山东省全科医学基地建设与人才培养探讨

发布时间：2019-07-02 20:35

【摘要】：背景全科医学引入我国并已发展20余年,在推动全民健康、促进社区医疗服务以及节约医疗成本等方面发挥了巨大作用。全科医学人才培养问题是关系我国社区卫生事业发展的重要因素,完善的全科医师培训基地是培养全科医学人才的重要保证。现阶段,我国全科医学教育包括在校教育、住院医师规范化培训、研究生教育和继续教育,全科医师培养主要通过"全科住院医师规范化培训"和"专业学位研究生教育"两条重要途径。当前全科医学师资主要由理论师资、临床师资、社区师资组成,各个阶段相应的师资有不同教学特点,这些师资不但要非常清楚并理解本阶段的教学内容与方法,还要通晓其它阶段的教育目的和任务,从而使全科医师的教育培养模式系统化。我国全科医学培训工作虽然发展迅速,但目前仍处于起步阶段。研究目的1 了解当前国内外全科医学现状;2 了解当前山东省全科医学师资现状、全科医师对全科医学师资的教学需求、全科医师培训相关专家对全科医学师资培养的建议,社区居民对全科医师的需求。发现当前我国全科医学发展的主要问题,为全科医学基地建设提供更好的借鉴。研究方法1通过阅读国内外相关文献,了解当前国内外全科医学现状;2对山东省内17地市全科医学师资、全科医师、全科医师培训相关专家、社区居民进行问卷调查,了解当前山东省全科医学师资现状、全科医师对全科医学师资的教学需求、全科医师培训相关专家对全科医学师资培养的建议,社区居民对全科医师的需求。结果1通过阅读国内外有关全科医学的文献,在澳大利亚、美国已经建立了完善的全科医师培养基地,制定了详细的全科医师培训计划,并且有专门的机构对全科医师进行不定期的培训及考核。这些国家的全科医学师资培养体系也很完善,有专门的机构对全科医学师资进行定期的考核。我国的全科医学基地也有严格的入选标准,对全科医师的培训制定了详细的培训计划。但是,全科医学师资的准入、认证、考核体系不完善,全科医学师资的水平参差不齐成为影响和制约全科医师培训质量的瓶颈。2通过对山东省的510名全科医学师资问卷调查,目前山东省内全科医学师资专业主要集中在内科(42.5%)、全科医学科(14.7%)、外科(8.0%)、急诊科(6.1%)、老年病科(5.3%)。师资类型主要分为临床基地专科师资(51.8%)、临床基地全科师资(42.4%)、社区实践基地师资(25.7%)、全科理论授课师资(18.2%)。资质认证形式主要集中于省级及以上全科师资培训班(38.4%)、专科师资兼任(23.9%)、基地医院全科师资培训班(22.9%)。全科医学师资认为全科医学师资的学历最低为本科(87.1%),职称最低为主治医师(93.5%),带教经历有全科医师带教经历(58.8%),带教年限为两年(53.3%)。全科医学师资准入方式为基地推荐(55.9%),培训方式为网络授课(50.8%),考核方式为开卷考试(50.8%)。参加过全科医学师资培训的全科医学师资,其主要的培训重点是全科理论培养(84%)、临床带技巧(75.3%),全科医学师资认为当前全科医学师资的培训重点主要是全科理论培养(89.2%)、临床带教技巧(81.0%)。3通过对山东省内203全科医师进行问卷调查,目前全科医师的工作岗位主要集中在内科(39.9%)、全科医学科(26.6%)、中医科(7.9%)。参加全科医师培训的类型主要集中于全科住院医师规范化培训(40.9%)、转岗培训(35.0%)。社区居民的就诊原因主要为就医诊病(80.8%)、健康咨询(26.6%)、开药(22.2%)。全科医师认为全科医学师资的最低学历为本科(70.0%),职称最低为主治医师(72.9%),应该具有专科带教经历和全科带教经历(69.0%)。93.1%全科医师认为完成培训的全科医师应该进行再培训,再培训的年限为1年(35.0%)。全科医师最希望的再培训形式为短期培训班(66.5%)。4通过对国内43名全科医师培训相关专家进行问卷调查,全科医师培训相关专家认为全科医学师资的最低学历为本科(65.1%),最低职称应为副主任医师及以上(58.1%),最低带教年限应为三年及以上(44.2%),培训方式应为短期学习班(72.1%),考核方式应为开卷考试(60.5%)。5通过对山东省内158名社区居民进行问卷调查,65.2%社区居民对社区医师的工作能力满意。社区居民就诊社区医师的原因主要是一般疾病诊治、取药、疾病咨询,38%社区居民对全科医师的理念很少了解及很少听说。87.3%社区居民认为有必要设立全科医师。社区居民认为全科医师具备的素质主要集中在具有责任心、爱心、同情心(93.7%)、全面的医疗技术(84.2%),全科医师的职责主要是诊治疾病(88.6%)、居民健康管理与咨询(84.8%),认为全科医师需要提高的方面主要集中在日常门诊(81.0%)、慢性疾病的防治(77.8%)、日常养生保健知识的宣教(65.8%)。结论全科医学教育培训体系在欧美国家经过了30余年的发展,在以澳大利亚、美国为代表的开展全科医学发展较早的国家,建立了功能完善、规模适度、机构适宜的全科医学教育体系,其中全科医学规范的师资队伍建设发挥了重要的作用,保证了全科医师培养教育任务的顺利实施,培养了能够满足社会基本医疗服务需求的医学人才。但是,当前我国的全科医师无论是质量还是数量还远远没有达到我国社区居民的基本医疗卫生需求。虽然当前我国的全科医学基地有严格的入选标准,为全科医师制定了详细的培训计划,但是我国的全科医学师资准入、认证、考核体系不完善,为全科医学基地建设的主要方面。通过对山东省内510名全科医学师资、203名全科医师、43名全科医师培训相关专家、158名社区居民进行问卷调查。发现当前全科医学师资的骨干力量为专科带教师资,主要集中在内科、外科、急诊、老年医学等专业方向与全科医学相近的综合程度较高的科室,师资类型集中在临床基地专科师资,专科带教师资对全科医学的理解不够深入,对全科医师的带教较为陌生,不能用全科医学的思维和方法指导学生。但是专科带教师资对本专科的常见病、多发病具有良好的知识体系及带教能力,因此,培训基地应发挥专科带教师资的优势,加强专科带教师资全科思维的培养;当前全科医学师资的准入认证体系不统一、培训体系不完善、考核体系不健全、监督体系未建立,培训基地需要完善全科医学师资准入认证体系、完善培训体系、健全考核体系、建立健全的监督体系,保证全科医学师资的质量,有利于全科医师同质化培养,保证全科医师的质量,让全科医师真正起到居民健康"守门人"的作用。目前全科医学师资带教的全科医师主要来自于转岗医师、社区全科医师、乡镇全科医师、规范化培训医师,全科医师的生源参差不齐,为保证全科医师培训质量,培训基地需严把全科医师的准入门槛,开展本科及全科医学研究生教育,提升全科医师教育水平。完成全科医师规范化培训的全科医师服务于基层医疗卫生机构,不能再次进入培训基地进行培训,加之全科医师的培训脱产时间较长,原单位不愿意将全科医师送入培训基地进行培训,使得全科医师的知识不能得到及时更新,需建立完善的全科医师再培训体系。当前社区居民对全科医学的认识不足。因此,需加大对全科医学、全科医师的概念宣传,让社区居民对全科医学、全科医师概念进行深入理解,正确认识全科医师。
[Abstract]:Background general medicine has been introduced in china and has been developed for more than 20 years, and has played a great role in promoting the health of all people, promoting the medical service of the community and saving medical cost. The problem of personnel training of general medicine is an important factor for the development of community health in China, and the perfect comprehensive training base is an important guarantee for the cultivation of general medical personnel. At present, the general medical education in China includes the education of the school, the standardized training of the residents, the post-graduate education and the continuing education, and the cultivation of the general practitioners is mainly