【摘要】：背景全科醫(yī)學(xué)引入我國(guó)并已發(fā)展20余年,在推動(dòng)全民健康、促進(jìn)社區(qū)醫(yī)療服務(wù)以及節(jié)約醫(yī)療成本等方面發(fā)揮了巨大作用。全科醫(yī)學(xué)人才培養(yǎng)問(wèn)題是關(guān)系我國(guó)社區(qū)衛(wèi)生事業(yè)發(fā)展的重要因素,完善的全科醫(yī)師培訓(xùn)基地是培養(yǎng)全科醫(yī)學(xué)人才的重要保證。現(xiàn)階段,我國(guó)全科醫(yī)學(xué)教育包括在校教育、住院醫(yī)師規(guī)范化培訓(xùn)、研究生教育和繼續(xù)教育,全科醫(yī)師培養(yǎng)主要通過(guò)"全科住院醫(yī)師規(guī)范化培訓(xùn)"和"專(zhuān)業(yè)學(xué)位研究生教育"兩條重要途徑。當(dāng)前全科醫(yī)學(xué)師資主要由理論師資、臨床師資、社區(qū)師資組成,各個(gè)階段相應(yīng)的師資有不同教學(xué)特點(diǎn),這些師資不但要非常清楚并理解本階段的教學(xué)內(nèi)容與方法,還要通曉其它階段的教育目的和任務(wù),從而使全科醫(yī)師的教育培養(yǎng)模式系統(tǒng)化。我國(guó)全科醫(yī)學(xué)培訓(xùn)工作雖然發(fā)展迅速,但目前仍處于起步階段。研究目的1 了解當(dāng)前國(guó)內(nèi)外全科醫(yī)學(xué)現(xiàn)狀;2 了解當(dāng)前山東省全科醫(yī)學(xué)師資現(xiàn)狀、全科醫(yī)師對(duì)全科醫(yī)學(xué)師資的教學(xué)需求、全科醫(yī)師培訓(xùn)相關(guān)專(zhuān)家對(duì)全科醫(yī)學(xué)師資培養(yǎng)的建議,社區(qū)居民對(duì)全科醫(yī)師的需求。發(fā)現(xiàn)當(dāng)前我國(guó)全科醫(yī)學(xué)發(fā)展的主要問(wèn)題,為全科醫(yī)學(xué)基地建設(shè)提供更好的借鑒。研究方法1通過(guò)閱讀國(guó)內(nèi)外相關(guān)文獻(xiàn),了解當(dāng)前國(guó)內(nèi)外全科醫(yī)學(xué)現(xiàn)狀;2對(duì)山東省內(nèi)17地市全科醫(yī)學(xué)師資、全科醫(yī)師、全科醫(yī)師培訓(xùn)相關(guān)專(zhuān)家、社區(qū)居民進(jìn)行問(wèn)卷調(diào)查,了解當(dāng)前山東省全科醫(yī)學(xué)師資現(xiàn)狀、全科醫(yī)師對(duì)全科醫(yī)學(xué)師資的教學(xué)需求、全科醫(yī)師培訓(xùn)相關(guān)專(zhuān)家對(duì)全科醫(yī)學(xué)師資培養(yǎng)的建議,社區(qū)居民對(duì)全科醫(yī)師的需求。結(jié)果1通過(guò)閱讀國(guó)內(nèi)外有關(guān)全科醫(yī)學(xué)的文獻(xiàn),在澳大利亞、美國(guó)已經(jīng)建立了完善的全科醫(yī)師培養(yǎng)基地,制定了詳細(xì)的全科醫(yī)師培訓(xùn)計(jì)劃,并且有專(zhuān)門(mén)的機(jī)構(gòu)對(duì)全科醫(yī)師進(jìn)行不定期的培訓(xùn)及考核。這些國(guó)家的全科醫(yī)學(xué)師資培養(yǎng)體系也很完善,有專(zhuān)門(mén)的機(jī)構(gòu)對(duì)全科醫(yī)學(xué)師資進(jìn)行定期的考核。我國(guó)的全科醫(yī)學(xué)基地也有嚴(yán)格的入選標(biāo)準(zhǔn),對(duì)全科醫(yī)師的培訓(xùn)制定了詳細(xì)的培訓(xùn)計(jì)劃。但是,全科醫(yī)學(xué)師資的準(zhǔn)入、認(rèn)證、考核體系不完善,全科醫(yī)學(xué)師資的水平參差不齊成為影響和制約全科醫(yī)師培訓(xùn)質(zhì)量的瓶頸。2通過(guò)對(duì)山東省的510名全科醫(yī)學(xué)師資問(wèn)卷調(diào)查,目前山東省內(nèi)全科醫(yī)學(xué)師資專(zhuān)業(yè)主要集中在內(nèi)科(42.5%)、全科醫(yī)學(xué)科(14.7%)、外科(8.0%)、急診科(6.1%)、老年病科(5.3%)。師資類(lèi)型主要分為臨床基地專(zhuān)科師資(51.8%)、臨床基地全科師資(42.4%)、社區(qū)實(shí)踐基地師資(25.7%)、全科理論授課師資(18.2%)。