At present, robotic surgery system, as a cutting-edge technique in minimally invasive surgery, has become a crucial component in the training programs for outstanding surgeons. Given the relatively late start of this technique and immature faculty resources, there is an urgent need to optimize and improve the teaching philosophies and methodologies for robotic skill training in China, and Sino-foreign cooperation has emerged as a significant pathway to promote this reform. Taking the "International Robotic Surgery Training Center (IRSTC)" jointly established by The First Affiliated Hospital of Sun Yat-sen University and University of California as an example, this article provides a comprehensive analysis of collaboration background, construction of the training system, curriculum design, cooperation channels, and localization practices, in order to provide a reference and valuable experiences for Sino-foreign cooperation in clinical skill training.

Chinese-foreign joint education program of clinical medicine is an important means to achieve the globalization of medical education. Chongqing Medical University and University of Leicester in the UK have jointly established a Chinese-foreign joint education program of clinical medicine to achieve the integration of Chinese and British cultivation concepts, management systems, teaching resources, teacher teams, evaluation systems, and multiculturalism. They have also constructed an internal teaching quality assurance system with the main contents of the improvement of management mechanisms, the formulation of training programs, the construction of teaching staff, the design of syllabuses, the curriculum assessment system, and teaching quality evaluation, as well as an external teaching quality assurance system with the core components of clinical medicine accreditation, Chinese-foreign joint education program evaluations, international quality audits, and professional quality monitoring. Both systems can help to comprehensively improve teaching quality.

Objective:To evaluate the application value of interactive learning in enhancing the diagnosis of breast cancer by residents in the department of radiology through training based on the interpretation of breast magnetic resonance imaging (MRI) features by the breast imaging reporting and data system (BI-RADS).Methods:A total of 23 trainees completed BI-RADS standardized reports of 250 cases. These cases were divided into a pre-training group (Group 1) and post-training groups (initial training, Groups 2-4; advanced training, Groups 5-6), forming a total of six groups. The efficacy of interactive learning through course lectures and case-based practice in enhancing their ability in breast cancer diagnosis was analyzed. All trainees generated reports based on the BI-RADS scoring criteria. Interpretation agreement rates, evaluation time, and confidence levels were recorded. SPSS 25.0 was used for independent samples t test, chi-square test, and rank-sum test. Results:During the initial stage of training, the agreement rate of 150 cases reached 80.00%, which was recommended as the endpoint for completion of the initial learning phase. A significant difference existed between Group 4 and Group 1 ( P=0.012) in agreement rate. Statistically significant differences were noted in evaluation time for Groups 5 and 6 before and after advanced training ( P=0.001 and 0.007, respectively). A significant difference in confidence level was observed for Group 5 ( P=0.005). Conclusions:Interactive training based on BI-RADS standardized reporting can improve the diagnosis of breast diseases by residents in the department of radiology, particularly for enhancing the quality of reports for mass-like enhancement breast diseases.

Objective:To explore the construction of a core competency evaluation indicator system for pediatric surgery operating room specialist nurses.Methods:The evaluation indicator system was constructed by reviewing literature, analyzing semi-structured interview results, and examining the characteristics of training specialized nurses in pediatric surgery operating rooms, as well as combining the characteristics of pediatric surgery and multi-source data. The research group discussed and proposed a preliminary core competency evaluation indicator system for specialized nurses in pediatric surgery operating rooms. This study used the Delphi expert inquiry method to conduct two rounds of expert consultation and ultimately established the core competency evaluation indicator system for pediatric surgery operating room specialist nurses. The expert positivity coefficient was represented by the questionnaire response rate, and the expert authority coefficient was calculated using the judgment coefficient and familiarity degree. The coefficient of variation and Kendall's W coefficient were used to measure the degree of coordination of expert opinions. Results:The effective response rates for the two rounds of expert consultation were 100.00% and 95.24%, respectively. The authority coefficients of the two rounds of expert consultation were 0.92 and 0.90, respectively. The coefficients of variation of indicators at various levels were less than 0.25. The Kendall's W coefficients for the first-, second-, and third-level indicators in the first and second rounds of expert consultation were 0.516-0.664 and 0.652-0.711, respectively ( P<0.001). The final core competency evaluation indicator system for pediatric surgery operating room specialist nurses included 3 first-level indicators, 15 second-level indicators, and 52 third-level indicators. Conclusions:The core competency evaluation indicator system for pediatric surgery operating room specialist nurses constructed in this study provides a scientific and practical guidance for training pediatric surgery operating room specialist nurses in China.

