柯氏评估模型在云南省订单定向医学生规范化培训效果中的评价研究

王星; 黄巧云; 刘莹钰睿; 雷安业; 陈越超; 李伟明

doi:10.16766/j.cnki.issn.1674-4152.004428

柯氏评估模型在云南省订单定向医学生规范化培训效果中的评价研究

doi: 10.16766/j.cnki.issn.1674-4152.004428

王星^{1, 2},
黄巧云^{1, 2},
刘莹钰睿^{1, 2},
雷安业^{1, 2},
陈越超³,
李伟明^{2, 4, ,}

1.
昆明医科大学公共卫生学院，云南昆明 650500
2.
云南省全科医学培训中心，云南昆明 650500
3.
云南省卫生健康委员会科教处，云南昆明 650032
4.
昆明医科大学海源学院

基金项目:

云南省卫生健康委员会2021年度赞助项目 20210101

详细信息

通讯作者:
李伟明，E-mail：liweiming55@163.com

中图分类号: R197.1
计量
- 文章访问数: 16
- HTML全文浏览量: 6
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-10-17
- 网络出版日期: 2026-06-02

Evaluation of the effect of Kirkpatrick's evaluation model on the standardized training of order oriented medical students in Yunnan Province

WANG Xing^{1, 2},
HUANG Qiaoyun^{1, 2},
LIU Yingyurui^{1, 2},
LEI Anye^{1, 2},
CHEN Yuechao³,
LI Weiming^{2, 4
, ,}

1.
School of Public Health, Kunming Medical University, Kunming, Yunnan 650500, China

摘要

摘要: 目的基于柯氏四级评估模型, 评估云南省订单定向医学生住院医师规范化培训的现状与效果, 为住培基地提供参考建议。方法于2022年6-8月, 采用分层整群抽样方法, 通过问卷调查对云南省8家全科培训基地的608名订单定向医学生进行横断面调查。同时, 对部分学员、带教老师及管理者进行访谈。结果 608名订单定向医学生中, 547名(90.0%)订单定向医学生了解规培政策, 555名(91.3%)学员对规培政策持支持态度; 学员表示实践操作机会以及不同基地的教学水平是影响结业考核通过的重要因素。学员对自我核心胜任力的评价中, 排名前三的因素分别为职业素养[(3.79±0.74)分]、沟通合作[(3.70±0.76)分]、病人管理[(3.61±0.74)分]。然而, 部分学员学习主动性不高, 且对薪资待遇[(2.65±1.01)分]满意度最低, 仅有160名(26.3%)服务期满后愿意继续留在基层工作, 且工作意愿为(3.79±0.74)分。结论云南省订单定向医学生住院医师规范化培训实施效果良好, 定向医学生对基地政策有一定了解, 但也渴望提升薪资待遇; 定向医学生住院医师规范化培训同质化特征显现, 但培训质量存在一定差异; 规培后定向医学生职业素养有所增强, 但服务期满后继续到基层服务意愿不强。
- 订单定向医学生 /
- 柯氏模型 /
- 培训效果
Abstract: Objective To evaluate the current status and effectiveness of standardized residency training for order-directed medical students in Yunnan Province based on the Kirkpatrick four-level evaluation model, and to provide reference suggestions for residency training bases. Methods From June to August 2022, a cross-sectional survey was conducted using stratified cluster sampling and questionnaires among 608 order-directed medical students from 8 general practice training bases in Yunnan Province.Simultaneously, interviews were conducted with some trainees, teaching staff, and administrators. Results Among the 608 order-directed medical students, 547(90.0%) were aware of the standardized training policy, and 555(91.3%) expressed support for the policy.Trainees indicated that practical operation opportunities and teaching quality at different bases were critical factors affecting the pass rate of the final assessment.In their self-assessment of core competencies, the top three factors ranked were professional ethics[(3.79±0.74) points], communication and collaboration[(3.70±0.76) points], and patient management[(3.61±0.74) points].However, some trainees showed low learning initiative, with salary satisfaction being the lowest[(2.65±1.01) points].Only 160 trainees (26.3%) chose to remain in primary care after completing their service, and their willingness to work[(3.79±0.74) points]was also a concern. Conclusion The implementation of standardized residency training for order-directed medical students in Yunnan Province has achieved positive outcomes.While these students demonstrate a basic understanding of the program's policies, they express a desire for improved salary and benefits.Although homogenization in training quality is evident, disparities persist.Post-training, their professional competencies have improved, yet their willingness to continue serving in primary healthcare after completing the residency remains low.
- Order oriented medical students /
- Kirkpatrick's evaluation model /
- Training effect

HTML全文

表 1 定向医学生对规培基地培训细则评价[例(%)]

Table 1. Evaluation of training rules for order-oriented medical students in standardized training bases [cases (%)]

