基层卫生服务关于助理全科医师岗位能力要求的探索

Exploration of Primary Health Services on the Competency Requirements for Assistant General Practitioner Positions

目的:构建助理全科医生(基层)岗位胜任力的评判指标体系,为我国目前基层全科医生的培养、考核、评价,提供一定的研究基础。方法:采用目的抽样法遴选2022年1—4月高等医学院校、各地市卫生行政管理部门、医院(三级、二级)、社区卫生服务机构(区级)的35名咨询专家。运用Delphi法和文献研究法对助理全科医生(基层)岗位胜任力评价指标体系加以确定;运用层次分析法计算各指标权重。结果:建立了助理全科医生(基层)岗位胜任力评价指标体系,其中一级指标、二级指标、三级指标分别为4个、11个、54个。一级指标包括人文执业、教育学习、公共卫生服务、基本医疗服务,权重分别为0.131 4、0.092 1、0.296 2、0.477 8。二级指标中,组合权重排在后3位的为科研教学(0.0185)、人文关怀(0.032 7)、职业素养(0.033 1),排在前3位的为临床诊疗(0.195 7)、综合医疗服务(0.194 6)、预防服务(0.182 8)。三级指标中,组合权重排在后3位的为医学经济决策(0.001 5)、批判性思维(0.001 9)、培训与教学评估/评价(0.003 1),排在前3位的为首诊与转诊服务(0.067 2)、多发病/常见病的诊断与处理(0.050 8)、康复医疗服务(0.040 8)、家庭医疗及健康评估服务(0.040 8)。结论:助理全科医生岗位胜任力评价指标体系(基层)的构建,让评价、考核、培养基层全科医生有据可依,该体系的有效性仍需后续继续开展实证研究。

Objective:To construct a judging index system for the competency of assistant general practitioner(primary care)positions to provide some research basis for the training,assessment and evaluation of current primary care doctors in China.Methods:A purposive sampling method was used to select 35 consultants from higher medical schools,local municipalities’health administration departments,hospitals(tertiary and secondary),and community health services(district level)for January to April 2022.The index system for evaluating the competency of assistant general practitioners(primary care)was determined by using the Delphi method and literature research method,the weight of each index was calculated by using the hierarchical analysis method.Results:A competency evaluation index system for assistant general practitioners(primary care)positions was established,with 4,11 and 54 primary,secondary and tertiary indicators,respectively.The primary indicators include humanistic practice,education and learning,public health services,and basic medical services,with weights of 0.1314,0.0921,0.2962,and 0.4778,respectively.Among the secondary indexes,the last three in combination weight were research and teaching(0.0185),humanistic care(0.0327),and professionalism(0.0331),and the top three were clinical treatment(0.1957),comprehensive medical services(0.1946),and preventive services(0.1828).Among the three levels of indicators,the last three in terms of portfolio weight were medical economic decision making(0.0015),critical thinking(0.0019),and training and teaching assessment/evaluation(0.0031),and the top three were first visit and referral services(0.0672),diagnosis and management of multiple/common illnesses(0.0508),rehabilitation medical services(0.0408),and family medicine and health assessment services(0.0408).Conclusion:The construction of the assistant physician job competency evaluation index system (grimary care)allows the evaluation,assessment,and training of primary care physicians,based on evidence,and the effectiveness of the system still needs to be followed by continued empirical research.