乡村医生职业素质提升的研究
|
摘要
农村卫生工作是我国卫生工作的重点,但是农村基层卫生服务较为落后,乡村医生在农村卫生工作中就起着举足轻重的作用。乡村医生支撑着中国农村三级医疗保健网的网底,又是农村卫生工作的主要实施者,对中国9亿农民的健康及保健影响深远。但是乡村医生的整体素质不高,存在学历低、年龄大、专业知识老化、分布不均等各种问题,严重影响农村卫生服务质量和农民的身体健康,可以说在一定程度上制约了农村的经济发展和和谐社会的建设进程。为此,本文进行了以乡村医生为主体的调查研究,旨在了解乡村医生职业素质的现状和存在的问题,找到提高乡村医生职业素质的途径和方法及相关保障措施,以期能为政府进一步发展乡村医生教育,提高培训效果和调整乡村医生政策,促进乡村医生作用的充分发挥提供客观依据,也希望通过提升乡村医生整体素质,从实际为农民节省开支,能有效防止因病致贫、因病返贫现象的出现。
本研究查阅了大量与乡村医生相关的文献资料,并对雷山县的卫生管理人员和村卫生室进行访谈和问卷调查。研究的主要内容为乡村医生相关情况及其职业素质现状。访谈资料主要采用描述性分析,问卷调查主要在Excel中建立数据进行分析,得到以下结果:
1.每行政村有0.48名乡村医生,每千口农民有0.5名乡村医生。
2.157个行政村,应建114个村卫生室,拥有村卫生室64个,占56%。
3.75名乡村医生中,无学历的23人,占31%,中专学历(含达到相当中专水平)的50人,占到67%,大专学历的2人,占0.027%。拥有医师资格人数5人,占0.067%。男性34名,女性41名,男女比例基本持平。
4.年龄构成中,45岁以下的有52人,占59%,45岁以上的有23人,占41%。
5.收入构成以医疗机构的收入为主,还包括出诊费、诊疗费、药费,总体处于中间,乡村医生普遍对收入不满意。
6.2005-2007年,该县75名乡村医生共计接受免费培训4次。其中,由县卫生局组织的2次、县疾控中心组织的1次、县妇幼保健站组织的1次。60%的乡村医生反映在培训中能获得一定知识和技能的提高,对工作有促进作用,但是缺乏系统的理论学习和实践指导。
7.40%村民反映乡村医生的医疗水平偏低,专业知识老化,只会对常见病进行诊治,无法满足村民的需要且医药费用比较高。
因此,针对以上内容,归纳出下面的结论:
1.本次研究结果显示,目前贵州贫困地区的乡村医生队伍建设存在诸多问题:数量少,无法满足农民的卫生服务需求、年龄结构偏大、分布不均、知识老化、职业素质低等,未能充分发挥农村三级医疗保健网网底的作用,乡村医生队伍急需整顿。
2.乡村医生应加强职业道德、专业知识和职业能力的再教育和再培训,并要兼顾以能力为本的学历教育和以临床实践技能为主的非学历教育,要制定符合乡村医生的教学大纲,加大中医药知识的普及和运用。
3.构建终身教育体系下的乡村医生继续教育制度,构建和实施学习支持服务体系,向乡村医生提供全方位的学习服务平台。同时,要积极建立乡村医生绩效考评制度,逐步形成良性竞争,以提高乡村医生整体队伍的素质。
4.在关注学历教育和非学历教育并重的前提下,积极拓宽专业口径,增设符合乡村医生的特殊专业,加大相关职能部门的沟通、协作,有针对性地进行职后培训。要提高乡村医生待遇并保证各项经费的落实和投入,从根本上,制度上解决乡村医生职业素质提升的问题。
5.乡村医生职业素质提升的教育手段要充分利用现代远程信息技术,缩短空间和时间上的距离,将声、色和模拟实践融为一体,有效解决乡村医生再培训时动手难的问题。
6.加强对乡村医生的监管力度,使其规范行医。
Rural health work is the focal point of our health work,however the grassroots health service in rural areas relatively lags behind.The rural doctors play a very important role in the work.Rural doctors,as the basis of China' s Rural Three-level Network of Health Services and the key members to implement the rural health work,exert great and long-term influences on the health and health care of the 0.9 billion rural people in China.However,the overall quality of the rural doctors is not high,with various problems,such as,low educational background,comparatively old age,out-dated professional knowledge,uneven distribution.The health service in rural areas cannot meet the requirement and the health condition of the rural people is affected accordingly.The economic development in rural areas and the construction of the harmonious society are constrained to some extend,as it were.In this paper, the investigation into and research on rural doctors are carried out,aiming at understanding the status quo of their professional quality and problems in existence,working out ways to improve their professional quality and supporting measures,in order to provide for the government an objective basis for the further development of rural doctors education,the improvement of training effectiveness and the adjustment of the policies on rural doctors as well as the full display of the role of the rural doctors.It is expected that the health expenses of the rural people could be tightened,the poverty condition owing to diseases could be prevented through improving the overall professional quality of rural doctors
For this research,I consulted a great amount of documents of the rural doctors,interviewed the health management staff and staff in village clinics in Lei Shan County and conducted questionnaire survey.The main content is the relating information and the status quo of the professional quality of rural doctors.The descriptive analysis is adopted for analyzing the materials obtained by interviewing.For the questionnaire, data are created in Excel files for analysis,we obtain the following results:
1.There are 0.48 doctors in an incorporated village,0.5 doctors for 1000 rural people.
