1、全科医师教育培训与评估全科医师教育培训与评估 Training and Assessment for General Practitioners 复旦大学医学院全科医学系复旦大学医学院全科医学系复旦大学附属中山医院全科医学科复旦大学附属中山医院全科医学科祝墡珠教授祝墡珠教授Zhu Shanzhu Faculty of General Practice,FuDan Medicine InstituteDepartment of General Practice,ZhongShan Hospital affiliated to FuDan University背景背景 Background：l据统
2、计，所有到医院就诊的患者中只有据统计，所有到医院就诊的患者中只有5%左右需要左右需要专科医师的诊治，而人群中专科医师的诊治，而人群中8090%的健康问题可的健康问题可以由以全科医师（家庭医师）为骨干的社区卫生服务以由以全科医师（家庭医师）为骨干的社区卫生服务队伍来解决队伍来解决 lAccording to the recent statistics,only 5%of the patients who go to hospital need the health-care from specialists,and 80%90%health problems can be solved by G
3、Ps-based community health-care system l发达国家的实践经验也告诉我们：控制医疗费用，有效利发达国家的实践经验也告诉我们：控制医疗费用，有效利用有限的医疗保险资源的关键措施是发展以全科医师为骨用有限的医疗保险资源的关键措施是发展以全科医师为骨干的社区卫生服务干的社区卫生服务l近近10年来，我们致力于毕业后全科医师的教育培训，探索年来，我们致力于毕业后全科医师的教育培训，探索建立新型的全科医师教育培训与评估模式建立新型的全科医师教育培训与评估模式 lThe experience gained in developed countries reinforces
4、the idea that to develop GPs-based health-care in community setting is a crucial measure to reduce medical costs and make use of the limited resources of Medicare more effectively lIn the recent decade,we have devoted ourselves to training GPs and developing a workable system for GPs training and as
5、sessment in the past decade研究目的研究目的 Research Objective：l在综合性教学医院进行全科医师规范化培训的探索，建立在综合性教学医院进行全科医师规范化培训的探索，建立适应生物心理社会医学模式的新型教学方式，取代专适应生物心理社会医学模式的新型教学方式，取代专科医学以知识和技能掌握为重点、以疾病为中心的传统教科医学以知识和技能掌握为重点、以疾病为中心的传统教学模式学模式lTo develop a new efficient system for standardized GPs training in comprehensive teaching h
6、ospital,corresponding with biological-psychological-social medical pattern and reforming the disease-oriented traditional system which focuses solely on medical knowledge and skills 研究方法研究方法 Research Methodl对象对象 以高等院校临床医学本科毕业，有志于从事社区卫生以高等院校临床医学本科毕业，有志于从事社区卫生服务工作的医师为培训对象服务工作的医师为培训对象lObjects We recrui
7、t students graduated from medical universities as our trainees,who have obtained bachelor degrees in clinical medicine,and willing to become GPsl方法方法 参考发达国家和地区的培训要求，结合我院多年的住院医师培参考发达国家和地区的培训要求，结合我院多年的住院医师培训经验，制定全科医师规范化培训大纲和要求、考核内容和评训经验，制定全科医师规范化培训大纲和要求、考核内容和评估方法。在教学实施过程中不断接受来自培训者和受训者的反估方法。在教学实施过程中不断接
8、受来自培训者和受训者的反馈意见，对培训和考核的方法、内容进行改进和完善馈意见，对培训和考核的方法、内容进行改进和完善 lMethods We tried to work-out a new set of regulations,a curriculum for standardized GPs training,the methods of examination and assessment,which drew on GPs training methods in the developed country and district,as well as the long-term res
9、idents training experience of our hospital.During the process,we tried to improve the methods of teaching and the content of the training courses and assessment step by step through collecting constructive feedback from the trainers and the trainees 培训方法培训方法 Training Methodsl分理论学习、临床轮转和社区实践三个阶段分理论学习
