Surgical training self-assessment
Self-assessment is an analysis and summary of our own performance in a certain period of time, the following is my collection of surgical training self-assessment, welcome to read reference!
Self-assessment of surgical training (1)
Laparoscopy has a history of 100 years since its birth, and is increasingly accepted because of its low trauma. Laparoscopy has a wide range of applications, most of which have replaced the traditional surgery, so that the traditional surgery has undergone a qualitative change. The three-month study of laparoscopy is summarized as follows;
First, the significance of further study of laparoscopy for surgeons.
With the widespread development of laparoscopy, our patients are increasingly accepting minimally invasive surgery. The significance of surgical re-invasive surgery is becoming more and more obvious. Minimally invasive surgery is superior in: First, the operator's hand does not enter the abdominal cavity, the operation outside the body, can be used to change the position and the pneumoperitoneum pressure as well as the appropriate pulling can be achieved to achieve the required surgical field exposure. There are several small incisions in the abdominal wall protected by trocars, which are not easily pulled, and the degree of injury is much smaller than that of traditional surgical incisions, which is an important difference between laparoscopic surgery and traditional surgery, and also an important factor of minimally invasive laparoscopic surgery. In addition, it can reduce the damage of organ peritoneum and the interference of organ function, and the postoperative intestinal function can be recovered quickly, and the intra-abdominal adhesion is less. Secondly, during the operation of laparoscopic surgery, it should be required to be bloodless surgery, and the surgical operation is first coagulation and hemostasis and then separation or even hemostasis and separation, so there is less bleeding. Third, the operation time is short. With the improvement of laparoscopic technology and experience, as well as the successful development of new and applicable instruments, experienced doctors and has matured the surgical time of the operation is gradually shortened, the general cholecystectomy only 20-30 minutes, colon resection surgery takes about 2 hours, splenectomy surgery takes about 30-100 minutes.
Second, laparoscopic surgeons should have the conditions.
Developed countries, the physicians engaged in surgery has established a set of strict qualification and quality control system, there is a strict training syllabus. Most national scholars believe that clinical laparoscopic surgeons should have the following qualities: First, they should have the qualification certificate of attending physician and engaged in specialized clinical work for more than 3 years; Second, they have been formally trained and qualified to obtain a certificate of completion of the examination; Third, they are proficient in surgical techniques, movements stable, accurate, light, fast; Fourth, they are clinically experienced, skilled in dealing with the common organ injuries.
And to be a qualified surgical laparoscopic surgeon, laparoscopic training appears important, the training content is mainly: First, to strengthen the theoretical learning, systematic study of the theoretical knowledge of laparoscopic surgery, master the working principle of laparoscopic equipment, familiar with the basic function of the surgical instruments, specifications and methods of use, to master the principles of laparoscopic surgical medicine, surgical indications, contraindications for surgery, the basic techniques of common surgical complications, surgical operation methods, the use of laparoscopic surgery, the use of laparoscopic surgery. surgical operation methods, prevention and treatment of surgical complications, and perioperative treatment. Second, technical training. Master the basic techniques of separation, ligation, suture and hemostasis. Laparoscopic surgery is very different from traditional open surgery, therefore, to master the laparoscopic surgical operation techniques, it is necessary to go through technical training and have a gradual adaptation process. To master the above techniques, it is necessary to go through three processes: laparoscopic simulation training, animal testing, and clinical practice. Simulation training is the use of laparoscopic surgery training box, simulation of the human abdominal cavity, can be through the monitor image of laparoscopic surgery technology training. The contents included are: hand-eye coordination training, orientation adaptation training, tissue separation training clip and suture knotting training simulated cholecystectomy training. Animal experiments are after the completion of simulation training, the selection of anatomical structure close to the human body for laparoscopic animal experiments, to complete the procedure of cholecystectomy, appendectomy. In the clinical stage, from clinical observation to clinical assistant, and then to clinical surgery, in the completion of 10-20 laparoscopic surgery assistant, to meet the requirements of qualified, can gradually transition to the operator, began to serve as an operator must be under the guidance of experienced physicians, the first anatomical simple operation, and then to complete the whole process of surgery, can not be rushed.
Third, the preparation, sterilization and cleaning of laparoscopic instruments are important.
