重庆市全科医师转岗培训效果及影响因素

许扬; 贾贺勋; 邓靖之; 杨文; 邓辉胜

doi:10.16766/j.cnki.issn.1674-4152.003132

重庆市全科医师转岗培训效果及影响因素

doi: 10.16766/j.cnki.issn.1674-4152.003132

1.
重庆医科大学附属第一医院全科医学科，重庆 400016
2.
重庆医科大学附属第一医院教务处

基金项目:

重庆市科委卫健委联合项目 2020ZLXM003

详细信息

通讯作者:
邓辉胜，E-mail: 702197987@qq.com

中图分类号: R192.3 R499
计量
- 文章访问数: 136
- HTML全文浏览量: 28
- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2023-01-15
- 网络出版日期: 2023-09-13

Training effect and influencing factors of job-transfer training for general practitioners in Chongqing province

1.
Department of General Practice, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

摘要

摘要: 目的分析重庆市全科医学教育中心全科医师转岗培训学员结业考核成绩及学员反馈意见，为改进转岗培训方案和制定培训策略提供建议。方法以2021年在重庆医科大学附属第一医院全科医学教育中心参加考核的220例全科医生转岗培训学员为研究对象, 采用标准的结业考核方案对学员的临床能力进行评价, 并采用电子问卷收集学员对转岗培训的反馈意见，采用SPSS 22.0统计学软件进行统计学分析。结果学员的技能考核即病史采集、体格检查、心肺复苏、临床思维、慢病管理以及理论考核的中位成绩分别为80.0(71.3, 80.0)分、80.0(70.0, 90.0)分、89.0(84.0，92.0)分、67.0(58.3，71.0)分、65.0(60.0，70.0)分及58.0(55.0，62.0)分，通过率分别为96.8%、89.5%、99.5%、74.5%、80.0%及40.9%，差异有统计学意义(均P＜0.05)。多因素线性回归显示，性别、年龄、学历和工作年限对总成绩影响差异有统计学意义(均P＜0.05)。在理论培训方面，学员提出希望能够增加理论培训课时, 并且希望培训内容更好地结合临床实践、满足基层实际需求等；而在临床实践方面，学员希望增加临床实践培训、科室轮转时间以及基层实践等。结论学员病史采集、体格检查及心肺复苏能力良好，理论水平、慢病管理及临床思维能力稍差，全科学员综合能力的个体差异较大。
- 全科医生 /
- 转岗培训 /
- 临床能力 /
- 影响因素
Abstract: Objective To analyze the completion assessment results of job-transfer training of general practitioners in Chongqing General Practice Education Center, and to provide constructive suggestions for improving the transfer training program and formulating training strategies. Methods The research subjects were 220 general practitioners who participated in the assessment at General Medical Education Center of the First Affiliated Hospital of Chongqing Medical University in 2021. Trainees ' inquiry ability was evaluated by a standard completion assessment program. The scores of these abilities were adopts SPSS 22.0 for statistical analysis. Results The median score of medical history collection, physical examination, cardiopulmonary resuscitation, clinical thinking, chronic disease management, and theoretical examinations were 80.0 (71.3, 80.0), 80.0 (70.0, 90.0), 89.0 (84.0, 92.0), 67.0 (58.3, 71.0), 65.0 (60.0, 70.0) and 58.0 (55.0, 62.0), respectively; and the passing rates were 96.8%, 89.5%, 99.5%, 74.5%, 80.0%, and 40.9%, respectively, and the differences were statistically significant (all P < 0.05). Multivariate linear regression showed that gender, age, education and working years had significant influences on the total score (all P < 0.05). In terms of theoretical training, students proposed to increase theoretical training class, and hoped that the training content could better combine clinical practice and meet the actual needs of the grassroots level. In terms of clinical practice, students hoped to increase clinical practice training, department rotation time, and grass-roots practice. Conclusion General practitioners ' physical examination, cardiopulmonary resuscitation and interrogation skills are in good performance while their theoretical, chronic disease management and clinical thinking skills are slightly poor. There are great individual differences of trainees ' comprehensive ability.
- General practitioners /
- Job-transfer training /
- Clinical ability /
- Influencing factors

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表 1 不同基本情况全科医生的结业考核得分比较(分)

Table 1. The comparison of the completion assessment of the general practitioners in different basic situations(points)

