Current situation analysis on the construction and application of post competency model for chinese general practitioners
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摘要:
目的 分析我国全科医师岗位胜任力模型构建及应用研究现状，为系统评价全科医师岗位胜任能力提供依据。 方法 2023年10月1—31日，检索知网、万方、维普、中华医学数据知识服务平台中有关全科医师岗位胜任力指标体系构建及应用的相关文献。 结果 初步检索有关文献893篇，经多次筛选，最后将66篇纳入分析。66篇文献中有41篇(62.1%)运用多种研究方法进行体系构建，采用最多的是文献研究法(37篇，56.1%)和Delphi法(32篇，48.5%)。9篇文献参考了WONCA树模型。岗位胜任力体系以多条目为特点，其中一级指标数3~8个不等，平均5.8个; 最后一级条目12~123个不等，平均34.3个。文献涉及研究对象：全科住培医师，社区全科医师，农村全科医师，农村订单式医学生，家庭医生，乡村医师，助理全科医师，全科主治医师，转岗培训全科医师。一级指标排名前5位的是职业道德、基本公共卫生服务、沟通能力/人际交往能力、全科基本医疗服务能力、教育学习能力。 结论 国内全科医师岗位胜任力的研究，以模型构建为主，实证研究及应用研究逐渐增多。与国外经典模型不同，基本公共卫生服务能力被着重强调。 Abstract:Objective To analyze the construction and application research status of post competency model of general practitioners in China, and to provide basis for systematic evaluation of post competency of general practitioners. Methods The relevant literature on the construction and application of general practitioner post competency index system in CNKI, Wanfang, Vipu and Zhonghua Medical Data Knowledge Service Platform was searched from October 1 to 31, 2023. Results After a preliminary search of 893 literatures, 66 were included in the analysis. Among the 66 literatures, 41 (62.1%) used a variety of research methods to construct the system, the most used were literature research method (37, 56.1%) and Delphi method (32, 48.5%). Nine articles referred to the WONCA tree model. The post competency system was characterized by multiple items, among which the number of first-level indicators ranges from 3 to 8, with an average of 5.8, the last level of entries ranged from 12 to 123, with an average of 34.3. The research objects involved in the literature include: general practitioners in residence, community general practitioners, rural general practitioners, rural order medical students, family doctors, rural physicians, assistant general practitioners, general practitioners in charge, and general practitioners in transfer training. The top five first-level indicators were professional ethics, basic public health services, communication skills/interpersonal skills, basic medical services in general, and education and learning ability. Conclusion The research on the post competence of general practitioners in China is mainly based on model construction, and the empirical research and applied research are increasing gradually. Different from foreign classical models, the basic public health service capacity is emphasized. -
Key words:
- General practitioner /
- Post competency /
- Model construction /
- System evaluation
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表 1 66篇文献的研究对象
Table 1. Subject investigated in the 66 included studies
研究对象 文献数[篇(%)] 全科医师 13(19.7) 社区全科医师 17(25.8) 家庭医师 11(16.7) 乡村医生、农村医生 8(12.1) 全科住培医师 5(7.6) 本科医学生 4(6.1) 农村订单式医学生 2(3.0) 助理全科医师 3(4.5) 转岗培训全科医师 1(1.5) 全科主治医师 1(1.5) 军医全科住培医师 1(1.5) 
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表 2 国内全科医师岗位胜任力指标(排名前10)
Table 2. Domestic general practitioner post competency index (Top 10)
能力指标 篇数(%) 职业道德 28(42.4) 基本公共卫生服务 24(36.4) 沟通能力/人际交往能力 24(36.4) 全科基本医疗服务能力 23(34.8) 教育学习能力/终生学习 23(34.8) 人文执业能力 11(16.7) 个人特质 10(15.2) 团队合作能力 9(13.6) 信息利用与管理能力 9(13.6) 综合管理能力/组织管理能力 6(9.1)
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表 3 国内全科医师岗位胜任力指标(排名前10)与国外全科医生能力标准的比较
Table 3. Comparison of the competency index of domestic general practitioners (top 10) and the competence standard of foreign general practitioners
国家或地区 全科医生岗位胜任力一级指标 中国 顺位前10项，职业道德、基本公共卫生服务、沟通能力/人际交往能力、全科基本医疗服务能力、教育学习能力/终生学习、人文执业能力、个人特质、团队合作能力、信息利用与管理能力、综合管理能力/组织管理能力 欧洲WONCA[2] 6项，初级保健管理、社区导向、特定问题处理技能、综合诊疗、以人为中心的照顾、全人医疗 美国ACGME[3] 6项，针对病患的照顾、医学知识、基于系统的实践、基于实践的学习与提升、职业精神、人际交流技能 英国RCGP[4] 5项，了解自己并联系他人、运用临床知识与技能、进行长时间且复杂的医疗保健、在卫生组织与系统中良好地工作、为完整个体与社区提供医疗服务 澳大利亚RACGP[4] 5项，交流与医患关系、应用专业知识与技能、人群健康与全科实践背景、专业与伦理角色、组织与法律维度 加拿大RCPSC[5] 7个角色，全科医学专家、沟通者、协作者、领导者、健康倡导者、学者、专业人士 日本[6] 7项，综合性方法、应对常见健康问题的诊疗能力、以患者为中心的医护能力、重视合作的管理、以社区为导向的方法、有益于公益的职业规范、应对各种诊疗环境的能力
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