基层全科医生临床技能数据库建设研究
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摘要
背景文献检索发现目前尚缺乏单独适用于毕业后全科医生的全科技能标准化培训及考核体系的统一标准,国内相关研究主要是针对全科医生综合能力方向,为此建立全科医生临床技能数据库,挖掘全科医生临床核心技能显得尤为重要。目的建立全科医生临床技能数据库,为进一步挖掘全科医生临床核心技能提供基础,同时为基层全科医生临床技能培训提供参考标准。方法通过文献分析及项目研究小组讨论、投票,初步得出全科医生临床技能项目,再通过问卷调查法,拟定全科医生临床技能数据库框架。文献分析以《第八届全国高等医学院校大学生临床技能竞赛范围》为参考组,整合国内外技能培训要求,与参考组重复≥2次者保留,其余项目进行问卷调查。于2017年4—10月,采用分层整群抽样法在四川省凉山州、阿坝州、甘孜州、成都市、南充市共抽取30个基层医疗卫生机构的临床工作人员作为调查对象,采用自行设计的全科医生临床技能需求调查问卷进行调查,问卷内容包括被调查者的基本情况及全科医生是否应该掌握某项技能,共计发放问卷3 600份,回收有效问卷3 231份,有效回收率为89.75%。结果通过文献分析、小组投票初步得出全科医生临床技能项目共计137项,其中与参考组重复≥2次者54项,其余项目83项。对该83项技能进行全科医生临床技能需求调查后纳入37项、排除32项、待定14项,共计初筛全科医生临床技能105项。结论本研究初步建立了全科医生临床技能数据库,该数据库有较好的覆盖性、科学性、实用性,可作为基层全科医生技能标准化培训的参考。
Background Literature retrieval results show that there is no unified standardized clinical skills training and assessment system for newly graduated general practitioners(GPs),and in China,there are quite a lot of studies about standardized comprehensive abilities training and assessment for GPs.Therefore,it is of great significance to establish a GP clinical skills database to screen the core clinical skills of GPs.Objective To establish a GP clinical skills database,providing a basis for the screening of the core clinical skills of GPs and offering a reference for clinical skills training for GPs in primary care facilities.Methods GP clinical skills were pooled by literature review at first.During the review process,the skills of GPs in articles at home and abroad were compared to the clinical skills included in the 8th National Medical College Students' Clinical Skills Competition Scope(reference group).Skills that were found to be the same as those in the reference group for twice or more times were kept as items in the database.Then the other skills were discussed and selected by voting by our research team members and were tested by a survey in a stratified cluster sample of 3 600 clinical professionals from 30 primary healthcare institutions in 5 areas of Sichuan Province(Liangshan Yi Autonomous Prefecture,Aba Tibetan and Qiang Autonomous Prefecture,Ganzi Tibetan Autonomous Prefecture,Chengdu City,and Nanchong City) during April to October 2017 with a self-developed questionnaire named Essential Clinical Skills of General Practitioners consisting of personal characteristics and the choice of clinical skills should be mastered by GPs.Altogether,3 231 cases returned responsive questionnaires,gaining a response rate of 89.75%.Results Of the 137 clinical skills collected though literature review and choice voting,54 were found to be identical with 54 skills in the reference group for twice or more times,other 83 were tested by the questionnaire survey.According to the survey results,37 were included in the database,32 were excluded,and other 14 were indeterminate.Finally,a total of 105 skills were included in the database.Conclusion Our GP clinical skills database has a wide coverage,good scientificity and practicability,which can be used as a reference tool for the standardized clinical skill training for GPs in primary care facilities.
Background Literature retrieval results show that there is no unified standardized clinical skills training and assessment system for newly graduated general practitioners(GPs),and in China,there are quite a lot of studies about standardized comprehensive abilities training and assessment for GPs.Therefore,it is of great significance to establish a GP clinical skills database to screen the core clinical skills of GPs.Objective To establish a GP clinical skills database,providing a basis for the screening of the core clinical skills of GPs and offering a reference for clinical skills training for GPs in primary care facilities.Methods GP clinical skills were pooled by literature review at first.During the review process,the skills of GPs in articles at home and abroad were compared to the clinical skills included in the 8th National Medical College Students' Clinical Skills Competition Scope(reference group).Skills that were found to be the same as those in the reference group for twice or more times were kept as items in the database.Then the other skills were discussed and selected by voting by our research team members and were tested by a survey in a stratified cluster sample of 3 600 clinical professionals from 30 primary healthcare institutions in 5 areas of Sichuan Province(Liangshan Yi Autonomous Prefecture,Aba Tibetan and Qiang Autonomous Prefecture,Ganzi Tibetan Autonomous Prefecture,Chengdu City,and Nanchong City) during April to October 2017 with a self-developed questionnaire named Essential Clinical Skills of General Practitioners consisting of personal characteristics and the choice of clinical skills should be mastered by GPs.Altogether,3 231 cases returned responsive questionnaires,gaining a response rate of 89.75%.Results Of the 137 clinical skills collected though literature review and choice voting,54 were found to be identical with 54 skills in the reference group for twice or more times,other 83 were tested by the questionnaire survey.According to the survey results,37 were included in the database,32 were excluded,and other 14 were indeterminate.Finally,a total of 105 skills were included in the database.Conclusion Our GP clinical skills database has a wide coverage,good scientificity and practicability,which can be used as a reference tool for the standardized clinical skill training for GPs in primary care facilities.
引文
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[15]万学红,卢雪峰.诊断学[M].8版.北京:人民卫生出版社,2013.
[16]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013.
