陕西省全科规培学员对早期健康问题的认知度及诊疗能力分析

王敏雯; 苏萍青; 于照祥; 崔洁; 冯巩

doi:10.16766/j.cnki.issn.1674-4152.004266

陕西省全科规培学员对早期健康问题的认知度及诊疗能力分析

doi: 10.16766/j.cnki.issn.1674-4152.004266

王敏雯^{1, 2},
苏萍青^1, ,,
于照祥^{1, 2},
崔洁^{1, 2},
冯巩³

1.
西安医学院第一附属医院全科医学科，陕西西安 710000
2.
西安医学院全科医学院，陕西西安 710000
3.
西安医学院全科医学研究所，陕西西安 710000

基金项目:

教育部产学合作协同育人项目 230724171107236

陕西省“十四五”教育科学规划项目 SGH23Y2464

陕西省教育厅大学生创新创业训练计划项目 S202311840093

详细信息

通讯作者:
苏萍青，E-mail：1473875829@qq.com

中图分类号: R192
计量
- 文章访问数: 2
- HTML全文浏览量: 2
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-04-01
- 网络出版日期: 2026-01-07

Awareness and diagnosis treatment ability of early health problems among general practice trainees in Shaanxi Province

WANG Minwen^{1, 2},
SU Pingqing^{1
, ,},
YU Zhaoxiang^{1, 2},
CUI Jie^{1, 2},
FENG Gong³

1.
Department of General Practice, the First Affiliated Hospital of Xi' an Medical University, Xi' an, Shaanxi 710000, China

摘要

摘要: 目的分析陕西省全科规培学员对早期健康问题的认知程度及诊疗能力的影响因素，为进一步针对性提升全科规培学员诊疗能力提供有力依据。方法选取2021年9月—2023年9月来自陕西省54个区(县)的98名在培学员作为调查对象，采用问卷调查的方式了解学员对早期健康问题的认知度以及诊疗能力自我评估情况。结果共回收问卷98份。调查结果显示，全科规培学员高年级学员对于该类健康问题的认知度[(12.94±3.02)分]高于低年级学员[(10.40±3.40)分，P＜0.01]，且诊疗能力自我评估得分[(11.71±2.80)分]也高于低年级学员[(9.91±3.16)分，P < 0.05];不同性别、年龄、培训种类、工作年限等学员的认知度及诊疗能力自我评估得分差异均无统计学意义。开展该类健康问题相关学术讲座和培训班(占比85.2%)普遍被认为最有助于提升诊疗能力，其中举办案例分享、开展相关讲座及小讲课、门诊带教占前3位。结论西部地区全科规培学员对早期健康问题的认知度及诊疗能力均存在一定不足，可针对不同年级规培学员采取不同的教学模式，进一步完善该类健康问题的临床带教与考核工作，不断提升全科住培质量，为培养优秀的基层医师做出贡献。
- 全科住院医师规范化培训 /
- 早期健康问题 /
- 自我认知度 /
- 诊疗能力
Abstract: Objective To provide strong evidence for further targeted improvement of general practitioners ' diagnostic and therapeutic abilities by analyzing the cognitive level and influencing factors of early health problems among general practitioners in the western region. Methods A total of 98 trainees from 54 districts and counties in Shaanxi Province were selected as survey participants between September 2021 and September 2023. A questionnaire survey was conducted to assess their awareness of early health problems and self-evaluated diagnostic and treatment competencies. Results A total of 98 questionnaires were collected in this study, and the survey results showed that the awareness of this type of health problem among senior students of general practitioner residency training (12.94±3.02) was higher than that of junior students (10.40±3.40, P < 0.01), and their self-assessment value of diagnosis and treatment ability (11.71±2.80) was also higher than that of junior students (9.91±3.16, P < 0.05); Other factors such as gender, age, type of training, and years of work experience didn ' t have a statistically significant impact on self-assessment of awareness and diagnostic and treatment abilities. Academic lectures and training courses related to this type of health issue (accounting for 85.2%) were generally considered to be the most helpful in improving diagnosis and treatment abilities, with case sharing, relevant lectures, and small lectures and outpatient mentoring ranking among the top three. Conclusion There are certain deficiencies in the awareness and diagnosis and treatment abilities of general practitioners Shaanxi Province regarding early health problems. Different teaching models are adopted for resident physicians of different grades to further improve the clinical teaching and assessment of such health problems, continuously improve the quality of general practitioners, and contribute to the cultivation of excellent grassroots physicians.
- Standardized training for general resident physicians /
- Early health issues /
- Self-awareness /
- Diagnosis and treatment ability

HTML全文

表 1 不同特征全科规培学员对早期健康问题的认知度及诊疗能力自我评估比较(x±s, 分)

Table 1. Analysis of cognition and self-assessment of early health problems among resident general practitioners with different characteristics (x±s, points)