Objective:To explore the effects of a method combining the knowledge, attitude, and practice (KAP) model with objective structured clinical examination (OSCE) on soft skill evaluation score, training satisfaction, personal growth, and radiation effect in training perinatal specialist nurses, and to evaluate the effectiveness of this method in improving the comprehensive clinical nursing ability and training effect of perinatal specialist nurses.Methods:Using the cluster sampling non-random grouping method, 63 trainees who received training at the Perinatal Specialist Nurse Training Base of Chongqing Maternal and Child Health Hospital from 2019 to 2020 were selected as the control group, and the conventional theoretical and clinical practice training and assessment methods were adopted. Additionally, 60 trainees who received training from 2021 to 2022 were selected as the experimental group, and the training method combining OSCE and KAP was adopted. General information questionnaire, training assessment satisfaction questionnaire, and a nursing soft skill evaluation scale were used for investigation. SPSS 25.0 software was used for descriptive analysis. The independent samples t-test and chi-square test were used to compare the differences in soft skill evaluation score, training satisfaction, personal growth, and radiation effect between the two groups of trainees after training. Results:The average difficulty of OSCE was 0.7 and the average discrimination was 0.5. The total score of soft skill evaluation in the experimental group was significantly higher than that in the control group ( t=3.73, P<0.001). After training, the total satisfaction score of the experimental group was (30.95±5.36), which was significantly higher than that of the control group (28.73±4.72) ( t=2.44, P=0.016). There were no significant differences in personal growth and radiation effect between the two groups after training ( P>0.05). Conclusions:The combination of KAP and OSCE in training perinatal specialist nurses is helpful to improve the trainees' soft skills and training satisfaction, and is worthy of promotion and application in clinical specialist nurse training.

Objective:To construct and evaluate a training program for cardiovascular nurse specialists based on a core competency framework.Methods:Among 61 trainees participating in the first training class for cardiovascular nurse specialists organized by a provincial nursing society, a training program focusing on the nine core competencies for cardiovascular nurse specialists was implemented, which consisted of 4-week theoretical and 4-week practical training. The effectiveness of the training program was evaluated using the Kirkpatrick model. Data analyses were performed by using SPSS 26.0. Categorical data were presented as the number of cases; continuous variables in normal distribution were expressed as mean±standard deviation; and continuous variables in non-normal distribution were presented as median (interquartile range) and compared using non-parametric tests.Results:At the reaction level, the satisfaction rates of trainees with the theoretical and practical sections of the training program were 98.36% (60/61) and 95.08% (58/61), respectively. At the learning level, the comprehensive assessment score of the trainees was (83.01±3.39) points, and all of them successfully obtained their completion certificates, with a pass rate of 100.00% (61/61). At the behavior level, the core competencies for cardiovascular nurse specialists were significantly improved after training [the total score increased from 291.00 (254.00, 334.25) to 410.50 (354.50, 433.00), P<0.001]. At the results level, at six months after training, there were significant increases in the number of participants engaging in cardiovascular care practices, clinical nursing education and guidance, leadership roles, and research projects within their units as well as the number of individuals achieving career advancement (all P<0.05). Conclusions:The trainees are highly satisfied with the core competency-focused cardiovascular nurse training program, which can improve core competencies and cardiovascular nursing capabilities, expand the scope of cardiovascular nursing services, and foster the sustained advancement of the participants.

