不同的继续医学教育模式对提高社区医生高血压诊治知识水平的作用

目的比较“以问题为中心、以病例为引导”的交互式、病例讨论式的分级培训模式和常规继续医学教育模式对提高社区医生高血压病诊治水平的作用。方法2002年7月至10月,对北京市海淀区22家和朝阳区20家二级医院和一级医院共632名内科系统的医生进行高血压病临床知识和病例诊治能力的基线问卷调查,针对存在的主要问题并结合实际情况,探索新的培训模式并对海淀区的医生运用新模式进行培训;朝阳区仍用常规的继续教育模式。2004年7月至9月,对两区参加调查医院的医生进行培训后问卷调查,并对两种模式的培训效果进行评价。结果（1）海淀区的医生运用新的培训模式培训后高血压病的知识和病例诊治能力均明显提高,平均总分由40．5提高到70．5（P〈O．01）,提高了74．1％。（2）朝阳区医生在常规的继续教育模式下高血压病的诊治水平也有所提高,平均总分由40．0提高到47．4（P〈0．01）,提高了18．5％,提高的幅度明显低于海淀区。结论“以问题为中心、以病例为引导”的交互式、病例讨论式的分级培训模式能更有效地提高社区医生高血压病的诊治水平。因此,有效地改善继续医学教育的模式是提高社区医生疾病诊治水平的关键措施之一。

The impact of two continuing education models on competence for hypertension diagnosis and treatment of community physicians

OBJECTIVE: To compare the impact of two different continuing education models: traditional model and a new model entitled "problem-oriented and case-based" mutual pattern and "train the trainer" course, on improving hypertension diagnosis and treatment competence of community physicians. METHODS: A total of 632 physicians from 22 district and community hospitals in Haidian district (new model) and 20 district and community hospitals in Chaoyang district (traditional model) in Beijing were trained during July to October 2002. The survey was carried out before and 2 years after training with examination questionnaire. RESULTS: The competence evaluated as a score (maximal 100) for hypertension diagnosis and treatment of physicians was similar in physicians before training from the two districts. Post training, the score significantly increased from 40.0 to 47.4 (P < 0.01) in physicians from Chaoyang district and from 40.5 to 70.5 (P < 0.01) in physicians from Haidian district and the final score for physicians from Haidian district is significantly higher than that for physicians from increased from Chaoyang district (P < 0.01). CONCLUSION: The new model is more efficient for improving community physician's competence for diagnosing and treating hypertension.