社区全科医师职业发展路径的质性研究

A qualitative study on the career development path of general practitioners in the community

目的分析上海市嘉定区马陆镇社区卫生服务中心不同岗位全科医师职业发展历程及困境。方法于2019年10月,采用典型抽样邀请上海市嘉定区马陆镇社区卫生服务中心不同岗位全科医师代表参与焦点小组访谈。基于饱和原则,最终共邀请5名全科医师,就各自的职业发展历程及困境展开深度访谈,采用Colaizzi 7步分析法对原始资料整理分析。结果社区全科医师职业发展分为入门阶段、经验积累阶段、职业分化阶段3个阶段。入门阶段,发生在刚入职社区卫生服务中心的0~24个月,主要通过社区轮岗熟悉社区卫生服务中心的工作;经验积累阶段,发生在入职社区卫生服务中心工作后的1~5年,全科医师在门诊、病房、家庭医生等不同岗位积累临床经验,同时通过兼职公共卫生条线管理、科教管理、区卫生健康委员会借调工作等积累管理经验;职业分化阶段,发生在入职社区卫生服务中心工作后的5年及以上,可全职担任管理岗,亦可担任临床岗位的同时兼任科组负责人。3位受访者在各自职业发展阶段均有职业发展困惑,主要包括临床技能提升困惑、临床和管理工作平衡困惑。结论在入门阶段需对全科医师加以及时的轮岗培训与科教驱动;职业分化阶段,在注重临床服务能力和管理能力的提升的基础上,还需结合政策发展方向和机构发展需求,引入专业人才分担慢性病管理、行政类工作,以促进全科医师职业成功分化。

Objective To analyze the career development path and related problems of general practitioners(GPs)in the community.Methods In October 2019,general practitioners with different positions working in Malu Town Community Health Service Center of Shanghai Jiading district were selected by typical sampling to participate in a focus group interview.Based on the saturation principle,5 general practitioners were invited for in-depth interviews on their career development and related issues.The original data were analyzed with Colaizzi′s seven-step analysis method.Results The career development of the general practitioners working in the community was divided into three stages:start stage,experience-accumulation stage and career-differentiation stage.In the start stage(the first 0-24 months),the GPs mainly got familiar with the community health service center through community rotation.In the experience-accumulation stage(1-5 years after entering the community health service center),GPs accumulated clinical experience from outpatient clinic,ward,and being family doctor,etc;at the same time,they accumulated management experience through part-time public health management,research and education management,secondment in district health committee.In the professional differentiation stage(5 years or more after entering the community health service center),GPs may take a position of full-time management,or department head.The three respondents had confusion in certain career development stages,including confusion in clinical skills upgrading and balance between clinical and management duties.Conclusions The study suggests that general practitioners in the entry stage need to be given timely clinical rotation as well as research and teaching training;in the career differentiation stage,it is necessary to incorporate upgrading clinical service and management capability with policy development directions and institutional development needs to promote the successful career differentiation of general practitioners.