Laparoscopic instruments and instruments belong to the precious instruments, surgical technology operation process, the use of these precision instruments not only to achieve the aseptic requirements, but also to know the performance of a variety of instruments, to ensure normal operation, easy to use, and the length of its service life. Therefore, the requirements of the surgeon and operating room staff must master the sterilization method, what kind of protection of precision instruments, and to ensure that the normal operation of the instruments in the operation. Instruments of the equipment are: monitor, video converter, pneumoperitoneum machine, electrocoagulation machine, cold light machine, flushing machine, video recorder, ultrasonic knife machine, carbon dioxide cylinders. General surgical instruments include: large sterile square tray, large sterile basin, treatment bowl, No. 3, 4, 7 shank needle holder, tissue scissors, gallbladder lithotripter, bladder lithotripter, and so on. Laparoscopic instruments include: pneumoperitoneum needles, puncture apparatus large (10CM) and small (5MM), conversion caps, and separation forceps.
Laparoscopic instruments are sterilized by: autoclave sterilization, gas fumigation sterilization, liquid immersion sterilization. The latter is currently the commonly used method of sterilization of laparoscopic instruments. The disinfectant solutions used are: 2% alkaline dialdehyde solution, complex iodine solution, 10% formaldehyde solution, Shilaji's Sterilization King solution, etc. The most commonly used is 2% alkaline dialdehyde solution. At present, the most commonly used is 2% alkaline dialdehyde solution, soaking for 10 minutes can achieve sterilization, 15 minutes can achieve effective disinfection. Soak the instruments before use repeatedly with saline rinse clean.
In summary, as a surgeon who is going to engage in minimally invasive surgery, it is necessary to undergo a rigorous and systematic technical training in order to master laparoscopic surgical operation procedures, to complete a variety of minimally invasive surgical procedures, and to bring the gospel to the patients.
Surgical training self-identification (2)
Over the past year, under the leadership of the hospital team and the dean in charge, in the hospital departments of the support and help and the hard work of doctors, constantly emancipate the mind, update the concept of setting up a high degree of dedication and responsibility, combined with the nature of the work of the department, around the hospital, "hospital management year," the central work, pragmatic, pragmatic, and the work of the hospital, and the work of the department of the hospital, and the work of the hospital. The center of the work, pragmatic, practical and hard work, better completed the work of the Department of the various tasks to ensure that the hospital at the beginning of the year to improve the level of scientific management, to improve the technical level of the discipline of the "two to improve" and to ensure medical safety, to ensure that the two benefits of the "double ensure that "The smooth implementation of the policy. Our annual. Total business income, the number of admissions, the number of discharges increased over the same period last year, the economic and social benefits of double growth. We will make a summary of nearly a year's work.
First, the basic situation of the department
General Surgery Department of the Second People's Hospital of Xinzhou City is one of the earliest departments established in the hospital, built in 1971. Now the general surgery department has 25 general wards and 4 ICUs (intensive care units). There are 18 medical staff in the department: 9 doctors, 3 deputy chief physicians, 1 attending physician, 5 residents; 9 nurses, 1 chief nurse, 3 nurse practitioners in charge, 5 nurse practitioners. The whole medical team has superior configuration and reasonable echelon. After nearly 40 years of development, through the careful accumulation of the predecessors, the young generation's efforts to learn, and bold innovation, many new knowledge, new technology should be transported to the clinic, and now the department can carry out more than medium surgery: cholecystectomy, choledochotomy, laparoscopic cholecystectomy, laparoscopic appendectomy, laparoscopic spermathecal varicocele, laparoscopic repair of gastric perforation, radical gastric cancer surgery, radical surgery for gastric cancer, radical surgery for colorectal cancer, splenectomy, pancreaticoduodenectomy and so on. The company's products and services have been widely recognized as one of the best in the world.
Second, the completion of the 2012 departmental indicators
2012 as of November, my department *** admitted 2,534 patients, outpatient clinic more than 1,852 times, 684 hospitalized, 682 discharged, nearly 290 cases of surgery, the average number of days of hospitalization ? days, the average hospitalization cost of yuan, the proportion of drug costs control to 33.85%, far below the required 41%, hospitalization costs and hospitalization days are lower than the local average. Grade A case rate of 100%, outpatient prescription rate ≥ 98%, admission and discharge diagnosis compliance rate ≥ 98%, cure rate ≥ 95%, diagnosis compliance rate before and after surgery ≥ 98%, basic nursing care qualification rate of ≥ 90%, nursing operation technology qualification rate of ≥ 95%, the overall nursing care rate reaches 100%, the rate of nosocomial infections ≤ 2%, the infection rate of aseptic surgical incision ≤ 0.05%, the rate of first aid items in good condition 100 The rate of hospital infection is ≤2%, the infection rate of sterile surgical incision is ≤0.05%, the intact rate of first-aid items is 100%, the quality of purchased medicines is 100%, the reporting rate of statutory infectious diseases is 100%, and the indexes of epidemic prevention are completed. In the local and neighboring areas has gained a good reputation
Third, to carry out new work on the contrary
1. I successfully performed a case of laparoscopic cholecystectomy, laparoscopy combined with choledochoscopy choledochotomy, to fill the gap in technology in the region
2. In the minimally invasive treatment of pediatric hernia, syringomyelia, due to the 5MM laparoscopy has not been equipped with yet, has not yet been carried out. If we can equip with equipment and select suitable cases, this will be another technological breakthrough of our hospital in the region.