through the "The standardized training of general residents" and the "professional degree post-graduate education" of two important ways. The current general medicine teachers are mainly composed of the theoretical teachers, the clinical teachers and the community teachers. The corresponding teachers in each stage have different teaching characteristics, not only are the teaching contents and methods of this stage be very clear and understood, but also the educational purposes and tasks of other stages, So as to systematize the education training mode of the whole medical doctor. Although the general practice of general medicine in China is developing rapidly, it is still in the early stage. The purpose of the study is to understand the current situation of general general medicine at home and abroad, and to know the current situation of general general medical teachers in Shandong province. It is found that the main problem of general medicine development in China is to provide a better reference for the construction of general medical base. The research method 1 is to understand the current situation of general general medicine at home and abroad by reading the relevant literature at home and abroad, and 2. Questionnaire survey of the general general medical teachers, the general practitioners, the general practitioners and the community residents in 17 cities of Shandong Province, and understand the current situation of general general medical teachers in Shandong province, The general practitioner's teaching requirements for general medical teachers and the advice of the relevant experts of the general practitioners on the training of general medical teachers and the needs of the community residents for the whole medical practitioner. As a result, by reading the literature on general medicine at home and abroad, in Australia, the United States has established a well-established full-medical practitioner training base, developed a detailed full-chart doctor's training program, and has specialized institutions to train and assess the general practitioners from time to time. The general practice medicine teacher training system of these countries is also perfect, with specialized institutions to conduct regular examination of the general medicine teachers. The general medical base of our country also has strict inclusion criteria, and has developed a detailed training plan for the training of the whole medical doctor. However, the access, certification and assessment system of general medicine teachers are not perfect, and the level of general medicine teachers is uneven, and the bottleneck of the quality of training of general practitioners is a bottleneck. Through a questionnaire survey of 510 general medical teachers in Shandong province, At present, the general practice of general medicine in Shandong province is mainly concentrated in the internal medicine (42.5%), the general practice (14.7%), the surgery (8.0%), the emergency department (6.1%) and the geriatrics department (5.3%). The type of the teachers is mainly divided into the clinical base specialty teachers (51.8%), the clinical base general practice teachers (42.4%), the community practice base teachers (25.7%) and the general practice teaching staff (18.2%). The form of qualification is mainly focused on the training courses of general general teachers at the provincial level and above (38.4%), the post of the specialized teachers (23.9%), and the general general staff training course (22.9%) of the base hospital. The general general medical teachers are of the opinion that the minimum degree of the general general medical teachers is the undergraduate (87.1%), the lowest title is the attending physician (93.5%), and the teaching experience of the