住院医师规范化培训基地评价指标体系研究
|
摘要
目的意义：住院医师规范化培训基地评价指标体系在加强住院医师培训基地建设，提高住院医师规范化培训质量方面具有重要意义。目前，我省乃至全国还没有建立一套完整的、科学的、规范的住院医师规范化培训基地评价指标体系，本研究旨在为建立该体系提供切实可行的评价指标。
主要研究过程：根据理论分析、社会调查、专家意见，并参照卫生部颁发的相关规定及安徽省三所三级甲等医院现行使用的住院医师培养有关规定，建立了有九大类的42个指标作为指标体系雏形，经过两轮Delphi方法正式预测及结合社会调查法完成本研究工作。
本次应用Delphi方法两轮有效回表率分别为95.83％和100％。专家意见采用率为86.67％和100％。应邀咨询专家为三所三级甲等医院的医务处、人事处、科教处的负责人或主要管理人员以及三所医院的内科、外科、妇产、儿科、影像等临床学科的专家，共46人，其中高级职称43人，中级职称3人；临床专家21人，既是临床专家又是教学管理专家12人，管理人员13人。两轮咨询均是在46位专家人数不变的情况下进行，有效地确保了本研究的完整性、可靠性。
研究结果：经过专家预测，计算出加权算术平均值、满分率、变异系数、等级和、协调系数及协调系数的显著性检验六个变量预测值。应用“等概率原则”求出每一个指标的相对重要性，并根据相对重要性确定出9个一级指标41个二级指标作为住院医师规范化培训基地评价指标体系，具体为①医院基本条件(医院规模及等级、科室或专业设置、学科建设及技术水平、图书资料及信息网络建设、教学用房)②组织管理(职责明确、组织机构健全、专人负责)③规章制度(培训登记制度、考勤制度、考核制度、考前资格审查制度、激励机制和淘汰机制)④培训组织及方案(培训大纲和细则、培训计划和方案、组织领导、培训方法)⑤培训内容(临床能力、政治思想和医德医风、教学能力、科研和创新能力、工作态度、外语水平、基本理论知识)⑥培训经费(专项经费、投入比例、其他
安徽医科大学硕士学位论文
社会医学与巨生事业管理
经费渠道)⑦考核(考核方法、考核内容、考核档案、考核组织)⑧师资队伍建
设(学术和技术水平、教书育人、学历结构、职称结构)⑨培训实施情况(住院
医师培训率、培训效果评价、培训时间、培训轮转、培训档案)。从整体指标分
析，本次预测协调系数为0.532，显著性水平为0.01，说明指标的协调性好，
本次Delphi方法应用成功，研究结果可取。
Objectives: The evaluated guideline system of standardized residents training center is very important in strengthening residents training center construction, improving the quality of standardized residents training. At present, there is not a serial of full, scientific, standardized guideline system of standardized residents training center in the whole nation regardless of our province, the aim of this study is to offer practical evaluable guidelines for establishing this system.
The main study courses are as follows: According to theoretic analysis, social investigation, specialists advice, and referring to associated regulations of health ministry and related rules about residents training stipulation using in 3 hospital of 3 A grade in Anhui Province, the primary 9 categories and 42 variables were set up, and the method of two courses of Delphi analysis and social investigation were used in the study.
In our study there are 95.83% and 100% availability feedback ratio, the adopted ratio of specialists advice are 86.67%, 100% in the 2 courses. The invited specialists are the Head or main manager from Department of Medical Administration, Department of Personnel, Department of Science and Technology, and the clinic specialists from Department of Medicine, Department of Surgery, Department of Gynecology and Obstetrics, Department of Paediatrics, Department of Image in 3 hospitals of 3A grade in Anhui province. There are 46 specialists, among them there are 43 Professor, 3 middle-rank specialists; 21 clinical speciality, 12 clinical specialists and teaching manager, 13 manger .All of 46 specialist joined the two course of study, so the integrality and reliability can be guaranteed.