Objective To study the efficacy and safety of less invasive surfactant administration(LISA)combined with budesonide and supported by nasal intermittent positive pressure ventilation(NIPPV)in preterm infants with respiratory distress syndrome(RDS).Methods Premature infants with RDS at the gestational age of 26-32 weeks in the neonatal ward of Xuzhou Central Hospital from Feb-ruary 2022 to March 2024 were divided into the observation group and the control group in this prospective randomized controlled trial.The control group suspended nasal continuous positive airway pressure(NCPAP),they were intubated and infused with PS into the lung through endotracheal tube and extubated(INSURE),then continued to receive NCPAP.In the observation group,a LISA tube was insert-ed through the vocal cords under direct vision with direct laryngoscope,then infused pulmonary surfactant(PS)and budesonide into the lung when NIPPV ventilation was applied.The results of blood gas analysis at 1h and 6h after intratracheal instillation of PS,medication administration,clinical efficacy,related complications of budesonide,bronchopulmonary dysplasia(BPD)were compared between the two groups.Results A total of 126 preterm infants with RDS were enrolled in the study,including 65 in the observation group and 61 in the control group.The incidence of regurgitation in the observation group were lower than those in the control group[(10.8％(7/65)vs 24.6％(15/61)],and the differences were statistically significant(P＜0.05).The PaO2/FiO2(P/F)in the observation group at 1h and 6h were higher than those in the control group,while PaCO2were lower than those in the control group,and the differences were statis-tically significant(all P＜0.05).The duration of non-invasive respiratory support(11.4±4.6 days vs 15.9±5.6 days),total oxygen inhaling(14.9±6.9 days vs 21.2±8.5 days),failure rate of machine withdrawal[(10.8％(7/65)vs 24.6％(15/61)],the rate of tracheal intubation within 72h[9.2％(6/65)vs 23.0％(14/61)],and re-administration of PS[18.5％(12/65)vs 34.4％(21/61)],the times of apnea[9.0(3.0-25.0)times vs 17.0(5.0-29.0)times]in the observation group were lower than those in the control group,and the differences were statistically significant(P＜0.05).The occurrence of BPD in the observational group were lower than those in the control group[15.4％(10/65)vs 34.4％(21/61)](P＜0.05).There were no significant differences between two groups in the related complications of budesonide(all P＞0.05).Conclusion LISA combined with budesonide and supported by NIPPV can effectively improve oxygenation,shorten the duration of non-invasive respiratory support,reduce the mechanical ventilation rate,and reduce the incidence of BPD in the treatment of premature infants with RDS at the gestational age of 26-32 weeks.

Objective To analyze the effects of fluid overload(FO)on clinical outcomes of extremely preterm infants with hemody-namically significant patent ductus arteriosus(hsPDA).Methods This retrospective study analyzed data from neonates ≤ 32 weeks ges-tational age(GA)admitted to the Neonatal Intensive Care Unit(NICU)of the Affiliated Hospital of Xuzhou Medical University between November 2021 and July 2024.Infants were categorized into hsPDA and non-hsPDA groups based on the presence or absence of hsPDA.General clinical data and daily FO situation in the first week after birth of the two groups were compared,and the risk factors affecting hsPDA were obtained by Logistic regression analysis.Using the first day of postnatal FO as the test variable and hsPDA as the state varia-ble,receiver operator characteristic(ROC)curve was drawn to calculate the cut-off value of FO,and the cut-off value was divided into groups to analyze the relationship between the first day FO and clinical outcome of very preterm infants.Results A total of 153 extremely preterm infants(GA≤32 weeks)were enrolled,including 110 in the hsPDA group and 43 in the non-HSPDA group.Univariate analysis showed that there were statistically significant differences in birth weight,1-minute Apgar score,postnatal antibiotic use time,parenteral nutrition time,invasive mechanical ventilation time,non-invasive mechanical ventilation time,hospital days,day 1,day 2 and day 4 FO between the two groups(P＜0.05).Multivariate Logistic regression analysis showed that invasive mechanical ventilation time and day 1 FO were risk factors of hsPDA.The ROC curve was drawn with the first day FO as the test variable and hsPDA as the state variable.The area under the curve was 0.903,the sensitivity and specificity were 79.1％and 89.1％,respectively,and the cut-off value of FO on the first day after birth was 8.78％.According to this cut-off value,107 cases were divided into FO≤8.78％group and 46 cases were FO＞8.78％group.Univariate analysis showed that FO＞8.78％group had lower Apgar score at 1 minute,longer invasive mechani-cal ventilation time,and higher incidence of moderate to severe bronchopulmonary dysplasia(BPD)and grade 3 to 4 intraventricular hem-orrhage(IVH).Logistic regression analysis showed that FO＞8.78％on the first day after birth was a risk factor for moderate to severe BPD and grade 3-4 IVH.Conclusion FO＞8.78％on the first day after birth of very preterm infants increased the incidence of moder-ate to severe BPD and grade 3-4 IVH.

