The level of clinical practice skills in medical students is one of the most important markers to evaluate themedical educational quality. We have designed a new integrative assessing scheme which chiefly evaluates the practicalskills, that is: clinical skills account for 50%, oral test of professional knowledge accounts for 20% ,case analysis 20%,medical history writing 5%, and medical ethics and work discipline 5%. Through the nearly two years' implement,theproject greatly accelerates the cultivation of clinical practice abilities in medical students, enormously promotes thestudents' initiative and consciousness in clinical practice training, and roundly improves the teaching quality of clinicalpractice.

Thirty-six healthy women were divided into 3 groups according to their calcium intake at week 18 of gestation. The levels of their blood calcium, phosphate, parathyroid hormone (PTH) and calcitonin were assayed during pregnancy and postpartum, and bone mineral density ( BMD) was measured postpartum. The levels of PHI and calcitonin were increasing with advancing pregnancy and reached the highest at the end of pregnancy. The women with higher calcium intake during pregnancy period had higher BMD than that of the women with ordinary diet during pregnancy period.

This paper analyzed the system,methods,content,scope and standards of last two competition in order to further improve the clinical skills competition for national medical students in China.According to the characteristics of medical education,the paper proposed several opinions and suggestions as follows:repechage should be cancelled in competition system and objective structured clinical examination should be used in competition; the content,scope and criteria of the competition should take the actual ability of the medical students at graduation into consideration.

Objective: To explore the dynamic regulation of histone acetylases p300 and p300/CBP associated factor (PCAF) on cardiac development gene NKX2.5 during cardio-genesis and to provide the new theoretical basis to clarify the regulatory mechanism for cardio-genesis in fetal mice.
Methods: Our research included 4 groups of cardiac tissues: Embryo (EB) 14.5 days group,n=10, EB 16.5 days group, n=10 and Neonatal 0.5 day group,n=5, Neonatal 7 days group,n=3. Immunoprecipitation was performed in myocardial tissues using anti-p300, anti-PCAF and anti-H3K9ac antibodies to retrieve p300, PCAF and H3K9ac binding DNA, the speciifc DNA sequences were ampliifed by real-time PCR to detect and the binding levels of p300, PCAF and the acetylation level of H3K9ac in NKX2.5 promoter sequence. In addition, the mRNA expression of NKX2.5 was examined by RT-PCR.
Results: The binding levels of p300 and PCAF had the timing consequence at different stage of cardio-genesis. The binding level of p300 in EB 16.5 days group (0.063 ± 0.021), Neonatal 0.5 day group (0.019 ± 0.008), Neonatal 7 days group (0.011 ± 0.003) were all lower than that in EB 14.5 days group (0.231 ± 0.033), and in Neonatal 0.5 day group and Neonatal 7 days group were lower than EB 16.5 days group, allP<0.05. The binding level of PCAF in EB 16.5 days group (0.063 ± 0.021), Neonatal 0.5 day group (0.019 ± 0.008), Neonatal 7 days group (0.011 ± 0.003) were all lower than that in EB 14.5 days group (0.185 ± 0.023), allP<0.05. The H3K9ac acetylation level and NKX2.5 mRNA expression level had the timing consequence at different stage of cardio-genesis. H3K9ac acetylation level in EB 16.5 days group (0.098 ± 0.014), Neonatal 0.5 day group (0.074 ± 0.010), Neonatal 7 days group (0.045 ± 0.014) were all lower than that in EB 14.5 days group (0.119 ± 0.020), and in Neonatal 7 days group was lower than EB 16.5 days group, allP<0.05. The NKX2.5 mRNA expression level in EB 16.5 days group (0.701 ± 0.181), Neonatal 0.5 day group (0.502 ± 0.159), Neonatal 7 days group (0.529 ± 0.13) were all lower than that in EB 14.5 days group (1.000 ± 0.130), allP<0.05.
Conclusion: Histone acetylases p300 and PCAF may dynamically regulate H3K9ac acetylation in NKX2.5 promoter sequence, and the mRNA of NKX2.5 was dynamically expressed during cardio-genesis in experimental fetal mice.

In order to improve the clinical skills of medical students,the First Clinical School of Tongji Medical College,Huazhong University of Science and Technology strengthened the construction of teaching base,teaching materials,teaching team,curriculum and assessment methods,and established a comprehensive experimental teaching system of clinical skills.

