教学双方对全科医师规范化培训的评价与需求研究
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摘要
背景我国的全科医师培训面临着基础薄弱、建设规模大、基层医疗卫生服务需求难以满足等难题,上海市闵行区与高校合作,在政府部门的助力下,建立了医教研协同型服务体系,有利于全科医师培训质量的提升。目的了解教学双方对全科医师规范化培训的评价与需求情况,以分析能有效提升全科医师培养水平的策略。方法以上海市闵行区2家全科医师规范化培训基地的问卷有效回收的带教教师(n=36)和管理人员(n=10)为教学供方,以在培学员(n=36)和出站学员(n=30)为教学需方,于2016年4—6月采用自行设计的问卷进行调查,内容包括受试者的基本信息及其对全科医师规范化培训的认知、评价、需求情况。结果共发放问卷120份,回收有效问卷112份(93.3%)。84.8%(39/46)的教学供方和69.7%(46/66)的教学需方对培训制度非常/比较了解。80.5%(37/46)的教学供方单位对培训制度感到非常/比较满意,56.0%(37/66)的教学需方单位对培训制度感到一般/不满意;80.5%(37/46)的教学供方个人认为培训制度合理但执行不到位,40.9%(27/66)的教学需方个人对目前的培训制度不满意。对于学员最需要提高的能力,43.5%(20/46)的教学供方认为是诊疗流程规范完备,28.3%(13/46)的教学供方和40.9%(27/66)的教学需方认为是临床诊疗能力。4类研究对象所在单位对培训制度的评价、个人对培训制度的评价以及认为学员最需要培养的能力、学员最需要提高的能力、考核最需要重视的方面、带教教师最需具备的能力比较,差异有统计学意义(P<0.05)。结论全科医师规范化培训存在制度执行不到位的情况,教学需方对培训制度的满意度较低。教学双方的培训需求均侧重于临床实践能力,但不同角色教学供、需方对培训的评价与需求情况存在差异。
Background China's general practitioner(GP) training system is confronted with weak foundation,large scale of construction,and insufficient qualified GPs for meeting people's needs of primary health care.Minhang District of Shanghai cooperates with universities to help establish a collaborative service system for medical education and research with the help of Minhang District Municipal Commission of Health and Family Planning to promote the training of GPs.Objective To investigate supply-and demand-side perspectives on the general status and needed improvements of standardized training for GPs,to explore strategies for effectively improving the quality of such trainings.Methods We conducted this survey from April 2016 to June 2016.Participants were recruited from two standardized training bases for GPs in Minhang District of Shanghai,including teachers and teaching managers(supply-siders for GP training),and individuals who were undergoing a GP training and those who had an experience of such training in the past(demand-siders for GP training).We used a selfdesigned questionnaire in the survey,which consists of basic personal information,levels of awareness,general evaluation,and demands for improvements of the standardized training for GPs.Results A total of 120 cases received the survey,and 112 of them(including 36 teachers,10 teaching managers,36 individuals who were undergoing the training and 30 who had been trained in the past) responded effectively,obtaining a response rate of 93.3%.The standardized GP training system was well understood/comparatively well known in 84.8%(39/46)of the suppliers and 69.7%(46/66)of the demanders for GP training,and it achieved a very/relatively high level of satisfaction in 80.5%(37/46)of the work units of the formers,but obtained a fair level of satisfaction/dissatisfaction in 56.0%(37/66)of the work units of the latters.Moreover,it was thought to be reasonable but was implemented inappropriately in 80.5%(37/46)of the suppliers,and obtained dissatisfaction in 40.9%(27/66) of the demanders.As regard to the capabilities of GPs that should be improved foremostly,GPs' diagnostic and therapeutic procedures were reported by 43.5%(20/46) of the suppliers,and GPs' clinical diagnostic and therapeutic abilities were reported by28.3%(13/46) of the suppliers,and 40.9%(27/66)of the demanders.The work unit evaluation and individual evaluation of the standardized GP training system,capabilities of GPs that should be trained and improved foremostly,aspects with the highest priority in performance assessment of GPs,and the most essential abilities of teachers for training GPs showed significant differences among different groups of suppliers and demanders(P<0.05).Conclusion The standardized GP training system was not implemented appropriately,and it achieved a very low satisfaction from the demanders.As for aspects of trainings for GPs that should be improved,GPs' clinical practice abilities were highlighted by both suppliers and demanders.And lastly,subjective general evaluation and demands for improvements of standardized training for GPs differed obviously among different groups of suppliers and demanders.
