Doctors training experience experience essay a
201X year is an important year, Liaocheng City Maternal and Child Health Hospital successfully purchased the development zone hospital, and the preparation of Liaocheng City Center Hospital, 201X year is also the end of the five years of my university clinical and successful graduation of the year, the opportunity is so coincidental, through the application, is very fortunate to join the city of women and children, and become a member of the city of women and children. I am very lucky to join Municipal Women and Children's Hospital by applying for the job. In order for us to better step into the brand new work, master the exquisite technical talent and better service for patients, our hospital organization arrangements for new clinical and nursing staff more than a hundred people to go to the Affiliated Hospital of Jining Medical College for further study, as a new employee this is a very rare opportunity. During the training period I was divided into the cardiology, theology, digestion, respiratory and other four internal medicine study, half a year's time to say long and short, but gained a lot of experience, experience is also a lot of experience, and now pick a few points in the cardiology and respiratory learning process to talk about the deeper feelings.
The cardiology department is one of the most important windows of the hospital, my hospital cardiology department has five wards plus a CCU ward, not only to receive the normal elderly chronic patients, but also to receive from the county on the transfer of the acute and critical patients, with urgent, busy, miscellaneous characteristics. In the face of the first diagnosis and rescue of critically ill patients, cardiology patients are often diagnosed unclear, unclear condition, rapid changes, if not handled properly, it is prone to medical disputes. And patients and their families are prone to impatience, anxiety, fear, cardiology is different from the wards, medical staff have enough time to communicate with patients and their families, XX timely understanding of the needs of patients, and the establishment of a good nurse-patient relationship. In the cardiology, patients and their families in the shorter contact time with health care personnel, has not yet established a good sense of trust, every subtle link of health care personnel are very sensitive, health care personnel's speech and behavior of the patient's psyche will have a great impact. The result is that the medical staff's treatment behavior is not understood, and patients and their families are left with the illusion of "not being taken seriously" and "emergency treatment is not urgent". Therefore, I feel more and more that "communication" is a very important part of cardiology. At the same time, it is important to learn how to observe in order to recognize the existence of problems, including the patient's condition, psychology, needs, and the observation of the family. Through observation and communication to learn to judge the patient's condition and needs to have an accurate understanding and judgment, which is conducive to the development of medical staff to save the work, but also for the patient to buy time. For example: patients with acute heart attack can be observed and roughly asked to understand the onset of time and triggers and precordial area and severity, past history, etc., the first time the initial diagnosis of its disease because of its rescue, for the patient's rescue and treatment to fight for time.
In the Department of Cardiology everyone is my teacher, everything is my experience, teach me a lot of things, whether it is to do people or do things. Of course, the work summary want to do a good job as an internist, only communication is not enough, but also need a solid theoretical foundation, rich clinical experience, rapid response, numbness of action, which is in the encounter with emergency situations can not stand the test of assurance. In the respiratory department compared with other departments, the complexity of the onset of respiratory diseases is more prominent in clinical medicine. And the etiology and pathogenesis of many diseases in respiratory disease is closely related to the living environment, smoking history and genetic factors, such as COPD, pulmonary heart disease, pulmonary embolism, asthma and respiratory tumors, etc.; the etiology and pathogenesis of many diseases is also closely related to the epidemiology, such as community-acquired pneumonia, acute exacerbation of chronic obstructive pulmonary disease caused by common colds due to the change of weather, there are epidemiological problems exist.
In terms of diagnosis, the complete diagnosis of respiratory diseases should include three aspects: ① functional diagnosis; ② pathological diagnosis, including the nature and location; ③ etiologic diagnosis, in the etiology, pathology, etc. difficult to clarify, then only clinical diagnosis can be obtained. The diagnosis is based on general information such as history, symptoms, signs, laboratory data, X-ray, CT, etc., as well as special tests such as bronchoscopy, sputum culture, etc. For some cases with very obvious clinical manifestations, the diagnosis is made on the basis of the clinical findings. For some of the clinical manifestations of the respiratory system diseases can be diagnosed only according to clinical symptoms and signs, such as COPD barrel chest, cardiogenic asthma, etc. XX100 FanWen ranking for those who are early in the disease is light, the symptoms are not obvious and there is no typical history of the person, you need to check in detail before the diagnosis can be determined.
