“四证合一”模式下肾脏病学专业型硕士研究生培养路径的探索与实践

Exploration and practice a training pathway for professional master′s degree students in nephrology under the "Four-Certificates-in-One" model

摘要

探索并实践一种适用于“四证合一”培养模式的肾脏病学专业型硕士研究生培养路径,以解决该模式下临床轮转与科研训练在有限时间内难以深度融合的普遍性挑战。基于国家政策与院校培养方案,江南大学附属医院肾内科构建了一条以“临床引领、科研进阶”为核心理念的阶梯递进式培养路径。该路径将3年培养周期视为一个连续统一体,分3个阶段引导学生构建“临床表型-病理改变-分子机制”三位一体的疾病认知体系。具体措施包括:初期通过轮转建立以问题为导向的“临床表型档案”;中期结合病理阅片会将临床表型与病理表现对接,并初步转化临床困惑为科学问题;后期深入分子机制层面,形成立体疾病观。科研训练以临床问题导向的文献综述为起点,闭环式地推进选题与方案设计,并采用“时间网格化”管理策略,在不影响临床职责的前提下高效利用非临床时间完成课题。同时,围绕临床胜任力、临床-科研融合能力、科研转化能力和“四证”达成情况设置过程性评价指标。该路径有助于推动临床实践与科研能力从“时间分割”向“认知融合”转变。它将科研训练有机嵌入临床能力成长的全过程,使科研成为深化临床理解的自然延伸,在一定程度上缓解了临床与科研在时间上的冲突。结合过程性评价,学生能够以真实病例为索引建立临床表型档案,完成临床-病理整合汇报,并围绕临床问题推进文献综述、开题和阶段性课题实施。实践表明,该路径有助于培养学生像“临床科学家”一样思考,建立跨层级的疾病解释框架,从而具备应对肾脏病学复杂性与快速发展的核心能力。阶梯递进式培养路径是对“四证合一”政策内涵的深化与实践,通过精心设计的认知阶梯,将临床实践与科研训练熔铸为有机整体,为培养高层次、复合型肾脏病学专科人才提供了可行参考。该路径的持续优化和有效推广有赖于高素质的导师队伍、形成性评价体系的创新以及培养生态的协同支持。

Abstract

This study aimed to explore and construct a structured training pathway for professional master′s degree students in nephrology under the "Four-Certificates-in-One" model,aiming to address the challenge of integrating clinical rotations with scientific research training within the limited three-year timeframe. Based on national policies and institutional training programs,the Department of Nephrology at the Affiliated Hospital of Jiangnan University designed and implemented a stepwise progressive training pathway guided by the core principle of "Clinical Guidance and Research Advancement". This pathway conceptualizes the three-year training period as a continuum,divided into three stages to guide students in constructing a holistic disease cognition framework integrating "Clinical Phenotype-Pathological Alteration-Molecular Mechanism". Specific measures included:1)establishing problem-oriented "Clinical Phenotype Profiles" during initial rotations;2) bridging clinical phenotypes with pathological manifestations via pathology reading seminars in the mid-phase,facilitating the initial translation of clinical uncertainties into scientific questions; and 3)delving into molecular mechanisms in the final stage to form a multi-dimensional disease perspective. Research training commenced with a literature review focused on solving clinical problems,fostering a closed-loop process for topic selection and protocol design. A "Time Gridding" management strategy was employed to efficiently utilize non-clinical hours for research tasks without compromising clinical duties. In addition,process-oriented evaluation indicators were established around clinical competency,clinical-research integration,research translation,and fulfillment of the four-certificate requirements. This pathway helped promote a shift from "time segmentation" to "cognitive integration" between clinical practice and research training. By embedding research training organically into clinical competency development,scientific inquiry became a natural extension for deepening clinical understanding,thereby alleviating,to some extent,the temporal conflict between clinical work and research. Based on the process evaluation,students were able to establish phenotype profiles indexed by real cases,conduct clinical-pathological integrated case reports,and advance literature review,proposal development,and phased project implementation around clinical questions. Practice demonstrated that this approach cultivates students′ ability to think like "clinical scientists",enabling them to establish a cross-hierarchical framework for disease interpretation and equipping them with the core competencies needed to navigate the complexity and rapid evolution of nephrology. The stepwise progressive training pathway represents a practical implementation of the "Four-Certificates-in-One" policy's principles. Through a meticulously designed cognitive ladder,it forges clinical practice and research training into an organic whole,providing a feasible reference for cultivating high-level,versatile nephrology specialists. The continuous optimization and extensive promotion of this pathway rely on a high-caliber faculty team,innovations in formative assessment systems,and synergistic support from the broader training ecosystem.

