全科医生临床能力培训效果评价及影响因素分析

目的 评估全科医生临床能力培训的效果,为今后进一步完善培训方案、提高培训质量提供科学依据.方法 以2011年7月至2012年10月期间参加上海市全科医生临床能力培训的759名学员为研究对象,比较这些学员参加培训前后的理论和操作成绩,分析影响培训效果的因素,评价培训的实施效果.结果 759名学员中,男性260名（34.26％）,女性499名（65.74％）;平均工作年限（13.6±7.1）年.学员培训前后理论和实际操作的总成绩分别为（67.40±8.57）分和（73.61±7.20）分,培训前后成绩的差异具有统计学意义（=17.96,P＜0.01）.培训后实际操作成绩的提高更为明显,培训前后体格检查的成绩分别为（12.90±3.76）分和（14.00±3.51）分,而临床技能成绩分别为（9.41±4.80）分和（13.40±4.02）分,前后成绩的差异均有统计学意义（t值分别为6.31和19.01,均P＜0.01）.在体格检查项目中,心肺体检、腹部体检、甲状腺检查和神经系统体检4个项目的培训后成绩高于培训前,且差异具有统计学意义（均P ＜0.05或0.01）;而临床技能的所有7个项目的培训后成绩均明显高于培训前（均P＜0.01）.多元线性回归分析显示,学员培训效果影响因素包括性别、教育程度、专业类别及培训前成绩（P＜0.01或＜0.05）.结论 全科医生培训后理论知识和实际操作能力都有提高,尤其是临床技能操作水平提高更为明显.今后的培训内容应结合社区全科医生实际工作特点,注重临床技能培训,提高社区全科医师的综合素养.

Effect of clinical competence training for general practitioners and influencing factors

Objective To evaluate the effect of clinical competence training for general practitioners in Shanghai.Methods Total 759 general practitioners participated in clinical competence training from July 2011 to October 2012 in Shanghai.The theoretical and practical operation scores of all the 759 trainees were compared before and after the training and the influencing factors of training effect were analyzed.Results The trainees,including 260 （34.26％） males and 499 （65.74％） females,had average working experiences （13.6±7.1） years.The average total scores before and after training were（67.40 ±8.57）and （73.61 ±7.20） （t =17.96,P ＜ 0.01）.The practical operation scores were improved more significantly,the average scores of physical examination before and after training were （12.90 ± 3.76） and （14.00 ±3.51）,scores of clinical skill before and after training were （9.41 ±4.80） and （13.40 ±4.02） （t =6.31 and 19.01,P ＜ 0.01）.Among seven items of physical examination test,scores of four items （cardiopulmonary examination,abdominal examination,neurological examination and thyroid examination） were significantly higher than those before training （P ＜ 0.05 or ＜ 0.01）.Scores of all 7 items of clinical skill test were higher than those before training （P ＜ 0.01）.The main factors influencing the effect of training were gender,educational background,score before training and type of practice （P ＜ 0.01 or ＜0.05）.Conclusions The clinical competence of general practitioners can be improved after the training.The training contents should be optimized in consistent with conditions of community health and general practitioners in the future.