OBJECTIVE: The aim of the study is to explore the establishment of paired-standardized patients (PSPs), which can cover the deficiency of standardized patients. METHOD: The outpatients and standardized patients consist of PSPs. The standard case of PSPs is established by the combination of PSPs and the laboratory and imaging information of the true patients. Then we apply the PBL model and PSPs to the clinic teaching in otorhinolaryngology. RESULT: The study of the ten standard cases of PSPs, which we have established, has enhanced the confidence and interest of medical students in clinical practice. CONCLUSION PSPs can cover the deficiency of standardized patients, which includes lacking of change and lively. At the other hand, PSPs can practice the medical students' clinical skills and the way of evidence-based medicine and can stimulate them to form the good habit of self-regulated learning.
Evidence-Based Medicine ; Humans ; Otolaryngology ; education ; Outpatients ; Problem-Based Learning ; Reference Standards

OBJECTIVE: The aim of the study is to cover the shortages of PBL, such as time-consuming, abstract, lacking of the course of clinic practice, and to introduce PBL to the teaching of otorhinolaryngology. METHOD: By the improvement of the international classic teaching model of PBL, we put forward "four-stage gradual expanding approach of PBL" and establish "four-stage gradual expanding approach of PBL in otorhinolaryngology". RESULT: Through the four stages of watching PBL, simulation PBL, internship PBL, practice PBL, we have accomplished the organic integration of theory teaching and clinical practice. CONCLUSION This teaching method is more adaptive to the teaching of otorhinolaryngology, and it can help the medicine students to establish the whole concept of medicine and can stimulate them to form the good habits of self-regulated learning and life-long learning efficiently.
Educational Technology ; Otolaryngology ; education ; Problem-Based Learning ; methods

The performance evaluation of tertiary public hospitals aims to strengthen functional positioning,and the weight of indicators such as the proportion of surgery is relatively high in the evaluation indicators.In this con-text,some tertiary comprehensive hospitals with a high proportion of internal medicine business are facing significant challenges in sustained development.It comprehensively reviews the impact of performance evaluation indicators on the direction of internal medicine specialties,and uses SWOT analysis tools to condense the sustainable develop-ment path of tertiary public hospitals.This includes growth strategies(improving the ability to treat difficult and criti-cal diseases,undertaking scientific and educational tasks),transformational strategies(technological innovation,price approval),multiple business strategies(adjusting outpatient and inpatient structures,building specialized disease centers,etc.),and defensive strategies(reasonable diagnosis and treatment,clinical pathways),inorder to provide reference for hospital managers.

Objective To analyze the problems existing in the homogenization management of multi-branch hospitals based on the annual performance assessment data,and provide reference for promoting the high-quality development of public hospital branch districts.Methods Based on the Performance Assessment Operation Manual of National Tertiary Public Hospitals(2022 edition),10 indicators including the proportion of discharged patients undergoing surgery and the proportion of fourth-level surgery were screened,and the functional positioning,quality and safety,revenue and expenditure structure,and cost control of 4 hospitals of a certain medical institution from 2022 to 2023 were descriptively analyzed.Results The CMI value and the proportion of discharged surgery in the main hospital were significantly better than those in the branch hospitals,and there was no significant difference in the medical quality indicators of the four hospitals,and the operation efficiency of the branch hospital with outstanding specialty characteristics was better than that of other hospitals.Conclusion Public hospitals pay more attention to the"big specialty,small comprehensive"mode in the layout of branch districts,pay more attention to the quality control management at the specialty level in medical quality management,and strengthen the benefit analysis of different hospitals in the same specialty in operation management.

Public welfare orientation is the core requirement of public hospital reform. A profound understanding of the connotation of public welfare in public hospitals is related to the effectiveness of deepening the reform and implementation of public hospitals guided by public welfare. The author reviewed and sorted out the historical evolution process of public hospital reform guided by public welfare, summarized and condensed the core connotation of public hospital public welfare, including " legal obligations, system concepts, people′s positions, and inclusive goals", and introduced the practice of deepening the public welfare reform of public hospitals based on the connotation of Union Hospital affiliated with Tongji Medical College of Huazhong University of Science and Technology based on this connotation, focusing on " party building, medical technology, health emergency response, improvement of services, salary distribution, economic operation, resource expansion and sinking" .