全科医师临床知识应用和培训需求的主观认知与客观测评的调查分析

Investigation on clinical knowledge and training needs of general practitioners:a perspective of subjective perception and objective assessment

目的调查全科医师对临床知识应用和培训需求的主观认知与客观测评情况并分析其关系。方法该研究为横断面研究。2020年8—12月,以项目组设计的全科医师能力指标体系为基础,邀请上海市长宁区10家社区卫生服务中心的业务主任或医务科负责人进行专家咨询,形成17条临床知识能力评价指标条目。以此为基础,分别对全科医生开展临床知识主观认知(应用和培训需求)和客观测评的调查,分析客观测评得分的影响因素,并采用四象限法对主观认知与客观测评得分的关系进行分析。结果共136名全科医师参与研究,年龄(39.25±5.90)岁,职称以主治医生为主(67.65%,92/136),学历以本科为主(88.20%,122/136)。主观认知方面,17个临床知识条目的日常应用得分为(1.55±0.21)分,培训需求得分为(1.65±0.09)分。客观测评总分为(74.21±14.0)分,年龄越高(OR=1.25,95%CI:1.14~1.37)、学历越高(OR=2.11,95%CI:1.57~2.83)、执业年限越长(OR=1.16,95%CI:1.04~1.30)的全科医师客观测评得分越高(均P<0.05)。糖尿病等内分泌疾病、脑血管疾病、呼吸系统疾病3个指标的客观测评得分最高,同时日常应用频率、培训需求均较高(列于第一象限);常见骨科疾病、常见心理疾病和计划免疫等指标的客观测评得分较低,但其日常应用频率、培训需求均较高(列于第二象限);常见恶性肿瘤、常见皮肤科疾病及健康问题和常见耳鼻喉科等指标的客观测评得分较低,日常应用频率、培训需求也均较低(列于第三象限);安宁疗护与姑息治疗等指标客观测评得分较高,但其日常应用频率、培训需求均较低(列于第四象限)。结论全科医生的临床知识水平与年龄、学历、执业年限相关。全科医师对临床知识的客观测评情况与主观应用频率、培训需求有一定重合与差异,可为相关培训提供参考。

Objective To analyze the clinical knowledge and training needs of general practitioners from subjective perception and objective assessment,and to analyze their relationship.Methods A survey was conducted among general practitioners from community health service centers in Shanghai Changning district from September to December 2020.Based on the general practitioner competency indicator system designed by the project team,17 clinical knowledge competency evaluation indicators were developed through expert consultation,and used for subjective perception and objective assessment of clinical knowledge and learning needs among general practitioners.The influencing factors of objective assessment scores were analyzed,and the relationship between subjective perception and objective assessment scores was analyzed using the four quadrant method.Results A total of 136 general practitioners participated in the study with the mean age of(39.25±5.90)years,most of whom were attending physician(67.65%,92/136)and had undergraduate education(88.20%,122/136).The average daily application frequency score was(1.55±0.21),and the training needs score was(1.65±0.09)for 17 clinical knowledge items;the average objective evaluation score was(74.21±14.0)points.The older the age(OR=1.25,95%CI:1.14-1.37),the higher the educational level(OR=2.11,95%CI:1.57-2.83),and the longer the working years(OR=1.16,95%CI:1.04-1.30)were significantly correlated with the higher objective evaluation scores(all P<0.05).The objective evaluation scores of endocrine diseases such as diabetes,cerebrovascular diseases and respiratory diseases are the highest,and the daily application frequency and learning needs are high(the first quadrant);The objective evaluation scores of common orthopedic diseases,common psychological diseases,and planned immunity indicators were relatively low,but their daily application frequency and learning needs were relatively high(second quadrant).The objective evaluation scores of indicators such as common malignant tumors,common dermatology diseases and health problems,and common ENT diseases were low,and the daily application frequency and learning needs were also low(the third quadrant).The objective evaluation scores of indicators such as hospice and palliative care are relatively high,but their daily application frequency and training needs are relatively low(listed in the fourth quadrant).Conclusions The clinical knowledge levels of general practitioners are correlated with age,education level,and years of practice.There is a certain overlap between the objective evaluation results of clinical knowledge and the frequency of knowledge usage and training needs of general practitioners,and a targeted training mechanism should be established.