vessels, and achieving the purpose of bone healing and pain relief. The manipulation of tendon therapy is closely combined with the manipulation of bone therapy, and the dynamic muscles around the spine are relaxed by means of activating tendons, adjusting tendons and loosening tendons, such as clicking, pressing, pushing and kneading, so as to achieve the effect of relaxing tendons and relieving pain.
Ozone injection therapy and sacral canal therapy.
Functional exercise: According to patients' different physical endowments and specific conditions, formulate corresponding personalized functional exercise programs, and selectively apply functional exercise methods of neck, waist, back muscles and dynamic muscle groups around the spine, such as neck-arm struggle, flying geese, walking backwards, arch bridge exercise, etc.
During my study in the operating department, I went to the hospital for ward rounds in advance to complete the patient's treatment in time. Go to the operating room around 8: 30 to visit or participate in the operation. As an assistant or two assistants, Luoyang Orthopedic Hospital has to perform more than 60 operations every day on average. The operating room has 14 ordinary operating room and 1 emergency operating room. The huge amount of surgery is a great challenge to the operating room, so the operation is usually arranged very tightly, and the operating room also has corresponding. Surgery preparation room? Half an hour before the end of one operation, the visiting nurse informed the next operation, and the patient arrived after the operation? Anesthesia recovery room? The interval between the two operations is about 10 minute. There is a lounge in the operating room where doctors and nurses can rest and eat. The whole operating room can't get off work until 2 1: 00 on average (except emergency), and write medical records at night, read books and consult materials to solve their own problems. In addition, I actively participated in the preoperative case discussion of orthopedics, and discussed all operations the next day.
During my study and further study, I will abide by the rules and regulations of hospitals and departments, respect teachers, unite with colleagues, and be strict with myself, so as not to be late, leave early, be absent from work for no reason or leave my post without permission. He is affable to patients, has a good attitude, and tries his best to put the theoretical knowledge and basic skills he has learned into practice, which has been highly praised by department directors, teachers and patients. In this process, I constantly sum up my learning methods and clinical experience, strive to improve my ability to think independently, solve problems independently and work independently, and constantly cultivate my lofty thoughts and good professional ethics of serving the people wholeheartedly. Through this study, I improved my level of writing related medical literature. Enhance the ability of diagnosis and treatment of common and frequently-occurring diseases in orthopedics; Further mastered the conservative treatment. In the meantime, I also actively participated in the activities sponsored by Luoyang Orthopedic Hospital. How to write a good medical paper? 、? Seminar on new progress of tissue defects in limbs? 、? 20XX National Hip and Knee Joint Disease Summit Forum? And other departments to organize classes and business classes, academic exchanges with experts. Through study and communication, I have greatly broadened my horizons, enriched my knowledge and learned some new surgical methods and techniques.
Second, the feeling of further study
1, good doctor-patient communication
We attach great importance to doctor-patient communication and have good habit of doctor-patient dialogue, which is worth learning. Knock on the door before entering the ward, ask about the illness, do physical examination, explain the diagnosis and treatment matters, listen to the complaints and demands of patients very patiently, and the doctor-patient relationship is very harmonious.
2, standardize the diagnosis and treatment behavior
Medical activities are standardized, according to unity? JCI standard newspaper? Engaged in medical activities. For the choice of treatment methods: surgery or conservative treatment, as well as their advantages and disadvantages, doctors will also discuss the choice of internal fixation devices with patients and their families, and they will decide the plan, thus showing respect for patients and ensuring their right to informed consent.
3. Protect patient privacy and information confidentiality.
There is no list of inpatients in each department, and doctors should exit the patient interface when they leave the computer; During the treatment operation, the bed curtain should be pulled; Can't talk about illness or patient information in public places; Can't talk about the illness with people who have nothing to do with the patient treatment team; Members of the treatment group are not allowed to exchange illness or opinions loudly in the ward. Respect patients and protect their privacy.
4, to ensure patient safety:
Accurately identify patients.
After admission, the medical staff carefully checked the patient's identity, and put a wristband on each patient's wrist with a label indicating the patient's basic information to confirm his identity.
Five, improve the safety of the use of high-risk drugs.
