全科医师临床基本技能模拟训练与知识强化教育精准课程的探索与实践

Exploration and practice of clinical basic skills simulation training and knowledge intensive education precise course for general practitioners

目的制定全科医师临床基本技能模拟训练与知识强化教育精准课程,提高学员的岗位胜任力。方法采用专家访谈法、文献查阅法和问卷调查法,将20名访谈对象按照理论知识传授组、单项技能组、临床思维能力与态度组进行访谈,同时对99名全科学员进行调研及访谈,依据专家组的意见和全科医师特点及培训需求,制定精准的培训课程体系。结果 20名专家对课程分类意见达到2/3频次的为以下4类:全科医学相关理论、单项技能、社区常见病慢性病的诊治与管理(临床思维能力)、人文法规与医德医风等;99名全科学员一般培训需求:学员认为培训的目的最主要是为了提高岗位胜任力;最需要的知识与技能是临床技能操作;最喜欢的培训方式是视频、讲授与操作相结合;最喜欢的人文课程是医患沟通。全科学员对培训专题意见达到2/3频次的项目集中在常见的临床技能和临床思维上,主要有:诊断基本技能、基本穿刺术、外科基本技能、妇科、产科基本技能、儿科基本技能、危重症抢救基本技能、基础护理技能、临床思维和综合知识等。依据调查结果,针对全科规培学员精准制定了导向明确,符合全科医师特点的标准课程体系,包含知识、技能和态度三个层次,内容涉及内科、外科、妇产科、儿科、急救、护理、全科临床思维及相关理论等。结论该课程体系促进了全科医师岗位胜任力的提升,实现临床基本技能规范化、标准化、同质化。

Objective To develop the basic clinical skills simulation training and knowledge intensive education precise course for general practitioners （GP） , so as to improve their job competency. Methods The methods of expert interview, literature review and questionnaire survey were adopted. The 20 participants were interviewed according to the theory of knowledge group, single skill group, clinical thinking ability and attitude group and 99 GP students were investigated. According to the views of the expert group and characteristics and training needs of GP, we developed training curriculum system accurately. Results The results of 20 experts at 2/3 frequency on the course classification opinions are four categories： GP theories, individual skills, diagnosis and management of common community diseases and chronic diseases （clinical thinking ）, humanities and medical ethics regulations. General training requirements of the GP students： students think the main purpose of the training is to improve the clinical competency ; clinical skills are the most needed knowledge and skills ; video and teaching combined with practice is the preferred way of training ; the most favorite humanity course is the doctor-patient communication. The projects which reach 2/3 frequency focused on the clinical skills and clinical thinking in common, which mainly include： basic diagnostic skills, basic puncture surgery, basic skills in surgery, gynecology, obstetrics, pediatrics, critical care rescue and nursing, clinical thinking and comprehensive knowledge etc. According to the survey results, a standard curriculum targeting at GP trainees was made with clear orientation. The system contains three levels involving knowledge, skills and attitudes. It concerned internal medicine, surgery, gynecology, pediatrics, emergency treatment, nursing, general clinical thinking and the related theory. Conclusion The curriculum system promotes the competency of general practitioners, and achieves the standardization, normalization and homogenization of clinical basic skills.