【摘要】：背景全科醫(yī)學引入我國并已發(fā)展20余年,在推動全民健康、促進社區(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)學人才培養(yǎng)問題是關(guān)系我國社區(qū)衛(wèi)生事業(yè)發(fā)展的重要因素,完善的全科醫(yī)師培訓基地是培養(yǎng)全科醫(yī)學人才的重要保證�，F(xiàn)階段,我國全科醫(yī)學教育包括在校教育、住院醫(yī)師規(guī)范化培訓、研究生教育和繼續(xù)教育,全科醫(yī)師培養(yǎng)主要通過"全科住院醫(yī)師規(guī)范化培訓"和"專業(yè)學位研究生教育"兩條重要途徑。當前全科醫(yī)學師資主要由理論師資、臨床師資、社區(qū)師資組成,各個階段相應(yīng)的師資有不同教學特點,這些師資不但要非常清楚并理解本階段的教學內(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。我國全科醫(yī)學培訓工作雖然發(fā)展迅速,但目前仍處于起步階段。研究目的1 了解當前國內(nèi)外全科醫(yī)學現(xiàn)狀;2 了解當前山東省全科醫(yī)學師資現(xiàn)狀、全科醫(yī)師對全科醫(yī)學師資的教學需求、全科醫(yī)師培訓相關(guān)專家對全科醫(yī)學師資培養(yǎng)的建議,社區(qū)居民對全科醫(yī)師的需求。發(fā)現(xiàn)當前我國全科醫(yī)學發(fā)展的主要問題,為全科醫(yī)學基地建設(shè)提供更好的借鑒。研究方法1通過閱讀國內(nèi)外相關(guān)文獻,了解當前國內(nèi)外全科醫(yī)學現(xiàn)狀;2對山東省內(nèi)17地市全科醫(yī)學師資、全科醫(yī)師、全科醫(yī)師培訓相關(guān)專家、社區(qū)居民進行問卷調(diào)查,了解當前山東省全科醫(yī)學師資現(xiàn)狀、全科醫(yī)師對全科醫(yī)學師資的教學需求、全科醫(yī)師培訓相關(guān)專家對全科醫(yī)學師資培養(yǎng)的建議,社區(qū)居民對全科醫(yī)師的需求。結(jié)果1通過閱讀國內(nèi)外有關(guān)全科醫(yī)學的文獻,在澳大利亞、美國已經(jīng)建立了完善的全科醫(yī)師培養(yǎng)基地,制定了詳細的全科醫(yī)師培訓計劃,并且有專門的機構(gòu)對全科醫(yī)師進行不定期的培訓及考核。這些國家的全科醫(yī)學師資培養(yǎng)體系也很完善,有專門的機構(gòu)對全科醫(yī)學師資進行定期的考核。我國的全科醫(yī)學基地也有嚴格的入選標準,對全科醫(yī)師的培訓制定了詳細的培訓計劃。但是,全科醫(yī)學師資的準入、認證、考核體系不完善,全科醫(yī)學師資的水平參差不齊成為影響和制約全科醫(yī)師培訓質(zhì)量的瓶頸。2通過對山東省的510名全科醫(yī)學師資問卷調(diào)查,目前山東省內(nèi)全科醫(yī)學師資專業(yè)主要集中在內(nèi)科(42.5%)、全科醫(yī)學科(14.7%)、外科(8.0%)、急診科(6.1%)、老年病科(5.3%)。師資類型主要分為臨床基地專科師資(51.8%)、臨床基地全科師資(42.4%)、社區(qū)實踐基地師資(25.7%)、全科理論授課師資(18.2%)。資質(zhì)認證形式主要集中于省級及以上全科師資培訓班(38.4%)、專科師資兼任(23.9%)、基地醫(yī)院全科師資培訓班(22.9%)。全科醫(yī)學師資認為全科醫(yī)學師資的學歷最低為本科(87.1%),職稱最低為主治醫(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)學師資準入方式為基地推薦(55.9%),培訓方式為網(wǎng)絡(luò)授課(50.8%),考核方式為開卷考試(50.8%)。參加過全科醫(yī)學師資培訓的全科醫(yī)學師資,其主要的培訓重點是全科理論培養(yǎng)(84%)、臨床帶技巧(75.3%),全科醫(yī)學師資認為當前全科醫(yī)學師資的培訓重點主要是全科理論培養(yǎng)(89.2%)、臨床帶教技巧(81.0%)。3通過對山東省內(nèi)203全科醫(yī)師進行問卷調(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)學科(26.6%)、中醫(yī)科(7.9%)。參加全科醫(yī)師培訓的類型主要集中于全科住院醫(yī)師規(guī)范化培訓(40.9%)、轉(zhuǎn)崗培訓(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(26.6%)、開藥(22.2%)。全科醫(yī)師認為全科醫(yī)學師資的最低學歷為本科(70.0%),職稱最低為主治醫(yī)師(72.9%),應(yīng)該具有�？茙Ы探�(jīng)歷和全科帶教經(jīng)歷(69.0%)。93.1%全科醫(yī)師認為完成培訓的全科醫(yī)師應(yīng)該進行再培訓,再培訓的年限為1年(35.0%)。