2.There are 157 incorporated villages.114 clinics should be built,but there are only 64,accounting for 56%.
3.There are totally 75 rural doctors,among whom 23 are with no academic credentials,accounting for 31%,50 are graduates from technical schools,taking 67%,2 are with college education background,making up 0.027%,5 are with the Certificate of the Qualified Doctor,taking 0.067%. There are 34 male doctors and 41 female ones.
4.In term of the age of the doctors,52 are under 45,taking 59%,23 are above 45,making up 41%.
5.The doctors' incomes are in middle level,taking their income from the medical institutions as the main part,plus visit fees,charges for diagnosis and treatment,charges for medicine.They are not satisfied with their incomes.
6.From year 2005 to 2007,75 rural doctors in this county were trained for 4 times free of charge,in which,twice were given by the Health Bureau of Lei Shan County,once by the Center for Disease Control of Lei Shan County and once organized by the Maternity and Children Healthcare Centre of Lei Shan County.60%of rural doctors said that they had obtained some knowledge and skills through training.Their work are promoted,but they need systematic study and practical guidance.
7.40%of villagers said the healthcare service offered by the rural doctors was in low level.The doctors' knowledge is out-dated.They could only diagnose and treat common diseases.It could not meet the villagers' demands.The medical charges were relatively high.
Therefore,according to the above,we can conclude the lower summings-up:
1.The research results show that there are many problems in building up the ranks of rural doctors in the poverty-stricken areas in Guizhou province presently,such as,small quantity,unsatisfied health services,old age,uneven distribution,out-dated knowledge and low professional knowledge.They haven't play their role of the basis of China' s Rural Three-level Network of Health Services. Therefore,they need to be well built-up.
2.The rural doctors should further their education and training in professional ethics,knowledge and ability while having academic education focusing on ability cultivation and non-academic education of practical clinical skills.The curriculum catering for rural doctors shall be set up for popularizing and applying traditional Chinese medicine.
3.The further education system for rural doctors within the lifelong education system shall be established.The supporting service system shall also be set up and implemented for offering them the comprehensive service platform.Meanwhile,the performance evaluation system for rural doctors shall be established for the reasonable competition to improve the quality of all rural doctors.
4.While emphasizing on both academic education and non- academic education,the special major for rural doctors shall be established.The relating departments shall strengthen their communication and cooperation and implement special post-occupational training.The rural doctors shall be well-paid.The disbursement of different kinds of funds shall be assured.It is the fundamental and institutional way to improve the quality of rural doctors.
5.In terms of the education means for improving the quality of rural doctors,the modern long-distance information technology shall be adopted to shorten space and save time while integrating sound, color and simulated practices to effectively enable them to get hands-on experience.
6.The supervision of rural doctors shall be strengthened for standardizing their practices.
