目的 探讨我国全科住院医师规范化培训中因地域、院间差异导致的疾病诊疗经验局限问题,并分析跨机构协同培训的必要性与可行路径。方法 采用质性研究方法,于2024年12月通过目的抽样,选取分别位于我国东南沿海与西北内陆的2所公立医院的全科住院医师、导师和培训管理者共30人,围绕培训差异与协同路径开展焦点小组访谈,运用主题分析法提炼核心主题。结果 共提炼出5个主题:(1)不同地域和医院的疾病谱、典型病例资源、患者就医行为和学科发展重点存在客观差异;(2)培训管理者虽意识到差异,但由于现行培训大纲侧重病种数量覆盖、学员本地就业导向主流和当前培训质量关注点多集中于教学能力提升,该差异对培训同质化的潜在影响尚未得到系统性重视;(3)开展多医院协同培训对促进教学同质化、拓展学员临床思维、提升导师带教水平具有显著必要性;(4)线下联合培训受政策、成本、距离和安全等现实约束,可行性较低;(5)线上协同培训(如远程病例讨论、在线教学门诊、共享人工智能病例库、导师线上集体备课等)被视为当前具备操作性的有效替代方案。结论 我国全科医师培训存在客观的地域、院间资源差异,对培训同质化构成挑战。建议以线上协同培训为切入点,积极探索并推进多中心联合培训模式,以此弥补单一机构培训资源的局限,系统提升全科医师队伍的整体培养质量。
潘存雪
,
郑俊炯
,
吴庆
,
何涛
,
王雪梅
,
布艾吉尔·阿布都瓦依提
,
李庆荣
,
肖非
,
林天歆
. 全科住院医师规范化培训地域、院间差异及协同路径的质性研究[J]. 中华医学教育杂志, 2026
, 46(5)
: 343
-350
.
DOI: 10.3760/cma.j.cn115259-20251025-01349
Objective To explore the limitations in clinical experience caused by regional and inter-hospital disparities in China′s standardized residency training for general practitioners, and to analyze the necessity and feasible pathways for inter-institutional collaborative training. Methods A qualitative research approach was adopted. In December 2024, purposive sampling was used to select 30 participants, including general practice residents, mentors, and training administrators from two public hospitals located in the southeastern coastal and northwestern inland regions of China. Focus group interviews were conducted, centered on training disparities and collaborative pathways. Thematic analysis was employed to extract core themes. Results Five key themes were identified: (1)Objective disparities exist between different regions/hospitals regarding disease spectrum, typical case resources, patient healthcare-seeking behaviors, and disciplinary development priorities. (2)Although training administrators are aware of these disparities, their potential impact on training homogenization has not been systematically addressed due to factors such as the current training guidelines emphasizing quantitative case coverage, the predominant trend of residents seeking local employment, and a primary focus on enhancing teaching and learning capabilities in current quality assessments. (3)Implementing multi-hospital collaborative training is necessary for promoting teaching homogenization, broadening residents′ clinical thinking, and improving mentors′ instructional skills. (4)Offline collaborative training faces low feasibility due to practical constraints including policy support, cost, geographical distance, and safety concerns. (5)Online collaborative training (e.g., remote case discussions, online teaching clinics, shared AI case databases, and virtual collaborative lesson preparation among mentors) is considered a viable and effective alternative at present. Conclusions Objective regional and inter-hospital resource disparities exist in China′s general practitioner training, posing a challenge to training homogenization. It is recommended to actively explore and promote a multi-center collaborative training model, starting with online collaborative training as an entry point. This approach can compensate for the limitations of single-institution training resources and systematically enhance the overall quality of general practitioner training.
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