上海市静安区社区卫生服务中心全科医生临床能力评估现况及问题分析

华明; 石建伟; 沈天寒

doi:10.16766/j.cnki.issn.1674-4152.004375

上海市静安区社区卫生服务中心全科医生临床能力评估现况及问题分析

doi: 10.16766/j.cnki.issn.1674-4152.004375

1.
上海市静安区卫生事业管理中心，上海 200070
2.
上海交通大学医学院，上海 200025

基金项目:

上海市科技计划项目 22692107200

上海市静安区卫生科研课题 2023SQ01

详细信息

通讯作者:
沈天寒，E-mail: vicarperk@163.com

中图分类号: R197.1 R192.3
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出版历程
- 收稿日期: 2025-05-02
- 网络出版日期: 2026-04-11

Current status of clinical competency assessment and problem analysis of general practitioners in community health centers in Shanghai Jing'an district

1.
Health Service Management Center of Jingan District, Shanghai 200070, China

摘要

摘要: 目的通过开展上海市静安区社区在职全科医生临床能力评估，分析其现况及薄弱点，为在职全科医生临床继续教育深化，助力全科医生临床能力提升提供依据。方法 2023年8—12月，组织静安区内所有的15家社区卫生服务中心在职的192名临床西医全科医生参加临床诊疗能力评估(包括临床理论知识、临床操作技能)。采用多元线性回归分析全科医生临床能力评估成绩的影响因素。结果 192名全科医生临床能力评估总成绩平均分为73.42±11.42(合格率86.46%)；理论成绩平均分为68.77±15.53(合格率71.35%)；操作技能平均分为82.48±16.81(合格率98.96%)。多元线性回归分析显示，规培情况(P < 0.001)、师资情况(P < 0.001)、轮训轮转情况(P=0.003)均是理论成绩得分的影响因素，师资情况(P=0.007)是放射片判读得分的影响因素，规培情况(P < 0.001)、师资情况(P < 0.001)、轮训轮转情况(P=0.025)均是总成绩的影响因素。结论社区在职全科医生临床能力总体评分不高，在临床理论知识及心电图方面较为薄弱，相比而言未经过规培、未获得师资、未定期轮训轮岗全科医生的总体临床能力不足更为明显。针对这些因素，未来需从优化毕业后教育与继续教育内容与形式、完善继续教育培训考核与动态评估等方面入手，完善全科医生规范化培训、加强全科师资队伍建设、有序推进轮训轮岗，构建科学合理的全科医生临床能力可持续发展体系，共同推动全科医生临床能力的持续提升。
- 全科医生 /
- 能力评估 /
- 继续教育
Abstract: Objective To analyze the current status and identify weaknesses in clinical competence among community-based general practitioners (GPs) in Jing ' an District, Shanghai, through a comprehensive competency assessment, and to inform strategies for enhancing clinical continuing education and fostering sustainable improvements in GP clinical capabilities. Methods A total of 192 GPs from 15 community health centers in Jing ' an District were organized to participate in the clinical competency assessment (including clinical theoretical knowledge and clinical operational skills) from August and December 2023. Multiple linear regression was employed to identify factors influencing assessment scores. Results The overall mean score of the 192 GPs was 73.42±11.42 (pass rate: 86.46%), with theoretical knowledge scoring 68.77±15.53 (pass rate: 71.35%) and procedural skills 82.48±16.81 (pass rate: 98.96%). Regression analysis revealed that standardized training history (P < 0.001), access to teaching faculty (P < 0.001), and participation in rotational training (P=0.003) significantly influenced theoretical scores. Faculty availability independently affected radiograph interpretation scores (P=0.007). These three factors collectively impacted overall scores (P < 0.001 for training, P < 0.001 for faculty, P=0.025 for rotation). Conclusion Community-based GPs demonstrates suboptimal clinical competence, particularly in theoretical knowledge and electrocardiogram interpretation. Deficiencies are more pronounced among GPs lacking standardized training, teaching faculty support, or rotational experience. To address these gaps, future efforts should focus on optimizing postgraduate and continuing education curricula, establishing dynamic competency evaluation frameworks, strengthening standardized residency training programs, enhancing faculty development, and implementing structured job rotation systems. These measures aim to establish a scientifically sound and sustainable development system for enhancing the clinical competency of general practitioners, thereby collectively driving continuous improvement in their clinical capabilities.
- General practitioner /
- Competency assessment /
- Continuing medical education

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表 1 192名全科医生临床能力评估整体得分情况

Table 1. The overall score of clinical capability assessment of 192 general practitioners

成绩类型	平均分(x±s，分)	合格[例(%)]	不合格[例(%)]
总成绩	73.42±11.42	166(86.46)	26(13.54)
理论成绩	68.77±15.53	137(71.35)	55(28.65)
操作技能	82.48±16.81	190(98.96)	2(1.04)
技能成绩(必考)	92.62±4.54	192(100.00)	0
技能成绩(抽考)	89.99±8.61	189(98.44)	3(1.56)
心电图判读	67.32±21.75	134(69.79)	58(30.21)
放射片判读	79.97±13.00	183(95.31)	9(4.69)

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表 2 不同特征全科医生临床能力评估得分比较(x±s，分)

Table 2. Comparison of the scores of clinical capability assessment of general practitioners with different characteristics (x±s, points)

