基于扎根理论探讨全科医生专长化培训方案的优化

孟佳; 郭萌; 王君颖; 姜礼红

doi:10.16766/j.cnki.issn.1674-4152.003089

基于扎根理论探讨全科医生专长化培训方案的优化

doi: 10.16766/j.cnki.issn.1674-4152.003089

哈尔滨医科大学附属第二医院全科医疗科，黑龙江哈尔滨 150086

基金项目:

全国医学专业学位研究生教育指导委员会全科医学教育教学研究课题 B-YXGP20210201-04

黑龙江省教育科学“十四五”规划2022年度重点课题 GJB1422775

详细信息

通讯作者:
姜礼红，E-mail: jianglihong2006@163.com

中图分类号: R192.3 R499
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- 被引次数: 0
出版历程
- 收稿日期: 2022-08-23
- 网络出版日期: 2023-08-28

Exploration the optimization of the special interests training program for general practitioners based on grounded theory

General Practice, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, China

摘要

摘要: 目的通过扎根理论视角，全面探索全科医生专长化培训方案的影响因素，为专长化培训方案的优化实施提供实证支持。方法对哈尔滨医科大学附属第二医院全科住培基地已完成专长化培训的14名学员进行半结构式访谈，基于程序化扎根理论研究方法，对访谈原始资料进行开放式编码、轴心式编码和选择式编码，最终构建相关理论模型。结果在开放式编码过程中，形成171个编码号、17个初始概念及6个范畴；通过轴心式编码总结出3个主范畴；最终选择式编码得出“全科医生专长化培养方案优化”这一核心范畴，并从3个维度进行理论模型构建。结论增强全科医生专长化培养的内向驱动力，满足其“全”加“专”综合素质提升的刚性需求，并注重培训过程中的兴趣驱动元素，为方案的优化实施提供坚实基础; 形成以专科带教教师为主导、全科教师为桥梁、各部门积极配合的协同管理模式，同时制定严格的考核管理标准，为确保专长化培训方案的高效实施提供有力的保障; 不断提高带教教师的带教意识，注重师资遴选及人员配置，使教学水平逐步提升是方案优化实施的核心因素。
- 全科医生 /
- 专长化 /
- 半结构访谈 /
- 扎根理论 /
- 质性研究
Abstract: Objective To comprehensively explore the factors influencing the special interests training program for general practitioners from a grounded theory perspective, and to provide empirical support for optimizing the implementation of the special interests training program. Methods The semi-structured interviews were conducted with 14 students who had completed the special interests training program at the standardized training base for general practice residents of the Second Affiliated Hospital of Harbin Medical University, Based on the procedural grounded theory research method, the open coding, axial coding, and selective coding were conducted on the raw interview data, and the relevant theoretical model was finally constructed. Results In the open coding process, 171 coding numbers, 17 initial concepts and 6 categories were formed. Three primary categories were summarized by axial coding. The final selection coding resulted in the core category "the optimization of the special interests training program for general practitioners" and the theoretical model was constructed from three dimensions. Conclusion To enhance the internal driving force of special interest straining of general practitioners, to meet the rigid demand for comprehensive quality improvement of "full" and " specialisation", and to focus on the interest-driven elements in the training process, so as to provide a solid foundation for optimizing the implementation of the program. A collaborative management mode should be established with specialized teachers as the leaders, general practice teachers as the bridge, and active cooperation from all departments. Strict assessment criteria should be formulated so as to provide a strong guarantee for the efficient implementation of the special interests training program. The core factors for the implementation of the program optimization are to constantly improve the teaching consciousness of teachers, pay attention to the selection of teachers and staff, and gradually improve the teaching level.
- General practitioners /
- Special interest /
- Semi-structured interview /
- Grounded theory /
- Qualitative research

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图 1 全科医生专长化培养方案优化理论框架

Figure 1. Theoretical framework for the optimization of general practitioner specialized training programs