全科醫(yī)師最希望的再培訓形式為短期培訓班(66.5%)。4通過對國內(nèi)43名全科醫(yī)師培訓相關(guān)專家進行問卷調(diào)查,全科醫(yī)師培訓相關(guān)專家認為全科醫(yī)學師資的最低學歷為本科(65.1%),最低職稱應(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%),培訓方式應(yīng)為短期學習班(72.1%),考核方式應(yīng)為開卷考試(60.5%)。5通過對山東省內(nèi)158名社區(qū)居民進行問卷調(diào)查,65.2%社區(qū)居民對社區(qū)醫(yī)師的工作能力滿意。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,38%社區(qū)居民對全科醫(yī)師的理念很少了解及很少聽說。87.3%社區(qū)居民認為有必要設(shè)立全科醫(yī)師。社區(qū)居民認為全科醫(yī)師具備的素質(zhì)主要集中在具有責任心、愛心、同情心(93.7%)、全面的醫(yī)療技術(shù)(84.2%),全科醫(yī)師的職責主要是診治疾病(88.6%)、居民健康管理與咨詢(84.8%),認為全科醫(yī)師需要提高的方面主要集中在日常門診(81.0%)、慢性疾病的防治(77.8%)、日常養(yǎng)生保健知識的宣教(65.8%)。結(jié)論全科醫(yī)學教育培訓體系在歐美國家經(jīng)過了30余年的發(fā)展,在以澳大利亞、美國為代表的開展全科醫(yī)學發(fā)展較早的國家,建立了功能完善、規(guī)模適度、機構(gòu)適宜的全科醫(yī)學教育體系,其中全科醫(yī)學規(guī)范的師資隊伍建設(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)的順利實施,培養(yǎng)了能夠滿足社會基本醫(yī)療服務(wù)需求的醫(yī)學人才。但是,當前我國的全科醫(yī)師無論是質(zhì)量還是數(shù)量還遠遠沒有達到我國社區(qū)居民的基本醫(yī)療衛(wèi)生需求。雖然當前我國的全科醫(yī)學基地有嚴格的入選標準,為全科醫(yī)師制定了詳細的培訓計劃,但是我國的全科醫(yī)學師資準入、認證、考核體系不完善,為全科醫(yī)學基地建設(shè)的主要方面。通過對山東省內(nèi)510名全科醫(yī)學師資、203名全科醫(yī)師、43名全科醫(yī)師培訓相關(guān)專家、158名社區(qū)居民進行問卷調(diào)查。發(fā)現(xiàn)當前全科醫(yī)學師資的骨干力量為專科帶教師資,主要集中在內(nèi)科、外科、急診、老年醫(yī)學等專業(yè)方向與全科醫(yī)學相近的綜合程度較高的科室,師資類型集中在臨床基地�？茙熧Y,專科帶教師資對全科醫(yī)學的理解不夠深入,對全科醫(yī)師的帶教較為陌生,不能用全科醫(yī)學的思維和方法指導學生。但是�？茙Ы處熧Y對本�？频某Ｒ姴�、多發(fā)病具有良好的知識體系及帶教能力,因此,培訓基地應(yīng)發(fā)揮�？茙Ы處熧Y的優(yōu)勢,加強專科帶教師資全科思維的培養(yǎng);當前全科醫(yī)學師資的準入認證體系不統(tǒng)一、培訓體系不完善、考核體系不健全、監(jiān)督體系未建立,培訓基地需要完善全科醫(yī)學師資準入認證體系、完善培訓體系、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"守門人"的作用。目前全科醫(yī)學師資帶教的全科醫(yī)師主要來自于轉(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)師培訓質(zhì)量,培訓基地需嚴把全科醫(yī)師的準入門檻,開展本科及全科醫(yī)學研究生教育,提升全科醫(yī)師教育水平。完成全科醫(yī)師規(guī)范化培訓的全科醫(yī)師服務(wù)于基層醫(yī)療衛(wèi)生機構(gòu),不能再次進入培訓基地進行培訓,加之全科醫(yī)師的培訓脫產(chǎn)時間較長,原單位不愿意將全科醫(yī)師送入培訓基地進行培訓,使得全科醫(yī)師的知識不能得到及時更新,需建立完善的全科醫(yī)師再培訓體系。當前社區(qū)居民對全科醫(yī)學的認識不足。因此,需加大對全科醫(yī)學、全科醫(yī)師的概念宣傳,讓社區(qū)居民對全科醫(yī)學、全科醫(yī)師概念進行深入理解,正確認識全科醫(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.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R-4

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相關(guān)期刊論文 前10條

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