3. Particle implantation technology: In 2007, with the establishment of our Cancer Hospital, the hospital formulated the policy of combining radiotherapy, chemotherapy, and surgery in the treatment of tumors. Particle implantation technology is the best embodiment of this policy. Radioactive particle (seed source) implantation for malignant tumors is an advanced minimally invasive treatment method, which is a kind of brachytherapy
with the advantages of safety, reliability, wide range of indications, and easy operation. Our hospital already has 64-row CT, which ensures the equipment base for particle implantation. Two deputy chief physicians of our department have already participated in the training, and will soon be able to obtain the qualification of operating this technology. The hospital can purchase particle implantation equipment, the work will be able to carry out immediately.
Fourth, talent training
Three trainee physicians of our department have successfully passed the examination of practicing physicians and registered, and now can carry out diagnosis and treatment under the guidance of the superior physician. 4 nurses have been trained and can work on shifts by themselves. 1 deputy director of the nurses participated in the examination of the title and successfully passed, and 1 attending physician has successfully passed the examination of the title of associate. Through the unremitting efforts and hard learning, the business level of the department members is constantly improving, laying the foundation for better patient service.
Fifth, political
A year under the leadership of the Secretary President, all medical staff of the Department of the Party's policies, conscientiously study the important thought of the three Represents, many times seriously study the medical ethics and medical style of the relevant documents, to improve the health care personnel to consciously resist poor professional moral behavior and the ability of bad air, and to further strengthen the construction of medical services and professional ethics of the health industry, to establish To further strengthen the construction of medical service and professional ethics in the health industry, and to establish the concept of serving the people's health wholeheartedly. The department has repeatedly carried out political study, and personal study.
Six, business learning
Department in order to improve the business quality of all medical staff, and constantly improve the level of business technology, actively participate in the business lectures organized by the hospital, medical staff in the department to carry out business learning lectures, the director of the room to accumulate clinical experience, combined with the patient's condition, case discussions, strengthen the writing of medical records, basically to achieve the Class A medical records. The level of business continues to improve,
Talent team continues to strengthen.
VII, strengthen the implementation of rules and regulations
We seriously organize the department staff, repeated study of the hospital's various documents and regulations. The entire staff can consciously abide by the hospital rules and regulations and labor discipline, to do small things in style, big things in principle, never make unprincipled disputes, mutual support and mutual understanding in the work, the section staff division of labor is clear, each in its own way, each responsible, united and pragmatic, to overcome all kinds of difficulties, to ensure that the smooth implementation of normal medical service work. Organize the staff of the department to seriously study the job duties, core systems, and work in strict accordance with the requirements of the duties, systems, and seriously study the "three basic" and carry out job training, to achieve strict requirements, rigorous style, tight organization. Strict implementation of the "three reasonable" norms, to achieve rational use of drugs, reasonable fees, services to people better completed the leadership of the work assigned to the task. The department held a weekly meeting, emphasizing safety, quality, doctors, nurses, the implementation of the duties; twice a month safety, quality inspection, the performance of unqualified to two thorough: regular safety education, to institutionalize, regular. Regular inspection and evaluation of medical records. Regular inspection and assessment of safety hazards.
Eight, medical ethics
"In addition to the human disease, to help the health of the perfect" is the ultimate goal of our medical profession, it is because of this light our efforts to persevere, it is with this commitment to the community to the health industry respect. Although the doctor-patient relationship is getting more and more tense, but in the clinical work I always put the patient in the first place to save lives, wholeheartedly for the patient service. People-oriented, the patient is first as a human being, civilized manners, quality service is the most basic requirements, respect for the patient's personality and rights, like treating a friend as patients to keep medical secrets, to win the patient's goodwill and trust, and at the same time to abide by the law,
clean practice, politely refused red packets, gifts.
