上海市全科医学社区师资带教状况调查及相关因素分析

Survey on teaching status of general practitioners in community health centers of Shanghai

目的调查上海市全科医学社区师资的带教情况，分析其影响因素，为今后有效提高社区全科医学教学水平提供依据。方法采用自行设计的调查问卷，对2012年7—10月问参加上海市某全科师资培训班的全科社区师资的一般情况、既往带教工作情况及自我教学能力评估等方面进行调查。结果742人完成问卷，平均年龄（37±6）岁。49．8％（366／734）的被调查者表示愿意带教；从教学中提升自身素质是愿意从事带教工作的主要原因58．6％（419／715）。不愿带教的主要原因是工作负荷大、缺乏带教时间（31．8％，378／1187）和缺乏带教经验（30．7％，364／1187）。106名既往有过社区带教经历的师资中，79．2％（80／101）带教前会先制定带教计划，但仅有8．9％（9／102）经常在带教中撰写教案；社区医疗工作实际需求（54．2％，56／92）是制定带教计划的首要依据，其次是学生实际情况和需求（29．1％，28／96），再次是教学大纲（17．7％，17／96）。目前社区教学中存在的问题主要有缺乏带教经验（50．5％，50／99）、缺乏带教时间（42．4％，42／99）、带教形式单一（24．1％，25／104）和教学大纲操作性不强（21．2％，22／104）。教学能力的自我评估显示，14．4％的师资不具备制定实施教学计划的能力，18．3％不具备运用多种教学方法的能力，31．2％无法每周安排1．5个工作日参与教学。logistic回归分析结果显示，学历高者（OR=2．027，P〈0．05）、有社区带教经历者（OR=3．069，P〈0．05）、个人素质和沟通能力强者（OR=2．488，P〈0．05）、带教能力强者（OR=2．399，P〈0．05）、愿意参加师资培训者（OR=11．382，P〈0．05）更愿意参加社区全科带教工作。结论上海市全科医学社区师资主要存在缺乏带教时间、带教经验不足、教学能力欠缺的问题。今后需特别重视对社区师资进行教育理论和技能的培训，提高社区全科医学教学水平。

Objective To survey the current situation of teaching for general practitioners （GPs） in community health centers of Shanghai. Methods A questionnaire survey on the teaching situation was conducted among 742 GP mentors who attended a municipal training workshop during July to October 2012 in Shanghai. The items of the survey included general background, previous teaching experience and selfevaluation on teaching ability. Results Among 742 GP mentors receiving the survey, the average age was （37 ＋ 6） years old. 49.8% （366/734） of mentors expressed their willingness of teaching, and the main reason was that it may upgrade themselves, while learning from teaching （58.6% , 419/715）. Heavy work load,lack of teaching time （ 31.8% , 378/1 187 ） and teaching experience （30.7% , 364/1 187 ） were the main obstacles for teaching. Among 106 GP mentors who had teaching experience in community health center previously, 79.2% （80/101） made teaching plans, but only 8.9% （9/102） often prepared syllabus. Teaching plans were made mainly according to the work needs in community health care （54.2% ,52/96） , the situation and demands students （29. 1% ,28/96） or requirement of syllabus （ 17.7% , 17/96）. The problems included lack of teaching experience （ 50.5 % , 50/99 ） and time （ 42.4% , 42/99 ） , monotonous instructional modality （24.1% ,25/104）, and weak operability of the syllabus （21.2%）. The self-reported results showed that 14.4% were not able to develop a teaching program and to execute, 18.3% were not able to use a variety of teaching methods, 31.2% were not able to engage in teaching for 1.5 days per week. Logistic regression analysis showed that mentors with higher education background （ OR = 2. 027, P 〈 0.05 ）, community teaching experience （ OR = 3. 069 ,P 〈 0.05 ） , higher self assessment of general personal quality and communication ability （ OR = 2. 488 ,P 〈 0.05 ）, higher teaching ability （ OR = 2. 399, P 〈 0.05 ） and strong training wishes （ OR = 11. 382, P 〈 0. 05 ） were more willing to engage in the teaching work. Conclusions Heavy work load, insufficiency of teaching capacity and experience are main problems for GP mentors in Shanghai community health centers. Educational theory and methods should be focus on teacher training so as to improve teaching abilities.