导师制全科医生转岗培训方案的实践效果分析

Analysis of the practical effect transfer training program of the general practitioner under tutorial system

目的在全科医生转岗培训中实践导师制培训方案并探讨培训效果。方法选取2015-2017年在重庆医科大学附属第一医院(重庆市全科医学教育中心)受训的295例全科医生转岗培训学员为研究对象,采用导师制方案进行培训。培训前进行入学摸底考试,培训后由重庆市卫生健康委员会统一组织同等难度的结业理论考试和心肺复苏、临床实践技能考核,采用百分制进行评价,60分为及格。结果培训前无论心肺复苏还是临床实践技能,不及格率都接近60%(59.36%、57.24%),培训后不及格率大幅下降(1.41%,0.71%),差异均有统计学意义(均P<0.05)。女性医生心肺复苏、临床实践技能培训后均优于男性医生,差异有统计学意义(均P<0.05);不同性别学员结业时理论考试得分差异无统计学意义(P>0.05)。中专毕业生在临床实践技能培训前得分明显低于大专、本科毕业生,培训后分数增加幅度也最大,差异有统计学意义(均P<0.05)。工作年限分别与培训后心肺复苏和临床实践技能得分呈负相关(心肺复苏r=-0.158,P=0.007;临床实践技能r=-0.121,P=0.004)。学历水平高低与培训后心肺复苏和临床实践技能均无相关性(心肺复苏r=0.101,P=0.083;临床实践技能r=0.062,P=0.293),与理论考试分数呈正相关(r=0.282,P<0.001)。结论通过导师制全科医生转岗培训方案,学员在心肺复苏、临床实践技能两方面都得到明显提高,并且理论考核成绩合格,提示导师制全科医生转岗培训方案能有效提高全科医生的诊疗能力。

Objective To practice the tutorial system in the general practitioners transfer training and discuss the training effect. Methods A total of 295 general practitioners who were trained in the First Affiliated Hospital of Chongqing Medical University(Chongqing general practice medical education center) from 2015 to 2017 were selected as the objects of the study, and the tutorial system was adopted for training. Before the training, the entrance examination were carried out. After the training, the Chongqing Municipal Health Committee uniformly organized the completion theory examination, cardiopulmonary resuscitation(CPR) and clinical practice skill examination of the same difficulty, which were evaluated by the percentage system, and 60 points were considered as passing. Results Before training, the failure rate of CPR and clinical practice skills was nearly 60%(59.36% vs. 57.24%), and the failure rate after training were significantly decreased(1.41% vs. 0.71%), After cardiopulmonary resuscitation and clinical practice skill training, female doctors were better than male doctors, with statistically significant difference(all P<0.05). There was no gender difference in the theoretical examination at the end of the course(P>0.05). The score of technical secondary school graduates before clinical practice skill training was significantly lower than that of college graduates and undergraduate graduates, and the increase of score after training was the highest(all P<0.05). Working years were negatively correlated with the score of CPR and clinical practice skill after training(CPR: r=-0.158, P=0.007;Clinical practice skills: r=-0.121, P=0.004). There was no correlation between education level and CPR and clinical practice skills after training(CPR: r=0.101, P=0.083;Clinical practice skills: r=0.062, P=0.293), but there was a positively correlated with theoretical test scores(r=0.282, P<0.001). Conclusion Through the transfer training program of general practitioners under the tutorial system, the trainees have significantly improved their skills in CPR and clinical practice, and passed the theoretical examination. It is suggested that the training program of general practitioner transfer under the tutorial system can effectively improve the diagnosis and treatment ability of general practitioners.