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表 1 开放式编码表

Table 1. Open coding table

范畴	初始概念	学员原始语句(节选)
刚性需求	知识薄弱	P01.我想学眼科疾病，希望自己可以分辨普通眼病，平时眼科接触少、做题也少, 知识薄弱
	工作适用	P08.咽炎、鼻炎、扁桃体炎、外耳道疾病在社区接触机会大一些
兴趣提升	尊重自主选择	P09.专长化学习靠自觉性，学生想选哪科，肯定是对这个感兴趣，就让他选择
	时间安排	P03、P04、P05.专长化1个月和3个月有区别, 但2个月和3个月学到的东西差不多
		P02.专长化时间放在最后，心有些散，有的需要找工作，有的要联系原单位工作的事情
	半自主学习模式	P09.目前阶段收获最大，平时虽然比较自由，但可以自己学习，有不会的问老师，老师有空会给我讲课
		P14.自律性高的同学这种模式的效果会更好，我的自律性比较弱，晚上回去很少看书
协同管理	全科教师管理	P08.培训开始前需要有全科老师和轮转科室协调好计划安排，我所在的耳鼻喉科的沟通存在困难
	带教教师管理	P09.老师走到哪我就跟到哪，“师带徒”式可以实现，带教老师会安排我们去门诊和病房
	教学部门配合	P02.专长化我们比较在意，在专科那只有老师在意，其他人不在意，好多科室还是不太认可，去眼科功能室很费劲，里边很多片子看不到
		P10、P11.所在教研室的教秘中间有更换，前期的教秘没有上课提醒，后期的教秘会通知我们上理论课
考核管理	材料考核	P07.需要上交的材料比较多，内容相似，觉得有些浪费时间，建议写类似患者接诊思路的内容比较有帮助
		P01.培养手册上要求的病种基本都看到了，但是有的病例个数少，比如青光眼
	理论考核	P06.专长化3个月可以分三阶段考试，定期理论考试是促进我们掌握理论知识的好方法
		P08.理论考试考过2次，挺难的，考题是从题库里随机抽的，有超纲，很多病都没见过
	出勤考核	P01.护士长进行出勤考核，每天1次，但有时候老师上手术我没去也没人找
带教意识	系统内配合	P13.带教老师去手术时候，同组的3个老师出门诊我们都可以跟着去
		P08.带教老师出门诊可以跟着，也可以去别的诊室老师那里看，碰到特殊典型病例老师们都会讲
	主动带教	P09.老师很爱讲，爱给我看，如果孩子有什么问题，她就会主动和我说
	教学时间安排	P14.我的带教老师带的学生多，一屋子都是人，老师门诊每天100个号，看的可快了，很少有时间讲解
	教学课程安排	P01.技能操作测眼压看得很少，目前会看裂隙灯，眼底镜看得也不多，不太熟悉，除了和老师出门诊没上过理论课，病例讨论没去过
		P10、P11.皮肤科主要学习常见疾病，银屑病、痤疮、湿疹、慢性苔藓、紫癜、药疹、疣、过敏性疾病等
师资配置	全科师资	P08.有专门的全科老师负责专长化，不懂的或轮转出现困难和全科老师沟通
	专科师资	P09.跟着儿科老师出门诊收获挺多的，她知识面太广了
		P07.带教老师是大主任，一般见不到几次面，主要是下级医生带教

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表 2 轴心式编码表

Table 2. Axial coding table

主范畴	对应范畴	范畴内涵
B1内向驱动	A1刚性需求	平时轮转接触病种有限，弥补知识薄弱点，岗位需要、基层分工驱动
	A2兴趣提升	尊重学员的自主选择，兴趣驱动半自主学习模式，合理安排培训时间
B2管理优化	A3协同管理	全科老师与带教老师及相关教学部门及时沟通协调，形成以带教教师为主导、全科教研室为桥梁、各教学部门积极配合的协同管理模式
	A4考核管理	建立规范的考核制度，制定相应考核细则，根据考核结果实施奖惩激励制度
B3教学优化	A5带教意识	带教教师做到主动带教并合理安排带教时间，制定教学计划，形成以带教教师为主导的系统内师资配合
	A6师资配置	完善全科师资及专科带教师资人员配置，注重专长化师资遴选

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