本研究查阅了大量与乡村医生相关的文献资料,并对雷山县的卫生管理人员和村卫生室进行访谈和问卷调查。研究的主要内容为乡村医生相关情况及其职业素质现状。访谈资料主要采用描述性分析,问卷调查主要在Excel中建立数据进行分析,得到以下结果:
1.每行政村有0.48名乡村医生,每千口农民有0.5名乡村医生。
2.157个行政村,应建114个村卫生室,拥有村卫生室64个,占56%。
3.75名乡村医生中,无学历的23人,占31%,中专学历(含达到相当中专水平)的50人,占到67%,大专学历的2人,占0.027%。拥有医师资格人数5人,占0.067%。男性34名,女性41名,男女比例基本持平。
4.年龄构成中,45岁以下的有52人,占59%,45岁以上的有23人,占41%。
5.收入构成以医疗机构的收入为主,还包括出诊费、诊疗费、药费,总体处于中间,乡村医生普遍对收入不满意。
6.2005-2007年,该县75名乡村医生共计接受免费培训4次。其中,由县卫生局组织的2次、县疾控中心组织的1次、县妇幼保健站组织的1次。60%的乡村医生反映在培训中能获得一定知识和技能的提高,对工作有促进作用,但是缺乏系统的理论学习和实践指导。
7.40%村民反映乡村医生的医疗水平偏低,专业知识老化,只会对常见病进行诊治,无法满足村民的需要且医药费用比较高。
因此,针对以上内容,归纳出下面的结论:
1.本次研究结果显示,目前贵州贫困地区的乡村医生队伍建设存在诸多问题:数量少,无法满足农民的卫生服务需求、年龄结构偏大、分布不均、知识老化、职业素质低等,未能充分发挥农村三级医疗保健网网底的作用,乡村医生队伍急需整顿。
2.乡村医生应加强职业道德、专业知识和职业能力的再教育和再培训,并要兼顾以能力为本的学历教育和以临床实践技能为主的非学历教育,要制定符合乡村医生的教学大纲,加大中医药知识的普及和运用。
3.构建终身教育体系下的乡村医生继续教育制度,构建和实施学习支持服务体系,向乡村医生提供全方位的学习服务平台。同时,要积极建立乡村医生绩效考评制度,逐步形成良性竞争,以提高乡村医生整体队伍的素质。
4.在关注学历教育和非学历教育并重的前提下,积极拓宽专业口径,增设符合乡村医生的特殊专业,加大相关职能部门的沟通、协作,有针对性地进行职后培训。要提高乡村医生待遇并保证各项经费的落实和投入,从根本上,制度上解决乡村医生职业素质提升的问题。
5.乡村医生职业素质提升的教育手段要充分利用现代远程信息技术,缩短空间和时间上的距离,将声、色和模拟实践融为一体,有效解决乡村医生再培训时动手难的问题。
6.加强对乡村医生的监管力度,使其规范行医。
Rural health work is the focal point of our health work,however the grassroots health service in rural areas relatively lags behind.The rural doctors play a very important role in the work.Rural doctors,as the basis of China' s Rural Three-level Network of Health Services and the key members to implement the rural health work,exert great and long-term influences on the health and health care of the 0.9 billion rural people in China.However,the overall quality of the rural doctors is not high,with various problems,such as,low educational background,comparatively old age,out-dated professional knowledge,uneven distribution.The health service in rural areas cannot meet the requirement and the health condition of the rural people is affected accordingly.The economic development in rural areas and the construction of the harmonious society are constrained to some extend,as it were.In this paper, the investigation into and research on rural doctors are carried out,aiming at understanding the status quo of their professional quality and problems in existence,working out ways to improve their professional quality and supporting measures,in order to provide for the government an objective basis for the further development of rural doctors education,the improvement of training effectiveness and the adjustment of the policies on rural doctors as well as the full display of the role of the rural doctors.It is expected that the health expenses of the rural people could be tightened,the poverty condition owing to diseases could be prevented through improving the overall professional quality of rural doctors
For this research,I consulted a great amount of documents of the rural doctors,interviewed the health management staff and staff in village clinics in Lei Shan County and conducted questionnaire survey.The main content is the relating information and the status quo of the professional quality of rural doctors.The descriptive analysis is adopted for analyzing the materials obtained by interviewing.For the questionnaire, data are created in Excel files for analysis,we obtain the following results:
1.There are 0.48 doctors in an incorporated village,0.5 doctors for 1000 rural people.
2.There are 157 incorporated villages.114 clinics should be built,but there are only 64,accounting for 56%.
3.There are totally 75 rural doctors,among whom 23 are with no academic credentials,accounting for 31%,50 are graduates from technical schools,taking 67%,2 are with college education background,making up 0.027%,5 are with the Certificate of the Qualified Doctor,taking 0.067%. There are 34 male doctors and 41 female ones.
4.In term of the age of the doctors,52 are under 45,taking 59%,23 are above 45,making up 41%.
5.The doctors' incomes are in middle level,taking their income from the medical institutions as the main part,plus visit fees,charges for diagnosis and treatment,charges for medicine.They are not satisfied with their incomes.
6.From year 2005 to 2007,75 rural doctors in this county were trained for 4 times free of charge,in which,twice were given by the Health Bureau of Lei Shan County,once by the Center for Disease Control of Lei Shan County and once organized by the Maternity and Children Healthcare Centre of Lei Shan County.60%of rural doctors said that they had obtained some knowledge and skills through training.Their work are promoted,but they need systematic study and practical guidance.
7.40%of villagers said the healthcare service offered by the rural doctors was in low level.The doctors' knowledge is out-dated.They could only diagnose and treat common diseases.It could not meet the villagers' demands.The medical charges were relatively high.
Therefore,according to the above,we can conclude the lower summings-up:
1.The research results show that there are many problems in building up the ranks of rural doctors in the poverty-stricken areas in Guizhou province presently,such as,small quantity,unsatisfied health services,old age,uneven distribution,out-dated knowledge and low professional knowledge.They haven't play their role of the basis of China' s Rural Three-level Network of Health Services. Therefore,they need to be well built-up.