The relative complexity of internal diseases, not well understood, met the patient in this regard, should also be on these symptoms and signs to attract a high degree of attention, familiar with the clinical significance of the settlement of their internal diseases, but also to identify these symptoms, signs because of internal diseases, or other systemic diseases caused by. The common clinical thinking method in internal medicine is: firstly, to find out the problem from the clinical manifestation and get the hint from it, then to carry out the relevant laboratory examination and get the corresponding diagnosis, and then to get the pathological diagnosis after further examination to make clear the site and nature of the disease (whether it is primary or secondary, whether it is organic or functional, and whether it is benign or malignant with or without tumors), and then to take the corresponding therapeutic measures. It is not like other departments which often adopt the thinking of "casting the net comprehensively and catching the fish with focus".
Hippocrates said: work not only requires excellent technology, but also requires art, in fact, the work of the doctor is also the same need for art. In this period of training, I have gained a lot of harvest, if you use simple words to summarize the words appear to be pale, at least can not be very accurate and clear expression of our great benefit. In short, I would like to thank our hospital for the training and careful service to our life. After the training, we will take a more active work attitude, more solid operating skills, more rich and deep theoretical knowledge, and go to the clinical post to improve the clinical diagnosis and treatment ability, and do our best for the cause of human health! I hope I can become a qualified and excellent doctor.
Doctors training experience experience essay two
Esteemed hospital leadership, hello! I am Qiu Haiyun, a nurse in the operating room, in August 1, 2017 to October 30, 2017 in Yunnan Province, Yunnan Province, the third people's hospital cardiac catheterization room for a period of three months of refresher training, first of all, I thank the leadership of the hospital to bring me this refresher training and learning opportunities, through the special learning in the cardiac catheterization room of the third people's hospital in Yunnan Province, through the teaching staff to take the specialty personalized training, combined with the interventional surgery of their own characteristics, from the The environment of the cardiac catheterization laboratory, interventional surgery nursing cooperation, daily management work and other aspects of strengthening learning, so that my professional vision can be improved, mastered the cardiac catheterization laboratory daily workflow and work priorities, to be able to competent cardiac catheterization laboratory nursing work. This training mainly went to the catheterization room to learn the elective angiography and emergency angiography when the nursing staff and the surgeon's cooperation, as well as the patient's intraoperative first aid measures, to understand the CA procedure, PCI, PTCA, thoracic aortic aneurysm, the principles of coronary artery disease, cardiac pacing therapy, radiofrequency ablation, to learn to interpret the abnormal electrocardiograms, to understand a variety of high-value consumables, through the study of summarized in the following areas:< /p>
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1. Nursing training for interventional procedures
Cardiac catheterization laboratory interventional procedures with different according to the type of surgery, can be broadly divided into percutaneous coronary intervention, electrophysiology radiofrequency ablation, pacemaker implantation and right heart catheterization intervention. According to the different risks of surgery, it can be divided into low-risk surgery, high-risk surgery and emergency surgery, etc. According to the different steps of nursing cooperation for different surgeries, it can be divided into simple surgery and complex surgery, etc. During the period of training, the teacher explained the steps of surgery for different types of surgeries, so as to let the trainee nurses be familiar with the surgical equipments and commonly used drugs required in various interventional surgeries in the cardiac catheterization laboratory, and to grasp the steps of nursing cooperation and the key points. In practice, the teacher guided the trainee nurses to start learning and cooperating with simple interventional surgeries, and gradually over to difficult and risky surgeries. In the process of access to the hands of the teacher asked the nurse to learn to observe a variety of parameters on the monitoring instrument, if there is an abnormality in time to report to the surgeon, learn to master a variety of first aid techniques.