IX. Problems restricting the development of the department
1. Newly developed projects due to the imperfection of the supporting facilities, constraints or delayed.
2. The number of beds in general surgery is small, some wards have been configured to 4 beds, affecting the patient treatment environment and mood, the patient has repeatedly mentioned, looking to improve.
3. Weak publicity, many patients in the region do not know the Department can carry out treatment programs, so that many patients lost.
4. Case paperwork is busy, occupying a lot of the doctor's work time, so that the understanding of the patient's condition, and patients timely and effective communication time is reduced, increasing the risk of doctor-patient disputes. I hope that the hospital can be equipped with electronic cases or machine-typed cases as soon as possible.
X. Shortcomings
Although I made good results in 2012, but there are still many problems in the work. There are the following points
1. The shift handover is not punctual, the weekday time consciousness is weak, procrastination, resulting in the whole department shift handover time delay, affecting the daily work.
2. As a result of the transition of the old and the new, this year did not complete the refresher training, next year must be sent out.
3. Due to fewer nursing staff, basic care is not in place, such as primary care patients were not able to get the services of primary care, only secondary to the daily work.
4. Department of young people, the majority of young people should be more organized to go out and activities to reduce work pressure, so that colleagues have a closer relationship, so that the work efficiency is higher.
20** year I Department of Nursing in the hospital leadership care, attention, nursing leadership support, in the whole section of the nurse's *** with the efforts to successfully complete the beginning of the year under the nursing work plan, according to the statistics of my department 20*** January to December **** admitted patients 1,228, an increase of last year, is summarized as follows:
First, strengthen the implementation of the core system and nursing quality management to ensure nursing safety.1, the head nurse is responsible for the work of each nursing staff control, good medical advice off, check off, handover off,
2, strict implementation of the hospital's rules and regulations, strengthen the nursing team management in the department,
3, improve and implement the core clinical nursing work system, obey the arrangements of the head nurse,
4, the cultivation of specialized nurses, such as the selection and dispatch of Nursing staff to higher hospitals for further training,
5, master the critical, major surgery patients resuscitation procedures
Second, focus on the details of service, improve patient satisfaction.
Adhere to the patient-centered, quality as the core, to provide patients with quality care services for the purpose of strengthening the construction of medical ethics of nursing staff, the implementation of the nursing staff code of conduct, the monthly satisfaction questionnaire issued to patients in the hospital, the results of the satisfaction survey results are more than 95%, but also many times to obtain the patient's praise, and the satisfaction of the survey of the problems that existed in the proposed corrective measures, and to seek the views of patients and their families, to patients and their families. Patients and their families, the views of patients and their families to give the greatest fulfillment of the requirements.
Third, standardize the writing of nursing instruments to reduce the pressure of comfortable writing.
Nursing paperwork that legal documents, is the objective basis for determining medical disputes, the writing process should be carefully considered, can be objective, true, accurate, timely, complete reflection of the patient's condition changes, and constantly strengthen the nursing paperwork to formalize the importance of writing, so that each nurse can correct the attitude of writing, colleagues to strengthen the supervision of the class to check the previous class records with or without errors, the quality control team to check regularly, the head nurse regular and irregular inspections and the quality control team to check. Regular and unscheduled inspections by quality control team, regular and unscheduled inspections by the head nurse and final quality inspection of discharge charts are carried out, and problems are found to be corrected in time. Monthly nursing paperwork quality analysis, the existence of problems proposed corrective measures, and continue to monitor.
Fourth, strengthen the quality of education of nurses, improve the quality of nursing services.
Give full play to the role of nursing quality control group, so that nurses can always grasp the progress of their own assessment and the completion of the situation, to find nursing hidden dangers. Nursing errors were found, timely nursing quality continuous improvement symposium and section life will summarize the work of the determination and inadequacy, timely correction, serious analysis of the causes of errors, discuss corrective measures to avoid similar accidents from happening again, for the wards of young nurses, dealing with disputes and other emergencies of inexperience, pay more attention to the cultivation of the nurses' communication skills, the use of difficult cases to discuss the incident, life will encourage the nursing to participate in the discussion, in order to cultivate their communication ability. Nursing to participate in the discussion, in order to cultivate their communication skills, teach young nurses to learn to deal with the problem
A year of nursing service quality, standardized nursing writing, patient satisfaction has achieved certain results, I hope that next year, on the basis of completing their work, to be able to add a new high in the workload, new business, new technology.
;