Background China's general practitioner(GP) training system is confronted with weak foundation,large scale of construction,and insufficient qualified GPs for meeting people's needs of primary health care.Minhang District of Shanghai cooperates with universities to help establish a collaborative service system for medical education and research with the help of Minhang District Municipal Commission of Health and Family Planning to promote the training of GPs.Objective To investigate supply-and demand-side perspectives on the general status and needed improvements of standardized training for GPs,to explore strategies for effectively improving the quality of such trainings.Methods We conducted this survey from April 2016 to June 2016.Participants were recruited from two standardized training bases for GPs in Minhang District of Shanghai,including teachers and teaching managers(supply-siders for GP training),and individuals who were undergoing a GP training and those who had an experience of such training in the past(demand-siders for GP training).We used a selfdesigned questionnaire in the survey,which consists of basic personal information,levels of awareness,general evaluation,and demands for improvements of the standardized training for GPs.Results A total of 120 cases received the survey,and 112 of them(including 36 teachers,10 teaching managers,36 individuals who were undergoing the training and 30 who had been trained in the past) responded effectively,obtaining a response rate of 93.3%.The standardized GP training system was well understood/comparatively well known in 84.8%(39/46)of the suppliers and 69.7%(46/66)of the demanders for GP training,and it achieved a very/relatively high level of satisfaction in 80.5%(37/46)of the work units of the formers,but obtained a fair level of satisfaction/dissatisfaction in 56.0%(37/66)of the work units of the latters.Moreover,it was thought to be reasonable but was implemented inappropriately in 80.5%(37/46)of the suppliers,and obtained dissatisfaction in 40.9%(27/66) of the demanders.As regard to the capabilities of GPs that should be improved foremostly,GPs' diagnostic and therapeutic procedures were reported by 43.5%(20/46) of the suppliers,and GPs' clinical diagnostic and therapeutic abilities were reported by28.3%(13/46) of the suppliers,and 40.9%(27/66)of the demanders.The work unit evaluation and individual evaluation of the standardized GP training system,capabilities of GPs that should be trained and improved foremostly,aspects with the highest priority in performance assessment of GPs,and the most essential abilities of teachers for training GPs showed significant differences among different groups of suppliers and demanders(P<0.05).Conclusion The standardized GP training system was not implemented appropriately,and it achieved a very low satisfaction from the demanders.As for aspects of trainings for GPs that should be improved,GPs' clinical practice abilities were highlighted by both suppliers and demanders.And lastly,subjective general evaluation and demands for improvements of standardized training for GPs differed obviously among different groups of suppliers and demanders.
引文
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[8]张冬青,刘彦,何坪,等.我国5所“5+3”全科医师规范化培训基地现状调查研究[J].重庆医学,2017,46(28):3953-3958.DOI:10.3969/j.issn.1671-8348.2017.28.022.ZHANG D Q,LIU Y,HE P,et al.Survey on status quo of5 standardized training bases of our country"5+3"general practitioners[J].Chongqing Medical,2017,46(28):3953-3958.DOI:10.3969/j.issn.1671-8348.2017.28.022.
[9]司庆燕.家庭医生签约服务需求下社区全科医生转岗培训的问题与对策研究[J].中国全科医学,2018,21(7):831-836.DOI:10.3969/j.issn.1007-9572.2018.07.016.SI Q Y.Challenges and solutions for training about contractual services for on-site primary physicians before transferring to the position of family doctors[J].Chinese General Practice,2018,21(7):831-836.DOI:10.3969/j.issn.1007-9572.2018.07.016.
[10]邵黎兵,吴晓东,黄栩,等.上海市全科医学规范化培训医师就业现状[J].解放军医院管理杂志,2018,25(7):655-657.DOI:10.16770/J.cnki.1008-9985.2018.07.017.SHAO L B,WU X D,HUANG X,et al.Current situation of general practitioners'standardized training in Shanghai[J].Hospital Administration Journal of Chinese People's Liberation Army,2018,25(7):655-657.DOI:10.16770/J.cnki.1008-9985.2018.07.017.
