医联体模式下全科住院医师规范化培训网络体系的构建研究

Network systems for standardized residency training of general practitioners in a medical association

目的构建医联体模式下全科住院医师规范化培训(简称住培)网络体系,并初步评价其效果和可行性。方法依托南京市江宁医院区域医联体优势,在医联体内建立由江宁医院全科医学科牵头、相关临床科室协同、各基层实践基地支撑的全科专业住培体系,建设联动网络,深度整合教学资源,进行试点实施。采取定性研究方法,列出半结构性访谈提纲,对全科医学科教研室成员、全科带教老师及二年级以上的全科在培住院医师、临床及社区教学基地住培管理人员进行横向、直接、深入访谈,进而评价该网络体系的初步实施效果。结果成功构建医联体模式下全科住培网络体系。全科教研室所有成员均认为该网络体系确定了全科医学科的组织架构,75%认为繁重的临床工作、绩效考核等压力制约了全科医学科的发展;88.71%的带教老师认为住院医师在医学知识、临床技能、人际沟通技能、全科思维等多方面能力得到提升,64.52%认为全科师资及住院医师缺乏有序的准入及淘汰机制;所有住培对象均表示科室轮转安排大致合理,66.67%认为临床及社区实践基地师资带教中融入了全科思维,55.56%建议提高全科住培的待遇;57.14%的基地住培管理人员建议加强带教老师的培训及经费投入,42.86%认为仍需要加强医联体内部的联系,更好地整合区域医疗资源。结论医联体模式下全科住培网络体系的构建和实施,为建设高质量的全科住培基地、培养更多的全科医学人才提供思路。

ObjectiveTo establish a network system for standardized residency training of general practitioners in the form of a medical association and evaluate its efficacy and feasibility.MethodsBased on the advantages of the regional medical association of Nanjing Jiangning Hospital,a standardized training system for general practitioners in the medical association was established,which was led by the General Practice Department of Jiangning hospital,coordinated by related clinical departments,and supported by various grassroots practice bases.A qualitative research method was adopted,semi-structured interviews were listed outline,and horizontal,direct,and in-depth interviews with different people concerned.The effect of the network system was evaluated.ResultsAll members of the Department of General Medical Sciences believed that the network system determined the organizational structure of the Department of General Medicine.75%were convinced that heavy clinical work and performance evaluation restricted the development of general medicine,88.71%of general tutors reported that general practitioners had improved in terms of medical knowledge,clinical skills,interpersonal communication skills,and general practice thinking,and 64.52%expressed the opinion that general tutors and general practitioners lacked an orderly access and elimination mechanism.All general practitioners said that the current rotation practice was necessary.66.67%believed that general practice thinking was involved in teaching.ConclusionThe construction and implementation of the network system for standardized residency training of general practitioners in the form of a medical association can provide ideas for the construction of a high-quality general practice training base and the cultivation of more general practice professionals.