项目	基本不符合 (n=5)	大部分不符合 (n=23)	基本符合 (n=309)	大部分符合 (n=204)	完全符合 (n=67)	统计量	P值
培训基地类型						3.023^a	0.554
省级医院	2(0.7)	14(5.0)	138(48.9)	99(35.1)	29(10.3)
州市级医院	3(0.9)	9(2.8)	171(52.5)	105(32.2)	38(11.7)
性别						-0.052^a	0.958
男性	3(1.1)	10(3.8)	123(46.4)	88(33.2)	41(15.5)
女性	2(0.6)	13(3.8)	186(54.2)	116(33.8)	26(7.6)
婚姻状况						9.688^a	0.046
已婚	1(1.2)	5(5.8)	33(38.4)	31(36.0)	16(18.6)
未婚	4(0.8)	18(3.4)	276(52.9)	173(33.1)	51(9.8)
规培专业						7.603^b	0.107
内科	4(0.7)	23(3.9)	302(50.8)	200(33.7)	65(10.9)
外科	1(12.5)	0	4(50.0)	3(37.5)	0
医技	0	0	3(50.0)	1(16.7)	2(33.3)
高校类型						13.983^b	0.007
双一流院校	1(4.0)	4(16.0)	11(44.0)	7(28.0)	2(8.0)
普通公办院校	4(0.7)	19(3.3)	298(51.2)	196(33.7)	65(11.2)
普通民办院校	0	0	0	1(100.0)	0
具有医师资格证						2.227^a	0.694
是	4(1.0)	17(4.1)	216(51.7)	133(31.8)	48(11.5)
否	1(0.5)	6(3.2)	93(48.9)	71(37.4)	19(10.0)
注：^a为Z值，^b为H值。

下载: 导出CSV

表 2 定向医学生对住院医师规范化培训政策态度[例(%)]

Table 2. Attitude of order-oriented medical students towards standardized training policies for resident physicians [cases (%)]

项目	支持(n=555)	反对(n=53)	χ²值	P值
所在培训基地类别			0.208	0.648
省级医院	259(91.8)	23(8.2)
州市级医院	296(90.8)	30(9.2)
性别			0.707	0.401
男性	239(90.2)	26(9.8)
女性	316(92.1)	27(7.9)
婚姻状况			0.381	0.537
已婚	80(14.4)	6(11.3)
未婚	475(91.0)	47(9.0)
参加培训专业类别			3.228	0.199
内科	543(91.4)	51(8.6)
外科	6(75.0)	2(25.0)
医技	6(100.0)	0
最高学历毕业院校			1.438	0.230
省内高校(云南)	550(91.5)	51(8.5)
省外高校	5(71.4)	2(28.6)
就读高校类型			0.486	0.786
重点院校(双一流)	24(96.0)	1(4.0)
普通公办院校	530(91.1)	52(8.9)
普通民办院校	1(100.0)	0
是否具有执业医师资格证			2.003	0.157
是	377(90.2)	41(9.8)
否	178(93.7)	12(6.3)

下载: 导出CSV

参考文献(18)