[17]王卫平.儿科学[M].8版.北京:人民卫生出版社,2013.
[18]赵堪兴,杨培增.眼科学[M].8版.北京:人民卫生出版社,2013.
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[26]董照伦,陈长香.医师信任患者量表中文版的效度和信度初步研究[J].中国心理卫生杂志,2016,30(7):481.DOI:10.3969/j.issn.1000-6729.2016.07.001.DONG Z L,CHEN C X.A preliminary study of validity and reliability of the Chinese Version of the Physician Trust in the Patient Scale[J].Chinese Mental Health Journal,2016,30(7):481.DOI:10.3969/j.issn.1000-6729.2016.07.001.
[2]全国全科医学专业技术队伍现状研究课题组.我国三城市社区卫生服务中心临床医师队伍现状调查[J].中华全科医师杂志,2009,8(2):99-103.Study Group for the National Survey on Current Status of General Practitioners.An investigation on current status of general practitioners-in-charge in three large cities of China[J].Chinese Journal of General Pratitioners,2009,8(2):99-103.
[3]申颖,左延莉,李虹,等.广西基层医疗机构全科医生基本医疗工作现状调查[J].中国全科医学,2016,19(22):2719-2723.DOI:10.3969/j.issn.1007-9572.2016.22.022.SHEN Y,ZUO Y L,LI H,et al.The current clinical practice of general practitioners in primary healthcare institutions in Guangxi[J].Chinese General Practice,2016,19(22):2719-2723.DOI:10.3969/j.issn.1007-9572.2016.22.022.
[4]中商产业研究院.2017年四川省各市GDP排行榜[EB/OL].(2018-02-02)[2018-05-29].http://www.sohu.com/a/220463340_642249.
[5]教育部医学教育临床教学研究中心,教育部临床医学专业实践教学指导分委员会.关于印发《第八届全国高等医学院校大学生临床技能竞赛范围》的通知[EB/OL].(2017-03-10)[2018-05-29].http://www.kmmu.edu.cn/uplo ad/20170310/2017031009542835.pdf.
[6]原国家卫生计生委办公厅.关于印发住院医师规范化培训基地认定标准(试行)和住院医师规范化培训内容与标准(试行)的通知[Z].2014.
[7]原卫生部科教司.关于印发《全科医师规范化培训大纲(试行)》《全科医师岗位培训大纲(试行)》的通知[Z].1999.
[8]正保远程教育.2017年临床执业医师实践技能考试大纲[EB/OL].(2017-03-22)[2018-05-29].http://www.med66.com/upload/html/2017/03/22/xk2cdc364a378f4b69843452daf1c4bced.doc.
[9]袁金娜,雷小光,叶孙益,等.医学生基本临床技能培训宝典[EB/OL].[2018-05-29].http://www.9299.net/read/909g6h31kk06kll9gkl80767.html.
[10]柯杨.北京大学住院医师规范化培训[M].北京:北京大学医学出版社,2010.
[11]原卫生部办公厅.关于印发基层医疗卫生机构全科医生转岗培训大纲(试行)的通知[EB/OL].(2011-01-11)[2018-05-29].http://www.nhfpc.gov.cn/qjjys/s3593/201101/cc492eb3eda04fe0909a0b0b61acbc36.shtml.
[12]四川省全科医师培训中心.四川省基层卫生医疗机构全科医生转岗培训结业考试[EB/OL].[2018-05-29].https://wenku.baidu.com/view/9d1be0211a37f111f0855b15.html.
[13]陈红.中国医学生临床技能操作指南[M].2版.北京:人民卫生出版社,2014.
[14]葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013.
[15]万学红,卢雪峰.诊断学[M].8版.北京:人民卫生出版社,2013.
[16]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013.
[17]王卫平.儿科学[M].8版.北京:人民卫生出版社,2013.
[18]赵堪兴,杨培增.眼科学[M].8版.北京:人民卫生出版社,2013.
[19]田勇泉.耳鼻咽喉头颈外科学[M].8版.北京:人民卫生出版社,2013.
[20]张学军.皮肤性病学[M].8版.北京:人民卫生出版社,(上接第450页)2013.
[21]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013.
[22]“国立”成功大学医学院附设医院.“国立”成功大学医学院附设医院家庭医学部住院医师教学训练计划[EB/OL].(2009-10-31)[2018-05-29].https://www.docin.com/p-815883716.html.
[23]The Hong Kong College of Family Physicians handbook on vocational training in family medicine[EB/OL].[2018-05-29].http://www.hkcfp.org.hk/Upload/Documents/BVTS/VTS_5thHandbook.pdf.
[24]Family Medicine Residency Review Committee.ACGMEprogram requirements for graduate medical education in family medicine[EB/OL].(2011-08-01)[2018-05-29].http://www.acgme.org/acWebsite/downloads/RRC_progReq/120pr07012007.pdf.
[25]RCGP.The RCGP curriculum:professional&clinical modules2.01-3.21 curriculum modules[EB/OL].(2016-01-19)[2018-05-29].http://www.gmc-uk.org/-/media/documents/RCGP_Curriculum_modules_jan2016.pdf_68839814.pdf.
[26]董照伦,陈长香.医师信任患者量表中文版的效度和信度初步研究[J].中国心理卫生杂志,2016,30(7):481.DOI:10.3969/j.issn.1000-6729.2016.07.001.DONG Z L,CHEN C X.A preliminary study of validity and reliability of the Chinese Version of the Physician Trust in the Patient Scale[J].Chinese Mental Health Journal,2016,30(7):481.DOI:10.3969/j.issn.1000-6729.2016.07.001.