[11]贾雪梅,朱俊勇,雷宏博,等.我国全科医学培养现状与思考[J].中国高等医学教育,2018,32(5):6-7,13.DOI:10.3969/j.issn.10021701.2018.05.003.JIA X M,ZHU J Y,LEI H B,et al.Current situation and thinking on the training of general medicine in China[J].China Higher Medical Education,2018,32(5):6-7,13.DOI:10.3969/j.issn.10021701.2018.05.003.
[12]刘力戈,赵春燕,潘丽恩.全科医师规范化培训的实施与过程管理[J].中国全科医学,2010,13(36):4111-4114.DOI:10.3969/j.issn.1007-9572.2010.36.020.LIU L G,ZHAO C Y,PAN L E.Implementation and process management of standardized training for general practitioners[J].Chinese General Practice,2010,13(36):4111-4114.DOI:10.3969/j.issn.1007-9572.2010.36.020.
[13]赵家义,韩一平,袁鹏群,等.浅谈研究型医院全科医师科研能力的培养[J].中国高等医学教育,2015,29(3):22-23.DOI:10.3969/j.issn.1002-1701.2015.03.012.ZHAO J Y,HAN Y P,YUAN P Q,et al.The cultivation of scientific research ability of general practitioners in research hospitals[J].China Higher Medical Education,2015,29(3):22-23.DOI:10.3969/j.issn.1002-1701.2015.03.012.
[14]朱文华,方力争,戴红蕾,等.HALC式全科住院医师规范化培训实践教学模式的教学效果研究[J].中国全科医学,2017,20(13):1606-1609,1625.DOI:10.3969/j.issn.1007-9572.2017.13.016.ZHU W H,FANG L Z,DAI H L,et al.Teaching effect of practical teaching model of HALC-type standardized training of general resident doctors[J].Chinese General Practice,2017,20(13):1606-1609,1625.DOI:10.3969/j.issn.1007-9572.2017.13.016.
[15]司庆燕,李文,陈士福.规范化培养全科医生需要注意的几个问题[J].医学与哲学,2014,35(1):74-76.SI Q Y,LI W,CHEN S F.Several issues need to pay attention in standardizing the training of general practitioners[J].Medicine and Philosophy,2014,35(1):74-76.
[16]黄美娟,邱科,包睿,等.全科医学生职业信心现状研究[J].中国全科医学,2018,21(25):3123-3127.DOI:10.12114/j.issn.1007-9572.2018.25.018.HUANG M J,QIU K,BAO R,et al.General medical students career confidence index(GMSCCI)in China[J].Chinese General Practice,2018,21(25):3123-3127.DOI:10.12114/j.issn.1007-9572.2018.25.018.
[2]田胜兰,方冬香,谭伟.全科住院医师规范化培训师资队伍建设现状的调查研究[J].中国继续医学教育,2017,9(13):11-13.DOI:10.3969/j.issn.1674-9308.2017.13.006.TIAN S L,FANG D X,TAN W.Investigation of teaching staff construction in general practice resident standardization training[J].China Continuing Medical Education,2017,9(13):11-13.DOI:10.3969/j.issn.1674-9308.2017.13.006.
[3]沈水能,陈艳,陈韶华,等.对全科住院医师规范化培训临床环节师资队伍建设现状调查引发的思考[J].全科医学临床与教育,2017,15(1):55-57.DOI:10.13558/j.cnki.issn1672-3686.2017.01.016.SHEN S N,CHEN Y,CHEN S H,et al.Thoughts on the current situation investigation of the teaching staff construction in the clinical training of the general practitioners[J].Clinical Education of General Practice,2017,15(1):55-57.DOI:10.13558/j.cnki.issn1672-3686.2017.01.016.
[4]葛瑶琪.南京市全科医生规范化培养情况调查与思考[D].南京:南京医科大学,2018.
[5]潘天园.浙江省全科医师规范化培训学员的十五年系统性回顾调查:关于全科医学发展模式的探讨[D].杭州:浙江大学,2015.
[6]翟艳萍.山西省全科医学住院医师规范化培训实施现状调查[D].太原:山西医科大学,2017.
[7]王丽,陈晓平,鲍红琴,等.浦东八家社区卫生服务中心全科医师岗位培训现状及需求[J].中国卫生资源,2017,20(2):146-148.DOI:10.13688/j.cnki.chr.2017.16421.WANG L,CHEN X P,BAO H Q,et al.Present situation and demands for on-the-job training of general practitioners in eight community health service centers in Pudong[J].Chinese Health Resource,2017,20(2):146-148.DOI:10.13688/j.cnki.chr.2017.16421.