general practitioner is 58.8%, with the teaching life of two years (53.3%). The access mode of general medicine teachers is the base recommendation (55.9%), the training mode is the network teaching (50.8%), and the assessment method is the opening-up test (50.8%). The main training focuses on the general practice theory (84%) and the clinical tape technique (75.3%), and the general practice medical teachers think that the training of the current general medicine teachers is mainly the general practice theory (89.2%). The clinical teaching technique (81.0%).3. According to the questionnaire of 203 whole doctors in Shandong Province, the work position of the whole doctor is mainly in the internal medicine (39.9%), the general medicine subject (26.6%) and the Chinese medicine section (7.9%). The type of training in general practitioners is mainly focused on the standardized training of general residents (40.9%) and post-job training (35.0%). The main reasons for the community residents were to see the doctor's disease (80.8%), the health consultation (26.6%) and the medicine (22.2%). The general practitioner is of the view that the minimum educational background for general practitioners is undergraduate (70.0%), with the lowest title of the attending physician (72.9%), and should have a professional experience and a general practice experience (69.0%). The number of retraining is one year (35.0%). The most promising re-training form for all practitioners is the short-term training course (66.5%).4. By carrying out a questionnaire on the training of the 43 full-medical practitioners in the country, the relevant experts in the whole department believe that the minimum educational background for general practitioners is undergraduate (65.1%), The minimum professional title shall be the Vice-Chief Physician and above (58.1%), the minimum teaching period shall be three years and above (44.2%), and the training mode shall be short-term study class (72.1%). The assessment method should be on-the-roll test (60.5%). Through a survey of 158 community residents in Shandong Province, 65.2% of the community residents are satisfied with the working ability of the community doctors. The reason of the community resident's visit to the community is the general disease diagnosis and treatment, the medicine taking, the disease counseling,38% of the community residents have little knowledge about the concept of the whole doctor, and very few. 87.3% of the community residents believe it is necessary to set up a full-science doctor. The community residents believe that the quality of the general practitioners is mainly in the sense of responsibility, the love, the compassion (93.7%), the comprehensive medical technology (84.2%), the responsibility of the whole doctor is mainly the diagnosis and treatment of the disease (88.6%), the resident's health management and consultation (84.8%), It is considered that the general practitioners need to be improved, mainly in the daily outpatient service (81.0%), the prevention and treatment of chronic diseases (77.8%), and the education of daily health-keeping health-care knowledge (65.8%). Conclusion The training system of general medical education has been developed in the European and American countries for more than 30 years. In the countries with the early development of general medicine in Australia and the United States, the general medical education system with perfect function, moderate scale and proper institution is established. The construction of the teaching staff of the general medicine standard has played an important role, and the successful implementation of the education task of the whole medical practitioner is ensured, and the medical personnel capable of meeting the needs of the basic