项目	人数	病史采集[M(P₂₅, P₇₅)]	体格检查[M(P₂₅, P₇₅)]	临床思维[M(P₂₅, P₇₅)]	慢病管理[M(P₂₅, P₇₅)]	心肺复苏[M(P₂₅, P₇₅)]	理论[M(P₂₅, P₇₅)]	总成绩(x±s)
性别
男性	104	79.0(73.0, 86.0)	79.0(67.0, 90.0)	66.0(55.8, 70.0)	61.5(60.0, 65.0)	87.0(82.0, 91.0)	57.0(55.0, 61.0)	68.1±5.5
女性	116	80.0(71.0, 86.8)	81.5(71.3, 90.8)	67.5(60.3, 71.8)	65.0(60.0, 73.8)	89.5(84.0, 92.0)	58.0(54.3, 62.0)	69.3±5.8
年龄(岁)
＜30	39	82.0(75.0, 88.0)	84.0(75.0, 93.0)	68.0(65.0, 72.0)	67.0(60.0, 75.0)	89.0(84.0, 93.0)	57.0(54.0, 61.0)	69.8±4.6
30~40	101	80.0(71.0, 88.0)	84.0(72.0, 90.0)	68.0(60.5, 72.0)	65.0(60.0, 70.0)	89.0(86.0, 92.0)	59.0(56.0, 63.0)	69.8±5.7
＞40	80	79.5(71.3, 85.0)	75.5(63.0, 86.0)	65.5(42.3, 69.0)	60.0(60.0, 65.0)	85.5(80.0, 91.0)	57(54.0, 61.0)	66.8±5.7
学历
专科	56	74.5(69.0, 82.0)	72.5(63.3, 83.8)	66.0(40.3, 68.8)	60.0(50.0, 69.5)	86.0(79.3, 90.8)	57.0(53.3, 60.8)	65.7±5.6
本科	131	80.0(72.0, 86.0)	80.0(70.0, 90.0)	67.0(60.0, 70.0)	64.0(60.0, 70.0)	89.0(84.0, 92.0)	58.0(54.0, 62.0)	68.9±5.0
研究生	33	86.0(79.0, 92.0)	90.0(80.5, 93.0)	71.0(66.0, 75.5)	67.0(61.0, 75.0)	90.0(86.5, 92.0)	61.0(57.0, 64.5)	73.1±5.3
执业医师证
无	42	75.0(69.0, 83.0)	76.5(67.0, 88.5)	66.0(51.8, 69.5)	65.0(60.0, 73.3)	85.0(78.3, 89.0)	54.5(52.0, 58.0)	66.5±5.6
有	178	80.0(73.0, 87.0)	81.5(71.0, 90.0)	68.0(59.8, 71.0)	64.0(60.0, 70.0)	89.0(85.0, 92.0)	59.0(56.0, 62.0)	69.2±5.6
工作地点
基层医院	135	78.0(71.0, 85.0)	77.0(67.0, 87.0)	66.0(42.0, 69.0)	63.0(60.0, 70.0)	88.0(82.0, 91.0)	57.0(54.0, 61.0)	67.5±5.2
综合性医院	85	81.0(72.0, 90.0)	85.0(74.5, 92.0)	70.0(66.0, 73.5)	65.0(60.0, 72.0)	89.0(86.0, 92.0)	60.0(56.5, 64.0)	70.7±5.8
工作年限(年)
＜5	32	81.0(72.3, 88.0)	84.0(72.3, 93.8)	70.5(66.0, 74.0)	67.5(60.0, 75.0)	89.0(84.3, 92.8)	58.0(54.0, 63.5)	70.6±6.4
5~9	48	81.0(71.0, 87.8)	81.0(73.0, 90.8)	68.0(64.0, 71.8)	65.0(60.0, 71.8)	89.0(84.3, 92.0)	58.0(55.0, 62.0)	69.4±5.1
10~14	49	77.0(70.0, 87.5)	80.0(69.5, 89.0)	68.0(55.0, 73.5)	65.0(60.0, 70.0)	90.0(86.5, 92.0)	59.0(54.0, 63.0)	68.8±6.0
≥15	91	80.0(73.0, 85.0)	79.0(64.0, 88.0)	65.0(43.0, 68.0)	62.0(60.0, 70.0)	86.0(82.0, 91.0)	57.0(55.0, 61.0)	67.6±5.3