2.The rural doctors should further their education and training in professional ethics,knowledge and ability while having academic education focusing on ability cultivation and non-academic education of practical clinical skills.The curriculum catering for rural doctors shall be set up for popularizing and applying traditional Chinese medicine.
3.The further education system for rural doctors within the lifelong education system shall be established.The supporting service system shall also be set up and implemented for offering them the comprehensive service platform.Meanwhile,the performance evaluation system for rural doctors shall be established for the reasonable competition to improve the quality of all rural doctors.
4.While emphasizing on both academic education and non- academic education,the special major for rural doctors shall be established.The relating departments shall strengthen their communication and cooperation and implement special post-occupational training.The rural doctors shall be well-paid.The disbursement of different kinds of funds shall be assured.It is the fundamental and institutional way to improve the quality of rural doctors.
5.In terms of the education means for improving the quality of rural doctors,the modern long-distance information technology shall be adopted to shorten space and save time while integrating sound, color and simulated practices to effectively enable them to get hands-on experience.
6.The supervision of rural doctors shall be strengthened for standardizing their practices.
引文
4 舒尔茨(美).改造传统农业[M].梁小民,译.北京;商务印书馆,2003:150
5 李德成.赤脚医生研究述评[J].中国初级卫生保健,2007.21(1):6-7
6 陶卫东.浅议职高商经专业学生的职业素质教育.职教通讯,2000,(7)
7 程然.宋桂荣.邹郁松.乡村医生在岗培训现状的调查研究[J].医学与哲学,2005,26(2):80-81
8 黄莹.乡村医生的演变与基层农村医疗卫生服务的研究[D].万方学位论文全网,2003
[1]彭存吉.乡村医生及其培训问题[J].黑龙江科技信息,2007,(3):42
[2]张艳.袁玲.对我国乡村医生教育的思考[J].中国农村卫生事业管理,2005,25(12):24-25
[3]陈资全.认真贯彻落实《决定》全面推进青海农村卫生改革与发展[J].中国卫生,2003,(1):10
[4]张东如.全国乡时医生在岗培训现况及对策研究[D].万方学位论文全网,2004
[5]杨琦.洪名勇.董景奎.健康投资与农村卫生事业的发展--对贵州农村医疗卫生现状的思考[J].山地农业生物学报2006,25(2):159-163
[6]程然.宋桂荣.邹郁松.乡村医生在岗培训现状的调查研究[J].医学与哲学,2005,26(2):80-81
[7]卫生部《2001-2010年全国乡村医生教育规划》.卫科教发[2001]364号
[8]姚乙诚.提高人的思想道德素质是思想工作的第一要务[J].丹东师专学报,2002,(81):107-109
[9]于翠兰.医德医风建设与医院管理[J].研究与探讨,2007,(2):48-49
[10]陈友放.职业院校应注重培养学生的五种能力[J].中国职业技术教育,2005,(2):45-46
[11]陈斌蓉.李莉.开发职业能力,提升就业质量.机械职业教育[J].2007,(6):8-9
