Investigation on the status and demand of general practitioners transfer training in Hebei Province
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摘要:
目的 调查河北省全科医生转岗培训现状及需求，为该省全科医生转岗培训方案的制定提供理论依据。 方法 选取2020年参加河北省全科转岗培训的801名学员进行问卷调查，收集相关数据并进行统计分析。 结果 全科转岗培训学员年龄多分布于41~50岁和31~40岁；大专学历占40.18%(309/769)；学员执业范围以内科为主(64.76%，498/769)；工作地点在乡镇卫生院的占70.35%(541/769)。多数学员未参加过全科医学相关学习及培训(69.70%，536/769)，不同工作地点学员在参加全科医学相关培训和对全科医学及其相关理论了解程度方面差异有统计学意义(P < 0.05)。学员认为需要提升的能力主要为全科医学相关理论知识(89.34%，687/769)和疾病的诊断与鉴别诊断(85.96%，661/769)；38.62%(297/769)的学员认为理论培训时长应大于6个月，42.26%(325/769)的学员认为实践培训时长应为7~12个月；44.21%(340/769)的学员认为基层实践教学能更好地锻炼全科医学临床思维，不同年龄、学历、职称和工作地点的学员对于全科医学临床思维培养方式的需求差异有统计学意义(P < 0.05)；62.16%(478/769)的学员认为培训师资应涵盖全科、专科和社区，不同学历的学员对于培训师资的需求差异有统计学意义(P < 0.05)。 结论 2020年河北省全科医生转岗培训学员年龄偏大，学历、职称相对较低，培训需求各有差异；多数学员之前未参加过全科医学相关学习及培训，且对全科医学理论及其相关政策了解不足。 Abstract:Objective To investigate the current situation and demand of general practitioners transfer training in Hebei Province, and provide theoretical basis for the formulation of the general practitioners transfer training program in Hebei Province. Methods A questionnaire survey was conducted on 801 students who participated in the general practice transfer training in Hebei Province in 2020, and relevant data were collected and analyzed statistically. Results The ages of the trainees in general practice transfer training were mostly distributed between 41-50 years old and 31-40 years old; tertiary education accounted for 40.18% (309/769); the trainees ' scope of practice was dominated by internal medicine (64.76%, 498/769); and the workplaces were in township and village health centers accounted for 70.35% (541/769). Most of the trainees had not participated in general practice related learning and training (69.70%, 536/769), and there were statistically significant differences in the trainees ' participation in general practice related training and understanding of general practice and its related theories at different work places (P < 0.05). Trainees thought that the abilities needed to be improved mainly included theoretical knowledge of general practice (89.34%, 687/769) and diagnosis and differential diagnosis of diseases (85.96%, 661/769). There was 38.62% (297/769) trainees believed that the theoretical training duration should be longer than 6 months, 42.26% (325/769) trainees believed that the practical training duration should be 7-12 months, and 44.21% (340/769) trainees believed that grassroots practice teaching could better exercise the clinical thinking of general practice, and there was a statistically significant difference in the needs of students of different ages, educational backgrounds, professional titles and work places for the training of clinical thinking of general practice (P < 0.05). There was 62.16% (478/769) trainees believed that the training teachers should cover general practice, junior college and community, and there was a statistically