农村上消化道癌筛查地区病理医师技术能力及影响因素分析

Analysis on skills of pathologists and influencing factors in the upper gastrointestinal cancer screening areas of rural China

目的探讨农村上消化道癌早诊早治地区病理医师技术能力水平及相关影响因素。方法以2019-01-01-2019-12-31参与农村上消化道癌早诊早治项目的病理医师为研究对象,由项目专家组依据现行技术方案和项目实例编写考核试题库,利用“早诊早治”APP建立考试平台进行技术能力考核,计算考核优秀率。采用多因素Logistic回归模型分析考核优秀率的影响因素。结果共纳入1304名病理医师进行分析,考核平均分为75.71,合格率为94.40%(1231/1304),优秀率为36.58%(477/1304)。对于各部分考核内容的平均答题正确率,其中“标本处理与病理诊断”为(78.84±8.83)%,“肿瘤病理诊断标准”为(71.70±9.85)%,“人群筛查质控”和“评价指标”分别为(65.37±9.22)%和(68.66±32.32)%。多因素分析结果显示,本科及以上文化程度(OR_(研究生)=2.185,95%CI为1.393~3.428,P=0.001;OR_(本科)=1.702,95%CI为1.155~2.507,P=0.007)、本专业工作5~<10年(OR=1.589,95%CI为1.072~2.356,P=0.021)、参加项目≥2年(OR=1.315,95%CI为1.034~1.672,P=0.026)、东中部地区(OR_(东部)=2.558,95%CI为1.660~3.942,P<0.001;OR_(中部)=2.294,95%CI为1.462~3.601,P<0.001)的病理医师考核优秀率相对较高。结论我国农村上消化道癌早诊早治地区病理医师基本掌握技术方案,但总体优秀率偏低。文化程度、本专业工作时长、参加项目时长和所在地区是病理医师考核优秀的主要影响因素,应有针对性继续加强病理医师培训。

Objective To assess the skills of pathologists in the upper gastrointestinal in cancer screening areas of rural China and analyze the influencing factors.Methods The pathologists who participated in the upper gastrointestinal cancer screening program of rural China in 2019 were selected.The questionnaires for skill assessment were created by the experts of upper gastrointestinal cancer screening program in rural China,and the"Early Diagnosis and Early Treatment"APP was used as the examination platform.The pathologists participating in the program in 2019 were assessed for pathological skill and screening scheme.Multivariate logistic regression model was used to analyze the potential factors of examination scores.Results A total of 1304 pathologists participated in the assessment.The average score was 75.71,the passing rate was 94.40%(1231/1304),and the excellent rate was 36.58%(477/1304).Among all items,the correct rates of the assessment were(78.84±8.83)%for specimen processing and pathological diagnosis,(71.70±9.85)%for tumor pathological diagnosis standard,(65.37±9.22)%for population screening quality control,and(68.66±32.32)%for evaluation index,respectively.The results of multivariate analysis showed that the excellent rate of pathologists with bachelor degree or above(OR=2.185,95%CI:1.393-3.428,P=0.001 for graduate;OR=1.702,95%CI:1.155-2.507,P=0.007 for bachelor degree),professional work with experience of 5-<10 years(OR=1.589,95%CI:1.072-2.356,P=0.021),more than 2 years of project participation(OR=1.315,95%CI:1.034-1.672,P=0.026),eastern and central region(OR=2.558,95%CI:1.660-3.942,P<0.001 for eastern region;OR=2.294,95%CI:1.462-3.601,P<0.001 for central region)was higher.Conclusions The pathologists basically master the screening scheme in rural upper gastrointestinal cancer screening areas,but the overall excellent rate is still low.Education level,working time of the specialty,time of participating in the program and the regions are the main influencing factors.Accordingly,the training of pathologists should be strengthened.