Results: According to specialist's prediction, 6 predict valuables, that is, weighted arithmetic mean, full-score ratio, coefficient of variation, sum of ranks, coefficient of concordance and significance test are calculated. By means of equal probability rules, relative significances of each valuable are calculated, according to its relative significance 41primarr variables and 9 secondary valuables are confirmed as evaluated system in residents standardized training center. That is: (1)essence qualification in hospital(the grade of hospital, department or specialty setting, department building and technology level, books and data, communication and internet building, classroom , (2)organized manage(definitude responsibility, right institutions, full-time manger),(3)rules(training register, check on work attendance, qualification checkup before examination inspiriting and eliminating mechanism),(4) training organization and scheme(training outlines and detailed rules, training plans and schemes, the lead of
organization, training methods),(5)training contents(clinical ability, politics and attitude, clinical morality and ethos, teaching ability, research and innovation ability, work attitude, foreign language level, basic academic knowledge), (6) training outlay(special outlay, invested ratio, other outlay source), (7) examination(methods, contents, records, organization), (8) teaching resource construction(science and technology ability, education and foster students, framework of educational background specialty title), (9) detail about
actualization(training ration of residents, evaluating training effects, training time, training rotation ,training records).As a whole, predict coefficient of concordance of all variables is 0.532,significance level is 0.01, It is concluded that all variables have good concordances from above result, so in this study Delphi method is triumphantly used, and the results are advisable system.
主要研究过程：根据理论分析、社会调查、专家意见，并参照卫生部颁发的相关规定及安徽省三所三级甲等医院现行使用的住院医师培养有关规定，建立了有九大类的42个指标作为指标体系雏形，经过两轮Delphi方法正式预测及结合社会调查法完成本研究工作。
本次应用Delphi方法两轮有效回表率分别为95.83％和100％。专家意见采用率为86.67％和100％。应邀咨询专家为三所三级甲等医院的医务处、人事处、科教处的负责人或主要管理人员以及三所医院的内科、外科、妇产、儿科、影像等临床学科的专家，共46人，其中高级职称43人，中级职称3人；临床专家21人，既是临床专家又是教学管理专家12人，管理人员13人。两轮咨询均是在46位专家人数不变的情况下进行，有效地确保了本研究的完整性、可靠性。
研究结果：经过专家预测，计算出加权算术平均值、满分率、变异系数、等级和、协调系数及协调系数的显著性检验六个变量预测值。应用“等概率原则”求出每一个指标的相对重要性，并根据相对重要性确定出9个一级指标41个二级指标作为住院医师规范化培训基地评价指标体系，具体为①医院基本条件(医院规模及等级、科室或专业设置、学科建设及技术水平、图书资料及信息网络建设、教学用房)②组织管理(职责明确、组织机构健全、专人负责)③规章制度(培训登记制度、考勤制度、考核制度、考前资格审查制度、激励机制和淘汰机制)④培训组织及方案(培训大纲和细则、培训计划和方案、组织领导、培训方法)⑤培训内容(临床能力、政治思想和医德医风、教学能力、科研和创新能力、工作态度、外语水平、基本理论知识)⑥培训经费(专项经费、投入比例、其他
安徽医科大学硕士学位论文
社会医学与巨生事业管理
经费渠道)⑦考核(考核方法、考核内容、考核档案、考核组织)⑧师资队伍建
设(学术和技术水平、教书育人、学历结构、职称结构)⑨培训实施情况(住院
医师培训率、培训效果评价、培训时间、培训轮转、培训档案)。从整体指标分
析，本次预测协调系数为0.532，显著性水平为0.01，说明指标的协调性好，
本次Delphi方法应用成功，研究结果可取。
Objectives: The evaluated guideline system of standardized residents training center is very important in strengthening residents training center construction, improving the quality of standardized residents training. At present, there is not a serial of full, scientific, standardized guideline system of standardized residents training center in the whole nation regardless of our province, the aim of this study is to offer practical evaluable guidelines for establishing this system.
The main study courses are as follows: According to theoretic analysis, social investigation, specialists advice, and referring to associated regulations of health ministry and related rules about residents training stipulation using in 3 hospital of 3 A grade in Anhui Province, the primary 9 categories and 42 variables were set up, and the method of two courses of Delphi analysis and social investigation were used in the study.
In our study there are 95.83% and 100% availability feedback ratio, the adopted ratio of specialists advice are 86.67%, 100% in the 2 courses. The invited specialists are the Head or main manager from Department of Medical Administration, Department of Personnel, Department of Science and Technology, and the clinic specialists from Department of Medicine, Department of Surgery, Department of Gynecology and Obstetrics, Department of Paediatrics, Department of Image in 3 hospitals of 3A grade in Anhui province. There are 46 specialists, among them there are 43 Professor, 3 middle-rank specialists; 21 clinical speciality, 12 clinical specialists and teaching manager, 13 manger .All of 46 specialist joined the two course of study, so the integrality and reliability can be guaranteed.