significant difference in the demand for training teachers among the trainees with different degrees (P < 0.05). Conclusion In 2020, the general practitioner transfer training trainees in Hebei Province are older, with relatively low academic qualifications and titles, and varying training needs. Most of the trainees have not participated in the study and training related to general practice before, and have insufficient understanding of the theories and related policies of general practice. -
Key words:
- General practitioners /
- Transfer training /
- Training status /
- Training needs
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表 1 769名培训学员的一般资料
Table 1. General information of 769 trainees
项目 类别 人(%) 项目 类别 人(%) 性别 男性 377(49.02) 职称 初级职称 524(68.14) 女性 392(50.98) 中级职称 171(22.24) 年龄 21~30岁 32(4.16) 副高职称 67(8.71) 31~40岁 329(42.78) 正高职称 7(0.91) 41~50岁 352(45.78) 工作地点 乡镇卫生院 541(70.35) 51~60岁 55(7.15) 社区卫生服务中心 128(16.64) >60岁 1(0.13) 二级医院 31(4.03) 学历 中专 140(18.21) 三级医院 69(8.97) 大专 309(40.18) 工作年限 0~5年 58(7.53) 本科 270(35.11) 6~10年 141(18.34) 硕士 42(5.46) 11~15年 161(20.94) 博士 8(1.04) 16~20年 173(22.50) 执业注册情况 内科 498(64.76) 20年以上 236(30.69) 外科 73(9.49) 执业情况 临床执业医师 476(61.90) 妇产 84(10.92) 执业助理医师 281(36.54) 儿科 35(4.55) 其他 12(1.56) 急诊 10(1.30) 其他 69(8.97) 
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表 2 不同工作地点学员培训现状[人(%)]
Table 2. Training status of trainees in different duty stations [persons (%)]
项目 人数
(n=769)工作地点 统计量 P值 乡镇卫生院或社区卫生服务中心(n=669) 二级医院或三级医院(n=100) 是否参加过全科医学相关培训 7.452a 0.006 是 233(30.30) 191(28.55) 42(42.00) 否 536(69.70) 478(71.45) 58(58.00) 对全科医学及其相关理论了解程度 -2.690b 0.007 非常了解 117(15.21) 97(14.50) 20(20.00) 比较了解 264(34.33) 219(32.74) 45(45.00) 一般了解 330(42.91) 304(45.44) 26(26.00) 不了解 58(7.54) 49(7.32) 9(9.00) 对转岗培训政策了解程度 -1.697b 0.090 非常了解 132(17.17) 114(17.04) 18(18.00) 比较了解 251(32.64) 208(31.09) 43(43.00) 一般了解 318(41.35) 288(43.05) 30(30.00) 不了解 68(8.84) 59(8.82) 9(9.00) 注：a为χ2值，b为Z值。
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表 3 学员的转岗培训需求情况
Table 3. Demand for general practice transfer training among trainees
项目 类别 人(%) 项目 类别 人(%) 临床能力 全科医学相关理论 687(89.34) 理论培训时长 0~1个月 164(21.33) 急危重症处理 615(79.97) 2~3个月 201(26.14) 临床操作技能 643(83.62) 4~5个月 107(13.91) 疾病诊断与鉴别诊断 661(85.96) 6个月以上 297(38.62) 疾病的防治与转诊 631(82.05) 实践培训时长 0~3个月 68(8.84) 慢病管理 605(78.67) 4~6个月 176(22.89) 理论培训方式 分散自学 301(39.14) 7~12个月 325(42.26) 集中学习 561(72.95) 12个月以上 200(26.01) 面授培训 581(75.55) 远程培训 536(69.70)
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表 4 不同一般资料培训学员全科医学临床思维培训方式需求[人(%)]
Table 4. Training needs for clinical thinking training in general medicine for trainees with different general information [persons (%)]