关键词

专业型硕士 / 肾脏病学 / 培养路径 / 阶梯递进式培养 / 四证合一

Key words

Professional master′s degree / Nephrology / Training pathway / Stepwise progressive training / Four-certificates-in-one

参考文献

[1] 国家卫生计生委, 中央编办, 国家发展改革委, 等 . 关于建立住院医师规范化培训制度的指导意见:国卫科教发〔2013〕56号[EB/OL]. (2014-01-16)[2025-04-30]. https://www.nhc.gov.cn/qjjys/c100016/201401/bb4b941d9f04433cb2804750d50141a1.shtml.

[2] 教育部, 国家卫生计生委, 国家中医药管理局, 等 . 关于医教协同深化临床医学人才培养改革的意见:教研[2014]2号[EB/OL]. (2014-06-30)[2025-04-30]. http://www.moe.gov.cn/srcsite/A22/s7065/201406/t20140611_170832.html.

[3] 国务院学位委员会 . 关于印发临床医学、口腔医学和中医硕士专业学位研究生指导性培养方案的通知:学位〔2015〕9号[EB/OL]. (2015-06-18)[2025-04-30]. https://yz.chsi.com.cn/kyzx/zcdh/201506/20150618/1482175169.html.

[4] Mokhtari B, Badalzadeh R, Ghaffarifar S . The next generation of physician-researchers:undergraduate medical students′ and residents′ attitudes,challenges,and approaches towards addressing them[J]. BMC Med Educ, 2024, 24(1): 1313. DOI: 10.1186/s12909-024-06166-8.

[5] Angerett N, Ferguson C, Kelly M, et al. A dedicated research rotation increases orthopaedic residency scholarly activity[J]. JBJS Open Access, 2024, 9(4): e24.00075. DOI: 10.2106/JBJS.OA.24.00075.

[6] Kochis MA, Cron DC, Coe TM, et al. Implementation and evaluation of an academic development rotation for surgery residents[J]. J Surg Educ, 2024, 81(11): 1748-1755. DOI: 10.1016/j.jsurg.2024.08.015.

[7] 教育部, 国家发展改革委, 财政部 . 关于加快新时代研究生教育改革发展的意见:教研〔2020〕9号[EB/OL]. (2020-09-22)[2025-04-30]. https://yz.chsi.com.cn/kyzx/jybzc/202009/20200922/1980120179.html.

[8] 国务院学位委员会, 教育部 . 关于印发《专业学位研究生教育发展方案(2020-2025)》的通知:学位〔2020〕20号[EB/OL]. (2020-09-25)[2025-04-30]. https://yz.chsi.com.cn/kyzx/jybzc/202009/20200930/1982289522.html.

[9] 教育部 . 关于深入推进学术学位与专业学位研究生教育分类发展的意见:教研〔2023〕2号[EB/OL]. (2023-12-19)[2026-04-30]. https://yz.chsi.com.cn/kyzx/zcdh/202312/20231219/2293237496.html.

[10] 江南大学无锡医学院 . 2023级江南大学临床医学全日制专业硕士研究生培养方案[EB/OL]. (2024-09-05)[2025-04-30]. https://wxms.jiangnan.edu.cn/info/1370/8765.htm.

[11] 中国医师协会 . 关于印发住培内容与标准、基地标准(2022年版)的通知:医协函〔2022〕557号[EB/OL]. (2022-08-05)[2025-04-30]. https://www.sysush.com/content/6a01e3fc-c6d0-47fb-b281-1b354d2e5d14.

[12] 国家卫生健康委人才交流服务中心 . 住院医师规范化培训结业理论考核大纲(试行)[EB/OL]. (2024-12-30)[2025-04-30]. https://www.21wecan.com/wsrcw/c100224/202412/1002228.shtml.

基金资助

江苏省中医临床重点专科建设项目(苏中医医政[2021]17号)

江南大学附属医院高层次专业技术人才科研启动项目(4542231GCRC)