Investigation on the current situation of outpatient teaching in standardized training for general practice residents
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摘要:
目的 本研究旨在调查分析湖南省全科专业基地教学门诊运行现状及存在问题，提出改进建议，优化教学效果。 方法 采用横断面调查法，通过问卷星平台对2023年11月湖南省全科专业骨干师资培训班的85名带教师资进行问卷调查，收集全科教学门诊诊间设置、带教教师要求、患者遴选、实施情况以及问题与难点等情况。 结果 （1）70.59%（60/85）的基地已开展教学门诊，75.00%（45/60）设有独立诊间，68.33%(41/60)设置独立教学评估室，但仅28.33%（17/60）配备录播设备；（2）58.33%(35/60)会提前预约教学门诊就诊患者，多为需要综合评估及用药指导的多种慢性病共病患者（88.33%，53/60）；（3）61.67%（37/60）采用独立门诊带教模式。70.00%（42/60）在带教过程中会注重分层教学，仅18.33%（11/60）能做到每次及时反馈；（4）教学门诊面临的主要问题包括门诊教学经验缺乏（76.67%，46/60）、带教师资不足（45.00%，27/60）及患者数量不足（35.00%，21/60）。 结论 全科专业基地教学门诊的开展已取得一定成果，其开展实施目前仍存在诸多问题和挑战，需要通过加强政策支持、完善考核标准和激励机制等措施不断改进和完善，以优化教学效果。 Abstract:Objective The purpose of this study is to investigate and analyze the current situation and existing problems of outpatient teaching in the standardized training of general practitioners in Hunan Province, and to propose suggestions for improving the effectiveness of the outpatient teaching. Methods A cross-sectional survey was conducted among 85 general practitioners in the backbone teacher training program for standardized general practice training in Hunan Province in November 2023 through the questionnaire star platform. Information on the setup of general practice clinics, the requirements of teachers, the selection of patients, the implementation of outpatient teaching, and the existing problems and difficulties was collected. Results (1) A total of 70.59% (60/85) of the training bases had established outpatient teaching, 75.00% (45/60) had independent clinics, 68.33% (41/60) of the residential training bases had independent teaching evaluation rooms; however, only 28.33% (17/60) were equipped with recording and broadcasting facilities. (2) A total of 58.33% (35/60) of patients made appointments for the outpatient teaching in advance; most were patients with multiple chronic diseases (88.33%, 53/60) who needed comprehensive assessment and medication guidance. (3) A total of 61.67% (37/60) adopted an independent outpatient teaching mode. In addition, 70.00% (42/60) of the teachers paid attention to stratified teaching in the teaching process, while only 18.33% (11/60) were able to provide timely feedback every time. (4) The main problems faced in the outpatient teaching included lack of teaching experience (76.67%, 46/60), shortage of teachers (45.00%, 27/60) and insufficient patient resources (35.00%, 21/60). Conclusion Some achievements have been made in the development of outpatient teaching in general practice bases; however, there are still many problems and challenges in its implementation. Further improvements are needed through strengthening policy support, refining assessment criteria and incentive mechanism, in order to optimize the teaching effectiveness. -
表 1 湖南省全科教学门诊实施情况(n=60)
Table 1. Implementation of general outpatient teaching in Hunan Province(n=60)
实施内容 人数(%) 是否采用独立门诊带教方式 是 37(61.67) 否 23(38.33) 全科教学门诊带教过程包含的步骤 全科住培医师在全科诊室单独接诊患者 54(90.00) 全科住培医师汇报和分析患者病情 57(95.00) 全科住培带教教师点评和分析 58(96.67) 反思总结 55(91.67) 是否注重分层教学 非常注重 11(18.33) 比较注重 31(51.67) 一般注重 11(18.33) 很少注重 7(11.67) 不注重 0 是否指导全科住培医师书写SOAP病历 非常注重 12(20.00) 比较注重 19(31.67) 一般注重 19(31.67) 很少注重 7(11.67) 不注重 3(5.00) 是否为全科住培医师示范规范的体格检查 每次都会 8(13.33) 经常会 29(48.33) 一般会 22(36.67) 偶尔会 1(1.67) 不会 0 是否注重全科住培医师全科临床思维的训练 非常注重 14(23.33) 比较注重 32(53.33) 一般注重 14(23.33) 很少注重 0 不注重 0 是否会为全科住培医师进行及时点评和反馈 每次都会 11(18.33) 经常会 25(41.67) 一般会 24(40.00) 偶尔会 0 不会 0 
