全科医师儿科专业继续教育的混合方法研究:以深圳市龙华区为例

Mixed methods research of pediatric professional training for general practitioners:taking Longhua District of Shenzhen as an example

目的了解深圳市龙华区社区健康服务中心(以下简称“社康”)全科医师既往儿科专业继续教育培训情况,探讨全科医师对未来儿科专业继续教育培训的意愿、需求及建议。方法本研究为混合方法研究。采用目的抽样方法选定深圳市龙华区社康全科医师进行个人深度访谈,对访谈内容录音、转录,使用NVivo软件对访谈内容进行编码,采用主题框架分析法进行资料整理和主题提炼。在定性访谈结果基础上,制定调查问卷,通过电子问卷平台发放。问卷数据采用Excel表格进行统计分析。结果定性研究结果显示,个人深度访谈10名全科医师后信息达到饱和。通过对访谈资料的反复阅读、归纳和分析,共提炼4个主题:①既往儿科培训机会及满意度;②参加儿科培训的意愿;③培训内容、形式、时长需求;④鼓励参加培训的措施。定量研究结果显示,问卷共收回223份,有效问卷219份。150人(68.5%)表示既往没有儿科专业继续教育培训机会或仅有少量培训机会,既往培训存在培训不成体系(39人/66.1%)、课程覆盖面窄(30人/50.8%)、内容脱离临床实践(29人/49.2%)、授课方式单调(27人/45.8%)等问题。210人(95.9%)愿意参加儿科培训。161人(73.5%)希望培训的形式为线上、线下相结合的方式。全科医师在儿童专业培训方面需求较高的是:呼吸(188人/85.8%)、消化(160人/73.1%)、感染(145人/66.2%)、皮肤(136人/62.1%)。结论全科医师既往儿科专业继续医学教育存在培训机会少、培训不成体系等问题。未来需根据全科医师需求,制订系统培训计划和鼓励措施,加强对全科医师的儿科专业培训,提升儿童诊疗能力,促进儿童分级诊疗的实施。

Objective To investigate the past continuing medical education(CME)in pediatrics for general practitioners in community health centers in Longhua District,Shenzhen,so as to explore the willingness,needs and suggestions of general practitioners for CME in pediatrics.Methods A mixed methods research were used in this study.Firstly,the purpose sampling method was used to select general practitioners in community health centers in Longhua District,Shenzhen for personal in⁃depth interviews.The interview contents were recorded and transcribed.The interview contents were coded by NVivo software.Theme frame analysis method was used for data sorting and theme extraction.Based on the results of qualitative interviews,the questionnaire was developed and distributed through the electronic questionnaire platform,and relevant questionnaire data were analyzed by Excel.Results The results of qualitative research showed that after personal in⁃depth interviews with 10 general practitioners,the information reached saturation.Through repeated reading,induction and analysis of the interview data,four themes were extracted:①previous pediatric training opportunities and satisfaction;②willingness to participate in pediatric training;③the demand of training content,form and duration;④measures to encourage participation in training.In terms of quantitative research results,a total of 223 electronic questionnaires were collected,among which there were 219 valid questionnaires.Besides,150(68.5%)general practitioners said that they had no or only a few training opportunities in pediatrics CME in the past.There were some problems in the past CME training,such as unsystematic training(39 practitioners,66.1%),narrow course coverage(30 practitioners,50.8%),the content divorced from clinical practice(29 practitioners,49.2%),monotonous teaching method(27 practitioners,45.8%),etc.And 210(95.9%)general practitioners were willing to participate in pediatric training,and 161(73.5%)hoped that the form of training would be a combination of online and offline.In terms of pediatrics specialty content training needs,the general practitioners had higher demand for respiratory(188 practitioners,85.8%),digestive(160 practitioners,73.1%),infectious(145 practitioners,66.2%)and dermatology(136 practitioners,62.1%)specialty.Conclusion There are still some problems in pediatrics CME,such as few training opportunities,unsystematic training,etc.In the future,we need to formulate systematic training plans and incentive measures according to the needs of general practitioners,to strengthen the pediatric professional training for general practitioners and improve their ability to receive children,in order to promote the implementation of hierarchical medical system for children.