2. Cardiac catheterization laboratory management training:
Cardiovascular interventional materials of various types, high safety requirements, catheter specifications, model complexity, the quality of interventional catheterization materials to a large extent determines the safety and quality of the medical act: interventional catheterization materials demand timeliness, intraoperative if the lack of a certain material or specifications, will affect the process of the operation and the effect. Therefore, guaranteeing the timely supply of required interventional catheterization supplies is also an important part of catheterization room nursing work. Do a good job of inventory and consumption records of various materials, to ensure that the material spare enough, the implementation of procedural standardized management can make the busy work become just organized.
3. Catheterization room nurses have the quality and ability
(1) sensitive observation ability cardiac catheterization room is a cardiovascular patient life and death of an important position, the doctor expects the catheterization room nurses should have a keen ability to observe, can find the patient's condition changes in the operation in a timely manner, and quickly tell the doctor to do a good job of resuscitation. (2) Skillful operation ability catheterization laboratory using mostly high-tech equipment, complex materials, requiring nurses to special equipment for surgery to do to memorize, can skillfully use. (3) scientific management ability of the catheterization room using a lot of instruments and special materials, so the nurse should do a good job of the scientific arrangement of the instruments and materials placed in a standardized manner, do a good job of cleaning and disinfection of the environment of the catheterization room and supervise the doctor's aseptic operation in the operation of the norms.
4. Catheterization room nurses should master the knowledge and skills
The choice of instruments according to the catheterization room to carry out the type and number of surgery, the appropriate time and amount of preparation of a variety of instruments and equipment. Intraoperative resuscitation familiar with the clinical manifestations of common intraoperative serious complications, resuscitation drugs and first aid measures.
5. Interventional surgery nurse cooperation
The patient into the catheter information verification, cardiac monitoring connection and oxygen inhalation, for the surgeon to lay the operating table, ready for the operation of the disposable materials and the operation of the required drugs, for the operator to put on surgical gowns, the operation of the monitoring and recording of vital signs, as well as for the surgeon to provide the operation of the middle of the special implantation of materials required. Handing over the surgical procedure to the ward nurse after the operation.
6. Radiation protection
Intervention catheterization room as a special operating room, all operations must be completed under the aid of X-ray, both with the operating room with the same disinfection management and environmental management system, but also with the operating room with the different ray contact protection management system, as a catheterization room nurses need to strengthen the knowledge of radiation protection learning, understanding of the basics of radiation and how to protect radiation, strict implementation of the protection of safety. As a catheterization laboratory nurse, you need to strengthen the knowledge of radiation protection, understand the basic knowledge of radiation and how to protect against radiation, strictly implement the safety operation procedures for protection, and correctly use the protective equipment to minimize the hazards of radiation on the body.
I look back on this time and review the changes in itself. In the days of the Third People's Hospital of Yunnan Province, my professional knowledge has been consolidated and growth, learned a lot of advanced technology and methods; but for me, the most important gain is still the concept of change. I am now happy for what I have given and gained. I am determined to bring the knowledge and concepts learned back to their own work, and in the work of the influence of colleagues, so that our hospital's cardiology intervention room work to a new level.
Doctors training experience experience essay three
Time flies, a white horse flies. In the blink of an eye, in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine six months of training life has been successfully concluded. Counting the six months of short time, I cherish. Because I know that the hospital selected me to go out for further study, in addition to the needs of the hospital business development, but also contains the leadership of the hospital's full trust in me and ardent hope, I also take this further study as a valuable learning opportunity. Through this six-month training and learning, not only improve my own business and technical level, but also make me open up the vision, expanding the idea, so that I have benefited from life, but also a clear sense of their own shortcomings. The following is my opportunity to talk about some of their own insights on this training and learning.