10、、临床轮转和社区实践三个阶段 l理论课程分别由资深全科医师和专科医师担任授课，理论课程分别由资深全科医师和专科医师担任授课，并邀并邀请美、英、中国台湾等地的资深全科医师来访讲学请美、英、中国台湾等地的资深全科医师来访讲学lThe training process involved 3 phases:academic learning,clinical rotation and community practicelSenior GPs and specialists assumed the teaching tasks together in academic curriculum.At th
11、e same time,we invited sophisticated GPs coming from Taiwan,UK,US to hold a course of lecturesl临床轮转要求病区主治以上医师带教，由我院全科医学临床轮转要求病区主治以上医师带教，由我院全科医学科负责教学的医师（副高职称）全程监控，及时掌握学科负责教学的医师（副高职称）全程监控，及时掌握学员的反馈信息，与带教老师协调员的反馈信息，与带教老师协调lAttending doctors in wards took charge of trainees clinical rotation and adjunct
12、 professor of Department of General Practice,with responsibility for training,supervised the whole course,who would learn from the feedback from trainees in time and coordinate with the supervisors of all wards培训方法培训方法 Training Methodsl社区实践期间，学员由所在社区的资深医师带教。带教老师先由我科社区实践期间，学员由所在社区的资深医师带教。带教老师先由我科统一进行
13、全科医学理论的培训，并通过电话联系、每半年度集中座谈统一进行全科医学理论的培训，并通过电话联系、每半年度集中座谈等方式及时反映社区带教过程中遇到的问题。学员则每周回我科集中等方式及时反映社区带教过程中遇到的问题。学员则每周回我科集中1次，利于双向交流次，利于双向交流lDuring community practice,the senior physicians in community would supervise our trainees,who received the academic training of General Practice in advance and reflec
14、ted the existing problems in trainees practice through frequent telephone communication and rap sessions every half an year.Trainees came back to our hospital every week so as to communicate with usl学年结束，举行学员座谈会，听取学员意见和建议，学年结束，举行学员座谈会，听取学员意见和建议，改进培训方法改进培训方法lWhen academic year was over,we would hold
15、a session for trainees,collecting constructive ideas and suggestions,to improve training methods培训内容和期限培训内容和期限Training Contents and Schedule l培训围绕以下六方面的能力培养培训围绕以下六方面的能力培养1.患者的照顾患者的照顾2.医学知识的掌握医学知识的掌握3.实践中的学习和提高实践中的学习和提高4.人际交流人际交流5.职业道德职业道德6.立足于卫生保健系统的医疗行为立足于卫生保健系统的医疗行为,为期为期4年年lIt took 4 years to perf
16、orm the training based on six aspects as follow:patient care,medical knowledge,practice-based learning and improvement,interpersonal communication skills,professionalism and health-care system-based practice 培训内容和期限培训内容和期限 Training Contents and Schedulel理论课程理论课程2个月，包括全科医学概论、预防医学、综合课程个月，包括全科医学概论、预防医学
17、、综合课程（社区诊所的管理、社区合理用药、老年病学、医患交流技（社区诊所的管理、社区合理用药、老年病学、医患交流技巧及计算机应用课程等）和专业英语巧及计算机应用课程等）和专业英语lAcademic courses took 2 months,including Panorama of General Practice,Preventive Medicine,comprehensive courses(such as management of clinic in community,rational prescription in community clinic,Geriatrics,ski
18、lls of physician-patient communication and computer application as well)and medical specialized Englishl临床轮转临床轮转26个月，包括内、外、妇、儿、急诊科、五官科、皮个月，包括内、外、妇、儿、急诊科、五官科、皮肤科、眼科、康复科、中医科、肤科、眼科、康复科、中医科、CDC等等l社区实践社区实践20个月个月l轮转期间每月安排学员集中轮转期间每月安排学员集中1次，讲授临床医学进展次，讲授临床医学进展 lClinical rotation took 26 months,including dep
19、artment of Internal Medicine,Surgery,Gynecology&Obstetrics,Pediatrics,Emergency,ENT,Dermatology,Ophthalmology,Rehabilitation,Traditional Medicine,CDC and Psychology etc.lCommunity practice took 20 monthslWe held a seminar every month to introduce the advancement of clinical medicine for trainees考核和评
