重庆市全科医生培养模式初探
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摘要
发展城市社区卫生服务是我国当前城市卫生工作的重点,也是我国初级卫生保健体制改革中的重要组成部分。社区卫生服务中全科医生扮演着重要的“守门人”角色,而我国目前可提供的全科医生的数量不足并且质量低下,制约了社区卫生事业工作的顺利开展,成为了发展的瓶颈。本课题通过文献查阅对国内外全科医生培养模式进行比较分析的基础上,采取分层随机抽样方式对重庆市9个区县150名全科医生进行标准化问卷调查,并对3位社区卫生服务中心主任及6名全科医生进行个人深度访谈,了解重庆市全科医生基本情况,知识结构及需求现状,以及影响全科医生发展的社区卫生服务的发展状况及面临的主要困难等,并对全科医生转岗培训进行评估,探讨提升重庆市全科医生知识水平及全科医生培养途径,促进社区卫生服务健康发展。
调查和访谈结果显示:(1)全科医生大专及以下学历占77.23%;中级职称及以下占94.06%。(2)知识能力提升要求“强烈”占85.15%;其中“很需要”临床医学占78.22%。(3)对培训的总体评价“很好”和“好”的占87.14%;对授课教师、授课方法、课程设置、培训场所、教材认为“很好”和“好”的分别占72.86%、62.85%、70.00%、34.29%、62.86%。(4)认为全科医生培养应以本科和专科为主的分别占51.49%、41.54%;对各学历层次的必要性调查中,认为本科和大专“很必要”和“较必要”的都占82.18%。(5)受教育程度为65%,掌握程度为18%,实际需要程度为52%;教育/需要为126%,掌握/需要为34%,掌握/教育27%。(6)“挂羊头卖狗肉”现象严重,社区卫生服务开展不全;政府经费投入严重不足,政策制定和落实不理想;全科医生身份尴尬,跳槽现象严重;首诊制和双向转诊未有效开展;全科医生质量参差不齐,总体偏低;认可的全科医生培养层次应集中在本科和专科层次。
结论和建议:(1)重庆市社区卫生服务还处于初级阶段,需要政府加大投入促进社区卫生服务事业快速、健康、顺利发展。(2)低学历、低职称现象较严重;所需要和重视的课程以临床学科为主;转岗培训总体上得到了转岗人员的肯定,但细节有待改善;应扩大转岗短期培训面,长远来讲,应在医学院校开设全科医学专业,以培养本科和专科为主。(3)全科医生受教育程度、实际掌握程度和实际需要程度都偏低;同时教育资源有浪费趋势,有待整合和改善;生物-心理-社会医学模式的意识有待加强。
The development of urban community health service is not only the focus of the work of urban sanitation in our country, but also the important components of reform of primary health care. General practitioners play an important "gatekeeper" roles in Community Health Service, but general practitioners provided by our country are insufficient number of poor quality, which restricted the work of community health services for the smooth conduct and has been a development bottleneck. On the basis of a comparative analysis of the model of training general practitioners at home and abroad through investigating literature, a stratified random sampling was used for investigating 150 general practitioners in nine districts and counties of Chongqing Municipality by standardized questionnaire, and three director of the Center for Community Health Service and six general practitioners were depth personal interviewed for the basic conditions ,the knowledge structure and the status of demand of general practitioners in Chongqing, as well as the major difficulties faced in the development of community health services that affected the development of general practitioners, then general practitioners transfer training was evaluated for upgrading the knowledge of general practitioner in Chongqing and exploring training means of general practitioners to promote the healthy development of community health services.
Surveys and interviews showed that: (1)Junior college and below accounted for 77.23%; middle title and bellow accounted for 94.06%. (2) "Strong" requirement to enhance ability and knowledge accounted for 85.15%;“need so much”clinic medicine accounted for 78.22%(3)In the overall evaluation of the training ,"very good" and "good" accounted for 87.14%;in the evaluation of teachers, teaching methods, curricula, training venues, teaching materials, "very good" and "good" respectively accounted for 72.86%, 62.85%, 70.00%, 34.29%, 62.86%.(4)That general practitioners should be training principally based undergraduate and junior college respectively accounted for 51.49%, 41.54%;In the survey of the need for qualifications, undergraduate and junior college that is "very essential" and "more essential" both accounted for 82.18%.(5)The level of education is 65%; of mastering is 18%; of the actual need is 52%;Education/need is 126%, mastering/need is 34%, mastering/education is 27%.(6)The phenomenon of "crying up wine selling vinegar" is serious and community health services is incomplete; The financial input is quite shortage; Policy formulation and implementation are not ideal; Embarrassing as general practitioners, job-hopping is common; The first consultation and referral system have not been implemented effectively; The quality of general practitioners is not equal and low wholly; Approved training level of general practitioners concentrated on the undergraduate and junior college level.