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表 2 220名学员结业考核得分影响因素的多元线性回归分析

Table 2. Multivariate linear regression analysis of factors influencing the score of 220 students' completion examination

项目	病史采集	体格检查	临床思维	慢病管理	心肺复苏	理论	总成绩
性别
B值	1.904	2.662	1.005	4.476	1.364	0.452	1.338
t值	1.391	1.625	0.483	3.049	1.587	0.568	2.004
P值	0.166	0.106	0.630	0.003	0.114	0.571	0.046
年龄
B值	-0.529	-0.721	-0.621	-0.480	-0.311	-0.110	-0.414
t值	-2.969	-3.382	-2.292	-2.513	-2.780	-1.066	-4.763
P值	0.003	0.001	0.023	0.013	0.006	0.288	< 0.001
学历
B值	4.763	5.957	0.574	5.705	1.798	0.887	3.077
t值	3.557	3.715	0.282	3.971	2.138	1.139	4.708
P值	< 0.001	< 0.001	0.778	< 0.001	0.034	0.256	< 0.001
执业医师证
B值	3.224	-0.522	0.760	-3.632	5.414	2.466	0.989
t值	1.586	-0.215	0.246	-1.665	4.241	2.087	0.996
P值	0.114	0.830	0.806	0.097	< 0.001	0.038	0.320
工作地点
B值	-1.736	2.810	7.880	-0.244	-1.169	1.317	1.428
t值	-1.010	1.365	3.014	-0.132	-1.083	1.318	1.701
P值	0.314	0.174	0.003	0.895	0.280	0.189	0.090
工作年限
B值	0.315	0.301	0.159	0.264	-0.014	0.035	0.209
t值	1.903	1.516	0.632	1.488	-0.131	0.361	2.589
P值	0.058	0.131	0.528	0.138	0.896	0.718	0.010

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表 3 220名学员对转岗培训内容的反馈情况

Table 3. Feedback of 220 trainees on the content of job transfer training

项目	人数(%)
您对全科转岗培训的集中理论培训课程有什么意见或建议
无	111(76.6)
希望精简内容	2(1.4)
希望增加课时，丰富内容	18(12.5)
希望培训内容结合临床实践	7(4.8)
希望更符合基层实际需求	3(2.1)
课程内容陈旧	1(0.7)
希望加强临床思维培养	2(1.4)
希望讲义共享	1(0.7)
您对全科转岗培训的临床实践有什么意见或建议
无	105(72.4)
科室轮转时间短	13(9.0)
希望增加门诊轮转	2(1.4)
增加临床实践训练	16(11.0)
增加基层实践	5(3.4)
经济损失大，建立福利保障机制	2(1.4)
加强培训反馈	1(0.7)
加大临床思维培养	1(0.7)

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参考文献(22)