20、估考核和评估 Examination and Assessmentl围绕上述围绕上述6方面的能力培养，制定相关知识、技能和态度要求，以及相应的考核和方面的能力培养，制定相关知识、技能和态度要求，以及相应的考核和评估表格：如病史质量评估表、临床能力考评表、医师接诊评估表、文献综述评评估表格：如病史质量评估表、临床能力考评表、医师接诊评估表、文献综述评估表、医患交流患者评估表、医患交流患者家属评估表、同事评价表、职业道德估表、医患交流患者评估表、医患交流患者家属评估表、同事评价表、职业道德评价表等，每半年考评评价表等，每半年考评1次，由全科教学组完成对学员的考评次，由全科教学组完成对学员的考评lA
21、ccording to the 6 aspects we mentioned above,we worked-out relevant requirements of knowledge,skills and attitudes,as well as examination and assessment forms respective:such as case history quality assessment form,clinical ability testing form,literature and review assessment form,physician-patient
22、 communication assessment form,patients relative-based communication assessment form,co-workers evaluation form and professional morality evaluation form etc.These examinations and assessments were performed by educational group of our department and relevant professionals every half an year考核和评估考核和
23、评估 Examination and Assessmentl阶段考核：各阶段培训结束后，由我科组织相阶段考核：各阶段培训结束后，由我科组织相应的理论和临床技能考核，并将考核结果记录应的理论和临床技能考核，并将考核结果记录在培训手册上在培训手册上lStage examinations:When every phase was over,our department would organize examinations of corresponding academic knowledge and clinical skills,recording the traines scores on t
24、he manualsl综合考核：培训结束后，要求学员完成以社区为基础的论综合考核：培训结束后，要求学员完成以社区为基础的论文一篇，通过论文答辩并结合既往考评结果，成绩合格者文一篇，通过论文答辩并结合既往考评结果，成绩合格者将获得卫生部颁发的全科医师规范化培训合格证书将获得卫生部颁发的全科医师规范化培训合格证书lComprehensive examinations:When the whole training was over,trainees were required to hand in a paper based on community setting.Those who went
25、through the defending smoothly and past assessments were eligible will acquire qualification certificates for GPs training issued by the Healthcare Ministry结果结果 Resultsl建立全科医师规范化培训的模式建立全科医师规范化培训的模式l制定相应的教学大纲、教学计划、教学管理文件和教学效果评制定相应的教学大纲、教学计划、教学管理文件和教学效果评估方法估方法l主编多部全科医师培训教材：如全科医学概论（第二版）；主编多部全科医师培训教材：如全
26、科医学概论（第二版）；全科医学导论（第一版）；社区常见健康问题（第二全科医学导论（第一版）；社区常见健康问题（第二版）等版）等 lFormulated a training pattern for GPslWorked out a training curriculum,scheme,administration and assessing methodslPublished several textbooks for GPs trainingl从从2000年年12月至月至2019年年9月举办了月举办了6期毕业后全科医期毕业后全科医师规范化培训，共招收师规范化培训，共招收165名学员。迄今有名
27、学员。迄今有70名学员名学员完成培训，通过各项考核，获得全科医师规范化培完成培训，通过各项考核，获得全科医师规范化培训合格证书训合格证书 lFrom Dec.2000 to Sep.2019,standardized GPs training courses have been run for 6 times,in which 165 students have been enrolled and 70 students have passed all the examinations and acquired the qualification certificates for GPs tr
28、aining讨论讨论 Discussionl目前，全科医师规范化培训仍处出于探索阶段，培养目前，全科医师规范化培训仍处出于探索阶段，培养合格的全科医师是社区卫生服务可持续发展的关键。合格的全科医师是社区卫生服务可持续发展的关键。我院全科医学科多年来致力于全科医学教育，旨在培我院全科医学科多年来致力于全科医学教育，旨在培养高素质的全科医师，充实全科医师及其师资队伍养高素质的全科医师，充实全科医师及其师资队伍lAt present,we are still exploring the standardized GPs training.Qualified GPs are crucial for t
