Analysis of training and practical effectiveness of traditional Chinese medicine (TCM) appropriate technology for primary general practitioners within a medical consortium
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摘要:
目的 探讨基于医联体的基层全科医生技能培训模式，并进行效果评价。 方法 选取2019—2021年参加自贡市中医适宜技术培训的108名基层全科医生为研究对象，其中沿滩区自贡市中医医院医联体成员单位的51名学员为观察组，非医联体成员单位的57名学员为对照组。观察组采用医联体模式，对照组采用培训班模式。1年后，采用柯氏模型从反应层、学习层、行为层、结果层4个层面评价培训效果。 结果 在反应层方面，对照组总分为(37.51±3.42)分，观察组为(40.71±3.79)分，观察组高于对照组(t=4.609, P＜0.001)。在学习层方面，对照组总分为(67.11±10.28)分，观察组为(72.67±11.69)分，观察组高于对照组(t=2.631, P=0.010)。在行为层方面，对照组总分为(30.63±9.98)分，观察组为(34.16±7.85)分，观察组高于对照组(t=2.024, P=0.045)。在结果层方面，对照组总分为(32.33±4.39)分，观察组为(36.16±8.24)分，观察组高于对照组(t=2.960, P=0.004)。 结论 基于医联体的技能培训可以提升基层全科医生中医适宜技术水平，促进其学习和医疗行为，并且具有良好的个人效益、组织效益和辐射效益。 Abstract:Objective To explore and evaluate the effectiveness of the primary general practitioner technology training model based on a medical consortium. Methods Totally 108 general practitioners from primary hospitals in Zigong were enrolled for traditional Chinese medicine (TCM) training. Among them, 51 students from the medical consortium of Zigong Traditional Chinese Medicine Hospital in Yantan District were selected as the observation group, while the remaining 57 students were selected as the control group. The observation group followed the medical consortium model, while the control group followed the traditional training class model. After one year, the evaluation was conducted using Kirkpatrick's four-level model, including reaction, learning, behavior and results. Results In the reaction layer, the observation group demonstrated a higher total score (40.71±3.79) compared to the control group (37.51±3.42), indicating a significant difference (t=4.609, P < 0.001). In the learning layer, the observation group also achieved a higher total score (72.67±11.69) compared to the control group (67.11±10.28), which was statistically significant (t=2.631, P=0.010). Similarly, in the behavior layer, the observation group obtained a higher total score (34.16±7.85) compared to the control group (30.63±9.98), showing a significant difference (t=2.024, P=0.045). Finally, in the results layer, the observation group had a higher total score (36.16±8.24) compared to the control group (32.33±4.39), which was statistically significant (t=2.960, P=0.004). Conclusion The technology training based on a medical consortium has been shown to improve the proficiency of traditional Chinese medicine among primary general practitioners, fostering their learning and medical practices. This training approach offers significant individual, organizational, and radiation benefits. -
表 1 2组基层全科医生学员基本情况比较[人(%)]
Table 1. Comparison of the basic situation of 2 groups of grass-roots general practitioners[people (%)]
组别 人数 性别 年龄 学历 职称 工作年限 男性 女性 ＜30岁 30~40岁 ＞40岁 本科及以上 大专 中专及以下 高级 中级 初级 ＜10年 10~20年 ＞20年 对照组 57 36(63.2) 21(36.8) 21(36.8) 10(17.5) 26(45.6) 16(28.1) 25(43.9) 16(28.1) 4(7.0) 10(17.5) 43(75.4) 24(42.1) 25(43.9) 8(14.0) 观察组 51 31(60.8) 20(39.2) 14(27.5) 15(29.4) 22(43.1) 14(27.5) 26(51.0) 11(21.6) 5(9.8) 11(21.6) 35(68.6) 21(41.2) 23(45.1) 7(13.7) 统计量 0.064a -0.218b -0.664b 0.218b -1.091b P值 0.800 0.827 0.507 0.827 0.275 注：a为t值，b为Z值。 
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表 2 2组学员培训后反应层效果比较(x±s，分)
Table 2. Comparison of the reaction between the two groups of learners(x±s, points)