Conclusions and recommendations(:1)The community health service in Chongqing is still in its initial stage; The government should increase investment for rapid , healthy and smooth development of community health service.(2)The phenomenon of low levels of education and title is serious; Clinical disciplines are main needed and valued in all curricula; Reorientation training on the whole staff have been affirmed totally, but the details need to be improved; Short-term training transfer should be expanded; A long-term perspective, the medical institutions should be set up a general practitioners specialty for undergraduate and junior college student.(3)The level of education, of actual mastering and of practical needs of knowledge of general practitioners are all low; At the same time there is a waste trend of educational resources that need be integrated and improved; The awareness of Biopsychosocial model should be strengthened.
调查和访谈结果显示:(1)全科医生大专及以下学历占77.23%;中级职称及以下占94.06%。(2)知识能力提升要求“强烈”占85.15%;其中“很需要”临床医学占78.22%。(3)对培训的总体评价“很好”和“好”的占87.14%;对授课教师、授课方法、课程设置、培训场所、教材认为“很好”和“好”的分别占72.86%、62.85%、70.00%、34.29%、62.86%。(4)认为全科医生培养应以本科和专科为主的分别占51.49%、41.54%;对各学历层次的必要性调查中,认为本科和大专“很必要”和“较必要”的都占82.18%。(5)受教育程度为65%,掌握程度为18%,实际需要程度为52%;教育/需要为126%,掌握/需要为34%,掌握/教育27%。(6)“挂羊头卖狗肉”现象严重,社区卫生服务开展不全;政府经费投入严重不足,政策制定和落实不理想;全科医生身份尴尬,跳槽现象严重;首诊制和双向转诊未有效开展;全科医生质量参差不齐,总体偏低;认可的全科医生培养层次应集中在本科和专科层次。
结论和建议:(1)重庆市社区卫生服务还处于初级阶段,需要政府加大投入促进社区卫生服务事业快速、健康、顺利发展。(2)低学历、低职称现象较严重;所需要和重视的课程以临床学科为主;转岗培训总体上得到了转岗人员的肯定,但细节有待改善;应扩大转岗短期培训面,长远来讲,应在医学院校开设全科医学专业,以培养本科和专科为主。(3)全科医生受教育程度、实际掌握程度和实际需要程度都偏低;同时教育资源有浪费趋势,有待整合和改善;生物-心理-社会医学模式的意识有待加强。
The development of urban community health service is not only the focus of the work of urban sanitation in our country, but also the important components of reform of primary health care. General practitioners play an important "gatekeeper" roles in Community Health Service, but general practitioners provided by our country are insufficient number of poor quality, which restricted the work of community health services for the smooth conduct and has been a development bottleneck. On the basis of a comparative analysis of the model of training general practitioners at home and abroad through investigating literature, a stratified random sampling was used for investigating 150 general practitioners in nine districts and counties of Chongqing Municipality by standardized questionnaire, and three director of the Center for Community Health Service and six general practitioners were depth personal interviewed for the basic conditions ,the knowledge structure and the status of demand of general practitioners in Chongqing, as well as the major difficulties faced in the development of community health services that affected the development of general practitioners, then general practitioners transfer training was evaluated for upgrading the knowledge of general practitioner in Chongqing and exploring training means of general practitioners to promote the healthy development of community health services.
Surveys and interviews showed that: (1)Junior college and below accounted for 77.23%; middle title and bellow accounted for 94.06%. (2) "Strong" requirement to enhance ability and knowledge accounted for 85.15%;“need so much”clinic medicine accounted for 78.22%(3)In the overall evaluation of the training ,"very good" and "good" accounted for 87.14%;in the evaluation of teachers, teaching methods, curricula, training venues, teaching materials, "very good" and "good" respectively accounted for 72.86%, 62.85%, 70.00%, 34.29%, 62.86%.(4)That general practitioners should be training principally based undergraduate and junior college respectively accounted for 51.49%, 41.54%;In the survey of the need for qualifications, undergraduate and junior college that is "very essential" and "more essential" both accounted for 82.18%.(5)The level of education is 65%; of mastering is 18%; of the actual need is 52%;Education/need is 126%, mastering/need is 34%, mastering/education is 27%.(6)The phenomenon of "crying up wine selling vinegar" is serious and community health services is incomplete; The financial input is quite shortage; Policy formulation and implementation are not ideal; Embarrassing as general practitioners, job-hopping is common; The first consultation and referral system have not been implemented effectively; The quality of general practitioners is not equal and low wholly; Approved training level of general practitioners concentrated on the undergraduate and junior college level.
Conclusions and recommendations(:1)The community health service in Chongqing is still in its initial stage; The government should increase investment for rapid , healthy and smooth development of community health service.(2)The phenomenon of low levels of education and title is serious; Clinical disciplines are main needed and valued in all curricula; Reorientation training on the whole staff have been affirmed totally, but the details need to be improved; Short-term training transfer should be expanded; A long-term perspective, the medical institutions should be set up a general practitioners specialty for undergraduate and junior college student.(3)The level of education, of actual mastering and of practical needs of knowledge of general practitioners are all low; At the same time there is a waste trend of educational resources that need be integrated and improved; The awareness of Biopsychosocial model should be strengthened.
引文
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