基于模块化教学的基层全科医生临床能力培训模式效果评价

Effectiveness of modular teaching program in clinical competence training for community general practitioners

目的探讨模块化教学在基层全科医生临床能力培训中的应用效果。方法该研究为横断面研究。于2022年9月至2023年4月,对来自上海市黄浦区所有10家社区卫生服务中心的20名全科医生进行140学时的基于模块化教学的临床能力培训。以20名已完成培训课程的全科医生为培训组,26名拟参加下一批培训课程的全科医生为未培训组,于2023年5月进行临床能力测评,测评内容包括理论测试和临床技能评估。比较两组全科医生在临床能力测评中的得分和培训组全科医生的满意度调查,评价培训效果。结果46名全科医生中,女性33名(71.7%),年龄27~47(37±6)岁,从事全科医学工作年限2~25(9.4±5.5)年,31名(67.4%)参加过全科住院医师规范化培训,31名(67.4%)为签约家庭医生。46名全科医生测评总分得分(69.7±9.6)分,其中理论测评得分(68.9±8.6)分,临床技能测评7项得分(69.8±10.6)分。培训组全科医生总分和单项得分均高于未培训组(均P<0.05)。多重线性回归模型显示,在校正了性别、年龄、学历、职称、全科工作年限、是否参加过全科住院医师规范化培训和是否为签约家庭医生后,与未培训组相比,培训组全科医生的病史采集、儿科接诊、留置胃管、腹腔穿刺及总分得分均更高,差异有统计学意义(均P<0.05)。在理论测试、神经系统查体、SOAP病历书写和小讲课方面,培训组和未培训组全科医生得分差异无统计学意义(均P>0.05)。20名培训组全科医生中对培训项目的总体满意度评分为(4.3±0.7)分,其中对培训课程满意度评分为(4.3±0.6)分,对师资满意度评分为(4.3±0.7)分,对组织安排工作满意度评分为(4.3±0.7)分。85%(17/20)全科医生认为此次培训对自身能力的提升非常有帮助/有帮助,90%(18/20)全科医生认为此次培训对今后的工作非常有帮助或有帮助。结论模块化教学有助于基层全科医生临床能力的提升,尤其是在临床技能方面,得到了全科医生的认可。

Objective To evaluate the application of modular teaching program in the clinical competence training for community general practitioners.Methods This was a cross-sectional study.A 140 teaching hour-modular training program was designed by the authors on the basis of the previous training experience and conducted in clinical competence training for 20 general practitioners(study group)from all 10 community health service centers in Shanghai Huangpu district between September 2022 and April 2023;and 26 general practitioners who planned to participate in the next batch of training courses were enrolled as the control group.The clinical competence assessment was conducted in May 2023,including knowledge level tests and clinical skill assessment.By comparing the scores of clinical competence assessment and satisfaction survey between two groups,the training effectiveness was evaluated.Results Among the 46 general practitioners,33(71.7%)were female,aged 27 to 47(37±6),working in general practice for 2 to 25(9.4±5.5)years,31(67.4%)had participated in standardized residency training for general practice and 31(67.4%)were contracted family doctors.The total score of 46 general practitioners was 69.7±9.6,and 68.9±8.6 for knowledge level and 69.8±10.6 for clinical skills.The total scores and single scores of trained participants were all significantly higher than those of untrained(all P<0.05).The multiple linear regression model showed that after controlling for gender,age,educational background,professional title,years of working in general practice,participation in standardized residency training,and status as a contracted family doctor,the trained participants had significantly higher scores in history collection,pediatric reception,indwelling gastric tube and abdominal puncture(all P<0.05).There was no statistically significant difference in the scores in knowledge level test,nervous system physical examination,SOAP medical record writing,and tutorium between the trained and untrained groups(all P>0.05).Among 20 general practitioners who completed training,the overall satisfaction score of the training program was 4.3±0.7 points,including 4.3±0.6 for the training course,4.3±0.7 for teachers,and 4.3±0.7 for the organization and arrangement;85%of the participants considered the training to be very helpful or helpful for improving their competence,and 90%considered the training to be very helpful or helpful for their future work.Conclusion Modular teaching program is helpful to improve the clinical competence of community general practitioners,especially in clinical skills.