Objective:To explore the application effect of Gibbs reflection cycle combined with KSR-CDIO model in geriatric nursing internship teaching.Methods:134 nursing students who interned in the geriatric department of The First Affiliated Hospital of Air Force Military Medical University from July 2020 to December 2023 were selected as the observation subjects. According to the order of internship, they were divided into a control group (traditional teaching, n=67) and an observation group (Gibbs reflection cycle combined with KSR-CDIO mode teaching, n=67). Compare the theoretical and operational assessment scores, self-directed learning ability, critical thinking attitude, and post teaching satisfaction evaluation of two groups before and after teaching. Perform t-test and chi square test using SPSS 25.0. Results:After teaching, the observation group's theoretical (89.65±8.93) and operational assessment scores (85.66±8.42) were higher than those of the control group (74.89±7.22; 71.21 ±6.83), and the difference was statistically significant ( P<0.05). After teaching, both groups showed an increase in self-directed learning scores. The observation group of nursing students showed improvement in learning awareness [(30.53±7.12) vs. (27.66±6.50)] and learning strategies (30.96±7.33) vs (26.85±6.34) and learning behavior (31.24±7.63) vs. (27.80±6.54) were higher than those in the control group; The comparison of interpersonal skills scores between two groups of nursing students before and after teaching showed no statistically significant difference ( P>0.05). After teaching, both groups showed an improvement in critical thinking ability, with the observation group being higher than the control group ( P<0.05). The recognition of teaching content richness (95.52% vs. 67.16%), practicality (97.01% vs. 67.16%), depth appropriateness (94.02% vs. 62.68%), and inspiration (95.52% vs. 64.17%) by the observation group of nursing students was higher than that of the control group ( P<0.05); There was no statistically significant difference in satisfaction with teacher ethics ( P>0.05). Conclusions:The combination of KSR-CDIO and Gibbs reflection cycle model in elderly care internship teaching aids has a good application effect, which can improve students' practical ability and self-directed learning ability, and have a positive effect on cultivating critical thinking attitudes among nursing students.

Objective:To analyze the quality of professional doctoral dissertations in clinical medicine and conduct an empirical study on key stages of proposal defense and midterm evaluation in the dissertation process management, and explore effective ways to improve the quality of doctoral dissertations.Methods:The study included 168 evaluation reports from 56 clinical medicine professional doctoral students at a university-affiliated hospital in the academic years of 2023 and 2024. A Spearman correlation analysis was used to assess the correlation between evaluation item scores and the overall evaluation score. Ordinal logistic regression was employed to identify factors influencing the evaluation item scores, and multiple linear stepwise regression was used to investigate factors affecting the overall evaluation score. Additionally, a self-designed questionnaire was distributed to the survey participants.Results:Among the evaluation items, "dissertation innovation" had the lowest excellence rate (15.48%). The item "basic theory and specialized knowledge" showed the strongest correlation with the overall evaluation score. After controlling for personal characteristics, a higher score on proposal defense was associated with a higher overall evaluation score ( β=0.50, P<0.001). For every 1-point increase in the proposal defense score, the "dissertation innovation" score increased by 1.25 points (odds ratio [ OR]=1.25, P=0.020), and the "dissertation content" score increased by 1.26 points ( OR=1.25, P=0.004). Regarding the evaluation of the proposal defense and mid-term progress (necessity of the research, attention from the supervisor, impact on the dissertation), some professional doctoral students and supervisors did not give sufficient attention. Conclusions:We should emphasize the proposal defense of professional doctoral dissertations, strengthen the cultivation of innovation ability, enhance the mastery of professional theories, and promote the establishment of positive relationships between students and supervisors, which contribute to improving the quality of doctoral dissertations.