项目	例数	认知度	诊疗能力自我评估
性别
男性	40	11.85±3.51	11.18±2.73
女性	58	11.66±2.98	10.50±3.12
t值		0.296	1.107
P值		0.768	0.271
住培种类
“5+3”全科规培医师	81	11.54±3.22	10.60±2.85
“3+2”全科规培医师	17	12.65±2.98	11.59±3.47
t值		1.302	1.245
P值		0.196	0.216
报名同等学力
是	21	12.67±2.87	11.71±2.85
否	77	11.48±3.24	10.52±2.97
t值		1.521	1.649
P值		0.132	0.102
取得执业医师资格证
是	54	12.20±3.28	11.17±3.16
否	44	11.16±3.02	10.30±2.68
t值		1.626	1.453
P值		0.107	0.149
年龄
21~23岁	18	11.22±3.28	10.06±2.58
24~26岁	58	11.72±3.19	11.02±3.10
27~29岁	12	12.50±3.56	10.42±2.64
>30岁	10	11.80±2.86	11.10±3.35
F值		0.380	0.572
P值		0.770	0.635
规培年级
第1年	35	10.40±3.40	9.91±3.16
第2年	32	12.03±2.61	10.81±2.72
第3年	31	12.94±3.02	11.71±2.80
F值		5.949	3.142
P值		0.004	0.048
工作年限
＜3年	73	11.64±3.17	10.59±3.01
3~5年	12	12.67±2.90	11.92±2.50
＞6年	13	11.38±3.64	10.77±3.08
F值		0.615	1.031
P值		0.543	0.361

下载: 导出CSV

表 2 早期健康问题诊疗能力的提升方法分析[例(%)]

Table 2. Frequency analysis of methods for improving diagnostic and therapeutic capacity related to early health problems [case(%)]

诊疗能力提升方法	“5+3”全科规培学员	“3+2”全科助理医师
入科宣教中介绍未分化疾病的诊疗	61(75.3)	13(76.5)
开展未分化疾病相关的教学活动(如小讲课、病例讨论等)	68(84.0)	14(82.4)
组织未分化疾病的相关考核	57(70.4)	14(82.4)
阅读未分化疾病相关文献、书籍、资料等	68(84.0)	14(82.4)
开展未分化疾病相关学术讲座、培训班等	69(85.2)	15(88.2)
建立规范的未分化疾病诊疗路径	65(80.2)	15(88.2)

下载: 导出CSV

表 3 提升全科规培学员早期健康问题诊疗能力的方法分析

Table 3. Statistics on methods used by resident general practitioners to improve their diagnostic and therapeutic abilities for early health problems

诊疗能力提升方法	例数(%)
案例分享	7(24.2)
小讲课、讲座	7(24.2)
门诊带教	7(24.2)
阅读相关文献	4(13.8)
诊疗规范	3(10.3)
知识竞赛	1(3.3)
总计	29(100.0)

下载: 导出CSV

参考文献(20)

