县域医疗卫生服务共同体背景下规范化培训的全科医师对发展亚专长认知的质性研究

Survey on the views of general practitioners on developing special interests in the context of county medical community

目的调查县域医疗卫生服务共同体(医共体)背景下规范化培训(规培)的全科医师对发展亚专长的看法。方法该研究为横断面调查。2019年11—12月,用自行设计的问卷对浙江大学医学院附属第一医院全科住院医师规培基地的49名规培全科医师进行问卷调查,了解其对发展亚专长的认知,并对14名规培全科医师进行定性访谈,了解其对亚专长全科医师的理解以及希望或不希望发展亚专长的原因。结果 49名规培全科医师均完成了问卷调查,问卷有效率100.0%。所有调查对象均来自县域医共体单位,其中91.8%(45/49)的全科医师表示希望发展亚专长,79.6%(39/45)的全科医师选择发展一个亚专长,希望发展的亚专长方向前3位依次为:内分泌、消化、心血管。对希望和不希望发展亚专长的全科医师分别进行访谈的结果显示,全科医师对发展亚专长认识不足,无法正确区分亚专长全科医师和专科医师;对于亚专长全科医师的地位、培训模式、考核标准仍有困惑,对于发展亚专长的需求多来源于患者诊疗需求、所在单位覆盖人群和就诊范畴、同行建议和个人兴趣等。结论规培全科医师有发展亚专长的意愿,但对亚专长的认识不足,尚需要进一步明确亚专长全科医师的定位,完善培养模式和考核认证方式。

Objective To explore the views of general practitioners(GPs)on developing special interests in the context of the county medical community.Methods A survey was conducted using self-designed questionnaire from November and December 2019,among 49 general practice residents trained in the First Affiliated Hospital of Zhejiang University School of Medicine.Meanwhile,structured interviews were undertaken with 14 general practice residents.Results Forty-nine valid questionnaires were collected with a response rate of 100.0%.All participants were from the county medical community units.The survey showed that 91.8%(45/49)of respondents were willing to develop special interests and 79.6%(39/45)chose one subject,and the top three subjects were endocrinology,gastroenterology and cardiology.The structured interviews demonstrated that most participants did not understand meaning of general practitioners with special interests(GPwSIs)clearly and were unable to distinguish GPwSIs from specialists;they were confused about the status,training mode,and assessment standards of GPwSIs.The interviews also showed that the demand for developing special interests for them was derived from the needs of patients for diagnosis and treatment,the target population of health care services,peer advice and personal interests.Conclusions Most general practice residents are willing to develop special interests,and internal medicine is the first choice;however,their understanding of the GPwSIs is insufficient.The survey suggests that the position,training model,assessment and certification of GPwSI need to be further clarified.