上海市全科住院医师临床接诊能力的评价与分析

Assessment for consultation competence of resident general practitioners in Shanghai

目的评价上海市全住院医师临床接诊能力。方法采用标准化病人（SP）接诊考核形式评价上海市全科医师规范化培训的住院医师的临床接诊能力，包括临床技能和医患交流技能两方面。临床技能评价内容包括信息收集、临床思维、健康宣教、门诊病史书写、接诊时间掌握；医患交流技能评价内容包括建立医患关系、信息收集和反馈、从患者角度理解问题、信息共享和知情同意、结柬接诊。以每项实际得分除以该项的总分（得分率）来评价住院医师各项接诊技能的掌握程度。结果157名全科住院医师参与了临床技能评价，平均年龄（28±2）岁，男性52人，女性105人。临床技能总得分率为（76±10）％，各项得分率从高到低依次为：接诊时间掌握（91±24）％，门诊病史书写（80±14）％，信息收集（76±12）％，临床思维（74±17）％，健康宣教（68±31）％。医患交流技能总得分率为（74±12）％，各项得分率从高到低依次为：建立医患关系（86±13）％，信息共享和知情同意（80±15）％，信息收集和反馈（74±15）％，结束接诊（62±27）％，从患者角度理解问题（43±30）％。结论经过上海市规范化培训的全科住院医师具备了一定临床接诊能力，但尚有不足，有待于今后的培训中进一步提高。

Objective To assess consultation competence of resident general practitioners in Shanghai. Methods Standardized patients （SPs） were employed as an assessment tool in exploring consultation competence of resident general practitioners （ GPs ）, including clinical and communication skills. Clinical skills included information collection, clinical thinking, health education, out-patient history taking and recording and reception time management, and patient-physician communication skills included building a good relationship, information collection and feedback, understanding issues from patient＇s perspective, sharing information and obtaining informed consent and close of consultation. Score rate defined as actual score of each item divided by total score of the domain was employed to assess competence of GPs in varied aspects. Results There were 157 resident GPs, 52 men and 105 women, with an average age of （28 ±2） years. Overall score rate of clinical skills averaged （76 ± 10） percent, and score rate of each item ranking from the highest to the lowest was reception time management （91 ±24） percent,out-patient history taking and recording （80 ±14） percent, information collection （76 ± 12 ） percent, clinical thinking （74 ± 17） percent, health education （68 ± 31 ） percent. Overall score rate of communication skills averaged （74 ± 12） percent, and score rate of each item ranking from the highest to the lowest was building a good patient-physician relationship （86 ± 13 ） percent, information collection and feedback （80 ± 15 ） percent, sharing information and obtaining informed consent （74 ± 15） percent, close of consultation （62 ±27） percent and understanding issues from patient＇s perspective （43 ±30） percent. Conclusions Resident GPs have improved their consultation competence to certain extent after standardized training, but there still exist some weakness to be improved in them.