[8]张冬青,刘彦,何坪,等.我国5所“5+3”全科医师规范化培训基地现状调查研究[J].重庆医学,2017,46(28):3953-3958.DOI:10.3969/j.issn.1671-8348.2017.28.022.ZHANG D Q,LIU Y,HE P,et al.Survey on status quo of5 standardized training bases of our country"5+3"general practitioners[J].Chongqing Medical,2017,46(28):3953-3958.DOI:10.3969/j.issn.1671-8348.2017.28.022.
[9]司庆燕.家庭医生签约服务需求下社区全科医生转岗培训的问题与对策研究[J].中国全科医学,2018,21(7):831-836.DOI:10.3969/j.issn.1007-9572.2018.07.016.SI Q Y.Challenges and solutions for training about contractual services for on-site primary physicians before transferring to the position of family doctors[J].Chinese General Practice,2018,21(7):831-836.DOI:10.3969/j.issn.1007-9572.2018.07.016.
[10]邵黎兵,吴晓东,黄栩,等.上海市全科医学规范化培训医师就业现状[J].解放军医院管理杂志,2018,25(7):655-657.DOI:10.16770/J.cnki.1008-9985.2018.07.017.SHAO L B,WU X D,HUANG X,et al.Current situation of general practitioners'standardized training in Shanghai[J].Hospital Administration Journal of Chinese People's Liberation Army,2018,25(7):655-657.DOI:10.16770/J.cnki.1008-9985.2018.07.017.
[11]贾雪梅,朱俊勇,雷宏博,等.我国全科医学培养现状与思考[J].中国高等医学教育,2018,32(5):6-7,13.DOI:10.3969/j.issn.10021701.2018.05.003.JIA X M,ZHU J Y,LEI H B,et al.Current situation and thinking on the training of general medicine in China[J].China Higher Medical Education,2018,32(5):6-7,13.DOI:10.3969/j.issn.10021701.2018.05.003.
[12]刘力戈,赵春燕,潘丽恩.全科医师规范化培训的实施与过程管理[J].中国全科医学,2010,13(36):4111-4114.DOI:10.3969/j.issn.1007-9572.2010.36.020.LIU L G,ZHAO C Y,PAN L E.Implementation and process management of standardized training for general practitioners[J].Chinese General Practice,2010,13(36):4111-4114.DOI:10.3969/j.issn.1007-9572.2010.36.020.
[13]赵家义,韩一平,袁鹏群,等.浅谈研究型医院全科医师科研能力的培养[J].中国高等医学教育,2015,29(3):22-23.DOI:10.3969/j.issn.1002-1701.2015.03.012.ZHAO J Y,HAN Y P,YUAN P Q,et al.The cultivation of scientific research ability of general practitioners in research hospitals[J].China Higher Medical Education,2015,29(3):22-23.DOI:10.3969/j.issn.1002-1701.2015.03.012.
[14]朱文华,方力争,戴红蕾,等.HALC式全科住院医师规范化培训实践教学模式的教学效果研究[J].中国全科医学,2017,20(13):1606-1609,1625.DOI:10.3969/j.issn.1007-9572.2017.13.016.ZHU W H,FANG L Z,DAI H L,et al.Teaching effect of practical teaching model of HALC-type standardized training of general resident doctors[J].Chinese General Practice,2017,20(13):1606-1609,1625.DOI:10.3969/j.issn.1007-9572.2017.13.016.
[15]司庆燕,李文,陈士福.规范化培养全科医生需要注意的几个问题[J].医学与哲学,2014,35(1):74-76.SI Q Y,LI W,CHEN S F.Several issues need to pay attention in standardizing the training of general practitioners[J].Medicine and Philosophy,2014,35(1):74-76.
[16]黄美娟,邱科,包睿,等.全科医学生职业信心现状研究[J].中国全科医学,2018,21(25):3123-3127.DOI:10.12114/j.issn.1007-9572.2018.25.018.HUANG M J,QIU K,BAO R,et al.General medical students career confidence index(GMSCCI)in China[J].Chinese General Practice,2018,21(25):3123-3127.DOI:10.12114/j.issn.1007-9572.2018.25.018.