上海市规范化培训全科医生社区卫生服务能力评估研究

Assessment of community health service ability of general practitioners after standardized training in Shanghai

目的 评估上海市规范化培训后全科医生的社区卫生服务能力,并与未经规范化培训的全科医生进行比较,进而评价本市全科医生规范化培训效果.方法 2014年9-11月采用回顾性队列研究,建立经过规范化培训和未经规范化培训的社区全科医生队列（规培组和非规培组各102名）,两组年龄、性别、教育背景、工作年限以及执业地点匹配,评估两组社区卫生服务（主要包括基本公共卫生服务和基本医疗服务）的能力.采用笔试评估全科医生基本公共卫生服务能力;采用客观结构化临床考核（OSCE）评估全科医生基本医疗服务能力,包括临床接诊和临床技能两部分.结果 规培组笔试成绩高于非规培组[（66±4）分比（62±7）分,P＜0.01],OSCE总分高于非规培组[（494±78）分比（448 ±80）分,P＜0.01],临床接诊和临床技能总分也均高于非规培组[分别为（245 ±44）分比（225 ±40）分;（252±59）分比（225 ±61）分,均P＜0.01].OSCE评估中,规培组在病史采集、医患沟通、基本操作、心电图判读、心肺复苏5个站点的评分高于非规培组（均P ＜0.01）;体格检查、病例分析和X线片判读站点评分两组比较差异无统计学意义（均P ＞0.05）.结论 经过规范化培训的全科医生的基本医疗卫生服务和基本公共卫生服务的能力总体均优于未经规范化培训的全科医生,但在基本医疗能力的某些方面还需要在培训和实践中加强.

Objective To assess community health service ability of general practitioners （GPs） with the Standardized General Practitioner Training（SGPT） in Shanghai.Methods One hundred and four GPs receiving SGPT and matched 102 GPs without SGPT were enrolled in this retrospective cohort study from September to November in 2014.Community health service ability,including abilities in basic medical service and public health service were assessed and compared between two groups.Written examination was applied in the public health services ability assessment.Objective structured clinical examination （OSCE） was applied for evaluation of basic medical service abilities.Results The scores of written examination in GPs with SGPT were higher than those without SGPT[（66 ±4） vs.（62 ±7）,P 〈0.01].The OSCE scores in GP with SGPT were higher than those without SGPT [（494 ± 78） vs.（448 ± 80）,P 〈 0.01].GPs with SGPT also abtained the higher scores in consultation competence and clinical skills assessment [（245 ± 44） vs.（225 ±40）,P〈0.01;（252 ±59） vs.（225 ±61）,P 〈0.01].In OSCE,GPs with SGPT got higher score than those without SGPT in 5 stations （medical history collection,doctor-patient communication,basic operation,ECG interpretation,and CPR） （all P 〈 0.01）;however,no significant differences were observed in 3 stations （physical examination,case analysis and X-ray interpretation） between two groups （all P 〉 0.05）.Conclusions GPs with SGPT have better basic medical service and public health service ability.But some aspects of basic medical service ability need to be strengthened in the training and practice.