Objective To explore the application of integrated teaching in improving the ability of geriatric comorbidity management in the standardized training of general practitioners. Methods A total of 91 residents who received standardized training in the general practice center of Shanghai East Hospital from August 2016 to April 2022 were enrolled. According to their years of training, 50 were assigned to the experimental group and 41 to the control group. The integrated teaching mode was used in the experimental group and whereas traditional teaching mode was used in the control group. We implemented process evaluation (reflective notes in five dimensions) and phased evaluation (multi station clinical skill assessment, annual theoretical assessment). The effects of the two groups were evaluated before and after this course. Results After training, the total score of experimental group was higher than that of the control group in five dimensions of reflective notes, with a statistically significant difference [(24.40±0.15) vs. (22.46±0.15), t=6.79, P<0.001]. The total score of experiment group was higher than that of the control group in the multi station clinical skill examination [(485.08±0.93) vs. (443.59±1.12)] and the annual theoretical examination [(82.18±3.33) vs. (71.24±10.59)],with a statistically significant difference (all P<0.001). Conclusions The ability to manage geriatric comorbidity was trained in the standardized training of general practitioners. The application of integrated teaching can promote students to form a systematic, holistic, and comprehensive clinical thinking, and improve the comprehensive diagnosis and treatment ability of geriatric comorbidity management and complex cases.
Ge Jianli
,
Geng Shasha
,
Pu Lin
,
Jiang Hua
. The application of integrated teaching in the management of geriatric comorbidity in the standardized training of general practitioners[J]. Chinese Journal of Medical Education, 2022
, 42(12)
: 1143
-1147
.
DOI: 10.3760/cma.j.cn115259-20220520-00655
[1] 邓世秋, 苏巧俐, 安康, 等. 全科规范化培训医师科研培训现状与需求调查[J].中华全科医师杂志,2021,20(2):230-233. DOI: 10.3760/cma.j.cn114798-20200807-00889.
[2] 杨辉, 韩建军, 许岩丽. 中国全科医生队伍建设的发展、挑战与展望[J].中国全科医学,2019,22(19):2267-2279. DOI: 10.12114/j.issn.1007-9572.2019.00.351.
[3] Fong JH. Disability incidence and functional decline among older adults with major chronic diseases[J]. BMC Geriatr, 2019,19(1):323. DOI: 10.1186/s12877-019-1348-z.
[4] Moin JS, Moineddin R, Upshur R. Measuring the association between marginalization and multimorbidity in Ontario, Canada:a cross-sectional study[J]. J Comorb, 2018,8(1):2235042X18814939. DOI: 10.1177/2235042X18814939.
[5] 王浩, 张琳, 方晓雅, 等. 中国中老年人慢性病共病现状及其空间分布研究[J].中国全科医学,2022,25(10):1186-1190,1196. DOI: 10.12114/j.issn.1007-9572.2022.0127.
[6] Mercer SW, Smith SM, Wyke S, et al. Multimorbidity in primary care: developing the research agenda[J]. Fam Pract, 2009,26(2):79-80. DOI: 10.1093/fampra/cmp020.
[7] Boyd CM, Darer J, Boult C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance[J]. JAMA, 2005,294(6):716-724. DOI: 10.1001/jama.294.6.716.
[8] 王辉, 赵付英, 姜岳. 全科医生主导的多学科团队服务模式管理老年人共病的实践与思考[J].中华全科医师杂志,2019,18(8):798-800. DOI: 10.3760/cma.j.issn.1671-7368.2019.08.022.
[9] 冯先义, 刘语思, 程炼.全科医疗照顾模式在社区多病共存患者中的应用[J].海南医学,2017,28(1):161-162. DOI: 10.3969/j.issn.1003-6350.2017.01.055.
[10] 胥娇,方明,董靖竹,等. 以能力为导向的全科住院医师培训创新模式探索与实践[J]. 中华医学教育探索杂志,2022,21(1):78-81. DOI:10.3760/cma.j.cn116021-20200203-00737.
[11] 殷培,任菁菁,应美珂,等. 全科住院医师规范化培训基地线上教学的探索与思考[J]. 中国毕业后医学教育,2020,4(4):329-332. DOI:10.3969/j.issn.2096-4293.2020.04.010.
[12] 杜改燕,齐殿君,王爽,等. 全科医学住院医师培训实施方案的探索与实践[J]. 中国全科医学,2011,14(10):1109-1111. DOI:10.3969/j.issn.1007-9572.2011.10.019.
[13] 张君君,魏华林,陈声宇. 全科医学科住院医师规范化培训结业考核体系的构建与实施分析[J]. 中国毕业后医学教育,2022,6(4):298-301,306. DOI:10.3969/j.issn.2096-4293.2022.04.003.
[14] 韩雪灵,李靓,徐玉萍. 基于OSCE的全科专业住院医师规范化培训实践技能结业考核成绩分析[J]. 中国毕业后医学教育,2020,4(6):565-568. DOI:10.3969/j.issn.2096-4293.2020.06.022.
[15] 谷光宇,李福旺,严春杰,等. 线上线下互动教学联合三维质量理论互评在全科医师规培中的应用研究[J]. 中华医学教育探索杂志,2022,21(7):910-914. DOI:10.3760/cma.j.cn116021-20210118-00932.
[16] 陈倩,祝墡珠. 临床操作技能评估在全科医师能力评估中应用简介[J]. 中华全科医师杂志,2012,11(1):30-31. DOI:10.3760/cma.j.issn.1671-7368.2012.01.015.
[17] 杨东霞, 时彦, 刘鲁英, 等. K-W-L教学模式在法学专业病理学教学中的应用[J].中国高等医学教育,2009(5):103-104. DOI: 10.3969/j.issn.1002-1701.2009.05.050.
[18] 王美荣,葛彩英,张丹丹,等. 全科医学规范化培养学员全科医疗应诊能力评价指标体系构建[J]. 医学与社会,2018,31(4):70-73. DOI:10.13723/j.yxysh.2018.04.022.
[19] 陈丽芬,贾建国,路孝琴. 列斯特评估量表及其在全科医生应诊能力评价中的应用[J]. 中国全科医学,2016(4):447-450. DOI:10.3969/j.issn.1007-9572.2016.04.018.
[20] Kwiek M. High research productivity in vertically undifferentiated higher education systems:who are the top performers?[J]. Scientometrics, 2018,115(1):415-462. DOI: 10.1007/s11192-018-2644-7.
[21] Suliman S, Hassan R, Athamneh K, et al. Blended learning in quality improvement training for healthcare professionals in Qatar[J]. Int J Med Educ, 2018,9:55-56. DOI: 10.5116/ijme.5a80.3d88.
[22] 梁庆丰. 规范化实践教育对医学研究生培养的深远影响[J].中华医学教育探索杂志,2020,19(2):125-128. DOI: 10.3760/cma.j.issn.2095-1485.2020.02.001.
[23] 关晓丽, 张正义. 全科住院医师规范化培训基地建设的探索与实践[J].毕业后医学教育,2020,4(1):85-88. DOI: 10.3969/j.issn.2096-4293.2020.01.022.
[24] 刘福生, 潘惠惠, 方晓磊, 等. 基于岗位胜任力的混合式教学模式在急诊内科住院医师规范化培训中的应用[J].中国中医急症,2021,30(8):1481-1483,1490. DOI: 10.3969/j.issn.1004-745X.2021.08.044.
[25] Ellis G, Sevdalis N. Understanding and improving multidisciplinary team working in geriatric medicine[J]. Age Ageing, 2019,48(4):498-505. DOI: 10.1093/ageing/afz021.