The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine is the southwest region, the most complete range of clinical Chinese medicine disciplines, the comprehensive level of service set of medical care, teaching, scientific research in one of the three first-class comprehensive hospitals of traditional Chinese medicine, the national demonstration of hospitals of traditional Chinese medicine, the National Chinese Medicine Clinical Research Base construction units, but also the national Chinese medicine clinical trial research (GCP) center, the National Chinese Medicine Eye Medical Center, the National Chinese Medicine Emergency Medical Center It is also the National Center for Clinical Trial Research of Chinese Medicine (GCP), National Medical Center of Chinese Medicine Eye Disease, National Medical Center of Chinese Medicine Emergency Disease, as well as the Clinical Base of Chinese Medicine, Combined Chinese and Western Medicine Emergency Care and Clinical Base of Infectious Disease of the State Administration of Chinese Medicine. The cardiovascular department is the cardiovascular base of the National Center for Clinical Trials of New Drugs and the key specialty of Chinese medicine in Sichuan Province. The department mainly uses both Chinese and Western medicine to diagnose and treat various cardiovascular diseases, and at the same time, the department also carries out interventional therapy for coronary heart disease and structural heart disease, cardiac electrophysiological examination and various pacemaker placement.
Over the past six months, under the careful guidance of the substitute teacher, I have mastered the diagnosis and treatment of various common and frequent diseases of the cardiovascular system, such as hypertension, coronary heart disease, arrhythmia, heart failure, myocarditis, cardiomyopathy, valvulopathy and other common and frequent diseases, and have gained a certain degree of familiarity with and mastery of the treatment of various emergencies and critical illnesses of cardiovascular disease and the process of resuscitation in CCU; I have also mastered the diagnostic methods, techniques, investigations and diagnostic methods of cardiovascular disease. I have also mastered the methods and techniques of consultation, the main points of physical examination and the accurate and rational application of routine medicines, and I am able to independently complete the operation of the electrocardiogram machine, master the main points of reading the electrocardiogram, and accurately issue the report card; at the same time, I have observed and learned a variety of interventional therapies, such as coronary arteriogram and stent implantation, permanent pacemaker implantation, electrophysiological examination of the heart and radiofrequency ablation, and so on.
In the process of further study, I was not only impressed by their exquisite medical technology, but also by their scientific and standardized departmental management, especially in the implementation of their core medical system. As a famous Chinese medicine tertiary teaching hospital in Southwest China, their three-level physician checkup system is reflected to the fullest extent. My cardiovascular department is divided into three medical groups, and the residents are all above the title of attending, each medical group has a deputy director or above to check in every day, and the director and deputy director of the department fix the business check-in every Monday and Thursday; in addition to the routine morning check-in, each medical group often organizes its own check-in in the afternoon; in the process of checking in the room, they analyze and comment on each patient's condition in detail from the perspective of evidence-based medicine, so that each participant in the room check-in can be more satisfied with the patient's condition, and the patient's condition is more stable. In the process, they analyze and comment on each patient's condition in detail from the perspective of evidence-based medicine, so that every doctor participating in the room check can "know what is true and what is not true"; if the patient develops symptoms other than those in their own department in the process of treatment, they will immediately invite the relevant departments for consultation; every Monday, Wednesday and Friday is the time for them to carry out interventional therapy, and pre-operative discussions will be held in the afternoons of Tuesday and Thursday; every Monday afternoon is the time for death discussions, and every Wednesday afternoon is the time for death discussions. Every Monday afternoon is the time to discuss the death, Wednesday afternoon is the time to discuss the difficult and critical cases; Friday afternoon is the time for business learning lectures; they also pay special attention to the doctor-patient communication system, each patient will be admitted to the hospital by the treating doctor personally write a doctor-patient communication record, which contains detailed records of the patient's condition and diagnosis, the proposed treatment program and some complications that may arise in the treatment process; critical patients in the treatment process repeatedly and repeatedly communicate with the patient's family members. In the process of critical patients in the treatment of repeated communication with the patient's family; intervention in the surgical treatment of patients in addition to the routine signing of the surgical consent form, there is also a preoperative conversation record; in addition, the department also has a special medical teaching secretary, responsible for the quality of the department's medical records and teaching arrangements.