medical service of the society are cultivated. However, the quality or quantity of the current Chinese medical practitioner is far from reaching the basic medical and health needs of the community residents in our country. Although the general medical base in our country has the strict inclusion criteria, the general practitioner has developed a detailed training plan, but the general practice medical teacher access, the certification and the assessment system of our country are not perfect, which is the main aspect of the construction of the general medical base. The questionnaire was conducted by a total of 510 general medical teachers,203 complete doctors,43 complete doctors and 158 community residents in Shandong Province. It is found that the backbone of the current general medicine teachers is a specialist with a high degree of comprehensive general medicine, such as internal medicine, surgery, emergency, gerontology and other professional directions, and the type of teachers is concentrated in the clinical base specialty. The teachers' understanding of the general medicine is not in-depth, and the teaching of the whole medical doctor is strange, and the students can not be guided by the thinking and the method of general medicine. However, the college teachers have a good knowledge system and teaching ability for the common diseases and the multi-occurrence of the specialty. Therefore, the training base should give full play to the advantages of the teachers in the specialty, strengthen the training of the general thinking of the teachers in the specialty, and the access authentication system of the current general medical teachers is not uniform. The training system is not perfect, the evaluation system is not sound, the supervision system is not established, the training base needs to improve the general practice medical teacher access certification system, improve the training system, improve the examination system, establish and improve the supervision system, and ensure the quality of the general medical teachers, Is beneficial to the homogenization of the whole medical practitioner, and ensures the quality of the whole medical practitioner, so that the whole medical practitioner can really play the role of the resident healthy "a man of a man". At present, the general practitioner is mainly from the doctor, the whole medical doctor of the community, the whole medical doctor of the town and the standard training doctor, the source of the whole medical doctor is uneven, in order to ensure the quality of the training of the whole department, the training base needs to strictly control the admission threshold of the whole medical practitioner, Carry out the undergraduate and general medical graduate education, and improve the education level of the whole doctor. The general practitioner who completed the standardized training of the whole medical doctor is serving the grass-roots medical and health institution, can not enter the training base again for training, and the training of the whole medical doctor is long, and the original unit is not willing to send the whole department doctor to the training base for training, So that the knowledge of the whole medical doctor can not be updated in time, and a complete comprehensive doctor re-training system needs to be established. The current community residents are not aware of general medicine. Therefore, it is necessary to increase the concept of the general medicine and the whole doctor, and let the residents of the community have an in-depth understanding of the concept of general medicine and the whole doctor, and correctly understand the whole doctor.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R-4

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