武汉市全科医师规范化培训基层实践基地建设情况及培训现状调查

Survey on status qua of community practice bases for general practice residency training in Wuhan city

目的了解武汉市全科医师规范化培训(规培)基层实践基地建设情况及规培现状与主要问题,为优化临床学习和社区实践提供参考。方法本研究为横断面调查。2021年3月4日至6月30日,选取武汉市11个具有全科规培资格的三甲医院所属的12个全科基层实践基地的主任、教学秘书及截至2021年6月30日于上述基地规培≥5个月且尚未结业的123名全科规培学员及在职的全部41名指导教师作为研究对象。查阅文献自行设计调查问卷,向各基层实践基地主任或教学秘书调查基层实践基地基本条件及师资力量情况,调查指导教师目前基地工作现状及对工作和学员的满意度,调查全科规培学员的一般情况、对基层实践基地的教学满意度、教学存在的主要问题、对未来工作预期等。结果问卷回收率100.0%。12个全科基层基地的建设条件满足《全科专业住院医师规范化培训基地标准(2019年修订版)》对社区医院规模的要求,但科室配置中9个基地未配有精神科;配有文献检索系统的有7个基地;12个基地均设有教学秘书,但仅1个设有全职教学秘书;12个基地与上级医院均建立了定点协助关系,但部分基地和上级医院之间交流频次较少。指导教师年龄40~50岁者较多,占68.3%(28/41),90.2%(37/41)的指导教师参与了疫情防控工作,认为带教工作与职称晋升相关者占36.6%(15/41),87.8%(36/41)的指导教师对带教相关工作绩效为满意,85.4%(35/41)的指导教师对学员学习情况满意。92.7%(114/123)的全科规培生对基层基地规培教学满意,全科医学专业型硕士学员与社会化学员对目前基层实践基地规培教学满意度差异有统计学意义(χ^(2)=6.92,P=0.032)。经过基层实践基地轮转后自认为能胜任未来临床工作的学员由39.8%(49/123)上升至60.2%(74/123)。结论武汉地区的所有基层实践基地的社区医院规模、负责人资质、师资队伍、与上级医院建立定点协助关系等主要指标已达到基本要求,但对教师的评价及激励政策仍需完善,学员的全科门诊接诊实践机会应增加,科研教学需加以重视,此外,目前基层指导教师工作繁忙,规培学员的管理仍需加强。

Objective To survey the status quo of community practice bases for general practice residency training in Wuhan city.Methods A questionnaire survey was conducted in 12 community general practice training bases affiliated to 11 tertiary hospitals in Wuhan city from March to June 2021.A total of 123 general practice residents and 41 instructors participated in the survey using the different questionnaires.The contents of questionnaires included the basic conditions of the training base and the current status of training at community base,as well as their satisfaction on the program and related problems.The statistical analysis was performed with SPSS software.Results The conditions of the 12 primary practice bases met the requirements of the Standard for Standardized Training Bases for General Practice Residents(2019 Revision)in terms of size of community hospitals,qualification of the person in charge and faculty team.The survey showed that only 3 bases had psychiatric department;7 bases had literature retrieval system;all 12 bases had a teaching secretary,but only 1 had a full-time teaching secretary;all 12 bases had established formal assistant relationship with higher-level hospitals,but the frequency of communication was low in some bases.Survey also showed that 68.3%(28/41)instructors were aged 40-50 years;90.2%(37/41)of instructors participated in epidemic prevention and control;36.6%(15/41)thought that instructing work was related to professional promotion;87.8%(36/41)of instructors were generally satisfied with the work performance.Most of trainees(92.7%,114/123)were satisfied with the training at the primary base,and there was a difference in satisfaction degree between trainees with different enrollment sources(χ^(2)=6.92,P=0.032).The proportion of trainees with confidence for future career increased from 39.8%(49/123)before training in community bases to 60.2%(74/123)after training.Conclusions The survey shows that primary practice bases for general practice residency training in Wuhan have met the basic requirements;however,the evaluation and motivation of teachers need to be improved,the opportunities for trainees to practice in general outpatient clinics should be increased,research and teaching need to be emphasized,and the management of trainees needs to be strengthened.