我国放射科住院医师规范化培训现状的调查与思考

Investigation and reflection on the current situation of standardized residency training for radiology in China

目的通过调查我国放射科住院医师规范化培训(简称住培)的现状及其在不同地区间的差异,分析可能的主要原因,探讨改进的措施,以期为我国放射科住培工作同质化提供参考依据。方法2019年12月通过线上问卷调查形式,对2017年和2018年完成住培的3679名放射科住院医师开展调查。调查范围涵盖我国31个省、自治区和直辖市7大区(东北、华北、华东、华南、华中、西北和西南),共计308个国家级住培放射科专业基地。调查内容主要包括住院医师的基本信息(如年龄、性别、婚姻、学历等)、培训医院等级、结业后工作去向、培训期间年收入以及基于六大核心胜任力的29个培训项目的执行频率和重要性评价等。结果共收回有效问卷1163份(32%),该住院医师群体基本信息中年龄、学历、年收入及毕业后工作去向在不同地区间有显著差异(P<0.05)。在沿海地区如华东和华南,住院医师更趋年轻化(年龄≤30岁)。高学历(硕士研究生和博士研究生)住院医师占比在东北、华北、华东区显著高于其他地区。在华南、华中区住院医师结业后工作去向主要集中于三级甲等医院(约占84.7%)。在年收入方面,华东区住院医师(年收入8万元)高于其他区域。29个培训项目中,有19项在不同地区的执行频率差异有统计学意义(P<0.05),但执行频率最高的CT诊断报告项目是一致的。执行频率排序前9位的为病人照护和知识技能胜任力领域,而沟通合作及职业素养等胜任力的培训频率排序靠后。结论虽然不同地区住院医师的基本信息差异可能会对培训质量产生一定影响,但是这种差异的消除难以在短期内实现。地区间的培训过程存在显著差异是现阶段放射科住培无法同质化的主要原因。未来,我国放射科住培应更多地强调一些软实力,如沟通合作、职业素养等能力的培训。

Objective In this study,we investigated the current situation of residency training in radiology in China and its differences in different regions,so as to explore the possible shortcomings and improvement measures and provide reference for the homogenization management of residency training in China.Methods In December 2019,a questionnaire survey was conducted among 3679 radiology residents from 308 national radiation training bases in seven regions(Northeast,North China,East China,South China,Central China,Northwest and Southwest)covering 31 provinces and autonomous regions in China,who completed standardized residency training in 2017 and 2018.According to the different training areas,the basic information of the residents,such as age,gender,marriage,education(Bachelor,Master or Doctor degree),training hospital level,post-employment orientation and annual income during the training period,and the"implementation frequency"and"importance"of 29 training tasks(based on the six core competencies of the milestone goals in the United States)were examined respectively.Results A total of 1,163 residents(32%)completed the questionnaire within the specified time.There were significant differences in age,education,annual income and post-graduation job destinations among the residents in different regions(all P<0.05).In coastal areas such as East China and South China,the residents were younger(≤30 years old)than other areas.The proportion of residents with advanced education(master’s or doctoral degree)was higher in Northeast China,North China and East China than in other regions.In South China and Central China,the work direction of residents mainly focused on tertiary first-class hospitals(accounting for 84.7%)when they finished the residency training.The annual income of residents in East China was higher than that of other regions.Of the 29 identified training tasks,19 were implemented significantly differently across regions,while the frequency of the most frequently conducted tasks of CT interpretation and reporting was consistent.The top 9 tasks in the frequency were all in the field of patient care and medical knowledge,while the frequency of interpersonal and communication skills and professionalism were lowerranking.Conclusion Although the basic information of residents varies from region to region,there are still significant differences in training quality and homogeneous management between regions.In the future,the standardized training of radiology residents in China should put more emphasis on some"soft"strength,such as the training of"interpersonal and communication skills"and"professionalism ability".