[12]管弦.浅谈我国乡村医生的现状及其应具备的素质[J].论著,2006,3(11):44-45
[13]胡爱萍.夏强.全球医学教育最基本要求及其推广的相关问题和对策[J].中国高等医学教育,2005,2(3):24.
[14]朴玉霞.李小岑.曾奇.推行“全球医学教育最清色本要求”加强乡村医生素质教育[J],中国医学伦理学.2007,20(1):97-98
[15]周伟.论乡村医生专业课程的设置[J].卫生职业教育,2001,(1):41
[16]田利军.如何提高乡医队伍的整体素质[J].中国乡村医药杂志,2001,8(9):5-6
[17]韩冬,钱跃升.山东省村卫生室及乡村医生现状与发展对策研究[J].中国农村卫生事业管理,2003,(23):24-25
[18]余小波.普通高校成人学历教育地位作用申论[J].长沙电力学院学报(社会科学版),2002,(4):115
[19]何涛.雷军.周敏.李小明.何青萍.加强医学成人教育改善农村医疗卫生状况[J].中国卫生事业管理,2005,(10):616-618
[20]杨秋海.成人高考舞弊现象评析[J].职业技术教育研究,2006,(8):14-15
[21]龚玉芳.郝祥俊.医学院校成人教育招生工作现状及发展前景的预测[J],承德医学院学报,2006,(3):110-1
[22]贵州省高等教育自学考试考试指南[E],北京理工大学出版社,2002
[23]裴立风.掌握建构主义理论 提高医学成人教育教学质量[J].医学教育.2000,(5):12-13
[24]姚云.杨洁.廖福义.关于构建乡村医生在岗培训制度的理性思考[J].卫生事业管理,2003.10(1):5-6
[25]马进.蒋飞.王春明.夏芹.孔巍.我国乡村医生队伍素质现状分析[J].中国初级卫生保健,2003,17(8):19-20
[26]张艰:任新玲:李圣青;印弘;吴昌归:临床进修医师综合素质培养的探讨[J].西北医学教育,2006,14(6):758-759
[27]孟群.周纪安.梁万年.黄道初.席彪.敬蜀青.吴沛新.黄琼丽.对贵州、四川、河北、吉林和安徽五省农村卫生服务与乡村医生教育现状调研报告[J].实用乡村医生杂志,1999,6(2):3
[28]李秀敏,张艳芳.执业医师考试与医学生临床实践能力的培养[J].中国高等医学教育,2005,(5):88
[29]高越明,陈增良,邹立人,朱建华.发挥高等医学院校职能培养高素质乡村医生--乡村医生连续统一体培养模式的研究与实践[J].中国高等医学教育.2004,(6):27-30
[30]周爱国.袁凌云.加强农村卫生队伍建设的对策探讨[J].红旗文稿,2007,(3):23-24
[31]韩煦.当前农村医疗卫生状况分析[J].理论界,2006,(5):28-29
[32]蔡文成.高桂云.郭琦.甘肃农村卫生资源配置现状与制度构建的路径选择[J].社科纵横,2006.,21(7):13
[33]曾照芳.冉华全.现代教育技术在高等医学教育改革中的应用研究[J].医学教育探索,2006,5(12):163-164
[34]管定国.浅论高等医学教育中信息网络技术的应用[J].西北医学教育,2006.14(1):41-42
[35]谭海珠.杨棉华.陈丹芸.林若薇.虚拟现实技术在医学中的发展与应用[J].医学教育探索,2005,(6):410-412
[43]谢军.浅谈临床医学生实习中存在的问题及对策[J].现代医药卫生.2008,(14):2214
[44]赛燕.但国蓉.董兆君.医学院校学生对多媒体网络教育模式的评价及对策研究[J].现代医药卫生.2008,(14):2212
[45]金新政 李芳.探讨高素质医药信息专业学科人才的培养目标和方法[J].医学与社会.2007,20(12):51
[46]李先龙.新型农村合作医疗制度改革探讨[J].医学与社会,2008,(1):49
[47]任海燕.方鹏骞.医生职业幸福感文献研究概况与分析[J].医学与社会,2008,(1):34
[48]董云萍.医忠关系的物化与和谐医患关系的构建[J].医学与社会,2009,22(1):22
[49]池美珠.许张晔.钱燕.临床实习质量的影响因素与对策探讨[J].医学与社会,2009,22(1):.66
[50]桂克全.社区中医科生存之道[J].中国卫生产业,2008,(12):84
[51]田少华.赵忠福.董平.循证医学在骨科临床教学中的应用[J].齐齐哈尔医学院学报,2008,29(7):854
[52]胡桂周.许统亮.多媒体在临床医学教学中的应用[J].医学信息,2008,(1):40
[53]张静.周增桓.熊梦辉.耿红梅.金春华.构建培养高素质创新型医学人才的开放性实验教学平台 [J].医学信息,2008,(1):35
[54]郭政 程牛亮 王斌全 周芸.以临床教学模拟医院为平台 实施全球医学教育最基本要求[J].中国医院,2007,11(10):76
[55]林崇健.李志曼.医院临床科室绩效评估模型的研究[J].中国医院,2007,11(10):38
[56]邱鹏芳.郑振俭.乡村医生素质对农村防疫事业发展的影响及对策[J].医学与社会,2007,20(8):13
[57]师小葶.田润录.李恩昌.医疗职业人格与医师专业精神的含义、内容、存在问题及对策[J].医学与社会,2007,20(10):20
[58]杜治政.关于医学专业精神的几个问题[J].医学与哲学:人文社会医学版,2007,28(3):1.
