On-the-Job Training for surgical procedures based on Toyota Producing System

本研究采用基于丰田生产系统的在职培训方法，对住院医师进行胸管插入的培训。在流程标准化后，我们按照标准方法对住院医师进行教学、评估和反馈。第一个成果是我们可以通过标准化来改进程序。我们可以注意到针头在手术过程中的运动，将一些方法纳入标准方法，以确保患者的安全。第二个成就是提高了每位住院医生的手术动机。三是揭示了临床在职培训中存在的伦理问题。我们认识到在医学教育临床研究的设计中需要建立伦理保护。我们也认识到需要建立客观的评价教育效果的方法。

In this study, an on-the-job training method based on Toyota Producing System was applied to our resident training for chest tube insertions. After the standardization of the procedure, we taught, evaluated and fed back to our residents according to the standard method.The first achievement is that we could improve the procedure through the standardization. We could notice needles movements in the procedure, put some methods into the standard method for patient safe. The second achievement is improving motivations for the procedure of each resident. The third achievement is that we could reveal the ethical unsolved problems in clinical on-the-job trainings. We cognized the need of establishing conservation of ethics in designing of medical educational clinical researches. We also cognized the need of established objective evaluation methods for the effect of educations.