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表 2 全科住培带教教师对开展全科教学门诊的认知与培训需求情况
Table 2. Problems and suggestions on the development of general outpatient teaching
实施内容 人数(%) 认为门诊教学对全科住院医师培养的作用(n=60) 门诊教学完全不必要 1(1.67) 病房教学更重要 5(8.33) 门诊教学与病房教学同等重要 51(85.00) 门诊教学更重要 3(5.00) 进行门诊带教的感受(n=60) 收获不大 2(3.33) 学员门诊接诊能力得到提升 29(48.33) 学员医患沟通能力得到提升 14(23.33) 学员临床思维能力得到提升 11(18.33) 老师自身能力提升 3(5.00) 其他 1(1.67) 认为门诊教学的困难来源于(n=60) 门诊量大、没有时间教学 46(76.67) 门诊患者不固定 35(58.33) 门诊教学经验不足 35(58.33) 不知道该怎么教 12(20.00) 不知道门诊该教什么 13(21.67) 其他 2(3.33) 认为门诊教学最突出的问题来自(n=60) 带教教师数量不足 27(45.00) 全科教学门诊疾病种类较为单一 14(23.33) 缺乏全科教学门诊带教经验 46(76.67) 全科教学门诊患者数量不足 21(35.00) 门诊诊间设置不合理 8(13.33) 其他 1(1.67) 是否愿意接受门诊带教的培训(n=85) 愿意 84(98.82) 不愿意 1(1.67) 想要获得哪些门诊带教方法的培训(n=84) 学员跟诊式 51(60.71) 学员边接诊，教师边指导 52(61.90) 学员独立接诊，教师最后指导 55(65.48) 翻转课堂 23(27.38) 病例为基础的教学(CBL) 35(41.67) 门诊模拟教学 37(44.05) 希望参与何种形式的门诊带教培训(n=84) 授课式 53(63.10) 观摩他人教学录像 64(76.19) 教学工作坊 63(75.00) 教学小组讨论 56(66.67) 一对一指导 30(35.71) 其他 0
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[1] 中国医师协会. 关于印发《全科专业住院医师规范化培训全科教学查房规范(试行)》和《全科专业住院医师规范化培训全科教学门诊规范(试行)》的通知[A/OL]. (2021-07-30)[2022-06-12]. https://www.cmda.net/ggtz/14203.jhtml .Chinese Medical Doctor Association. Notice on Printing and Issuing General Practice Teaching Rounds Standards for Standardized Training of General Practice Residents (Trial) and General Practice Teaching Outpatient Standards for Standardized Training of General Practice Residents (Trial)[A/OL]. (2021-07-30)[2022-06-12].https://www.cmda.net/ggtz/14203.jhtml .[2] 杨凯超, 李开军, 吴伟东, 等. 全科住院医师规范化培训基地教学门诊开展现状调查[J]. 浙江医学教育, 2023, 22(4): 225-230.YANG K C, LI K J, WU W D, et al. Investigation on the current situation of teaching clinics in the standardized training base for general residents[J]. Zhejiang Medical Education, 2023, 22(4): 225-230. [3] 吴玲燕, 徐志杰, 童钰铃, 等. 基于CIPP模型的全科基层实践基地指导医师门诊教学能力提升项目评价研究[J]. 中国全科医学, 2024, 27(7): 801-809.WU L Y, XU Z J, TONG Y L, et al. Evaluation of the Improvement Programme on Ambulatory Training Ability of Community Preceptors in Practice Base of General Practice Based on the CIPP Model[J]. Chinese General Practice, 2024, 27(7): 801-809. [4] 肖美霞, 施胜铭, 温晓红, 等. 助理全科专业住院医师规范化培训教学门诊中融入思政教育元素的探索与实践[J]. 全科医学临床与教育, 2025, 23(1): 46-49.XIAO M X, SHI S M, WEN X H, et al. Exploration and practice of integrating civic and political education elements in teaching clinic for residents standardized training of assistant general practitioner[J]. Clinical Education of General Practice, 2025, 23(1): 46-49. [5] 张帆, 张燕萍, 王均祎, 等. 标准化病人结合案例教学在医学生问诊培训中应用分析[J]. 中国现代医生, 2021, 59(8): 141-144.ZHANG F, ZHANAG Y P, WANG J, et al. Application analysis of standardized patients combined with case teaching in medical students' inquiry training[J]. China Modern Doctor, 2021, 59(8): 141-144. [6] 孙艳春, 王伟, 谢学勤, 等. 六省基层全科医生专业知识能力抽样分析[J]. 中华全科医师杂志, 2021, 20(6): 691-695.SUN Y C, WANG W, XIE X Q, et al. Sampling analysis of professional knowledge and ability of primary general practitioners in six provinces[J]. Chinese Journal of General Practitioners, 2021, 20(6): 691-695. [7] 陈丽芬, 曹若瑾, 陈超, 等. 列斯特评估量表在三级医院全科医学教学门诊的应用研究[J]. 中华全科医师杂志, 2022, 21(8): 756-759.CHEN L F, CAO R J, CHEN C, et al. Application of Lester assessment package in general practice teaching clinic of tertiary hospital[J]. Chinese Journal of General Practitioners, 2022, 21(8): 756-759. [8] 张国明, 邱捷, 潘家炜. 全科医学教学门诊在住院医师规范化培训中的应用及效果评价[J]. 