[59]孙永杰 姜涌 牛丽凤.。对辽宁省乡村医生解决心理问题等现状调查分析[J].实用全科医学,2008,6(5):514
[60]郝如敏 邓书林 孙胜林.北京市农村卫生人员现状和中等卫生职教发展对策研究--对昌平区农村卫生人员状况的调查分析[J].卫生职业教育,2008,26(4):115
[61]王丽平 张利刚 薛伟.四地乡村医生调查--时代变我也变[J].中国卫生产业.,2008,(5):53
[62]徐恒秋.对加强农村卫生人才队伍建设的几点思考[J].中国农村卫生事业管理,2008,28(2):85
[63]郭清.以农村卫生为重点 提高全民族健康素质[J].中国农村卫生事业管理,2008,28(2):83
[64]季谭.中国绝大部分乡镇卫生院亏损 矛头指向制度[J].医院领导决策参考.2008,(1):23
[65]韩仁贵.管理村卫生室需强化村委会职责[J].中国社区医师,2009,(4):50
[66]刘顺平.像培养大学生村官那样扶持村医[J].中国社区医师,2009,(4):50
[67]孙敏.闫娟.袁鸿江.四川省边远山区乡村医务人员服务需求调查[J].中国公共卫生,2008,24(2):226
[68]李芳健.王家骥.我国现阶段全科医师规范化培训刍议[J].中国社区医师,2008,(1):3-4
[69]李璐埸.基层需要什么样的医疗工作者[J].首都医药,2009,(1):6
[70]李璐瑒.传统中医药理念[J].首都医药,2009,(1):35
[71]江一民 杜兆辉.论社区卫生服务中心绩效评估中的效率指标[J].实用全科医学,2008,6(6):619
[72]张雅凤,林忠嗣,张楚石,黄霞.提高农村卫生人员素质 建设农村卫生服务网络--辽宁省农村医疗卫生现状的调研[J].实用中医内科杂志,2008,(12)
[1]Brad A.Petrisor,Mohit Bhandari.Principles of teaching evidence-based medicine [J].Injury,2006,37 (4)
[2]Way DP,Hudson A,Blagi B.Comparison of three parallel basic science pathways in the same medical college.Academic Medicine,2000,75(75):
[3]Peters AS,Rosovsky RG,Crowder C,et al.Long-term outcomes of the new pathway program at harvard medical school a randomized controlled trial.Academic Medicine,2000,75 ( 75 )
[4]Margaret Lieb Zalon.A prime-time primer for distance education.Nurse Educator,2000,251,25(1).
[5]:Moore GT,Block SD,Style CB,et al.The influence of the new pathway curriculum on Harvard medical students.Academic Medicine,1994,69(69).
[6]Blumenthal D,Hsiao W,2005,Privatization and its discontends-the evolving Chinese health care system.N Engl J Med,353
[7]Dahl E,Elstad JI.2001.Recent changes in social structure and health in equalities in Norway.Scand J Public Health,55
[8]WHO.2000.Health System:Improving Performance.World Health Report.
[9]WHO.2000.Partnership in Health and Poverty;Towards a Common Agenda Report of an Intenational Meeting.WHO headquarters Geneva.
[10]Fran(?)ois Lemaire;The Nuremberg doctors' trial:the 60th anniversary [J].Intensive Care Medicine,2006
[11]Claire Keith;Feedback to doctors about prescribing errors in the hospital setting [J].Pharmacy World & Science,2007
[12]Fran(?)ois Lemaire;The Nuremberg doctors' trial:the 60th anniversary [J].Intensive Care Medicine,2006
[13]Shun-ichiro Bessho;Yasushi Ohkusa;When do people visit a doctor [J].Health Care Management Science,2005
[14]Joseph Lipscomb;ClaireF.Snyder;CarolynC.Gotay;Cancer outcomes measurement [J].Quality of Life Research,2006
[15]RonD.Hays;Joseph Lipscomb;Next steps for use of item response theory in the assessment of health outcomes [J].Quality of Life Research,2007
[16]Joseph Lipscomb;Health resource allocation and quality of care measurement in a social policy framework [J].Policy Sciences,
5 李德成.赤脚医生研究述评[J].中国初级卫生保健,2007.21(1):6-7
6 陶卫东.浅议职高商经专业学生的职业素质教育.职教通讯,2000,(7)
7 程然.宋桂荣.邹郁松.乡村医生在岗培训现状的调查研究[J].医学与哲学,2005,26(2):80-81
8 黄莹.乡村医生的演变与基层农村医疗卫生服务的研究[D].万方学位论文全网,2003
[1]彭存吉.乡村医生及其培训问题[J].黑龙江科技信息,2007,(3):42
[2]张艳.袁玲.对我国乡村医生教育的思考[J].中国农村卫生事业管理,2005,25(12):24-25
[3]陈资全.认真贯彻落实《决定》全面推进青海农村卫生改革与发展[J].中国卫生,2003,(1):10
[4]张东如.全国乡时医生在岗培训现况及对策研究[D].万方学位论文全网,2004
[5]杨琦.洪名勇.董景奎.健康投资与农村卫生事业的发展--对贵州农村医疗卫生现状的思考[J].山地农业生物学报2006,25(2):159-163
[6]程然.宋桂荣.邹郁松.乡村医生在岗培训现状的调查研究[J].医学与哲学,2005,26(2):80-81
[7]卫生部《2001-2010年全国乡村医生教育规划》.卫科教发[2001]364号
[8]姚乙诚.提高人的思想道德素质是思想工作的第一要务[J].丹东师专学报,2002,(81):107-109
[9]于翠兰.医德医风建设与医院管理[J].研究与探讨,2007,(2):48-49
[10]陈友放.职业院校应注重培养学生的五种能力[J].中国职业技术教育,2005,(2):45-46
[11]陈斌蓉.李莉.开发职业能力,提升就业质量.机械职业教育[J].2007,(6):8-9
[12]管弦.浅谈我国乡村医生的现状及其应具备的素质[J].论著,2006,3(11):44-45
[13]胡爱萍.夏强.全球医学教育最基本要求及其推广的相关问题和对策[J].中国高等医学教育,2005,2(3):24.