项目 人数 病例讨论 病房教学 门诊教学 基层实践教学 课堂教学 χ2值 P值 性别 8.300 0.081 男性 377 55(14.59) 80(21.22) 60(15.92) 163(43.24) 19(5.04) 女性 392 63(16.07) 65(16.58) 78(19.90) 177(45.15) 9(2.30) 年龄(岁) 30.919 0.009 21~30 32 3(9.38) 10(31.25) 6(18.75) 11(34.38) 2(6.25) 31~40 329 43(13.07) 67(20.36) 70(21.28) 140(42.55) 9(2.74) 41~50 352 59(16.76) 61(17.33) 58(16.48) 163(46.31) 11(3.13) 51~60 55 13(23.64) 7(12.73) 4(7.27) 26(47.27) 5(9.09) >60 1 0 0 0 0 1(100.00) 学历 26.937 0.026 中专 140 16(11.43) 25(17.86) 25(17.86) 70(50.00) 4(2.86) 大专 309 38(12.30) 54(17.48) 60(19.42) 145(46.93) 12(3.88) 本科 270 46(17.04) 58(21.48) 49(18.15) 108(40.00) 9(3.33) 硕士 42 16(38.10) 7(16.67) 4(9.52) 13(30.95) 2(4.76) 博士 8 2(25.00) 1(12.50) 0 4(50.00) 1(12.50) 职称 35.954 < 0.001 初级职称 524 63(12.02) 107(20.42) 99(18.89) 239(45.61) 16(3.05) 中级职称 171 27(15.79) 26(15.20) 32(18.71) 78(45.61) 8(4.68) 副高职称 67 23(34.33) 12(17.91) 7(10.45) 21(31.34) 4(5.97) 正高职称 7 5(71.43) 0 0 2(28.57) 0 工作地点 54.116 < 0.001 乡镇卫生院 541 70(12.94) 98(18.11) 89(16.45) 264(48.80) 20(3.70) 社区卫生服务中心 128 16(12.50) 21(16.41) 41(32.03) 46(35.94) 4(3.13) 二级医院 31 9(29.03) 8(25.81) 3(9.68) 10(32.26) 1(3.23) 三级医院 69 23(33.33) 18(26.09) 5(7.25) 20(28.99) 3(4.35) 工作年限 18.490 0.296 0~5年 58 8(13.79) 18(31.03) 13(22.41) 16(27.59) 3(5.17) 6~10年 141 18(12.77) 27(19.15) 29(20.57) 62(43.97) 5(3.55) 11~15年 161 25(15.53) 29(18.01) 32(19.88) 71(44.10) 4(2.48) 15~20年 173 27(15.61) 36(20.81) 31(17.92) 73(42.20) 6(3.47) 20年以上 236 40(16.95) 35(14.83) 33(13.98) 118(50.00) 10(4.24) 合计 769 118(15.34) 145(18.86) 138(17.95) 340(44.21) 28(3.64)
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表 5 不同情况培训学员培训师资需求情况[人(%)]
Table 5. Demand for training teachers among trainees in different situations [persons (%)]
项目 例数 全科师资 专科师资 全科+专科
师资社区师资 全科+专科+
社区师资χ2值 P值 性别 5.985 0.200 男性 377 50(13.26) 10(2.65) 91(24.14) 2(0.53) 224(59.42) 女性 392 33(8.40) 8(2.04) 93(23.72) 4(1.02) 254(64.80) 年龄(岁) 18.536 0.447 21~30 32 1(3.13) 2(6.25) 8(25.00) 1(3.13) 20(62.50) 31~40 329 41(12.46) 10(3.04) 81(24.62) 2(0.61) 195(59.27) 41~50 352 33(9.38) 6(1.70) 81(23.01) 3(0.85) 229(65.06) 51~60 55 8(14.55) 0 14(25.45) 0 33(60.00) >60 1 0 0 0 0 1(100.00) 学历 28.917 0.013 中专 140 17(12.14) 3(2.14) 26(18.57) 1(0.71) 93(66.43) 大专 309 32(10.36) 8(2.59) 71(22.98) 1(0.32) 197(63.75) 本科 270 24(8.89) 3(1.11) 71(26.30) 4(1.48) 168(62.22) 硕士 42 10(23.81) 4(9.52) 12(28.57) 0 16(38.10) 博士 8 0 0 4(50.00) 0 4(50.00) 职称 7.604 0.823 初级职称 524 58(11.07) 13(2.48) 127(24.24) 5(0.95) 321(61.26) 中级职称 171 16(9.36) 3(1.75) 35(20.47) 1(0.58) 116(67.84) 副高职称 67 8(11.94) 2(2.99) 19(28.36) 0 38(56.72) 正高职称 7 1(14.29) 0 3(42.86) 0 3(42.86) 工作地点 17.290 0.097 乡镇卫生院 541 63(11.65) 12(2.22) 117(21.63) 4(0.74) 345(63.77) 社区卫生服务中心 128 6(4.69) 2(1.56) 41(32.03) 1(0.78) 78(60.94) 二级医院 31 5(16.13) 1(3.23) 6(19.35) 0 19(61.29) 三级医院 69 9(13.04) 3(4.35) 20(28.99) 1(1.45) 36(52.17) 工作年限 15.116 0.459 0~5年 58 8(13.79) 2(3.45) 18(31.03) 2(3.45) 28(48.28) 6~10年 141 16(11.35) 6(4.26) 32(22.70) 2(1.42) 85(60.28) 11~15年 161 15(9.32) 3(1.86) 38(23.60) 0 105(65.22) 15~20年 173 17(9.83) 4(2.31) 39(22.54) 1(0.58) 112(64.74) 20年以上 236 27(11.44) 3(1.27) 57(24.15) 1(0.42) 148(62.71) 合计 769 83(10.79) 18(2.34) 184(23.93) 6(0.78) 478(62.16)
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