中国全科医师岗位胜任力评价指标体系研究现状:一项系统综述

Current status of post competency evaluation index system for general practitioners in China:a systematic review

目的探讨中国全科医师岗位胜任力评价指标体系研究现状,归纳、总结中国全科医师岗位胜任力评价指标体系。方法该研究为系统综述。以“全科医生”“全科医师”“家庭医生”“住院医师规范化培训”“胜任力模型”“岗位胜任力”“评价体系”等作为中文检索词,以“general practitioner”“family doctor”“competency”“core capability”“assessment”“evaluation”等作为英文检索词,并附加自由词,检索中国知网、万方数据知识服务平台、维普中文期刊服务平台、SinoMed、PubMed等数据库,检索时限为建库至2022年10月。严格依据纳入标准与排除标准,由2名研究员独立进行文献筛选。采用Ekman质量评价工具对纳入的文献进行质量评估。应用Excel表格提取资料信息,包括文献的基本信息、指标体系的基本信息和指标内容。结果共检索到相关文献1284篇,最终纳入33项研究。33项研究共应用了15种研究方法,应用3种及以上方法的有28项(84.8%)。验证信效度良好的研究14项(42.4%),计算了指标权重的研究17项(51.5%)。应用的理论基础涉及12种,有20项(60.6%)研究借鉴了国外成熟的胜任力模型,14项(42.4%)结合了全科医师的工作分析和岗位要求,11项(33.3%)进行了政策文件解读。通过内容分析法得到初始指标1537个,剔除重复指标后得到1268个指标,合并归纳后得到一级指标6个、二级指标31个。一级指标中“患者照护能力”出现的频率最高[36.4%(462/1268)],该维度下出现频率最高的二级指标是“掌握医学理论知识”,其次是“以社区为导向的照顾能力”“常见病、多发病的治疗和随访”;体现全科医疗特点的是“以家庭为单位的照顾能力”和“以人为中心的照顾理念”。“职业精神与道德素养”[(16.3%(207/1268)]、“临床带教和学习能力”[14.3%(181/1268)]、“基于系统的实践能力”[(11.1%(141/1268)]出现频率分别列在一级指标中的第2、3、4位。“基本公共卫生服务能力”[11.0%(139/1268)]出现频率列在一级指标的第5位,其二级指标“社区重点人群健康管理”体现了对居民全生命周期的照顾理念和连续性的全科医学基本原则。“人际关系与沟通能力”[10.9%(138/1268)]出现频率列在一级指标的第6位。结论中国全科医师岗位胜任力指标评价体系相关研究较多,但有待深入,研究采用的方法较多、理论基础丰富、具有中国特色。该研究归纳、总结出了包括6个一级指标、31个二级指标的中国全科医师岗位胜任力评价指标体系,该体系体现了全科医学的基本原则和特色。

Objective To explore the current status of the post competency evaluation index systems of Chinese general practitioners(GPs),and to summarize the post competency evaluation index systems of GPs in China.Methods This study was a systematic review.We searched China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform,China Science and Technology Journal Database(CQVIP),SinoMed,PubMed and other databases using"general practitioner"or"family doctor"or"standardized training for residents"or"post competency"or"evaluation system"or"core capability"or"assessment"or"evaluation"etc.as search terms and adding free words.The search was conducted from data establishment to October 2022.Literature screening and data extraction were carried out independently by 2 researchers using strict inclusion and exclusion criteria.The Ekman quality evaluation tool was used to evaluate the quality of the included literature.Excel was used to extract data information,including basic information of literatures,basic information of index systems and index content.Results A total of 1284 literatures were retrieved and 33 studies were included.A total of 15 research methods were used,and 28(84.8%)applied 3 or more methods.There were 14 studies(42.4%)with good reliability and validity,and 17 studies(51.5%)with index weights.There were 12 applied theoretical bases,of which 20 studies(60.6%)used mature foreign competency models as a reference,14 studies(42.4%)combined the job analysis and position requirements of GPs,and 11 studies(33.3%)interpreted policy documents.The content analysis method yielded 1537 initial indicators,1268 indicators after eliminating repeated indicators,and 6 first-level indicators and 31 second-level indicators after combining and summarizing.Among the first-level indexes,"patient care"appeared most frequently(36.4%(462/1268));the secondary index with the highest frequency in this dimension was"master medical theoretical knowledge"followed by"community-oriented care ability"and"treatment and follow-up of common and frequently-occurring diseases";the indicators"family-based care ability"and"human-centered care concept"reflected the characteristics of general medical practice.The frequency of"professional spirit and moral quality"(16.3%(207/1268)),"clinical teaching and learning ability"(14.3%(181/1268))and"system-based practical ability"(11.1%(141/1268))ranked second,third and fourth among the first-level indicators respectively.The frequency of"basic public health service ability"(11.0%(139/1268))ranked the fifth,and the secondary indicator"health management of key community groups"reflected the concept of the whole life cycle of residents and the basic principle of continuity of care in general medicine.The frequency of"interpersonal and communication skills"(10.9%(138/1268))ranked sixth.Conclusions There have been numerous researches on the post competency index evaluation system of GPs in China,but more research is still needed.There are many research methods with rich theoretical basis and Chinese characteristics.This study summarized the post competency evaluation index systems of GPs in China,generalized 6 first-level indicators and 31 second-level indicators that reflect the basic principles and characteristics of general medicine.