Objective To establish the reference intervals of neutrophil to lymphocyte ratio(NLR),mono-cyte to lymphocyte ratio(MLR)and platelet to lymphocyte ratio(PLR)in different genders and age groups in northern Chinese adults.Methods The data were analyzed according to the Clinical and Laboratory Stand-ards Institute C28-A3.Outliers were checked and judged according to the Dixon method.Subgroups were di-vided according to gender or age factors,and reference intervals were established for different subgroups.Ref-erence intervals were expressed as two-sided 95％percentiles.Results The reference intervals of NLR,MLR and PLR were 0.90-3.82,0.09-0.33 and 71.20-246.87,respectively.The results showed that NLR and PLR in men were lower than those in women(P＜0.001),while MLR in men was significantly higher than that in women(P＜0.001).Linear trend plots showed that NLR,MLR and PLR changed significantly in dif-ferent genders and age groups.In men,NLR and MLR increased with age,while PLR gradually increased and reached the peak before 50 years old,and gradually decreased after 50 years old.In women,NLR and MLR showed the lowest values at 50-＜60 years old,while PLR reached the peak at about 50 years old.The refer-ence intervals established by the model set were verified,and the percentages beyond the reference intervals were less than 10％in different genders and age groups.Conclusion The reference intervals of NLR,MLR and PLR in different genders and age groups of healthy adults in northern China are established in the study.

Objective:To explore an innovative model of ability-oriented training for general practitioners and to evaluate its implementation effectiveness.Methods:A total of 49 general practitioners who participated in the training in 2015 were selected as the research objects, and they were trained in a new mode with innovative teaching and training system and comprehensive assessment mode as the main content. The results of theoretical examination and self-assessment scores of post competency were compared before and after the training. SPSS 19.0 was used for t test. Results:The theoretical examination results of the first year of training were higher than those before training [(77.23±0.55) scores vs. (69.14±4.63) scores], with significant differences ( t=12.15, P=0.001); and the results of the second year of training were also higher than those of the first year of training [(83.72±0.45) scores vs. (77.23±0.55) scores], with significant differences ( t=8.12, P=0.001). The self-assessment questionnaire showed that there were significant differences in such five abilities of the students' competency as medical knowledge and clinical skills, autonomous learning, interpersonal communication, teamwork, core values and doctor professionalisms through the comparison of systematic training ( t=2.76, 4.53, 12.09, 2.33, 2.40, all P<0.05). Conclusion:The innovative training model for general practitioners is effective, and the practice of the new model could provide reference for continuously improving the training and education of general practitioners in China.

Objective:To explore an innovative model of ability-oriented training for general practitioners and to evaluate its implementation effectiveness.Methods:A total of 49 general practitioners who participated in the training in 2015 were selected as the research objects, and they were trained in a new mode with innovative teaching and training system and comprehensive assessment mode as the main content. The results of theoretical examination and self-assessment scores of post competency were compared before and after the training. SPSS 19.0 was used for descriptive analysis and t test of data. Results:The theoretical examination results before training were significantly different from those after the first year of training, and the results of the first year of training were also significantly different from those of the second year of training ( t values were 12.15 and 8.12, respectively), ( P<0.05). The self-assessment questionnaire showed that through systematic training, five aspects of the students' competency such as medical knowledge and clinical skills, autonomous learning, interpersonal communication, teamwork, core values and doctor professionalisms were significantly improved to different degrees ( P<0.05). Conclusion:The innovative training model for general practitioners is effective, and the practice of the new model could provide reference for continuously improving the training and education of general practitioners in China.

Objective To explore the application method and value of mind mapping in the clinical teaching of general practitioners for the purpose of improving the teaching qualities. Methods A total of 60 GPs were divided into the test group and control group, undergoing the mind mapping teaching and tra-ditional teaching, respectively. The clinical knowledge achievements were compared in the two groups, and the results were analyzed. At the same time, a questionnaire was conducted. Results The difference between two groups in theoretical teaching was statistically significant (P<0.05), and there was no significant difference in physical examination (P>0.05). In addition, the results of the questionnaire survey showed that the test group was better than the control group in medical knowledge, self-learning ability, interpersonal communication ability, team cooperation ability and other dimensions. Conclusion Mind mapping is an effective teaching tool for general practitioners.

Objective To construct the professional competency evaluation index system for clini-cal medical professional degree postgraduates. Methods With the literature review and expert consulting, we constructed preliminarily the evaluation index system framework; using the Delphi method, we selected indicators and determined the weights system. Data are recorded and processed using Excel 2003 and SPSS 19. Result The response rate of the Delphi survey were 97％and 96％. The mean of authorities was 0.827 and 0.812, and the harmonious coefficients had statistical significance (P<0.05). The professional compe-tency evaluation index system was established, which was composed of 2 first level indicators, 5 second level indicators and 31 third level indicators; The weight coefficients of the indicators at first level was 0.586 and 0.414. Conclusion The index system construction method is scientific, the process is reasonable, and has certain practical value.