[14]朴玉霞.李小岑.曾奇.推行“全球医学教育最清色本要求”加强乡村医生素质教育[J],中国医学伦理学.2007,20(1):97-98
[15]周伟.论乡村医生专业课程的设置[J].卫生职业教育,2001,(1):41
[16]田利军.如何提高乡医队伍的整体素质[J].中国乡村医药杂志,2001,8(9):5-6
[17]韩冬,钱跃升.山东省村卫生室及乡村医生现状与发展对策研究[J].中国农村卫生事业管理,2003,(23):24-25
[18]余小波.普通高校成人学历教育地位作用申论[J].长沙电力学院学报(社会科学版),2002,(4):115
[19]何涛.雷军.周敏.李小明.何青萍.加强医学成人教育改善农村医疗卫生状况[J].中国卫生事业管理,2005,(10):616-618
[20]杨秋海.成人高考舞弊现象评析[J].职业技术教育研究,2006,(8):14-15
[21]龚玉芳.郝祥俊.医学院校成人教育招生工作现状及发展前景的预测[J],承德医学院学报,2006,(3):110-1
[22]贵州省高等教育自学考试考试指南[E],北京理工大学出版社,2002
[23]裴立风.掌握建构主义理论 提高医学成人教育教学质量[J].医学教育.2000,(5):12-13
[24]姚云.杨洁.廖福义.关于构建乡村医生在岗培训制度的理性思考[J].卫生事业管理,2003.10(1):5-6
[25]马进.蒋飞.王春明.夏芹.孔巍.我国乡村医生队伍素质现状分析[J].中国初级卫生保健,2003,17(8):19-20
[26]张艰:任新玲:李圣青;印弘;吴昌归:临床进修医师综合素质培养的探讨[J].西北医学教育,2006,14(6):758-759
[27]孟群.周纪安.梁万年.黄道初.席彪.敬蜀青.吴沛新.黄琼丽.对贵州、四川、河北、吉林和安徽五省农村卫生服务与乡村医生教育现状调研报告[J].实用乡村医生杂志,1999,6(2):3
[28]李秀敏,张艳芳.执业医师考试与医学生临床实践能力的培养[J].中国高等医学教育,2005,(5):88
[29]高越明,陈增良,邹立人,朱建华.发挥高等医学院校职能培养高素质乡村医生--乡村医生连续统一体培养模式的研究与实践[J].中国高等医学教育.2004,(6):27-30
[30]周爱国.袁凌云.加强农村卫生队伍建设的对策探讨[J].红旗文稿,2007,(3):23-24
[31]韩煦.当前农村医疗卫生状况分析[J].理论界,2006,(5):28-29
[32]蔡文成.高桂云.郭琦.甘肃农村卫生资源配置现状与制度构建的路径选择[J].社科纵横,2006.,21(7):13
[33]曾照芳.冉华全.现代教育技术在高等医学教育改革中的应用研究[J].医学教育探索,2006,5(12):163-164
[34]管定国.浅论高等医学教育中信息网络技术的应用[J].西北医学教育,2006.14(1):41-42
[35]谭海珠.杨棉华.陈丹芸.林若薇.虚拟现实技术在医学中的发展与应用[J].医学教育探索,2005,(6):410-412
[43]谢军.浅谈临床医学生实习中存在的问题及对策[J].现代医药卫生.2008,(14):2214
[44]赛燕.但国蓉.董兆君.医学院校学生对多媒体网络教育模式的评价及对策研究[J].现代医药卫生.2008,(14):2212
[45]金新政 李芳.探讨高素质医药信息专业学科人才的培养目标和方法[J].医学与社会.2007,20(12):51
[46]李先龙.新型农村合作医疗制度改革探讨[J].医学与社会,2008,(1):49
[47]任海燕.方鹏骞.医生职业幸福感文献研究概况与分析[J].医学与社会,2008,(1):34
[48]董云萍.医忠关系的物化与和谐医患关系的构建[J].医学与社会,2009,22(1):22
[49]池美珠.许张晔.钱燕.临床实习质量的影响因素与对策探讨[J].医学与社会,2009,22(1):.66
[50]桂克全.社区中医科生存之道[J].中国卫生产业,2008,(12):84
[51]田少华.赵忠福.董平.循证医学在骨科临床教学中的应用[J].齐齐哈尔医学院学报,2008,29(7):854
[52]胡桂周.许统亮.多媒体在临床医学教学中的应用[J].医学信息,2008,(1):40
[53]张静.周增桓.熊梦辉.耿红梅.金春华.构建培养高素质创新型医学人才的开放性实验教学平台 [J].医学信息,2008,(1):35
[54]郭政 程牛亮 王斌全 周芸.以临床教学模拟医院为平台 实施全球医学教育最基本要求[J].中国医院,2007,11(10):76
[55]林崇健.李志曼.医院临床科室绩效评估模型的研究[J].中国医院,2007,11(10):38
[56]邱鹏芳.郑振俭.乡村医生素质对农村防疫事业发展的影响及对策[J].医学与社会,2007,20(8):13
[57]师小葶.田润录.李恩昌.医疗职业人格与医师专业精神的含义、内容、存在问题及对策[J].医学与社会,2007,20(10):20
[58]杜治政.关于医学专业精神的几个问题[J].医学与哲学:人文社会医学版,2007,28(3):1.
