目的 了解北京市乡村两级即乡镇卫生院医务人员和乡村医生继续医学教育现状和政策工具对其具体影响。方法 2016年7月至8月,课题组根据地理位置、经济水平、历史文化等因素选取北京市H区C乡、J镇和B镇所辖乡镇卫生院及下辖21个行政村作为调查现场进行实地观察和个人深入访谈,采取质性研究中的目的性抽样方法,抽取21名乡镇卫生院医务人员、21名乡村医生、42名村民共计84人进行深入访谈。访谈内容包括个人基本信息,基本医疗服务提供,继续医学教育方式、学时、内容和效果等。结果 H区乡镇医务人员接受继续医学教育动力较足,“多形式、多渠道”培训形式得到医务人员基本肯定,培训内容得到认同,培训效果较好。在村一级,乡村医生接受继续医学教育动力较弱,“以会代训”和“网络化教学”的并轨使继续教育不同程度“走过场”,培训内容与实际需求存在差距,培训效果一般。结论 直接性政策工具的规制方式和直接提供方式因为缺乏灵活性和竞争机制使乡村两级继续医学教育的作用不能充分发挥,需要以疾病谱变化为依据,增加“因地制宜、有的放矢”的培训内容,在强化考核的同时改进激励机制,调动医务人员的学习自主性与积极性。
董屹
,
王晨
,
李娜
,
姜悦
,
马力
,
刘兰秋
,
彭迎春
,
贾东梅
,
齐韶涵
. 政策工具对北京市乡村两级继续医学教育的影响分析[J]. 中华医学教育杂志, 2018
, 38(1)
: 113
-118
.
DOI: 10.3760/cma.j.issn.1673-677X.2018.01.026
Objective It is important to understand the status quo of continuing medical education in Beijing rural area and specific influences of policy instruments on it. Methods According to the geographical position,economic level,historical and cultural factors,from July to August,2016,the investigation group selected the J,C and B township of H county in Beijing as well as its 21 administrative villages as research field to conduct field observation and individual in-depth interviews. The sample included 21 township hospital doctors,21 village doctors,42 villagers as total of 84 people. Interview questions include: personal basic information,basic medical and public services,continuing medical education method,class hours,content,and effect. Results The status quo of continuing medical education in H County presented the following condition: township medical staffs were willing to accept continuing medical education,diverse forms and lessons’ contents were affirmed,the effect was overall better. At village level,village doctors accepting continuing medical education power was weak,education form combined with network teaching system conducted ineffectively,there was a gap between training content and actual demand,the effect was overall general. Conclusions Regulation and directly provision of direct policy tools had some drawbacks in terms of lack of flexibility and competition mechanism gave rise to negative action of continuing medical education. It was necessary to adjust contents and improve incentive mechanism for enhancing learning autonomy of township doctors.
[1] B·盖伊·彼得斯,弗兰斯·K·M·冯尼斯潘.公共政策工具 [M].顾建光,译.北京: 中国人民大学出版社,2006: 13.
[2] 李侠,熊玉婷.政策工具的选择、收益与群体行为[J].科学与管理,2013 (3): 23-28,35. DOI: 10.3969/j.issn.1003-8256.2013.03.004.
Li X,Xiong YT.Study on selection,profit of policy instrument and group behavior[J].Science and Management,2013 (3): 23-28,35. DOI: 10.3969/j.issn.1003-8256.2013.03.004.
[3] 严强.公共政策学 [M].北京: 社会科学文献出版社,2008: 99-101,108.
[4] 蒋祎,汪洋,曾缓.新医改背景下我国农村医学教育的改革[J].复旦教育论坛,2012,10(1): 93-96.
Jiang Y,Wang Y,Zeng H.On the rural medical education reform under the background of new medical system reform in China[J].Fudan Education Forum,2012,10(1): 93-96.
[5] 卫生部.继续医学教育规定(试行)(卫科教发 [2000] 477号) [EB/OL].[2017-06-20].http://wenku.baidu.com/link?url=E4axfClc0BljnBiqnF2dMZ0TkaYD26sFUYxYfjc-DNhMKbBTWgdVbs1t3XzqgqrvlFXJ4xFDiC299P11DLdyZTOlLlumPxVgQEa_BMzlsoi.
[6] 卫生部,国家发展与改革委员会,财政部,等.乡镇卫生院管理办法(试行)(卫农卫发 [2011] 61号) [EB/OL].[2016-07-26].http://www.nhfpc.gov.cn/zwgk/wtwj/201304/aee238407a984102ad51619065210902.shtml.
[7] 国家卫生和计划生育委员会,国家发展与改革委员会,教育部,等.村卫生室管理办法(试行)(国卫基层发 [2014] 33号 [EB/OL].[2016-07-26].http://www.nhfpc.gov.cn/jws/s3581/201406/55de 13fd597a4918bfc42e3a5b7ff2b8.shtml.
[8] 北京市人事局,北京市卫生局,北京市教育委员会,等.关于加强北京市社区卫生人才队伍建设的实施意见(京人发 [2006] 74号) [EB/OL].[2017-07-17].https://www.lawxp.com/statute/s77133 2.html.
[9] 中共北京市委组织部,中共北京市卫生局党组.关于印发《关于加强卫生人才队伍建设的意见》的通知(京卫发 [2010] 20号) [EB/OL].[2017-07-24].http://www.51wf.com/print-law?id=2109020.
[10] 国家卫生和计划生育委员会,国家发展与改革委员会,教育部,等.全国乡村医生教育规划(2011-2020年)(国卫科教发 [2013] 26号) [EB/OL].[2017-06-30].http://www.nhfpc.gov.cn/qjjys/s 3593/201310/a01af8848c7f4ae081985ff4744461ee.shtml.
[11] 熊烨.政策工具视角下的医疗卫生体制改革: 回顾与前瞻——基于1978-2015年医疗卫生政策的文本分析[J].社会保障研究,2016 (3): 51-60.
Xiong Y.Medical and health system reform from the perspective of policy tools: Retrospect and prospect——based on the text analysis of the 1978-2015 health policies[J].Social Security Studies,2016 (3): 51-60.
[12] 姚力.“把医疗卫生工作的重点放到农村去”——毛泽东“六·二六”指示的历史考察[J].当代中国史研究,2007,14(3): 99-104,128.
Yao L.“Shift the priority of medical and health work to the rural areas”: A historical investigation of Mao Zedong’s instruction on 26 June 1965[J].Contemporary China History Studies,2007,14(3): 99-104,128.
[13] 北京市卫生局,北京市发展与改革委员会.关于落实1486个村卫生机构标准化建设计划的实施方案(京卫基层字 [2005] 8号) [EB/OL].[2017-07-15].http://www.bjchfp.gov.cn/zwgk/ghjh1/20 1612/t20161221_205499.htm.
[14] 林光汶,郭岩,Legge,D.等.中国卫生政策 [M].北京:北京大学医学出版社,2009: 134.
[15] 刘圣中.现代科层制: 中国语境下的理论与实践研究 [M].上海: 上海人民出版社,2012: 50,98.