我国专科医师培养与准入的现状、问题与对策

Training and Admittance of Medical Specialist in China: Current Situation, Problems and Strategies

目的 从医学教育制度、住院医师培养、执业医师管理的角度 ,分析我国专科医师培养和准入管理的现状与问题 ,提出解决问题的思路与对策 ,为建立我国专科医师制度提供科学依据。 方法 运用广义循证医学原理和方法 ,回顾性调查 1996～ 2 0 0 2年间我国医学教育招生情况、办学形式、专业构成、住院医师培养和专科医师培养的现状 ,提取数据后分析所存在的问题 ,提出对策和建议。 结果 截止 2 0 0 1年 ,我国共有医师 16 4万人。 1996～ 2 0 0 2年 ,医学专业本科及大专招生比例稳步上升 ,中专医学专业逐年下降。已有 30余万人参加医师资格考试 ,其中本科学历不足 15 %。约 5 2 0 0 0人已完成规范化住院医师培养 ,6 570 0余人正在接受培训。国内尚无规范的专科医师培养和准入制度。 结论 医学教育学制和办学形式多样 ,住院医师培养的软、硬件条件不成熟和缺乏专科医师培养体系是我国医师培养与管理的三大难题 ,也是导致我国医师队伍整体水平不高的主要原因。卫生部、教育部和财政部已联合立项资助“中国专科医师培养和准入制度研究” ,相关研究结果将陆续推出。

Objective To provide scientific eviden ce for the establishment of medical specialist system in China by analyzing the current situation and problems, putting forward solution thoughts and countermea sures, from the angle of medical education system, residency training program an d licensed physician management. Methods Principle and method of evidence-based medicine were adopted. Retrospective investigation was conduc ted to gain information from 1996 to 2002 about enrollment and running form of m edical education, current situation of residency and specialist training. Data w as then extracted and analyzed for the benefit of corresponding countermeasures. Results By the end of 2001, there were totally 1 640 thousan d physicians in China. The enrollment proportion of undergraduate and junior col lege student steadily increased from 1996 to 2002, while the situation quite the reverse as for medical secondary school. More than 300 thousand have taken part in the licensure exam, among whom less than 15% had university diploma. About 5 2 000 doctors have already completed the residency training program, and 65 700 are being trained. Standardized system of specialist training and admittance is not available in China. Conclusion It was three main tough pr oblems that mainly account for the poor quality of doctor as a whole in China, w hich include diversity of educational system, insufficient software and hardware of residency training program, and absence of specialist training system. An al lied funded program of 'research on medical specialist training and admittance ' has been on the way, and research outcomes will be published soon.