[1]	叶蕾, 姜侠, 王俐钧, 等. 以岗位胜任力为导向的中医公费医学生培养模式探索与实践[J]. 滨州医学院学报, 2024, 47(3): 232-234. YE L, JIANG X, WANG L J, et al. Exploration and practice of training mode of public funded medical students of traditional Chinese medicine oriented by post competence[J]. Journal of Binzhou Medical University, 2024, 47(3): 232-234.
[2]	李一陵. 让定向医学生下得去留得住有发展[J]. 中国卫生人才, 2022(7): 10-11. LI Y L. Enabling oriented medical students to go and stay with development[J]. China Health Human Resources, 2022(7): 10-11.
[3]	刘波, 宋茂荣, 宋晶. 国内农村订单定向医学生研究发展动态: 基于知网233篇文献的分析[J]. 教育文化论坛, 2022, 14(5): 102-111. LIU B, SONG M R, SONG J. Research on development trends of domestic rural-oriented medical students: based on the analysis of 233 literatures in CNKI[J]. Tribune of Education Culture, 2022, 14(5): 102-111.
[4]	全国人民代表大会常务委员会. 对十四届全国人大一次会议第4934号建议的答复[Z/OL]. (2023-03-10)[2026-03-01]. http://www.npc.gov.cn/c2/c30834/202303/t20230310_424092.html. Standing Committee of the National People's Congress. Reply to Recommendation No. 4934 of the First Session of the Fourteenth National People's Congress[Z/OL]. (2023-03-10)[2026-03-01]. http://www.npc.gov.cn/c2/c30834/202303/t20230310_424092.html.
[5]	孙美娜, 陈越超, 袁丹, 等. 云南省订单定向培养医学专科生基层就业意愿及其影响因素[J]. 医学与社会, 2019, 32(7): 126-129, 134. SUN M N, CHEN Y C, YUAN D, et al. Employment willingness to grassroots and influencing factors of demand-oriented medical college students in Yunnan Province[J]. Medicine and Society, 2019, 32(7): 126-129, 134.
[6]	马玉, 王宝婕, 张潍纤, 等. 云南省免费医学生教育政策执行状况研究[J]. 云南中医学院学报, 2021, 44(6): 79-84. MA Y, WANG B J, ZHANG W X, et al. Study on the implementation of free medical student education policy in Yunnan Province[J]. Journal of Yunnan University of Traditional Chinese Medicine, 2021, 44(6): 79-84.
[7]	姚倩, 张雁儒. 基于柯式和CIPP模型构建住院医师规范化培训评估体系[J]. 卫生职业教育, 2019, 37(12): 138-140. YAO Q, ZHANG Y R. Constructing an assessment system for standardized residency training based on the Coleman and CIPP models[J]. Health Vocational Education, 2019, 37(12): 138-140.
[8]	国家卫生健康委员会. 对十三届全国人大四次会议第4369号建议的答复[EB/OL]. (2021-09-22)[2022-02-12]. http://www.nhc.gov.cn/wjw/jiany/202202/cea7095e33824d34b90559f4b2d369d1.shtml. ational Health Commission. Response to Recommendation No. 4369 of the Fourth Session of the Thirteenth National People's Congress[EB/OL]. (2021-09-22)[2022-02-12]. http://www.nhc.gov.cn/wjw/jiany/202202/cea7095e33824d34b90559f4b2d369d1.shtml.
[9]	刘浩, 王雪洋, 晏莹莹, 等. 多元视角探索下订单定向医学生满意度调查[J]. 卫生软科学, 2024, 38(8): 86-90. LIU H, WANG X Y, YAN Y Y, et al. Survey on satisfaction of medical students in compulsory rural service directed medical student free training program under multiple perspectives[J]. Soft Science of Health, 2024, 38(8): 86-90.
[10]	中华人民共和国国家卫生健康委员会. 关于"加大对住院医师规范化培训资金投入"建议的答复(摘要)[EB/OL]. (2016-12-22)[2024-12-12]. https://www.mof.gov.cn/zhuantihuigu/2016jyta/2016rd/201612/t20161222_2495052.htm. National Health Commission of the People's Republic of China. Response to the Recommendation on "Increasing Funding for Standardized Residency Training" (Abstract)[EB/OL]. (2016-12-22)[2024-12-12]. https://www.mof.gov.cn/zhuantihuigu/2016jyta/2016rd/201612/t20161222_2495052.htm.
[11]	贺春香, 龚放, 谢波. 重庆市首届农村订单定向医学生基层工作情况及对策建议[J]. 中国全科医学, 2021, 24(31): 4009-4019. HE C X, GONG F, XIE B. First targeted admission medical graduates in primary care in Chongqing: working status and recommendations[J]. Chinese General Practice, 2021, 24(31): 4009-4019.
[12]	姬建鑫, 韩颖, 杨林, 等. 全科医师规范化培训学员的满意度及影响因素研究[J]. 中国全科医学, 2019, 22(10): 1213-1217. JI J X, HAN Y, YANG L, et al. Trainees'satisfaction with standardized general practitioner training and associated factors[J]. Chinese General Practice, 2019, 22(10): 1213-1217.
[13]	魏艳君, 牟燕, 甄天民, 等. 云南省免费医学生教育政策执行状况研究[J]. 中国高等医学教育, 2021(12): 79-84. WEI Y J, MOU Y, ZHEN T M, et al. Study on the implementation status of free medical student education policy in Yunnan Province[J]. China Higher Medical Education, 2021(12): 79-84.
[14]	胡丹, 李明, 张华. "5+3"模式下订单定向医学生培养质量研究[J]. 中国高等医学教育, 2023(6): 45-49. HU D, LI M, ZHANG H. Research on the cultivation quality of order-oriented medical students under the "5+3" model[J]. China Higher Medical Education, 2023(6): 45-49.
[15]	郑艳玲, 余芳, 陈艳黎, 等. 我国全科医生离职意愿及其影响因素分析[J]. 中华全科医学, 2019, 17(9): 1543-1546. doi: 10.16766/j.cnki.issn.1674-4152.000993 ZHEN Y L, YU F, CHEN Y L, et al. Turnover intention and related factors among general practitioners in China[J]. Chinese Journal of General Practice, 2019, 17(9): 1543-1546. doi: 10.16766/j.cnki.issn.1674-4152.000993
[16]	马超, 赵丽华. 青海省医学生招生政策对生源地选择的影响[J]. 青海医学院学报, 2023, 41(3): 82-87. MA C, ZHAO L H. The impact of enrollment policies on student source selection of medical students in Qinghai Province[J]. Journal of Qinghai Medical College, 2023, 41(3): 82-87.
[17]	张年, 余昌胤, 朱纪明, 等. 我国农村订单定向医学生培养的研究热点与趋势分析[J]. 中国全科医学, 2023, 26(4): 486-493. ZHANG N, YU C Y, ZHU J M, et al. Research hotspots and trends on the training of targeted admission medical students in China[J]. Chinese General Practice, 2023, 26(4): 486-493.
[18]	FU M Y, GONG Z W, ZHU Y Z, et al. Inappropriate antibiotic prescribing in primary healthcare facilities in China: a nationwide survey, 2017-2019[J]. Clin Microbiol Infect, 2023, 29(5): 602-609. doi: 10.1016/j.cmi.2022.11.015