项目	类别	人数	理论成绩	临床技能
项目	类别	人数	理论成绩	技能成绩(必考)	技能成绩(抽考)	心电图判读	放射片判读
性别	男性	58	64.59±14.81	92.16±4.99	90.26±8.44	60.60±22.52	80.78±12.06
	女性	134	70.58±15.54	92.82±4.34	89.88±8.71	70.22±20.84	79.63±13.41
t值			2.489	0.932	0.279	2.866	0.561
P值			0.014	0.353	0.781	0.005	0.575
年龄(岁)	≤30	15	79.33±10.92^ab	91.27±4.61	92.47±4.00	68.00±24.41	75.33±17.67
	31~40	81	71.93±14.73^a	92.89±4.21	90.11±10.76	70.00±20.33	79.94±12.95
	41~50	89	64.61±15.72	92.76±4.82	89.53±6.79	65.06±22.82	81.07±12.12
	＞50	7	62.57±13.20	90.57±4.47	89.29±9.20	63.57±18.42	76.43±13.14
F值			6.434	1.043	0.516	0.803	1.021
P值			＜0.001	0.375	0.672	0.494	0.384
学历	本科及以下	174	67.80±15.83	92.53±4.59	89.63±8.90	66.81±21.98	80.03±13.04
	硕士及以上	18	78.11±7.78	93.44±4.15	93.56±3.58	72.22±19.34	79.44±12.94
t值			4.705	0.808	1.855	1.005	0.181
P值			＜0.001	0.420	0.065	0.316	0.856
职称	初级	14	76.71±15.74	93.14±3.21	93.29±4.56	75.71±16.27	73.21±14.89^d
	中级	140	67.64±15.98	92.69±4.37	89.30±9.21	65.29±22.45	79.32±12.62^d
	高级	38	69.95±13.10	92.18±5.54	91.31±7.05	71.54±19.97	84.74±12.41
F值			2.343	0.291	1.955	2.417	4.887
P值			0.099	0.748	0.144	0.092	0.009
工作年限(年)	＜5	49	72.12±15.09^c	91.84±3.93	91.47±4.59	69.08±21.23	75.51±14.04^c
	5~10	50	71.64±15.49	92.94±4.60	90.14±10.42	61.90±21.43	80.90±13.08
	＞10	93	65.46±15.26	92.86±4.80	89.14±9.12	69.30±21.94	81.83±11.93
F值			4.242	0.982	1.187	2.123	4.090
P值			0.016	0.377	0.308	0.123	0.018
规培情况	规培	81	77.78±11.03	92.56±4.39	91.91±5.07	69.14±22.02	80.93±12.40
	非规培	111	62.20±15.07	92.67±4.67	88.59±10.26	65.99±21.56	79.28±13.43
t值			8.270	0.167	2.949	0.989	0.866
P值			＜0.001	0.868	0.004	0.324	0.387
师资情况	师资	82	76.85±10.49	92.70±4.48	90.13±8.83	67.01±21.05	83.54±10.70
	非师资	110	62.75±15.98	92.56±4.61	89.89±8.48	67.55±22.36	77.32±13.94
t值			7.371	0.198	0.193	0.168	3.366
P值			＜0.001	0.843	0.847	0.867	＜0.001
轮训轮岗情况	轮训轮岗	18	80.00±12.12	91.56±4.08	91.72±5.40	67.78±27.07	77.22±18.01
	非轮训轮岗	174	67.61±15.41	92.73±4.59	89.82±8.87	67.27±21.22	80.26±12.40
t值			4.020	1.040	0.890	0.090	0.700
P值			＜0.001	0.298	0.373	0.925	0.493
注：与41~50岁比较，^aP＜0.05；与＞50岁比较，^bP＜0.05。与＞10年比较，^cP＜0.05。与高级比较，^dP＜0.05。

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表 3 自变量赋值情况

Table 3. Assignment of independent variables

自变量	赋值方法
性别	男性=1，女性=2
年龄	≤30岁=1，31-40岁=2，41-50岁=3，＞50岁=4
学历	本科及以下=1，硕士及以上=2
职称	初级职称=1，中级职称=2，高级职称=3
工作年限	少于5年=1，5~10年=2，10年以上=3
规培情况	是=1，否=2
师资情况	是=1，否=2
轮训轮岗情况	是=1，否=2

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表 4 全科医生临床能力评估得分影响因素的多元线性回归分析

Table 4. Multivariate linear regression analysis on the influencing factors of the clinical capability assessment scores of general practitioners

因变量	自变量	B	SE	β	t值	P值
理论成绩	性别	3.669	1.946	0.109	1.885	0.061
	年龄	1.308	1.800	0.058	0.727	0.468
	学历	1.410	3.111	0.027	0.453	0.651
	工作年限	-0.952	1.286	-0.051	-0.740	0.460
	规培情况	11.458	2.317	0.365	4.944	< 0.001
	师资情况	12.872	1.834	0.411	7.017	< 0.001
	轮训轮转情况	10.015	3.275	0.188	3.058	0.003
放射片判读	职称	3.015	2.036	0.118	1.481	0.140
	工作年限	1.855	1.214	0.119	1.528	0.128
	师资情况	5.143	1.881	0.196	2.734	0.007
总成绩	性别	2.484	1.499	0.100	1.657	0.099
	年龄	0.938	1.386	0.057	0.677	0.499
	学历	0.338	2.402	0.009	0.141	0.888
	职称	1.065	1.575	0.048	0.676	0.500
	工作年限	-1.025	1.032	-0.075	-0.993	0.322
	规培情况	8.282	1.797	0.359	4.609	< 0.001
	师资情况	8.831	1.454	0.384	6.072	< 0.001
	轮训轮岗情况	5.795	2.563	0.148	2.261	0.025

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