Results: According to specialist's prediction, 6 predict valuables, that is, weighted arithmetic mean, full-score ratio, coefficient of variation, sum of ranks, coefficient of concordance and significance test are calculated. By means of equal probability rules, relative significances of each valuable are calculated, according to its relative significance 41primarr variables and 9 secondary valuables are confirmed as evaluated system in residents standardized training center. That is: (1)essence qualification in hospital(the grade of hospital, department or specialty setting, department building and technology level, books and data, communication and internet building, classroom , (2)organized manage(definitude responsibility, right institutions, full-time manger),(3)rules(training register, check on work attendance, qualification checkup before examination inspiriting and eliminating mechanism),(4) training organization and scheme(training outlines and detailed rules, training plans and schemes, the lead of
organization, training methods),(5)training contents(clinical ability, politics and attitude, clinical morality and ethos, teaching ability, research and innovation ability, work attitude, foreign language level, basic academic knowledge), (6) training outlay(special outlay, invested ratio, other outlay source), (7) examination(methods, contents, records, organization), (8) teaching resource construction(science and technology ability, education and foster students, framework of educational background specialty title), (9) detail about
actualization(training ration of residents, evaluating training effects, training time, training rotation ,training records).As a whole, predict coefficient of concordance of all variables is 0.532,significance level is 0.01, It is concluded that all variables have good concordances from above result, so in this study Delphi method is triumphantly used, and the results are advisable system.
引文
1．孙明玺，吴俊卿．《实用预测方法与案例分析》．科学技术文献出版社，1993．
2．齐小华，高福安．《预测理论与方法》．北京广播学院出版社，1994．
3．卫生部科技司，北京市卫生局．《住院医师规范化培训研讨会》．2002，6．
4．卫生部科技司，四川大学华西医学中心．《全国住院医师培训工作研讨会》．2003，10．
5．卫生部科技司，《临床住院医师规范化培训大纲》．1995，9．
6．刘中怀，《医院人才管理学》．经济管理出版社．1988．
7．赖预建，考核工作是临床住院医师规范化培训的重要环节．医学教育，1997，5：34-36．
8．张成兰．住院医师规范化培训质量监控和保证体系的探讨与实践．医学教育，1998，1：29—33．
9．李远斌，黄俊辉，冯天举．住院医师规范化培训的实施．中华医院管理杂志，1999，15(6)：337-339．
10．胡志．特尔菲方法在筛选农村初级卫生保健指标体系中的应用．中国卫生统计．1990
11．潘晓军．关于高素质创新医学人才与培养．医学教育，2002，6：15-16．
12．刘本固著．教育评价的理论与实践，杭州：浙江教育出版社，2001
13．(美)海耶尔主编．管理百科全书，上海：上海辞书出版社，1991
14．马洪，孙尚清主编．现代管理百科全书，北京：中国发展出版社，1991
15．于宗河，武光华主编．中国医院院长手册，北京：人民卫生出版社，1999
16．周远清等主编．21世纪中国高等教育，北京：高等教育出版社，2001