世界最新医学信息文摘, 2023, 23(23): 159-162.ZHANG G M, QIU J, PAN J W. Application and effect evaluation of general practice teaching clinic in standardized resident training[J]. World Latest Medicine Information, 2023, 23(23): 159-162. [9] 李健, 朴慧烘, 刘莹莹, 等. 全科医生接诊能力评价工具系统综述[J]. 中华全科医学, 2021, 19(5): 841-845. doi: 10.16766/j.cnki.issn.1674-4152.001931LI J, PIAO H H, LIU Y Y, et al. The evaluation instruments of the general practitioners ability for the patient encounter-A systemic review[J]. Chinese Journal of General Practice, 2021, 19(5): 841-845. doi: 10.16766/j.cnki.issn.1674-4152.001931 [10] 孔燕, 李虹. 南宁市社区实践教学基地医师带教现状和培训需求调查及带教意愿影响因素分析[J]. 广西医学, 2021, 43(13): 1618-1622.KONG Y, LI H. Survey on teaching status and training demands and analysis of influencing factors of willingness to teach in teacher physicians from community practicing training bases in Nanning City[J]. Guangxi Medical Journal, 2021, 43(13): 1618-1622. [11] 吴秀勤, 冷雁, 陈曦, 等. 以目标为导向的督导式康复医学科教学门诊的建设与实践[J]. 中国康复医学杂志, 2023, 38(11): 1592-1596.WU X Q, LENG Y, CHEN X, et al. Construction and practice of goal-oriented supervised teaching clinic of rehabilitation medicine[J]. Chinese Journal of Rehabilitation Medicine, 2023, 38(11): 1592-1596. [12] 邱艳, 郑园园, 孙莹, 等. 全科师资教学门诊分级分层带教现状调查[J]. 医学教育研究与实践, 2021, 29(3): 411-414.QIU Y, ZHENG Y Y, SUN Y, et al. Investigation on GP-S Based Teaching Clinic Status among General Practitioner Preceptors[J]. Medical Education Research and Practice, 2021, 29(3): 411-414. [13] 李莉蓉. 国内外全科医学教育发展现状与展望[J]. 高教学刊, 2021(7): 31-34.LI L R. Current Situation and Prospect of General Practice Education at Home and Abroad[J]. Journal of Higher Education, 2021(7): 31-34. [14] 潘萱达, 于晓松, 单海燕. 国内外全科医生激励机制对比与启示[J]. 中国全科医学, 2023, 26(1): 14-20.PAN X D, YU X S, SHAN H Y. Research Progress and Prospects of Incentive Mechanisms for General Practitioners in China and Abroad[J]. Chinese General Practice, 2023, 26(1): 14-20. [15] 余馨妍, 吴玲燕, 毛玲娜, 等. 教学门诊在全科住院医师规范化培训中的实践现状与启示[J]. 中华医学教育探索杂志, 2024, 23(9): 1281-1285.YU X Y, WU L Y, MAO L N, et al. Implementation of teaching clinic in the standardized training of general practice residents: current situation and implications[J]. Chinese Journal of Medical Education Research, 2024, 23(9): 1281-1285. [16] 沈昊, 赵俊. 医教协同背景下省域临床教学基地建设状况及问题对策研究[J]. 中国医院, 2022, 26(1): 51-53.SHEN H, ZHAO J. Analysis on the current situation, problems and countermeasures of provincial clinical teaching bases under the background of health and education coordination[J]. China Hospitals, 2022, 26(1): 51-53. [17] 吴丽红, 朱文华, 戴红蕾, 等. 基于全科医生岗位胜任力的全科师资考核模式探索[J]. 中华医院管理杂志, 2021, 37(2): 163-166.WU L H, ZHU W H, DAI H L, et al. Exploration of assessment model for general practice faculty based on general practitioner post competence[J]. Chinese Journal of Hospital Administration, 2021, 37(2): 163-166. [18] 靳明伟, 樊姨君, 郭明, 等. 标准化病人联合莱斯特评估法在全科门诊教学中的应用效果[J]. 中华全科医学, 2024, 22(11): 1953-1956. doi: 10.16766/j.cnki.issn.1674-4152.003773JIN M W, FAN Y J, GUO M, et al. Application effect of standardized patient combined with Leicester assessment package evaluation method in general outpatient teaching[J]. Chinese Journal of General Practice, 2024, 22(11): 1953-1956. doi: 10.16766/j.cnki.issn.1674-4152.003773 [19] 马军庄, 邵双阳, 任菁菁, 等. 多元化教学模式在全科未分化疾病门诊教学中的构建与实践[J]. 中国继续医学教育, 2023, 15(4): 65-69.MA J Z, SHAO S Y, REN J J, et al. Construction and Practice of Multiple Teaching Mode in Outpatient Clinic Teaching of Medically Unexplained Physical Symptoms in General Practice[J]. China Continuing Medical Education, 2023, 15(4): 65-69.
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