[1]	尹德卢, 辛倩倩, 殷涛, 等. 城市社区全科医生团队各岗位人员配置需求测算分析[J]. 中华医院管理杂志, 2016, 32(9): 674-678. doi: 10.3760/cma.j.issn.1000-6672.2016.09.011 YIN D L, XIN Q Q, YIN T, et al. Measurement and analysis of staffing standards of family doctor interdisciplinary team[J]. Chinese Journal of Hospital Administration, 2016, 32(9): 674-678. doi: 10.3760/cma.j.issn.1000-6672.2016.09.011
[2]	赵轶明, 王永晨. 全科医学临床师资综合指标体系的初步构建[J]. 中华医学教育探索杂志, 2020, 19(9): 1102-1107. doi: 10.3760/cma.j.cn116021-20191208-00254 ZHAO Y M, WANG Y C. Preliminary construction of comprehensive index system for clinical teachers in general practice[J]. Chinese Journal of Medical Education Research, 2020, 19(9): 1102-1107. doi: 10.3760/cma.j.cn116021-20191208-00254
[3]	陈皓阳, 李翔逸, 闫如玉, 等. 文献分析视角下影响家庭医生签约服务的问题及其严重性研究[J]. 中国全科医学, 2020, 23(7): 789-794. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202007026.htm CHEN H Y, LI X Y, YAN R Y, et al. Problems Affecting Contracted Family Doctor Services and Their Severity Based on Literature Analysis[J]. Chinese General Practice, 2020, 23(7): 789-794. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202007026.htm
[4]	卫生部公办厅. 卫生部办公厅关于印发《基层医疗卫生机构全科医生转岗培训大纲(试行)》的通知[J]. 中华人民共和国国家卫生健康委员会公报, 2011(1): 58-63. https://www.cnki.com.cn/Article/CJFDTOTAL-WSGB201102015.htm Public Office of the Ministry of Health. Notice of the General Office of the Ministry of Health on printing and distributing "Training Outline for Post Transfer of General Practitioners in Grassroots Medical and Health Institutions (Trial)"[J]. Bulletin of National Health Commission, PRC, 2011(1): 58-63. https://www.cnki.com.cn/Article/CJFDTOTAL-WSGB201102015.htm
[5]	国务院办公厅. 国务院办公厅关于改革完善全科医生培养与使用激励机制的意见[J]. 中华人民共和国教育部公报, 2018(4): 9-13. https://www.cnki.com.cn/Article/CJFDTOTAL-CDZB201904008.htm General Office of the State Council. Opinions of The General Office of the State Council on reforming and improving the incentive mechanism for training and using general Practitioners[J]. Gazette of the State Council of the People's Republic of China, 2018(4): 9-13. https://www.cnki.com.cn/Article/CJFDTOTAL-CDZB201904008.htm
[6]	胥娇, 方明, 董靖竹, 等. 以能力为导向的全科住院医师培训创新模式探索与实践[J]. 中华医学教育探索杂志, 2022, 21(1): 78-81. XU J, FANG M, DONG J Z, et al. Exploration and practice of innovative model of ability-oriented training for general practitioners[J]. Chinese Journal of Medical Education Research, 2022, 21(1): 78-81
[7]	章锃瑜, 卢晓强. 基层医院实施社区全科医生转岗培训的实践与探索[J]. 浙江临床医学, 2019, 21(4): 581-582. ZHANG Z Y, LU X Q. Practice and exploration of community general Practitioners' post transfer training in grassroots hospitals[J]. Zhejiang Clinical Medical Journal, 2019, 21(4): 581-582.
[8]	孙艳春, 王伟, 张耀光, 等. 基层全科医生临床思维能力现状及其影响因素[J]. 中国卫生资源, 2021, 24(4): 441-447. https://www.cnki.com.cn/Article/CJFDTOTAL-WSZY202104021.htm SUN Y C, WANG W, ZHANG Y G, et al. Current situation and influencing factors of clinical thinking ability of grassroots general practitioners[J]. Chinese Health Resources, 2021, 24(4): 441-447. https://www.cnki.com.cn/Article/CJFDTOTAL-WSZY202104021.htm
[9]	赵明月, 孙骞, 尹爱田, 等. 全科医生培养机制中的问题与解决路径[J]. 中国卫生事业管理, 2017, 34(7): 534-536. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWSG201707018.htm ZHAO M Y, SUN Q, YIN A T, et al. Problems and Solutions in the Cultivation Mechanism of General Practitioners[J]. Chinese Health Service Management, 2017, 34(7): 534-536. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWSG201707018.htm
[10]	陈红, 沙玛·木拉提, 李奇凤, 等. 新疆维吾尔自治区2012—2020年全科医生转岗运行情况研究[J]. 中国全科医学, 2022, 25(34): 4339-4343, 4349. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202234016.htm CHEN H, SHAMA Mulati, LI Q F, et al. General Practitioner Transfer in Xinjiang Uygur Autonomous Region from 2012 to 2020[J]. Chinese General Practice, 2022, 25(34): 4339-4343, 4349. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202234016.htm
[11]	刘颖, 邱艳, 任文, 等. 我国全科医师亚专长培养现状及发展思考[J]. 中华医学教育探索杂志, 2021, 20(4): 406-408. LIU Y, QIU Y, REN W, et al. Current status and development of the training of general practitioners with special interest(GPSI)in China[J]. Chinese Journal of Medical Education Research, 2021, 20(4): 406-408.