[59]孙永杰 姜涌 牛丽凤.。对辽宁省乡村医生解决心理问题等现状调查分析[J].实用全科医学,2008,6(5):514
[60]郝如敏 邓书林 孙胜林.北京市农村卫生人员现状和中等卫生职教发展对策研究--对昌平区农村卫生人员状况的调查分析[J].卫生职业教育,2008,26(4):115
[61]王丽平 张利刚 薛伟.四地乡村医生调查--时代变我也变[J].中国卫生产业.,2008,(5):53
[62]徐恒秋.对加强农村卫生人才队伍建设的几点思考[J].中国农村卫生事业管理,2008,28(2):85
[63]郭清.以农村卫生为重点 提高全民族健康素质[J].中国农村卫生事业管理,2008,28(2):83
[64]季谭.中国绝大部分乡镇卫生院亏损 矛头指向制度[J].医院领导决策参考.2008,(1):23
[65]韩仁贵.管理村卫生室需强化村委会职责[J].中国社区医师,2009,(4):50
[66]刘顺平.像培养大学生村官那样扶持村医[J].中国社区医师,2009,(4):50
[67]孙敏.闫娟.袁鸿江.四川省边远山区乡村医务人员服务需求调查[J].中国公共卫生,2008,24(2):226
[68]李芳健.王家骥.我国现阶段全科医师规范化培训刍议[J].中国社区医师,2008,(1):3-4
[69]李璐埸.基层需要什么样的医疗工作者[J].首都医药,2009,(1):6
[70]李璐瑒.传统中医药理念[J].首都医药,2009,(1):35
[71]江一民 杜兆辉.论社区卫生服务中心绩效评估中的效率指标[J].实用全科医学,2008,6(6):619
[72]张雅凤,林忠嗣,张楚石,黄霞.提高农村卫生人员素质 建设农村卫生服务网络--辽宁省农村医疗卫生现状的调研[J].实用中医内科杂志,2008,(12)
[1]Brad A.Petrisor,Mohit Bhandari.Principles of teaching evidence-based medicine [J].Injury,2006,37 (4)
[2]Way DP,Hudson A,Blagi B.Comparison of three parallel basic science pathways in the same medical college.Academic Medicine,2000,75(75):
[3]Peters AS,Rosovsky RG,Crowder C,et al.Long-term outcomes of the new pathway program at harvard medical school a randomized controlled trial.Academic Medicine,2000,75 ( 75 )
[4]Margaret Lieb Zalon.A prime-time primer for distance education.Nurse Educator,2000,251,25(1).
[5]:Moore GT,Block SD,Style CB,et al.The influence of the new pathway curriculum on Harvard medical students.Academic Medicine,1994,69(69).
[6]Blumenthal D,Hsiao W,2005,Privatization and its discontends-the evolving Chinese health care system.N Engl J Med,353
[7]Dahl E,Elstad JI.2001.Recent changes in social structure and health in equalities in Norway.Scand J Public Health,55
[8]WHO.2000.Health System:Improving Performance.World Health Report.
[9]WHO.2000.Partnership in Health and Poverty;Towards a Common Agenda Report of an Intenational Meeting.WHO headquarters Geneva.
[10]Fran(?)ois Lemaire;The Nuremberg doctors' trial:the 60th anniversary [J].Intensive Care Medicine,2006
[11]Claire Keith;Feedback to doctors about prescribing errors in the hospital setting [J].Pharmacy World & Science,2007
[12]Fran(?)ois Lemaire;The Nuremberg doctors' trial:the 60th anniversary [J].Intensive Care Medicine,2006
[13]Shun-ichiro Bessho;Yasushi Ohkusa;When do people visit a doctor [J].Health Care Management Science,2005
[14]Joseph Lipscomb;ClaireF.Snyder;CarolynC.Gotay;Cancer outcomes measurement [J].Quality of Life Research,2006
[15]RonD.Hays;Joseph Lipscomb;Next steps for use of item response theory in the assessment of health outcomes [J].Quality of Life Research,2007
[16]Joseph Lipscomb;Health resource allocation and quality of care measurement in a social policy framework [J].Policy Sciences,