组别 例数 培训内容(20分) 培训方案(15分) 完整性、系统性(5分) 适用性(5分) 针对性(5分) 难易度(5分) 培训方式(5分) 培训时间(5分) 培训场地(5分) 对照组 57 4.18±0.71 4.14±1.01 3.61±0.98 3.95±0.88 3.23±1.10 3.46±1.02 3.61±0.96 观察组 51 4.08±0.96 4.04±1.10 4.04±0.85 4.20±0.92 4.20±0.92 3.84±0.99 4.04±0.80 t值 0.593 0.533 2.402 1.442 3.040 3.319 2.486 P值 0.555 0.595 0.018 0.152 0.003 0.001 0.014 组别 例数 培训师资(15分) 总分(50分) 专业知识水平(5分) 教学水平(5分) 教学方式(5分) 对照组 57 4.37±1.01 4.11±0.86 2.86±1.20 37.51±3.42 观察组 51 4.35±0.72 4.24±0.93 3.84±0.81 40.71±3.79 t值 0.093 0.755 4.928 4.609 P值 0.926 0.452 ＜0.001 ＜0.001
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表 3 2组学员培训前后学习层效果比较(x±s，分)
Table 3. Comparison of the learning between the two groups of learners(x±s, points)
组别 例数 时间点 理论知识(30分) 综合能力(20分) 中医学概论(10分) 常用腧穴定位(10分) 中医适宜技术的合理选用(10分) 病情评估能力(10分) 医患沟通技巧(10分) 对照组 57 培训前 6.28±2.03 5.11±1.71 5.93±2.21 5.25±1.74 5.95±1.72 培训后 7.18±1.54b 6.65±1.13b 6.77±1.58b 6.70±1.20b 7.18±1.24b 观察组 51 培训前 6.12±2.03 5.37±1.81 6.18±2.01 5.25±1.64 6.02±1.92 培训后 7.08±1.60b 7.75±1.47b 7.73±1.43b 6.92±1.65b 7.22±1.50b t值a 0.321 4.316 3.273 0.800 0.152 P值a 0.749 ＜0.001 0.001 0.426 0.879 组别 例数 时间点 操作技能(50分) 总分
(100分)操作前准备(10分) 操作方法(10分) 操作时间及疗程(10分) 禁忌证与注意事项(10分) 异常反应及处理措施(10分) 对照组 57 培训前 5.33±1.77 5.46±1.68 5.72±1.83 4.47±1.81 4.30±1.69 53.68±15.97 培训后 6.93±1.39b 7.30±1.05b 7.05±1.60b 5.68±1.09b 5.67±1.23b 67.11±10.28b 观察组 51 培训前 5.14±1.70 5.51±1.48 5.67±2.03 4.41±1.77 4.53±1.71 54.20±14.96 培训后 7.33±1.48b 8.18±1.11b 7.49±1.42b 6.53±1.10b 6.45±1.30b 72.67±11.69b t值a 1.463 4.224 1.498 4.006 3.220 2.631 P值a 0.146 ＜0.001 0.137 ＜0.001 0.002 0.010 注：a为2组培训后比较。与同组培训前比较，bP＜0.05。
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表 4 2组学员培训后行为层效果比较(x±s，分)
Table 4. Comparison of the behavior between the two groups of learners(x±s, points)
组别 例数 时间点 医疗行为(20分) 学习行为(10分) 运用中医思维分析病情(5分) 通过多种途径获取学习资料(5分) 规范进行中医技术操作(5分) 有效进行医患沟通(5分) 正确进行疗效评价(5分) 主动更新相关知识(5分) 对照组 57 培训前 2.51±0.83 2.40±0.78 2.86±0.61 2.68±0.93 2.21±0.90 2.09±0.89 培训后 2.84±1.24b 3.00±1.25b 3.67±1.06b 3.19±0.97b 2.82±1.05b 3.00±1.31b 观察组 51 培训前 2.06±0.99 2.47±0.76 3.06±0.73 2.37±0.75 2.45±0.70 2.63±0.85 培训后 3.31±1.09b 3.51±0.93b 4.14±0.85b 3.59±0.96b 3.37±1.33b 3.55±1.19b t值a 2.095 2.382 2.530 2.119 2.389 2.272 P值a 0.039 0.019 0.013 0.036 0.019 0.025 组别 例数 时间点 教学行为(10分) 科研行为(10分) 总分(50分) 主动承担教学任务(5分) 制订教学计划(5分) 发表论文(5分) 参与科研工作(5分)) 对照组 57 培训前 2.33±0.66 2.02±0.81 2.25±0.87 1.72±0.75 23.07±4.24 培训后 3.18±1.15b 3.02±1.23b 3.16±1.29b 2.75±1.17b 30.63±9.98b 观察组 51 培训前 2.67±0.55 2.27±0.49 2.47±0.73 1.96±0.75 24.41±4.27 培训后 3.76±1.18b 3.04±1.25b 3.25±1.23b 2.63±1.15b 34.16±7.85b t值a 2.628 0.091 0.398 -0.568 2.024 P值a 0.010 0.930 0.691 0.571 0.045 注：a为2组培训后比较。与同组培训前比较，bP＜0.05。
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表 5 2组学员培训后结果层效果比较(x±s，分)
Table 5. Comparison of the results between the two groups of learners(x±s, points)
组别 例数 时间点 个人效益(20分) 组织效益(15分) 技术水平(5分) 职业价值感(5分) 绩效收入(5分) 个人发展前景(5分) 服务能力(5分) 经济效益(5分) 患者满意度(5分) 对照组 57 培训前 2.93±0.59 2.11±0.92 1.82±0.76 2.46±0.89 2.25±0.89 2.56±.089 2.47±0.78 培训后 3.82±0.91b 2.79±1.13b 2.82±1.14b 3.12±1.23b 3.12±1.14b 3.14±1.04b 3.70±1.02b 观察组 51 培训前 2.98±0.76 2.61±0.83 1.84±0.76 2.12±0.95 2.41±0.73 2.39±0.83 2.73±0.72 培训后 4.20±0.69b 3.33±1.13b 2.96±1.08b 3.14±1.11b 3.71±1.24b 3.47±1.12b 4.35±0.77b t值a 2.367 2.502 0.638 0.064 2.554 1.587 3.717 P值a 0.020 0.014 0.525 0.949 0.012 0.116 ＜0.001 组别 例数 时间点 辐射效益(15分) 总分(50分) 向同事传递培训内容(5分) 对乡村医生开展相关培训(5分) 普及中医药健康知识(5分) 对照组 57 培训前 2.07±0.78 2.44±0.68 2.44±0.82 23.54±3.99 培训后 2.68±1.02b 3.54±0.97b 3.58±1.07b 32.33±4.39b 观察组 51 培训前 2.22±0.58 2.55±0.58 2.33±0.71 24.18±4.46 培训后 3.33±0.95b 4.14±0.87b 3.53±1.01b 36.16±8.24b t值a 3.406 3.338 -0.247 2.960 P值a 0.001 0.001 0.805 0.004 注：a为2组培训后比较。与同组培训前比较，bP＜0.05。
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