基于CIPP模型的全科基层实践基地指导医师门诊教学能力提升项目评价研究

Evaluation of the Improvement Programme on Ambulatory Training Ability of Community Preceptors in Practice Base of General Practice Based on the CIPP Model

背景基层实践基地指导医师的门诊教学能力是关系到全科住院医师规范化培训质量的重要因素。近年来,国内多个地区开展了社区全科师资培训项目,但缺少采用综合方法评价项目实施情况的相关研究。目的探明浙江大学医学院附属第二医院“分层督导式教学门诊”培训项目的实施现状与阻碍因素,为制定问题导向的应对策略提供理论参考和策略支持。方法2021年10月—2022年1月,基于CIPP模型,使用内容分析法、专家会议法、深度访谈法、专家评分法、问卷调查法等多种研究方法,从背景、输入、过程和成果4个方面对浙江大学医学院附属第二医院全科医学科“分层督导式教学门诊”培训项目的实施情况进行系统评估。结果政策文件分析和文献回顾结果表明,社区师资培训是受到国家卫生政策大力支持的医疗人才培养计划,且目前在国内已有广泛的实践基础。浙江大学医学院附属第二医院全科医学科“分层督导式教学门诊”培训制度基本涵盖了社区全科师资培训的内容和过程规范,基层实践基地制定的考核和激励制度缺乏实施细则,2021年5月—2022年1月,10名基层指导医师共完成了57人次社区教学门诊,每人参加4~7轮次,人均门诊教学能力评价得分从第1轮次的(78.6±5.7)分提升至第7轮次的(87.8±4.5)分。基层指导医师和全科住院医师对“教学场地与设备”“培训形式”“培训内容”及“培训效果”的满意度均超过90%,但基层指导医师对“教学激励制度”的满意度仅为20%。参与项目培训的受访者反映目前存在的主要阻碍因素是“教学相关激励制度不健全”“教学门诊患者招募困难”与“培训内容适用性不足”。结论“分层督导式教学门诊”培训项目初期取得了较为理想的结果,但仍有较大的提升空间,在下一阶段的培训中需要结合基层实践基地的实际情况制定相应的策略,以持续地改进培训质量。

Background The training ability of community preceptors is an important factor related to the quality of standardized training for general practitioners(GPs).In recent years,training programs for community GP preceptors have been conducted in several regions of China,but no research evaluated the implementation of these programs using a comprehensive approach so far.Objective To explore the current situation and obstacles to the implementation of training program of Graded-Supervised Ambulatory Training by the Second Affiliated Hospital of Zhejiang University School of Medicine,and provide theoretical references and strategic support for the development of problem-oriented countermeasures.Methods From October 2021 to January 2022,the implementation status of Graded-Supervised Ambulatory Training program by the Second Affiliated Hospital of Zhejiang University School of Medicine was systematically evaluated based on CIPP model from four aspects of context,input,process and product,using multiple research methods such as content analysis,expert panels,in-depth interviews,expert rating,and surveys.Results The results of policy document analysis and literature review indicated that community preceptor's training is strongly supported by national health policies,and has been widely implemented in China.The training system developed by the Second Affiliated Hospital of Zhejiang University School of Medicine basically covers the content and process of community preceptor training programme,while the assessment and incentive system developed by the community lacks of detailed instructions.From May 2021 to January 2022,ten community preceptors completed 57 times of ambulatory training,each attending four to seven times.The average score of ability of ambulatory training increased from(78.6±5.7)in the first round to(87.8±4.5)in the seventh round.The satisfaction rates of“site and equipment of training”“training forms”“content of training”and“effect of training”were over 90%among community preceptors and GP residents,yet the satisfaction rate of“proper incentives”among community preceptors was only 20%.Participants reported that the main barriers at present were“imperfect incentive system”“difficulties in recruiting appropriate patients”and“inapplicable training content”.Conclusion In the initial stage,the Graded-Supervised Ambulatory Training programme has achieved desired results in many aspects,but there is still room for improvement.In the next stage of training,countermeasures should be formulated based on the actual situation of the community practice base to continuously improve the quality of training.