[1]	祝墡珠, 于晓松, 路孝琴. 全科医学概论[M]. 北京: 人民卫生出版社, 2018: 135. ZHU S Z, YU X S, LU X Q. Introduction to General Practice[M]. Beijing: People's Medical Publishing House, 2018: 135.
[2]	中国老年医学学会, 全科未分化疾病专家协作组. 乏力诊治与管理专家共识(2024)[J]. 中华全科医学, 2024, 22(9): 1453-1462. doi: 10.16766/j.cnki.issn.1674-4152.003658 Chinese Geriatric Society, Expert Collaboration Group for Undifferentiated Diseases in General Practice. Expert Consensus on Diagnosis, Treatment, and Management of Frailty (2024)[J]. Chinese Journal of General Practice, 2024, 22(9): 1453-1462. doi: 10.16766/j.cnki.issn.1674-4152.003658
[3]	BAITHA U, DEB K S, RANJAN P, et al. Estimated prevalence of medically unexplained physical symptoms in the medicine outpatient department of a tertiary care hospital in India[J]. Gen Hosp Psychiatry, 2019, 61: 47-52. doi: 10.1016/j.genhosppsych.2019.10.006
[4]	AAMLAND A, MALTERUD K, WERNER E L. Patients with persistent medically unexplained physical symptoms: a descriptive study from Norwegian general practice[J]. BMC Fam Pract, 2014, 15: 107. DOI: 10.1186/1471-2296-15-107.
[5]	娄铮, 刘颖, 任菁菁. 县级综合医院普通内科门诊未分化疾病就诊情况分析[J]. 中国全科医学, 2023, 26(31): 3945-3950. LOU Z, LIU Y, REN J J. Analysis of undifferentiated diseases in general internal medicine clinics of county-level general hospitals[J]. Chinese General Practice, 2023, 26(31): 3945-3950.
[6]	邱艳, 任文, 刘颖, 等. 综合性医院全科线上-线下门诊就诊情况分析[J]. 中华医院管理杂志, 2018, 34(7): 552-555. QIU Y, REN W, LIU Y, et al. Analysis of online and offline outpatient visits in general hospitals[J]. Chinese Journal of Medical Hospital Management, 2018, 34(7): 552-555.
[7]	娄铮, 刘颖, 任菁菁. 浙江省全科医生对未分化疾病诊治的观点研究[J]. 中华全科医学, 2024, 22(2): 321-324. doi: 10.16766/j.cnki.issn.1674-4152.003394 LOU Z, LIU Y, REN J J. A study of the opinions of general practitioners in Zhejiang Province on the diagnosis and treatment of medically unspecified disease[J]. Chinese Journal Of General Practice, 2024, 22(2): 321-324. doi: 10.16766/j.cnki.issn.1674-4152.003394
[8]	陈俊名, 徐皓, 赵盛男, 等. 解读躯体症状-重新认识躯体症状障碍[J]. 医学与哲学, 2018, 39(9): 63-65. CHEN J M, XU H, ZHAO S N, et al. Understanding somatic symptoms: rethinking somatic symptom disorder[J]. Medicine and Philosophy, 2018, 39(18): 63-65.
[9]	叶康丽, 徐志杰, 杜亚平, 等. 应对未分化疾病: 从过度诊断走向医患共同决策[J]. 中国全科医学, 2020, 23(36): 4541-4547. YE K L, XU Z J, DU Y P, et al. Coping with undifferentiated diseases: from overdiagnosis to doctor-patient shared decision making[J]. Chinese General Practice, 2020, 23(36): 4541-4547.
[10]	朱铭来, 王恩楠. 医保支付方式改革如何减轻道德风险: 来自医保基金支出的证据[J]. 保险研究, 2021, 42(4): 75-90. ZHU M L, WANG E N. How does medicare payment reform mitigate moral hazard? Evidence from health care fund expenditures[J]. Insurance Research, 2021, 42(4): 75-90.
[11]	王剑强. 未分化疾病的全科诊疗思维与策略[J]. 中华全科医学, 2023, 21(3): 485-489. doi: 10.16766/j.cnki.issn.1674-4152.002913 WANG J Q. General practice thinking and strategy of diagnosis and treatment of undifferentiated diseases[J]. Chinese Journal Of General Practice, 2023, 21(3): 485-489. doi: 10.16766/j.cnki.issn.1674-4152.002913
[12]	苏源. 宁夏引导居民基层就诊的实施困境与仿真策略研究[D]. 济南: 山东大学, 2020. SU Y. Research on the implementation dilemma and simulation strategy of guiding residents to seek medical treatment at the basic level in Ningxia[D]. Jinan: Shandong University, 2020.
[13]	ABRAHAMSEN C, LINDBAEK M, WERNER E L. Experience with a structured conversation tool: a qualitative study on feasibility in general practice in Norway[J]. Scand J Prime Health Care, 2022, 40(2): 190-196. doi: 10.1080/02813432.2022.2076396
[14]	李亚茹, 裘力锋, 张佳, 等. 以岗位胜任力为目标的全科医生门诊教学探讨[J]. 中国毕业后医学教育, 2020, 4(4): 307-310. LI Y R, QIU L F, ZHANG J, et al. Out-patient teaching method of general practitioners oriented to post competency[J]. Chinese Journal of Graduate Medical Education, 2020, 4(4): 307-310.
[15]	J∅SSANG I H, AAMLAND A, HJÖRLEIFSSON S. Discovering strengths in patients with medically unexplained symptoms: a focus group study with general practitioners[J]. Scand J Prime Health Care, 2022, 40(3): 405-413. doi: 10.1080/02813432.2022.2139345
[16]	HENNINGSEN P, GUNDEL H, KOP W J, et al. Persistent physical symptoms as perceptual dysregulation: a neuro psycho behavioral model and its clinical implications[J]. Psychosom Med, 2018, 80(5): 422-431. doi: 10.1097/PSY.0000000000000588
[17]	TOBBACK E, MARIMAN A, CLAUWAERT L, et al. Opinion paper: the role of work in the management of medically unexplained physical symptoms[J]. Acta Clinica Belgica, 2019, 74(3): 151-156. doi: 10.1080/17843286.2018.1462754
[18]	CHUA I S, GAZIEL YABLOWITZ M, KORACH Z T, et al. Artificial intelligence in oncology: path to implementation[J]. Cancer Med, 2021, 10(12): 4138-4149. doi: 10.1002/cam4.3935
[19]	李静尧, 邱阳, 王海东. 人工智能技术在肺癌临床诊疗中的应用与展望[J]. 重庆医学, 2024, 53(7): 961-964, 971. LI J Y, QIU Y, WANG H D. Application and prospects of artificial intelligence technology in clinical diagnosis and treatment of lung cancer[J]. Chongqing Medicine, 2024, 53(7): 961-964, 971.
[20]	周英达, 卓书雄, 金花, 等. 上海市社区全科医生对未分化疾病认知度和诊疗能力的自我评价研究[J]. 中国全科医学, 2021, 24(31): 3979-3985. ZHOU Y D, ZHUO S X, JIN H, et al. Self-rated capability of identifying, diagnosing and treating medically unexplained physical symptoms in shanghai general practitioners in community health centers[J]. Chinese General Practice, 2021, 24(31): 3979-3985.