北京市基层医生医学知识获取途径及临床问题解决方式的现状研究

A cross-sectional study on medical knowledge sources and clinical problem solving behavior of physicians among district and community based hospitals in Beijing

目的 :了解北京市基层一、二级医院医生获取新的医学知识的主要途径 ,及其在临床实践中解决问题的主要方式。分析影响基层医生将知识转化为临床能力的因素。方法 :北京市海淀区和朝阳区 4 2家基层医院 (包括二级医院 9家 ,一级医院 17家 ,乡卫生院 16家 )共计 6 32名内科系列的医生 ,采用问卷调查方式 ,进行继续医学教育和临床能力调查。结果 :1 基层医生获取医学知识的主要途径中“参加院外市级或区级继续教育培训”排在第一位 (4 4 % ) ,其次是阅读专业期刊书籍 (2 2 % )和上级医生指导 (15 % )。 2 .高级职称医生中通过阅读获取知识的比例明显高于初中级职称的医生。 3.当在临床实践中遇到问题时 ,高级职称医生最常用的解决途径为“查看有关疾病的诊疗指南”、“查看相关书籍、期刊” ,而中低职称医生解决的主要途径为“请教上级医生”、“查看有关疾病的诊疗指南”。 4 .基层医生认为影响诊疗水平提高的原因为“缺乏学习时间”(34% )和“缺乏专家的实际指导”(33% )。 5 .基层医生认为目前继续教育系统存在的问题包括 :与临床实际联系不足 ,且内容重复、陈旧 ,授课时间和地点不合理 ,授课形式枯燥。结论 :1.继续医学教育课程是基层医生获取临床知识的主要途径。 2 .该系统课程设置、教学方式、教学?

Objective:To study the sources of primary medical knowledge and problem solving behavior of physicians in medical practice among districts and community based hospitals in Beijing.To analyze the possible factors that affect the improvement of physican's clinical ability.Method:A questionnaire survey was carried out in 42 district and community level hospitals in ChaoYang district and HaiDian district,632 physicians in internal medicine department participated.Result:1. 44% of those physicians consider “join the course set up by continue medical education system” is the most important knowledge source.The second source is “Reading professional book and periodical”(22%) and the third is “Directed by senior physician”(15%).2. Senior physicians use “Reading professional book and periodical” as the primary knowledge source.3. When facing clinical problem,Senior physicians use “to Read guideline of the disease” and “Read related books”,while residents use “to Consult Senior physicians”4. 34% of the physicians think “no enough time for learing” is the main obstacle of improving clinical ability,and 33% of them think the obstacle is “hard to obtain direction by expert in clinical practice”.5. The defects of continue medical education system are “Course related to clinical practice insufficiently”,“Contents lag behind the times or overlap”,“discommodious of school time and place”.Conclusion:1. The courses set up by ontinue medical education system is the main knowledge source of physicians in community based hospital.2. Continue medical education system has many defects,unable to promote the transition from knowledge to clinical ability.3. Improve clinical ability of senior physicians is the key point to boost quality of medical service.