資質(zhì)認(rèn)證形式主要集中于省級(jí)及以上全科師資培訓(xùn)班(38.4%)、專(zhuān)科師資兼任(23.9%)、基地醫(yī)院全科師資培訓(xùn)班(22.9%)。全科醫(yī)學(xué)師資認(rèn)為全科醫(yī)學(xué)師資的學(xué)歷最低為本科(87.1%),職稱(chēng)最低為主治醫(yī)師(93.5%),帶教經(jīng)歷有全科醫(yī)師帶教經(jīng)歷(58.8%),帶教年限為兩年(53.3%)。全科醫(yī)學(xué)師資準(zhǔn)入方式為基地推薦(55.9%),培訓(xùn)方式為網(wǎng)絡(luò)授課(50.8%),考核方式為開(kāi)卷考試(50.8%)。參加過(guò)全科醫(yī)學(xué)師資培訓(xùn)的全科醫(yī)學(xué)師資,其主要的培訓(xùn)重點(diǎn)是全科理論培養(yǎng)(84%)、臨床帶技巧(75.3%),全科醫(yī)學(xué)師資認(rèn)為當(dāng)前全科醫(yī)學(xué)師資的培訓(xùn)重點(diǎn)主要是全科理論培養(yǎng)(89.2%)、臨床帶教技巧(81.0%)。3通過(guò)對(duì)山東省內(nèi)203全科醫(yī)師進(jìn)行問(wèn)卷調(diào)查,目前全科醫(yī)師的工作崗位主要集中在內(nèi)科(39.9%)、全科醫(yī)學(xué)科(26.6%)、中醫(yī)科(7.9%)。參加全科醫(yī)師培訓(xùn)的類(lèi)型主要集中于全科住院醫(yī)師規(guī)范化培訓(xùn)(40.9%)、轉(zhuǎn)崗培訓(xùn)(35.0%)。社區(qū)居民的就診原因主要為就醫(yī)診病(80.8%)、健康咨詢(xún)(26.6%)、開(kāi)藥(22.2%)。全科醫(yī)師認(rèn)為全科醫(yī)學(xué)師資的最低學(xué)歷為本科(70.0%),職稱(chēng)最低為主治醫(yī)師(72.9%),應(yīng)該具有專(zhuān)科帶教經(jīng)歷和全科帶教經(jīng)歷(69.0%)。93.1%全科醫(yī)師認(rèn)為完成培訓(xùn)的全科醫(yī)師應(yīng)該進(jìn)行再培訓(xùn),再培訓(xùn)的年限為1年(35.0%)。全科醫(yī)師最希望的再培訓(xùn)形式為短期培訓(xùn)班(66.5%)。4通過(guò)對(duì)國(guó)內(nèi)43名全科醫(yī)師培訓(xùn)相關(guān)專(zhuān)家進(jìn)行問(wèn)卷調(diào)查,全科醫(yī)師培訓(xùn)相關(guān)專(zhuān)家認(rèn)為全科醫(yī)學(xué)師資的最低學(xué)歷為本科(65.1%),最低職稱(chēng)應(yīng)為副主任醫(yī)師及以上(58.1%),最低帶教年限應(yīng)為三年及以上(44.2%),培訓(xùn)方式應(yīng)為短期學(xué)習(xí)班(72.1%),考核方式應(yīng)為開(kāi)卷考試(60.5%)。5通過(guò)對(duì)山東省內(nèi)158名社區(qū)居民進(jìn)行問(wèn)卷調(diào)查,65.2%社區(qū)居民對(duì)社區(qū)醫(yī)師的工作能力滿(mǎn)意。社區(qū)居民就診社區(qū)醫(yī)師的原因主要是一般疾病診治、取藥、疾病咨詢(xún),38%社區(qū)居民對(duì)全科醫(yī)師的理念很少了解及很少聽(tīng)說(shuō)。87.3%社區(qū)居民認(rèn)為有必要設(shè)立全科醫(yī)師。社區(qū)居民認(rèn)為全科醫(yī)師具備的素質(zhì)主要集中在具有責(zé)任心、愛(ài)心、同情心(93.7%)、全面的醫(yī)療技術(shù)(84.2%),全科醫(yī)師的職責(zé)主要是診治疾病(88.6%)、居民健康管理與咨詢(xún)(84.8%),認(rèn)為全科醫(yī)師需要提高的方面主要集中在日常門(mén)診(81.0%)、慢性疾病的防治(77.8%)、日常養(yǎng)生保健知識(shí)的宣教(65.8%)。結(jié)論全科醫(yī)學(xué)教育培訓(xùn)體系在歐美國(guó)家經(jīng)過(guò)了30余年的發(fā)展,在以澳大利亞、美國(guó)為代表的開(kāi)展全科醫(yī)學(xué)發(fā)展較早的國(guó)家,建立了功能完善、規(guī)模適度、機(jī)構(gòu)適宜的全科醫(yī)學(xué)教育體系,其中全科醫(yī)學(xué)規(guī)范的師資隊(duì)伍建設(shè)發(fā)揮了重要的作用,保證了全科醫(yī)師培養(yǎng)教育任務(wù)的順利實(shí)施,培養(yǎng)了能夠滿(mǎn)足社會(huì)基本醫(yī)療服務(wù)需求的醫(yī)學(xué)人才。