全科医生胜任力是保障高质量基层医疗服务的前提,全科临床诊疗思维培养是实现全科医生胜任力的重要手段。本研究基于全科医生胜任力,设计实施了包含核心模块、案例模块、实践模块三大模块的全科临床诊疗思维课程,以病史采集、慢病管理、接诊实践与病历书写等为具体培训内容,涵盖了世界家庭医生组织全科医生胜任力6大核心要素和12项基本特征。经过为期4月的课程培训,52名全科医学专业硕士研究生客观结构化临床考试中的病史采集等成绩均明显提高[(68.41±14.69)分比(62.77±14.50)分],其差异具有统计学意义(P<0.05)。基于胜任力的全科临床诊疗思维课程培训具有良好的成效,可以进一步推广实施。
The professional competency of general practitioners (GP) is the prerequisite of ensuring high-quality primary medical services. The training of clinical thinking is an important means to realize the professional competence of GP. This course design includes 3 modules and 10 contents, covering 6 core elements and 12 basic characteristics of WONCA GP professional competency. After the 4-month training, the scores of 52 postgraduate students of GP in Objective structured clinical examination were significantly improved [(68.41 ± 14.69) vs. (62.77 ± 14.50), P<0.05]. The clinical thinking in general practice course based on professional competency has a favorable educational effect, which can be further promoted and implemented.
[1] 国务院办公厅关于改革完善全科医生培养与使用激励机制的意见[J].中华人民共和国教育部公报,2018,(1):10-14.
[2] 田蕾, 孙宝志. 对我国七省市抽样调查临床医生岗位胜任力的现状及其评价[J].医学教育管理,2015(1):29-33. DOI: 10.3969/j.issn.2096-045X.2015.01.007.
[3] Epstein RM, Hundert EM. Defining and assessing professional competence[J]. JAMA, 2002,287(2):226-235. DOI: 10.1001/jama.287.2.226.
[4] 李一萱, 张阳, 于晓松. 中外全科医生岗位胜任力模型分析与借鉴[J].中华全科医师杂志,2021,20(2):248-252. DOI: 10.3760/cma.j.cn114798-20200603-00663.
[5] WONCA Europe. The European Definition of General Practice/Family Medicine-2011 Edition[EB/OL].[2022-04-20]. https://www.woncaeurope.org/.
[6] 李颖, 宋浩明, 杨军, 等. 模拟病例和小组讨论教学方式在临床思维培养课程中的应用[J].中华医学教育杂志,2020,40(12):983-987. DOI: 10.3760/cma.j.cn115259-20190712-00549.
[7] Miller GE. The assessment of clinical skills/competence/performance[J]. Acad Med, 1990,65(9 Suppl):S63-67. DOI: 10.1097/00001888-199009000-00045.
[8] 陆媛, 于德华, 张斌, 等. PBL教学模式在全科医师规范化培训中的实践应用[J].中国全科医学,2014,(16):1880-1883. DOI: 10.3969/j.issn.1007-9572.2014.16.019.
[9] 邰春玲, 隋树杰, 史淑杰. 翻转课堂医学教育领域应用研究评述[J].中华医学教育杂志,2016,36(3):398-400,408. DOI: 10.3760/cma.j.issn.1673-677X.2016.03.020.
[10] 黄文娟, 林惠思, Timothy Noel Stephens, 等. 全科住院医师培训的全方位评估体系[J].中国全科医学,2018,21(19):2335-2337,2342. DOI: 10.12114/j.issn.1007-9572.2018.00.040.