MOOC (massive open online courses) is a hot spot of research and practice in the field of education in recent years. Based on the concept, origin and characteristics of MOOC, and the situation of the construction of MOOC in China, this study applies MOOC to teaching reform in accordance with the current situation of residency standardized training. It introduces the teaching process of curriculum design, online learning, offline teaching and supplementation, and full assessment and evaluation. Besides, it also analyzes the advantages and limitations of the application of the curriculum for the course and puts forward some suggestions for improvement in order to provide a reference for further deepening the reform of the teaching of resident physicians.

Standardized training of residents is a necessary way for clinical medical personnel train-ing. Residents graduating from medical colleges and universities should accept the standardized, scientific, strict pre-service training, in order to realize role conversion from medical students to hospital physicians. This paper summarizes and analyzes the pre-service training, focusing on the training object, course design, organization implementation, evaluation, questionnaire survey, and puts forward some thoughts and sugges-tions on strengthening and improving pre-service training form, expanding the content of training, and quan-tifying the evaluation of training effect.

Background and purpose:This study investigated the value of cervical ultrasound and TSH-sup-pressed thyroglobulin in the diagnosis of recurrence or metastasis of differentiated thyroid carcinoma (DTC).Methods:This study analyzed the data on 196 thyroid carcinoma patients who underwent neck dissection after clinically sus-pecious recurrence of DTC in Peking Union Medical College Hospital from Aug. 2010 to Dec. 2014. Among the 196 patients, 62 patients sonographically suspecious recurrence after total thyroidectomy and/or radioactive iodine ablation therapy were enrolled in this study. The ultrasonic features of lymph node involvement were retrospectively analyzed. The value of the ultrasonic features in the diagnosis of lymph node involvement and a TSH-suppressed serum Tg level in the diagnosis of recurrence or metastasis of DTC was also evaluated.Results:Of the 62 patients, 59 were pathologi-cally conifrmed with lymph node involvement, 1 case with local recurrence and 2 cases without recurrence or metasta-sis. There were 121 ultrasonographically suspected lymph nodes, conifrmed by pathology, 92 were metastatic ltsions, 25 were non-metastatic, 3 were ifbrous tissue and 1 was striated muscle. The positive predictive rate of cyst, calciifcation or hyper-echogenicity in cortex was 100% in the diagnosis of lymph node involvement. There was a signiifcant difference in disordered vascularity and cyst in cortex between metastatic and non-metastatic lymph nodes. Forty-nine patients were positive for Tg, whereas 13 were negative. The accuracy, sensitivity and speciifcity of TSH-suppressed serum Tg in the diagnosis of recurrence or metastasis of DTC were 82.3%, 81.7% and 100%.Conclusion:The disordered vascularity and cyst in cortex of the lymph node are highly speciifc indexes in diagnosing lymph node involvement. TSH-suppressed serum Tg level has high diagnostic value for detection of recurrence or metastasis of DTC. Cervical ultrasound can identify recurrent or metastatic lesions in both Tg-positive and Tg-negative patients.

The ultrasound part of “2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer” is comprehensive and informative. The content includes the indications for thyroid ultrasound and aspects needed to be evaluated, malignancy risk prediction based on sonographic pattern, decision-making based on ultrasound appearances, follow-up of benign thyroid nodules and surveillance of persistent and recurrent thyroid cancer with ultrasound. Compared with 2009 version of American Thyroid Association (ATA) guidelines, there is a great deal of development. The most important revision was that it analyzed ultrasound pattern of risk stratiifcation of malignancy in thyroid nodules and gave a detailed description of relevant concepts and definitions. Altogether, the new guidelines provided an algorithm for evaluation and management of patients with thyroid nodules based on sonographic pattern and ifne needle aspiration (FNA) cytology. Comprehensive review of the guidelines and appropriate adjustment in practices will make ultrasound examination more reasonable and may enhance the level of medical practices basically..

Identifying the goals of outstanding doctor tralning and orienting medical students' competency, we conducted rational integration and construction of curriculum system for graduate students of clinical medicine and implemented 5 modes of module teaching including professional course, foreign language course, practical skill course, scientific research course and comprehensive ability course . According to the different characters of courses and professional development , we adopted multi-dimensional teaching methods and input the quality education throughout the whole teaching process. These efforts promoted the reform of graduate course evaluation system and provided effective security for improving teaching contents, teaching methods, teaching means and evaluating methods.