17．封兴华，李芸梅等．法国的住院医师培养体系和启示，国外医学．医学教育分册．2002，23，2：12-13
18．苏元林．谈加强临床医师队伍建设．中华医院管理杂志．1999，5
19．李静，朱洪平等．继续医学教育的现状与展望．解放军医院管理杂志．2002，9：347-348
20．王华，苏博等．军医大学住院医师培训第一阶段临床能力评估指标体系研究．中国高等医学教育．2002，4：59-61
21．孙庆毅．重视住院医师”三基”培训管理的效率与策略．国外医学教育，2001，41-42
22．杨欣，李克敏等．从妇产科住院医师培训看美国的毕业后教育．国外医学教育．2001，4：42-44
23．冯丽，黄耀忠．加强住院医师规范化培训 推动人才培养．卫生软科学．2002，16(3)：23-24
24．贾敏，张占伟等．临床住院医师规范化培训：问题及对策．中国高等医学教育．2002，1：56-58
25．孙晓宁，苏燕等．住院医师规范化培训新模式．中国医院．2003，7(2)：44-45
26．吴仁友，陈明等．建立医学终身教育体系的初步探讨．继续医学教
育．2002，16(4)：33-36
27．安发美．对住院意识培训基地实行量化评价的探索．继续医学教育1992，6(4)：17-19
28．赖豫建．考核工作是临床住院医师规范化培训的重要环节．医学教育．1997，5：34-36
29．刘晓玲．注重青年住院医师培训 促进医院发展．继续医学教育．2001，15(3)：36-37
30．张良吉，魏光辉等．认真抓好临床住院医师规范化培训．重庆医科大学学报．2002，134-136
31．袁波，朱役等．住院医师规范化培训的实践．解放军医院管理杂志．2001，8(6)：435-436
32．孙庆毅．住院医师轮转期培训的探索．继续医学教育．2002，16(4)：31-33
33．周朝友．特尔菲法(Telphi)用于山区卫生人力资源管理指标的筛选．中国农村卫生事业管理．1993，3：36-38
34．许金花．特尔菲法(Telphi)与管理预测，滨州医学院学报．1992，1：85-86
35．孙瑞华等．医师科研绩效评估指标体系构建的探讨研究．中华医学科研管理杂志．2000，13(1)9-12
36．胡志．中国农村初级卫生保健指标体系研究．中国农村卫生事业管理．1989，10
37．艾尔巴比(美)著，李银河编译．社会研究方法．四川人民出版社．1987
2．齐小华，高福安．《预测理论与方法》．北京广播学院出版社，1994．
3．卫生部科技司，北京市卫生局．《住院医师规范化培训研讨会》．2002，6．
4．卫生部科技司，四川大学华西医学中心．《全国住院医师培训工作研讨会》．2003，10．
5．卫生部科技司，《临床住院医师规范化培训大纲》．1995，9．
6．刘中怀，《医院人才管理学》．经济管理出版社．1988．
7．赖预建，考核工作是临床住院医师规范化培训的重要环节．医学教育，1997，5：34-36．
8．张成兰．住院医师规范化培训质量监控和保证体系的探讨与实践．医学教育，1998，1：29—33．
9．李远斌，黄俊辉，冯天举．住院医师规范化培训的实施．中华医院管理杂志，1999，15(6)：337-339．
10．胡志．特尔菲方法在筛选农村初级卫生保健指标体系中的应用．中国卫生统计．1990
11．潘晓军．关于高素质创新医学人才与培养．医学教育，2002，6：15-16．
12．刘本固著．教育评价的理论与实践，杭州：浙江教育出版社，2001
13．(美)海耶尔主编．管理百科全书，上海：上海辞书出版社，1991
14．马洪，孙尚清主编．现代管理百科全书，北京：中国发展出版社，1991
15．于宗河，武光华主编．中国医院院长手册，北京：人民卫生出版社，1999
16．周远清等主编．21世纪中国高等教育，北京：高等教育出版社，2001
17．封兴华，李芸梅等．法国的住院医师培养体系和启示，国外医学．医学教育分册．2002，23，2：12-13
18．苏元林．谈加强临床医师队伍建设．中华医院管理杂志．1999，5
19．李静，朱洪平等．继续医学教育的现状与展望．解放军医院管理杂志．2002，9：347-348
20．王华，苏博等．军医大学住院医师培训第一阶段临床能力评估指标体系研究．中国高等医学教育．2002，4：59-61
21．孙庆毅．重视住院医师”三基”培训管理的效率与策略．国外医学教育，2001，41-42
22．杨欣，李克敏等．从妇产科住院医师培训看美国的毕业后教育．国外医学教育．2001，4：42-44
23．冯丽，黄耀忠．加强住院医师规范化培训 推动人才培养．卫生软科学．2002，16(3)：23-24
24．贾敏，张占伟等．临床住院医师规范化培训：问题及对策．中国高等医学教育．2002，1：56-58
25．孙晓宁，苏燕等．住院医师规范化培训新模式．中国医院．2003，7(2)：44-45
26．吴仁友，陈明等．建立医学终身教育体系的初步探讨．继续医学教
育．2002，16(4)：33-36
27．安发美．对住院意识培训基地实行量化评价的探索．继续医学教育1992，6(4)：17-19
28．赖豫建．考核工作是临床住院医师规范化培训的重要环节．医学教育．1997，5：34-36
29．刘晓玲．注重青年住院医师培训 促进医院发展．继续医学教育．2001，15(3)：36-37
30．张良吉，魏光辉等．认真抓好临床住院医师规范化培训．重庆医科大学学报．2002，134-136
31．袁波，朱役等．住院医师规范化培训的实践．解放军医院管理杂志．2001，8(6)：435-436
32．孙庆毅．住院医师轮转期培训的探索．继续医学教育．2002，16(4)：31-33
33．周朝友．特尔菲法(Telphi)用于山区卫生人力资源管理指标的筛选．中国农村卫生事业管理．1993，3：36-38
34．许金花．特尔菲法(Telphi)与管理预测，滨州医学院学报．1992，1：85-86
35．孙瑞华等．医师科研绩效评估指标体系构建的探讨研究．中华医学科研管理杂志．2000，13(1)9-12
36．胡志．中国农村初级卫生保健指标体系研究．中国农村卫生事业管理．1989，10
37．艾尔巴比(美)著，李银河编译．社会研究方法．四川人民出版社．1987