但是,當(dāng)前我國(guó)的全科醫(yī)師無(wú)論是質(zhì)量還是數(shù)量還遠(yuǎn)遠(yuǎn)沒(méi)有達(dá)到我國(guó)社區(qū)居民的基本醫(yī)療衛(wèi)生需求。雖然當(dāng)前我國(guó)的全科醫(yī)學(xué)基地有嚴(yán)格的入選標(biāo)準(zhǔn),為全科醫(yī)師制定了詳細(xì)的培訓(xùn)計(jì)劃,但是我國(guó)的全科醫(yī)學(xué)師資準(zhǔn)入、認(rèn)證、考核體系不完善,為全科醫(yī)學(xué)基地建設(shè)的主要方面。通過(guò)對(duì)山東省內(nèi)510名全科醫(yī)學(xué)師資、203名全科醫(yī)師、43名全科醫(yī)師培訓(xùn)相關(guān)專(zhuān)家、158名社區(qū)居民進(jìn)行問(wèn)卷調(diào)查。發(fā)現(xiàn)當(dāng)前全科醫(yī)學(xué)師資的骨干力量為專(zhuān)科帶教師資,主要集中在內(nèi)科、外科、急診、老年醫(yī)學(xué)等專(zhuān)業(yè)方向與全科醫(yī)學(xué)相近的綜合程度較高的科室,師資類(lèi)型集中在臨床基地專(zhuān)科師資,專(zhuān)科帶教師資對(duì)全科醫(yī)學(xué)的理解不夠深入,對(duì)全科醫(yī)師的帶教較為陌生,不能用全科醫(yī)學(xué)的思維和方法指導(dǎo)學(xué)生。但是專(zhuān)科帶教師資對(duì)本專(zhuān)科的常見(jiàn)病、多發(fā)病具有良好的知識(shí)體系及帶教能力,因此,培訓(xùn)基地應(yīng)發(fā)揮專(zhuān)科帶教師資的優(yōu)勢(shì),加強(qiáng)專(zhuān)科帶教師資全科思維的培養(yǎng);當(dāng)前全科醫(yī)學(xué)師資的準(zhǔn)入認(rèn)證體系不統(tǒng)一、培訓(xùn)體系不完善、考核體系不健全、監(jiān)督體系未建立,培訓(xùn)基地需要完善全科醫(yī)學(xué)師資準(zhǔn)入認(rèn)證體系、完善培訓(xùn)體系、健全考核體系、建立健全的監(jiān)督體系,保證全科醫(yī)學(xué)師資的質(zhì)量,有利于全科醫(yī)師同質(zhì)化培養(yǎng),保證全科醫(yī)師的質(zhì)量,讓全科醫(yī)師真正起到居民健康"守門(mén)人"的作用。目前全科醫(yī)學(xué)師資帶教的全科醫(yī)師主要來(lái)自于轉(zhuǎn)崗醫(yī)師、社區(qū)全科醫(yī)師、鄉(xiāng)鎮(zhèn)全科醫(yī)師、規(guī)范化培訓(xùn)醫(yī)師,全科醫(yī)師的生源參差不齊,為保證全科醫(yī)師培訓(xùn)質(zhì)量,培訓(xùn)基地需嚴(yán)把全科醫(yī)師的準(zhǔn)入門(mén)檻,開(kāi)展本科及全科醫(yī)學(xué)研究生教育,提升全科醫(yī)師教育水平。完成全科醫(yī)師規(guī)范化培訓(xùn)的全科醫(yī)師服務(wù)于基層醫(yī)療衛(wèi)生機(jī)構(gòu),不能再次進(jìn)入培訓(xùn)基地進(jìn)行培訓(xùn),加之全科醫(yī)師的培訓(xùn)脫產(chǎn)時(shí)間較長(zhǎng),原單位不愿意將全科醫(yī)師送入培訓(xùn)基地進(jìn)行培訓(xùn),使得全科醫(yī)師的知識(shí)不能得到及時(shí)更新,需建立完善的全科醫(yī)師再培訓(xùn)體系。當(dāng)前社區(qū)居民對(duì)全科醫(yī)學(xué)的認(rèn)識(shí)不足。因此,需加大對(duì)全科醫(yī)學(xué)、全科醫(yī)師的概念宣傳,讓社區(qū)居民對(duì)全科醫(yī)學(xué)、全科醫(yī)師概念進(jìn)行深入理解,正確認(rèn)識(shí)全科醫(yī)師。
[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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R-4

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