[12]	李妍君, 魏来, 范生根, 等. 转岗全科医生服务能力评价指标体系构建及应用研究[J]. 中华全科医学, 2022, 20(4): 539-543. doi: 10.16766/j.cnki.issn.1674-4152.002396 LI Y J, WEI L, FAN S G, et al. Construction and application of the service performance evaluation index system for job-transfer general practitioners[J]. Chinese Journal of General Practice, 2022, 20(4): 539-543. doi: 10.16766/j.cnki.issn.1674-4152.002396
[13]	章锃瑜, 卢晓强. 基层医院实施社区全科医生转岗培训的实践与探索[J]. 浙江临床医学, 2019, 21(4): 581-582. ZHANG Z Y, LU X Q. Practice and exploration of community general Practitioners' post transfer training in grassroots hospitals[J]. Zhejiang Clinical Medical Journal, 2019, 21(4): 581-582.
[14]	张雅丽, 张金佳, 张敏, 等. 河北省全科医生转岗培训学员的培训现状及需求调查[J]. 中华全科医师杂志, 2021, 20(10): 1053-1058. ZHANG Y L, ZHANG J J, ZHANG M, et al. Survey on the status quo and training needs of general practitioner job-transfer training program in Hebei Province[J]. Chinese Journal of General Practitioners, 2021, 20(10): 1053-1058.
[15]	龙佳佳, 谢宝玉, 何淑媛, 等. 广西全科医生规范化培训现状及相关对策研究[J]. 中国卫生产业, 2020, 17(1): 183-185, 198. https://www.cnki.com.cn/Article/CJFDTOTAL-WSCY202001076.htm LONG J J, XIE B Y, HE S Y, et al. Research on the Current Situation and Related Countermeasures of Standardized Training for General Practitioners in Guangxi[J]. China Health Industry, 2020, 17(1): 183-185, 19. https://www.cnki.com.cn/Article/CJFDTOTAL-WSCY202001076.htm
[16]	任晓斌. 2020年河北省全科医生转岗培训调查研究[D]. 石家庄: 河北医科大学, 2022. REN X B. Investigation on job transfer training of general practitioners in Hebei Province in 2020[D]. Shijiazhuang: Hebei Medical University, 2022.
[17]	于晓松. 新中国成立70年以来中国全科医学发展与展望[J]. 中华全科医学, 2019, 17(11): 1797-1799. doi: 10.16766/j.cnki.issn.1674-4152.001058 YU X S. The development and prospect of chinese general practice since the founding of new China 70 years ago[J]. Chinese Journal of General Practice, 2019, 17(11): 1797-1799. doi: 10.16766/j.cnki.issn.1674-4152.001058
[18]	任洁, 冯永亮, 董爽, 等. 山西省3市12县基层医生高血压知识掌握及指南培训效果的影响因素分析[J]. 中华高血压杂志, 2020, 28(7): 680-684. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ202007020.htm REN J, FENG Y L, DONG S, et al. Analysis of influencing factors of basic doctors' knowledge of hypertension and guide training effect in 3 cities and 12 counties of Shanxi Province[J]. Chinese Journal of Hypertension, 2020, 28(7): 680-684. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ202007020.htm
[19]	张雅丽, 安英武, 张金佳, 等. "以器官系统为中心"的教学模式对我国全科医生转岗培训的启示[J]. 中华全科医师杂志, 2020, 19(11): 1067-1069. ZHANG Y L, AN Y W, ZHANG J J, et al. "Application of organ system-based teaching in general practitioner job-transfer training[J]. Chinese Journal of General Practitioners, 2020, 19(11): 1067-1069.
[20]	张宇, 刘晓民, 李悦, 等. 基于情景模拟的多元化教学法在内科临床教学中的应用[J]. 卫生职业教育, 2019, 37(23): 85-86. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYX201923049.htm ZHANG Y, LIU X M, LI Y, et al. Application of diversified teaching method based on scenario simulation in internal medicine clinical teaching[J]. Health Vocational Education, 2019, 37(23): 85-86. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYX201923049.htm
[21]	陈思, 毛志刚, 付阳, 等. 构建基于互联网的临床基础检验学多元化教学体系[J]. 国际检验医学杂志, 2020, 41(3): 378-379, 384. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ202003033.htm CHEN S, MAO Z G, FU Y, et al. To construct a diversified teaching system of clinical basic laboratory science based on Internet[J]. International Journal of Laboratory Medicine, 2020, 41(3): 378-379, 384. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ202003033.htm
[22]	丁宁, 张玉, 王成, 等. 综合性医院培养全科医生的实践与思考[J]. 中国医院, 2019, 23(4): 73-75. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYU201904024.htm DING N, ZHANG Y, WANG C, et al. Practice and thoughts on general practitioner training in general hospitals[J]. Chinese Hospitals, 2019, 23(4): 73-75. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYU201904024.htm