综合医院亚专长全科医师发展现状的调查研究

吴静怡; 任菁菁; 刘颖; 郑园园; 陈小央; 杨凯超; 李开军

doi:10.16766/j.cnki.issn.1674-4152.003225

综合医院亚专长全科医师发展现状的调查研究

doi: 10.16766/j.cnki.issn.1674-4152.003225

吴静怡^{1, 2},
任菁菁^1, ,,
刘颖¹,
郑园园¹,
陈小央¹,
杨凯超²,
李开军²

1.
浙江大学医学院附属第一医院全科医学科，浙江杭州 310003
2.
丽水市中心医院全科医学科，浙江丽水 323000

基金项目:

2021年全国全科医学教育教学研究课题 A-YXGP20210201-08

详细信息

通讯作者:
任菁菁，E-mail：3204092@zju.edu.cn

中图分类号: R192
计量
- 文章访问数: 168
- HTML全文浏览量: 60
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2022-06-07
- 网络出版日期: 2023-11-23

Development status of General Practitioner with Special Interest in comprehensive hospitals: a survey

1.
Department of General Practice, the First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, China

摘要

摘要: 目的了解国内综合医院全科医学科亚专长全科医师(general practitioner with special interest, GPwSI)发展现状。方法于2022年4月，通过网络对国内综合医院全科医师进行调查，调查内容包括全科医师的基本信息、亚专长发展现状、未来发展亚专长意愿及培训需求等。结果共收回问卷203份，其中有效问卷200份，有效率为98.5%。200名全科医师年龄为(37.8±9.3)岁，男性83人(41.5%)，女性117人(58.5%)，参加过亚专长培训的全科医师24人(12.0%)，未参加过全科亚专长培训176人(88.0%)。与未参加过亚专长培训的全科医师组相比，参加过亚专长培训组的全科医师从事全科工作年限更长(P < 0.05)。在参加过亚专长培训医师的发展方向上，最常见的是心脑血管亚专长(50.0%，12/24)；在意愿发展亚专长方向上，最常见的是内分泌亚专长(83.5%，142/170)。在亚专长培训起始阶段问题上，与副主任医师及以上组比较，主治医师及以下更愿意尽早开展亚专长培训(P < 0.05)，且更倾向于自我指导(P < 0.05)。结论现阶段我国部分综合医院全科医学科虽已有亚专长全科医师，但仍未有完善的培训体系及认证模式。因此当前首先应建立全科医师亚专长培训发展与认证机构，确定认证标准；各地区可因地制宜积极开展全科医师亚专长培训。
- 综合医院 /
- 全科医学科 /
- 亚专长 /
- 全科医师 /
- 继续教育
Abstract: Objective The purpose of this study is to understand the development status of General Practitioner with Special Interest (GPwSI) in comprehensive hospitals in China. Methods In April 2022, a questionnaire was sent through the Internet to a large number of general practitioners in comprehensive hospitals in China. The questionnaire included the basic information of general practitioners, the development status of GPwSI in comprehensive hospitals, and the willingness and training needs of general practitioners to develop general specialties, and so on. Results A total of 203 questionnaires were collected, of which 200 were valid, with an effective rate of 98.5%. Among the 200 general practitioners, the mean age was (37.8±9.3) years, 83 (41.5%) were male, 117(58.5%) were female, 24 (12.0%) had participated in general special interests training, and 176(88.0%) had not. Compared with the group who had not participated in any special interest training, the group of general practitioners who had participated in special interest training had longer working years (P < 0.05). Among those who had participated in special interests training, the most important specialty is cardiovascular and cerebrovascular (50.0%, 12/24). While, those who are willing to develop general special interests, the most important is endocrinology (83.5%, 142/170). Regarding the start of general specialty training, compared with the group of assistant chief physician and above, the attending physician and below are more willing to start training, as early as possible (P < 0.05), and prefer self-study (P < 0.05). Conclusion At present, some of comprehensive hospitals in China have GPwSI, however, there is still no complete training system and certification mode. Therefore, we should first establish a general special interest training and certification organization, and determine the certification standards at present. Each region chooses its own training mode.
- Comprehensive hospital /
- General practice /
- Special interests /
- General practitioners /
- Continuing Education

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图 1 不同人群亚专长方向选择的比较

Figure 1. The comparison of the choice of sub-specialty directions among different populations

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表 1 参加过亚专长培训组和未参加过亚专长培训组的全科医师基本信息比较

Table 1. Comparison of basic information between general practitioners who have participated in subspecialty training groups and those who have not

