全科住院医师规范化培训师资开展教学门诊的意愿及影响因素研究

The Willingness and Influencing Factors of Standardized Training Instructors for General Practitioners to Conduct Teaching Clinics

背景全科住院医师规范化培训(以下简称住培)师资开展规范的教学门诊是培养合格全科医生的关键环节,2021年7月中国医师协会组织专家修订了《全科专业住院医师规范化培训全科教学门诊规范(试行)》,全国各全科住培基地均参照此规范开展教学门诊。然而现阶段各住培基地教学门诊的实施仍处于探索阶段,且重视程度不足,教学门诊质量不高、开展形式不规范现象普遍存在。目的了解全科住培师资开展教学门诊的意愿和影响因素,并分析开展教学门诊的难点与困惑,提出思考与建议。方法于2021年10月—2023年11月,以参加广东省省级全科住培普通师资培训班、骨干师资培训班的全科住培师资为调查对象(n=1003)。采用自行设计的问卷对纳入师资进行调查,内容涉及师资的基本情况、工作情况及全科教学门诊带教情况。通过“问卷星”平台制作电子问卷,并实现问卷的线上发放和回收。结果全科师资的平均年龄为(40.7±14.1)岁,724名(72.18%)师资所在机构开设了全科教学门诊,792名(78.96%)有带教意愿,710名(70.79%)无带教经验,904名(90.13%)自评带教能力为60~89分,583名(58.13%)未接受过全科教学门诊师资培训,462名(46.06%)期望以多种类型培训相结合的形式开展师资培训,分别有417名(41.58%)和309名(30.81%)认为全科教学门诊的教学难点是指导全科住院医师在全科门诊独立接诊患者和分层教学,377名(37.59%)认为最难实现的教学目的是指导全科住院医师掌握全科临床思维、提高其临床决策能力,216名(21.54%)认为全科住院医师最需要的培训内容是问诊技巧,456名(45.46%)认为所在机构未开展/不愿意开展教学门诊的原因为缺乏时间。多因素Logistic回归分析结果显示,所在机构开设全科教学门诊情况、带教经验、自评带教能力、接受全科教学门诊师资培训情况是全科师资教学门诊带教意愿的影响因素(P<0.05)。结论大部分全科住培师资愿意开展全科教学门诊,但存在带教经验、带教培训、带教能力不足等困难。建议优化和规范全科教学门诊、加强全科教学门诊师资的全科理念培训、强化带教激励措施、完善住培师资监督和反馈机制,以提升全科教学门诊质量。

Background The implementation of standardized teaching clinic activities by the faculty of standardized training of general practice residents(hereinafter referred to as residency training)is a key link in the cultivation of qualified general practitioners.And in July 2021,the Chinese Physicians'Association organized experts to revise the Specification for General Practice Teaching Clinic for Standardized Training of Residents in the Specialty of General Practice(for Trial Implementation),which is referenced by all the residency training bases of general practice across the country to carry out the teaching clinic.However,at this stage,the implementation of teaching clinic in each residency training base is still in the exploratory stage,and the degree of attention is insufficient,and the phenomenon of low quality and irregularity in the form of teaching clinic prevails.Objective To understand the current situation and influencing factors on the willingness of general practice residency faculty to conduct teaching clinics,not only to analyze the difficulties and confusions in conducting teaching clinics,but also provide reflections and recommendations.Methods From October 2021 to November 2023,a survey was conducted among general practitioners who participated in the provincial-level general practice residency training programs for regular and key instructors in Guangdong Province.A self-designed questionnaire was used to collect data from the included instructors,covering their basic information,work situation,and their willingness to teach.The electronic questionnaire was created using the"Questionnaire Star"platform,which also facilitated the online distribution and collection of the survey.Results The average age of general practice faculty was(40.7±14.1)years,724(72.18%)faculty members'institutions had general practice teaching clinics,792(78.96%)had a desire to teach,710(70.79%)had no experience in teaching,904(90.13%)had self-assessed their competence in teaching as a score of 60-89,and 583(58.13%)had received no general practice teaching clinic faculty training,462(46.06%)expected faculty training to be conducted in the form of a combination of multiple types of training,417(41.58%)and 309(30.81%),respectively,believed that the teaching difficulty of general practice teaching clinics was to instruct general practice residents to independently receive patients in the general practice clinic and to teach in a tiered manner,and 377(37.59%)believed that the most difficult teaching objective to achieve was to instruct general practice residents in general practice clinical thinking and improve their clinical decision-making skills,216(21.54%)believed that the most needed training component for general practice residents was consultation skills,and 456(45.46%)believed that the reason their institution did not/would not conduct a teaching clinic was lack of time.Also,the results of the multifactorial logistic regression analysis showed that the availability of general practice teaching clinics at the institution where they are located,experience in teaching,self-assessment of teaching competence,and acceptance of faculty training in general practice teaching clinics were the factors influencing the willingness to teach in general practice faculty teaching clinics(P<0.05).Conclusion Most of the general practice resident training faculty are willing to carry out general practice teaching clinics,but there are difficulties such as insufficient experience in teaching,training in teaching,and ability in teaching.So it is recommended to optimize and standardize general practice teaching clinics,strengthen the training of general practice concepts for general practice teaching clinic faculty,strengthen incentives for teaching,and improve the monitoring and feedback mechanism for resident faculty in order to improve the quality of general practice teaching clinics.