The goal of patient safety first requires hospitals to make a list of high-warning drugs according to their own data and the requirements/guidelines of regulatory/industry organizations. Policies/regulations should emphasize the identification, location, labeling and storage of each high alert drug in the list. According to the actual situation, penicillin and cephalosporin for intravenous use are temporarily listed as high-risk drugs under specific conditions, and the potential risk of anaphylactic shock under special conditions is minimized through careful evaluation of each patient.
The incidence of nosocomial infection was reduced.
An important way to eliminate or reduce the risk of infection is hand hygiene. Every ward has a disposable disinfectant. Wash your hands before and after the evaluation, diagnosis and treatment of patients, and don't forget the importance of repeatedly educating patients and their families to wash their hands.
V reduce the risk of injury caused by patients falling/falling out of bed.
Evaluate patients, arrange high-risk and severe patients in bunks close to medical staff, strengthen education, including the education of accompanying personnel, and mark the bunks with sticky paper to prevent falling/falling off the bed.
V Ensure that the surgical site is correct, the operation is correct and the patient is correct.
Wrong surgical site, wrong surgical operation and wrong patient operation are considered unforgivable, but such mistakes are common all over the world and have been the most reported warning events in the Joint Committee warning event database. Therefore, the goal of patient safety requires the hospital to formulate and implement the following measures: (1) marking the surgical site, which is obvious and easy to understand and difficult to remove or clean; Patients should participate in the validation process. When a patient enters the operating room, the hospital uses a checklist to confirm the correct patient, correct operation and surgical site marking. Relevant documents (such as preoperative evaluation and surgical plan, preoperative evaluation and informed consent), images and test results are ready, and all equipment/transplant instruments are confirmed to be in place, correct and effective. Before the official start of the operation, the whole operation team should stop all the operations at hand and verify again whether the operation site is correct, whether the operation method is correct and whether the patient is correct. Pause? The process should be recorded in the medical record.
Educate patients to use the alarm device in the bathroom.
Tell the inspector that there is an alarm in the patient's bathroom. If there is no escort, the patient's bathroom has problems, you can use the alarm device to inform the nurse and pay attention to the bathroom when patrolling the ward.
In the days of studying in xx-x Hospital, I feel that the work here is very formal and orderly. All operations and processes have standardized documents, and everyone in the ward works in an orderly way. Everyone's work enthusiasm and initiative are very high, and the relaxed and harmonious environment makes everyone have a relaxed and healthy mentality. Everyone consciously abides by discipline, and the employees here are highly conscious and work in an orderly way. Everything you do is for. Reduce risks and ensure medical quality and patient safety? .
Three. Comments and suggestions:
The main purpose of learning is to apply what you have learned, use the advanced technology, advanced management mode and advanced ideas you have learned, and combine the actual situation of your unit to improve your work and improve the level of diagnosis and treatment. According to the present situation of the hospital, combined with what I have learned, I put forward the following opinions and suggestions.
1, develop new technology projects.
It is planned to carry out cervical and lumbar superior traction, Jin Zhandan massage, ozone injection therapy and sacral canal injection therapy, and gradually carry out cervical spine lifting and lumbar three-dimensional traction reduction treatment.
2, set up a department to treat neck, shoulder, back and leg pain.
With the increase of people's work pressure, increasing attention to health and the establishment of medical insurance system, neck, shoulder, back and leg pain has a wide range of sources and more patients. In order to make the treatment more systematic, standardized, make better results, really become bigger and stronger, and improve the competitiveness of the hospital. Clinics and departments for neck, shoulder, lumbocrural pain can be gradually established.
3. Reduce risks and ensure medical quality and patient safety.
20xx65438+passed by xx-xx Hospital in February? JCI standard newspaper? Certification. JCI standards mainly focus on the medical quality and patient safety of hospitals and their continuous improvement and improvement. It is the highest level hospital gold medal certification in the world. JCI certification process is a process of improving hospital quality and service. Is it execution? Patient-centered? Service concept, strengthen the safe treatment process of patients; The experiences we can learn from are: hospital system construction, medical process, continuous quality improvement, medical safety, etc. And realize it? Reduce risks and ensure medical quality and patient safety? .
Studying in xx-x Orthopedic Hospital for half a year is a very valuable experience in my life and I have benefited a lot. Thank you for your care, support and help as always.
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