全科住院医师规范化培训毕业学员的岗位胜任力调查

Survey on post competency of general practitioners with completion of residency training

目的了解全科住院医师规范化培训(住培)毕业学员的岗位胜任力情况。方法该研究为问卷调查。于2022年1至3月采用单纯随机抽样的方法抽取于苏州市立医院完成全科住培的2009至2021届学员,对其进行问卷调查,进一步对其中仍从事全科医疗的学员进行岗位胜任力调查。自行设计问卷,内容包括学员的基本情况,与岗位胜任力相关的临床、公卫、人文、科研教学能力的相关问题。每项能力满分100分,分为4个等级,即A级86~100分、B级70~85分、C级55~69分、D级0~54分,评分为A级者认为该项能力优秀。统计各项能力达优秀学员的占比。结果(1)基本情况:调查有效问卷回收率为96.3%(157/163)。纳入分析的157名毕业学员中男性62名(39.5%),毕业后工作单位属性主要是城市社区卫生服务机构[78名(49.7%)],所在岗位属性大部分仍为全科医疗[119名(75.8%)]。(2)临床诊疗能力:毕业学员的病史采集、基本药物使用、常见病多发病诊疗以及慢性非传染性疾病管理能力自评达优秀者占比均在半数以上,分别为58.8%(70/119)、57.1%(68/119)、54.6%(65/119)以及54.6%(65/119);基于循证的临床决策、体格检查、检查解读、转诊服务、家庭医疗服务、康复服务、急救以及初步的心理咨询与治疗能力达优秀者占比均偏低,分别为43.7%(70/119)、42.9%(52/119)、38.7%(46/119)、37.8%(45/119)、33.6%(40/119)、22.7%(27/119)、21.0%(25/119)以及16.8%(20/119)。(3)基本公共卫生服务能力:毕业学员的基本公共卫生服务相关能力自评优秀者均不足半数,达优秀学员占比从高到低依次为人群与个人健康教育能力[38.7%(46/119)]、疾病的预防控制与保健能力[33.6%(40/119)]、对签约患者的健康管理能力[33.6%(40/119)]、重点和特殊人群保健能力[26.1%(31/119)]、协助处理突发公共卫生事件能力[25.2%(30/119)]、临床相关传染病的处理能力[22.7%(27/119)]、基于流行病学的社区诊断能力[22.7%(27/119)]、领导社区健康的能力[21.0%(25/119)]。(4)人文素养能力:毕业学员人文素养的各项能力自评优秀者均达半数以上,达优秀学员占比从高到低依次为尊重患者及保护其隐私[82.4%(98/119)],对患者富有责任感[73.9%(88/119)],理解患者的需求[61.3%(73/119)],与患者、家属及照顾者的有效沟通能力[55.5%(66/119)],以及与患者的合作能力[52.1%(62/119)]。(5)科研教学能力:毕业学员达优秀者占比从高到低依次为持续学习创新能力[47.9%(57/119)]、全科住培带教能力[10.9%(13/119)]、查阅文献能力[10.1%(12/119)]。结论我院全科住培毕业学员岗位胜任力不同组分达优秀者占比不同,临床诊疗和人文素养能力较强,而基本公共卫生服务和科研教学能力尚有待加强。

Objective To survey the post competency of general practitioners who completed residency training in Suzhou Municipal Hospital.Methods A questionnaire survey on post competency of general practitioners was conducted from January to March 2022.General practitioners who completed standardized residential training in Suzhou Municipal Hospital from 2009 to 2021 were randomly selected for the survey.The self-designed questionnaire included the basic information and post competency in terms of clinical,public health,research and teaching abilities as well as medical ethics and humanism.A self-evaluation was also performed and the abilities were graded(A 86-100,B 70-85,C 55-69,D 0-54),and grade A was classified as excellent.Results A total of 163 questionnaires were distributed and 157 valid ones were collected with a recovery rate of 96.3%.Among 157 respondents 62(39.5%)were males.The participants mainly worked in urban community health service institutions(78(49.7%)),and most of them worked as general practice(119(75.8%)).For the self-assessment of clinical skills,the proportion of respondents with excellent abilities in history taking,basic drug use,diagnosis and treatment of common diseases,and chronic disease management was 58.8%(70/119),57.1%(68/119),54.6%(65/119)and 54.6%(65/119),respectively.The proportion of respondents with excellent abilities in evidence-based clinical decision making,physical examination,tests interpretation,referral services,family medical services,rehabilitation services,first aid,and psychological counseling and treatment was 43.7%(70/119),42.9%(52/119),38.7%(46/119),37.8%(45/119),33.6%(40/119),22.7%(27/119),21.0%(25/119),and 16.8%(20/119),respectively.For the self-assessment of basic public health service ability,the proportion of respondents with excellent abilities in health education,disease prevention and control,health management,health care for key and special groups,handling public health emergencies,management of infectious diseases,epidemiology-based community diagnosis and community health leadership was 38.7%(46/119),33.6%(40/119),33.6%(40/119),26.1%(31/119),25.2%(30/119),2.7%(27/119),22.7%(27/119),and 21.0%(25/119),respectively.For humanistic literacy,the proportion of respondents with excellent abilities in privacy protection,sense of responsibility for patients,understanding patients′needs,effective communication and cooperation with patients was 82.4%(98/119),73.9%(88/119),61.3%(73/119),55.5%(66/119)and 2.1%(62/119),respectively.For research and teaching,the proportion of respondents with excellence abilities in continuous learning and innovation,training and teaching and literature retrieval was 47.9%(57/119),10.9%(13/119),10.1%(12/119),respectively.In addition 56.3%(67/119)of respondents were interested in scientific research,23.5%(28/119)had published articles as the first author or correspondence author,and only 6.7%(8/119)had scientific research projects in the last 5 years.Conclusion The post competency of general practitioners who received standardized residency training in our hospital varies in different aspects,their abilities in basic public health service,scientific research and teaching are relatively low,which need to be strengthened.