混合性评估在上海市郊区社区全科医生能力评估中的应用

Application of mixed assessment of competence of general practitioners in Shanghai suburban communities

2018年12月对上海市某郊区20家社区卫生服务中心的29名全科医生进行临床和教学能力评估,方法采用为期1 d共3个板块共8个站点的混合性评估。参评医生年龄(37.8±4.7)岁,女性占75.9%(22/29)。3个板块中,临床思维能力板块的平均分和合格率最低,为(66.8±9.7)分和75.9%。8个站点中,成人SOAP病历书写的平均分和合格率最低,为(53.8±13.4)分和34.5%。社区工作年限<15年的全科医生儿科门诊接诊得分高于≥15年者[(68.6±10.2)分比(58.5±9.4)分,t=2.787,P<0.05]。不同带教年限、不同职称的全科医生各项得分差异均无统计学意义。基层实践基地的全科医生在临床思维能力板块的平均分(t=2.115)及其中的成人门诊接诊(t=3.410)、临床操作能力板块中的眼底镜及读片(t=3.816)和检耳镜及读片(t=2.286)、临床教学能力板块的平均分(t=2.618)和其中的教学情景演练(t=2.452)及小讲课(t=2.802)均高于非基层实践基地者,差异均有统计学意义(P<0.05)。结果提示混合性评估可作为全科医生能力评估的方法之一。社区教学基地建设虽可以有效提升郊区全科医生的临床和教学能力,但临床思维能力仍普遍较弱。

A pilot mixed assessment method was used to evaluate the clinical and teaching ability of general practitioners(GPs)in a suburban district of Shanghai.In December 2018,29 GPs from 20 community health centers in a suburban district of Shanghai were assessed by a mixed method consisting of 3 domains and 8 stations for one day.The average age of GPs was(37.8±4.7)years and 22 were females(75.9%).In 3 domains,the average score(66.8±9.7)and qualified rate(75.9%)of clinical thinking abilities were the lowest.In 8 stations,the average score[(53.8+13.4)points]and qualified rate(34.5%)of adult SOAP medical record writing station were the lowest.The average score of pediatric outpatients consult station of GPs with<15 years of community work experience was higher than that of GPs with>15 years of work experience[(68.6+10.2)vs.(58.5+9.4),t=2.787,P<0.05].There was no significant difference in the scores among GPs with different teaching years and titles.The average scores of clinical thinking ability domain(t=2.115)and adult outpatient consult station(t=3.410);in the clinical operation ability domain the ophthalmoscopy and readings(t=3.816)and otoscopy and reporting station(t=2.286);clinical teaching abilities(t=2.618)and simulated educational situation station(t=2.452)and mini lectures station(t=2.802)of GPs in the community teaching base were higher than those in non-community teaching base(all P<0.05).Mixed assessment method can be used as one of the important means for GPs′ability assessment.The community teaching bases have effectively improved the clinical and teaching abilities of GPs in suburban areas,however,the clinical thinking abilities of them are still weak.