组别	人数	性别[人(%)]		年龄(x±s，岁)	学历[人(%)]		职称[人(%)]
组别	人数	男性	女性	年龄(x±s，岁)	硕士研究生及以上	本科及以下	副主任医师及以上	主治医师及以下
参加过亚专长培训组	24	11(45.8)	13(54.2)	39.2±9.2	12(50.0)	12(50.0)	13(54.2)	11(45.8)
未参加过亚专长培训组	176	72(40.9)	104(59.1)	37.6±9.4	68(38.6)	108(61.4)	76(43.2)	100(56.8)
总计	200	83(41.5)	117(58.5)	37.8±9.3	80(40.0)	120(60.0)	89(44.5)	111(55.5)
统计量		0.211^a		0.793^b	1.136^a		1.032^a
P值		0.646		0.429	0.286		0.310

组别	人数	参加工作年限[M(P₂₅, P₇₅)，年]		从事全科年限[M(P₂₅, P₇₅)，年]	培训类型[人(%)]
组别	人数	参加工作年限[M(P₂₅, P₇₅)，年]		从事全科年限[M(P₂₅, P₇₅)，年]	5+3全科住培	助理全科住培	全科转岗	以上均未参加
参加过亚专长培训组	24	18(5, 24)		6(4, 9)	9(37.5)	0	7(29.2)	8(33.3)
未参加过亚专长培训组	176	11(4, 22)		5(3, 8)	67(38.1)	5(2.8)	76(43.2)	28(15.9)
总计	200	11(4, 22)		5(3, 8)	76(38.0)	5(2.5)	83(41.5)	36(18.0)
统计量		-1.089^c		-1.991^c	5.246^a
P值		0.276		0.047	0.155
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 参加过亚专长培训的全科医师一般情况(n=24)

Table 2. General information of general practitioners who have participated in sub-specialty training (n=24)

项目	人数	百分比(%)
全科亚专长培训阶段
目前已是亚专长全科医师	15	62.5
正在参加亚专长培训	9	37.5
固定的亚专长临床导师位数
无	10	41.7
1位	5	20.8
2位	3	12.5
大于2位	6	25.0
接诊数与亚专长相关比例
0~25%	7	29.2
25%~50%	8	33.3
50%~75%	7	29.2
>75%	2	8.3
发展亚专长对个人的影响(多选)
增强亚专长疾病的诊治能力	24	100.0
提高个人职业成就感	17	70.8
提高个人劳动收入	6	25.0
没什么用，徒增日常工作量	1	4.2
其他	2	8.3

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表 3 有发展亚专长意愿的全科医师特征及培训需求

Table 3. Characteristics and training needs of general practitioners with a desire to develop subspecialties

组别	人数	年龄(x±s，岁)	培训类型[人(%)]			开始培训的阶段[人(%)]					理论培训方式[人(%)]
组别	人数	年龄(x±s，岁)	全科住培	全科转岗	以上均未参加	住培期间	住培结束后	晋升主治以后	任何阶段		线下培训	线上培训	线上+线下	自学
主治医师及以下	95	31.2±5.8	63(66.3)	21(22.1)	11(11.6)	26(27.4)	29(30.5)	28(29.5)	12(12.6)		14(14.7)	13(13.7)	64(67.4)	4(4.2)
副主任医师及以上	75	46.0±5.8	5(6.7)	54(72.0)	16(21.3)	10(13.3)	10(13.3)	41(54.7)	14(18.7)		6(8.0)	8(10.7)	59(78.7)	2(2.7)
总计	170	37.8±9.4	68(40.0)	75(44.1)	27(15.9)	36(21.2)	39(22.9)	69(40.6)	26(15.3)		20(11.8)	21(12.4)	123(72.4)	6(3.5)
统计量		-16.519^a	63.442^b			16.851^b					2.948^b
P值		< 0.001	< 0.001			0.001					0.400

组别	人数	实践培训方式[人(%)]				培训时长[人(%)]				精进方式[人(%)]
组别	人数	跟师坐诊	病房轮岗	导师协同诊治		1年内		1年以上		自我自导	小组学习	参与专科理论学习	专科门诊跟师坐诊	专科病房进行
主治医师及以下	95	67(70.5)	68(71.6)	68(71.6)		60(63.2)		35(36.8)		40(42.1)	66(69.5)	75(78.9)	67(70.5)	77(81.1)
副主任医师及以上	75	56(74.7)	60(80.0)	50(66.7)		53(70.7)		22(29.3)		15(20.0)	45(60.0)	54(72.0)	58(77.3)	63(84.0)
总计	170	123(72.4)	128(75.3)	118(69.4)		113(66.5)		57(33.5)		55(32.4)	111(65.3)	129(75.9)	125(73.5)	140(82.4)
统计量		0.359^b	1.598^b	0.476^b		1.060^b				9.358^b	1.660^b	1.105^b	0.998^b	0.251^b
P值		0.549	0.206	0.490		0.303				0.002	0.198	0.293	0.318	0.617
注：^a为t值，^b为χ²值。

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