大型综合性公立医院在中国全科医学岗位培训中的地位与作用

Standing and Role of the Large-Scale Comprehensive Public Hospital in General Medical Education in China

对社区和乡村医生进行正规的、系统的全科医学教育,已成为提高我国基层医疗卫生机构专业水平、解决群众看病就医问题、确保医药卫生体制改革获得成功的关键环节之一。全科医学教育的概念从20世纪80年代末引入我国以来,受到了党和政府以及医学教育界的高度重视,经过十余年的努力,取得了一定的成绩;但由于多方面的原因,目前尚未形成成熟的、适合我国国情的、针对基层医疗机构在职人员的岗位培训模式和全科医学教育体系。由于培训效果不尽如人意,客观上制约了我国社区和农村医疗卫生服务体系的建设和发展。本文分析了我国全科医学教育的现状、存在的主要问题和主要原因,根据在与县级医院、乡镇卫生院和城市社区卫生服务中心的长期合作中积累的经验,介绍了集课程教学、适宜医疗技术推广和区域医院合作网络建设为一体的"三位一体"的乡村和社区医师培训模式。认为,大型综合性医院在对基层医务人员进行全科医学岗位培训过程中可以承担集培训中心、临检中心和技术后援基地为一身的技术核心的角色。这种角色不是任何其他类型的医疗机构和医学教育机构所能担当的。

To carry out normal or regular general medical education to the rural and community doctors has become one of the key links in promoting the professional ability in primary medical and health institutions,resolving the problems of the medical care for the common people,and assuring the success of health system reform in China.The general medical education has attracted high attention from both the government and the medical educationists since its concept was introduced into China at the end of 1980s,and a series of good achievements have been made through the effort of more than a decade.Nevertheless,there is still no well-developed on-the-job training model or general medical education system that is especially suitable now in China for the rural and community doctors owing to various causations.Objectively,the construction and development of the rural and community medical and health care system were largely restrained by the unsatisfactory outcome of on-the-job training.By the analysis of the current status,the existing problems and the main causes of the general medical education system in China,and based on our own experiences of collaborating with the county hospitals and the rural and community hospitals/clinics for many years,we propose a novel model of ＂three in one＂ for training the rural and community doctors,comprising training courses,feasible technique popularization and establishment of regional hospital collaboration network.We believe that the large scale comprehensive hospital may play a key role as the center of technique training,clinical laboratory center and technique supporting base in the process of on-the-job training for the rural and community doctors,which cannot be undertaken by any other kind of hospitals or medical educational institutes.