29、he sustainable development of community health-care system.We devoted ourselves in the past decade to training eligible GPs so as to enforce the team of GPs and trainersl全科医师教育培训的重点在于培养全科医师提供合理、全科医师教育培训的重点在于培养全科医师提供合理、有效、人性化医疗照顾的能力，以及寻找、评价和利用有效、人性化医疗照顾的能力，以及寻找、评价和利用最佳医疗方案，解决患者健康问题的能力，以适应社区最佳医疗方案，解决患
30、者健康问题的能力，以适应社区卫生服务发展的需求卫生服务发展的需求lThe training for GPs should focus on developing students comprehensive ability(including offering rational,effective and individual health-care as well as managing health problems through assessing and adopting best medical methods),accommodating to the need of commu
31、nity health-care service讨论讨论 Discussion 综合性教学医院有着得天独厚的教学条件，在全科医学的教育培训中担负不综合性教学医院有着得天独厚的教学条件，在全科医学的教育培训中担负不可或缺的责任可或缺的责任 全科医学教育离不开专科医师的作用，然专科医师若未经过相关的全科知识全科医学教育离不开专科医师的作用，然专科医师若未经过相关的全科知识培训，其专科医疗的临床思维方式在一定程度上将影响全科医师的培训质培训，其专科医疗的临床思维方式在一定程度上将影响全科医师的培训质量量lGPs training can best be done in comprehensive t
32、eaching hospitals where there are superior educational resources,which will help to enhance GPs training programslSpecialists play an important role in General Practice education,whose special medical ideas will effect the quality of GPs training unless they receive academic education from experienc
33、ed GPs l目前的培训评估大多通过调查问卷的方式，缺目前的培训评估大多通过调查问卷的方式，缺乏客观标准，培训的优劣将难以彰显乏客观标准，培训的优劣将难以彰显lIn general,we assess the training quality by questionnaire,lack o objective standard,which couldnt evaluate the merits and weakness objectively of training pattern讨论讨论 Discussionl由于目前全科医师的社会地位不高，经济收入低下，导由于目前全科医师的社会地位不高，
34、经济收入低下，导致培训生源不足，生源质量得不到保障；培训过程中学致培训生源不足，生源质量得不到保障；培训过程中学员流失员流失lAt present,GPs social status and income arent satisfied,on account of which,therere not enough trainees for GPs training and the quality of trainees couldnt be ensured,furthermore a part of trainees will leave school during the trainingl
35、政府应增加对全科医学培训的投入：在高等医学院校成立全政府应增加对全科医学培训的投入：在高等医学院校成立全科医学系；从政策、财政两方面保障全科培训的开展；借助科医学系；从政策、财政两方面保障全科培训的开展；借助媒体宣扬全科医学，争取全社会的支持；切实提高全科医师媒体宣扬全科医学，争取全社会的支持；切实提高全科医师的社会和经济地位的社会和经济地位lGovernment should reinforce the General Practice education:to set up the department of General Practice in medical university;t
36、o ensure the implement of GPs training by policy and financial subsidization;to publicize General Practice by media and gain the support of the Public;so as to enhance the GPs social and economic position 总之，随着我国医疗体制的深入改革，全科医师教育日益显示总之，随着我国医疗体制的深入改革，全科医师教育日益显示其重要性。综合性医院率先进行这方面的探索，有助于改进和其重要性。综合性医院率先进行
37、这方面的探索，有助于改进和完善全科医师培养模式，尽快建立完善全科医师培养模式，尽快建立1支能满足广大居民基本医支能满足广大居民基本医疗保健服务的全科医师队伍疗保健服务的全科医师队伍lGPs education is becoming more and more important with the modernization of Medicare system in our country.GPs training done in comprehensive teaching hospitals will help to enhance GPs training programs and provide a team composed of GPs satisfying the basic health-care needs of the PublicThank You !