As a Chinese medicine hospital, Chinese medicine special treatment is one of their major features. The cardiovascular department carries out Chinese medicine treatment programs generally have moxibustion treatment, auricular acupuncture point treatment, Chinese medicine foot bath, Chinese medicine collapsed impregnation, acupuncture and other Chinese medicine treatment programs, the former three are mostly; moxibustion treatment is the use of purchased coronary heart moxibustion, strong kidney moxibustion, analgesic moxibustion, etc., after admission to the hospital, each patient is issued a course of treatment (7 days); auricular acupuncture point treatment is their homemade. Their herbal foot baths were the most commonly carried out and were used by almost every patient. This is because they have a strict ratio of Chinese medicine to be used (25% of the medicinal ratio), so in addition to prescribing oral Chinese medicine to patients, they also carry out Chinese medicine foot baths to increase the ratio of Chinese medicine to be used.
As a department specializing in cardiovascular disease, the high utilization rate of equipment in the department is another major feature of the department. Cardiovascular Department *** with 80 beds, but the cardiac monitor is configured with more than 40 units. Heart failure, arrhythmia patients routine ECG monitoring, interventional patients also routine ECG monitoring 2-3 days. The department is also equipped with bedside Doppler ultrasound, and patients admitted to the hospital routinely undergo cardiac Doppler ultrasound examination. In addition, the department also has a cardiac function test room, arrhythmia and hypertension patients routinely carry out 24-hour ambulatory electrocardiogram, heart rate variability analysis and ambulatory blood pressure examination, every day the department is equipped with 24-hour ambulatory electrocardiogram detector and ambulatory blood pressure monitor will appear to be in short supply.
Cardiac intervention and non-pharmacological device therapy is a major trend in the treatment of modern cardiovascular diseases. The department has an interventional catheterization room equipped with digital subtraction angiography and cardiac Doppler ultrasound and other advanced equipment, mainly to carry out left and right heart catheterization and monitoring, coronary angiography, percutaneous coronary angioplasty and stenting, balloon dilatation of heart valves, radiofrequency ablation of tachyarrhythmias (supraventricular tachycardia, atrial fibrillation, ventricular tachycardia, etc.), placement of a variety of pacemakers and interventional treatment of congenital heart disease, which has generated considerable medical practice revenue for the department.
In the performance evaluation of the department, they take the medical income created by the individual as the standard, and adopt the principle of "more work, more pay" and "distribution according to work" to mobilize the work enthusiasm of the department staff. At the same time, they to play the advantages of the characteristics of Chinese medicine and medical quality indicators as the main content of the quality of medical records writing, the implementation of the core medical system, Chinese medicine identification and treatment of qualified rate, the proportion of Chinese and Western medicines, the four reasonable use, the incidence of medical errors and participate in the teaching activities of the situation as the basis for assessment, the formulation of a comprehensive assessment of the department staff rules, the Department of Medical Teaching Secretary of the Department of the personnel (doctors) to assess every month!
In terms of nursing, they use the nursing grouping work mode to divide nursing staff into two working groups, each group has a nursing team leader. Each working group is divided into treatment groups, work groups, inspection groups, mobile groups, etc., each group division of labor, solidarity and collaboration, so that the complexity of the nursing work carried out in an orderly manner.
Through the six-month period of further study, so that my business skills have been greatly improved, but at the same time I am also y aware of their own shortcomings, feel the grass-roots hospitals and tertiary hospitals in the hardware and software facilities between the existence of the obvious gap. At the time of our hospital to create a second-class B Chinese medicine hospital, I put myself in the process of further study, see, feel, think and inpatient internal medicine and the actual situation of the combination of the following points, hope to be able to play a certain role in promoting the development of the department.
1, the strict implementation of the core medical system
The implementation of the core medical system is to improve the quality of medical care, to ensure the importance of medical safety initiatives. In the process of routine business in the department, should strictly implement the checkup system, consultation system, difficult and critical case discussion system, death case discussion system and other core medical systems. In terms of the title structure of our hospital, now hospitalized internal medicine has fully equipped to implement the ability of the third-level physician checkup system, but due to the title of deputy director of the staff above the daily outpatient medical tasks, resulting in the implementation of the third-level physician checkup system is difficult to implement, it is recommended to designate one day a week in the morning for the deputy director of the physician in the internal medicine business of the time of the checkup, which is designated to checkup in the morning of the deputy director of the doctor does not bear the task of the outpatient medical tasks.
