紧密型医联体内社区卫生服务中心全科医生医疗能力培训教学需求分析

背景　目前医联体内社区卫生服务中心全科医生医疗能力培训教学安排缺乏需求证据支持。目的　为紧密型医联体模式下社区卫生服务中心全科医生培训制定以需求为导向的培训计划。方法　2019年11-12月，采用整群抽样法，对四川大学华西医院紧密型医联体模式中9家社区卫生服务中心的65名全科医生进行全科培训需求内容的问卷调查，问卷内容包括全科医学基本理论知识、全科医学基本技能、全科医学其他技能、全科医学临床操作4部分37个条目，每个条目均采用Likert 10级评分法，并根据条目需求评分设置优先等级。结果　按条目评分≥9分的全科医生人数占比从高到低排序，在全科医学基本理论知识部分，需求最高的是全科医生的临床诊疗策略〔47.7%（31/65）〕；在全科医学基本技能部分，需求最高的是呼吸系统常见疾病的全科处理〔55.4%（36/65）〕；在全科医学其他技能部分，培训需求最高的是社区营养指导〔36.9%（24/65）〕；在全科医学临床操作部分，需求最高的是氧气疗法、呼吸疾病常用吸入器和喷雾器使用方法〔46.2%（30/65）〕。根据评分优先等级标准，筛选出全科医生的临床诊疗策略、心脑血管常见疾病的全科处理、呼吸系统常见疾病的全科处理、社区常见症状和急症的全科医学处理、急救技术、常见实验室检查结果解读、常见影像识别解读（放射、B超）、十二导联及动态心电图判读8项作为首选培训内容，以及消化系统常见疾病的全科处理等13项主要备选培训内容。结论　本研究提出了紧密型医联体社区卫生服务中心系统性培训方案中的8项首选培训内容和13项主要备选培训内容，可为医疗机构根据其自身资源定制培训方案提供参考。

Training Needs of General Practitioners in the Community Health Center within a Compact Medical Consortium

Background　The evidence is absent to support the trainings for improving professional capabilities of community general practitioners（GPs） working within a medical consortium. Objective　To formulate a demand-oriented training plan for GPs in the community health center（CHC） within a compact medical consortium. Methods　A survey was conducted from November to December 2019 in a cluster sample of 65 GPs working at 9 CHCs within West China Hospital of Sichuan University medical consortium for collecting data about training needs of general practice. A questionnaire was used in the survey，which consists of essential theoretical knowledge，essential and other skills and clinical practice of general practice，with questions presented using 37 10-point Likert items（a higher score indicating a higher demand）. And the priority level of item contents was set later according to the rated score. Results　The items with an average score of≥9 revealed that，the most in-demand essential theoretical knowledge，essential and other skills and clinical practice of general practice were clinical diagnostic and treatment strategies〔47.7%（31/65）〕，general treatment of common respiratory system diseases〔55.4%（36/65）〕，community nutrition guidance〔36.9%（24/65）〕，and performance of oxygen therapy，and use of common inhalers and nebulizers for respiratory diseases〔46.2%（30/65）〕，respectively. According to the priority criteria，contents covered by 8 items，including general diagnostic and treatment strategies，general treatment of common cardiovascular and cerebrovascular diseases，and common respiratory diseases as well as common symptoms and emergencies in the community，first aid techniques，interpretation of common laboratory test results，common image recognition（X-ray and B-mode ultrasound images），interpretation of 12-lead ECG and dynamic ECG were set as the first choice of training content，and the contents covered by 13 items，involving general treatment of common digestive system diseases，were listed as the major alternatives. Conclusion　This study proposed a systematic training program with 8 aspects of first-choice training contents and 13 aspects of major alternatives listed，for community GPs working within a compact medical consortium，which may be used as a reference for medical institutions developing GPs training programs based on their own conditions.