2, increase the department hardware investment
Modern diagnostic and treatment technology, in addition to the need to have a strong level of business skills, hardware facilities is also an indispensable part of the investment. Through the feeling of further study during the period, let me y appreciate the lack of equipment in our hospital, some times there is really a kind of "clever woman can't cook without rice," the embarrassment and helplessness, the department's emergency proportion is not high and the lack of hardware facilities have a certain relationship. In terms of the business development of inpatient internal medicine, it is recommended that the hospital laboratory carry out natriuretic peptide, N-terminal natriuretic peptide, blood gas analysis and other testing programs, and the Department of Internal Medicine to purchase cerebral function therapeutic instrument, cerebral hemodynamic detector and other equipment, and at the same time recommended the development of painless gastroscopy. In addition, the department has an existing idle ventilator, it is recommended to send people to learn to use.
3, fully demonstrate the characteristics of Chinese medicine
Since the creation of my hospital to create a second-class Chinese medicine hospital, the Department of Internal Medicine has carried out the treatment of Chinese medicine appropriate technology. Previously, the department routinely carried out Chinese medicine appropriate technology are acupuncture, auricular acupuncture points, acupoints, moxibustion, gua sha, bloodletting at the ear tip, cupping, enema and other items. Due to the limitation of the New Agricultural Cooperative Policy, the treatment programs carried out in the department now are only acupuncture, acupoint sticking and moxibustion. But no matter what kind of Chinese medicine treatment program, it has not been formed in the patients' mind is our hospital "Chinese medicine special treatment" concept, and even such as acupuncture and other invasive operation part of the patients are still very rejected. In my opinion, in terms of Chinese medicine appropriate technology treatment, we can learn from the cardiovascular department of Chengdu University of Traditional Chinese Medicine Hospital to carry out Chinese medicine foot bath treatment for most patients. The reason is that first of all, everyone has to wash their feet every day, and people are very happy to accept the addition of Chinese medicine soup during foot washing; secondly, some patients who reject oral medicines (especially oral Chinese medicines) are also willing to accept this method of Chinese medicine treatment; again, this treatment is not invasive; and fourthly, it can increase the ratio of traditional Chinese medicines while increasing the income from the treatment. In addition, the department should develop its own in-hospital preparations as soon as possible, such as their silver scape clear lung oral solution, stroke wake-up injection are very widely used.
4, the refinement of the department staff professional
Inpatient medicine belongs to the category of large internal medicine, patients throughout the internal medicine of various systems. Because of the hospital conditions and patient resources, can not be divided into three hospitals like the refinement of the secondary departments, departmental personnel can not achieve the requirements of the section proficiency. Therefore, it is necessary to refine the professional direction of the department staff, not requiring each system of professional direction are refined, at least the cardiovascular system, respiratory system, digestive system, nervous system, endocrine system and other professional refinement of the department staff head, so that "a hundred schools of thought, each lead a end". At present, the Department of Internal Medicine has personnel in the cardiovascular and gastroenterology completed advanced study, it is recommended to co-ordinate the arrangement of personnel to further study respiratory, endocrine and neurology.
5, reasonably equipped with medical personnel
At present, the Department of Internal Medicine medical staff **** 11, staffing is slightly inadequate, especially in the nursing staff. Our existing nursing staff of 5, every day only to complete the basic nursing work. The nursing content of the level of care can not be fully completed, and the piece of Chinese medicine specialty care is even more unable to reflect. It is recommended to increase 1-2 nursing staff appropriately when conditions allow.
The above is my own half-year training time a little experience, when our hospital to create a second-class Chinese medicine hospital, I hope that my little experience can provide a limited reference for the hospital's up to standard work. Finally, I would like to thank the leadership of the hospital to give me this valuable learning opportunity, so that I have a lot of experience and feelings, perhaps this learning opportunity will not give their work to bring about sweeping changes, but on life, on the work I have more thoughts, I hope it can penetrate into my thoughts, to give new meaning to my life.