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| 基于混合研究方法对比两个全科培训基地全科住院医师对培训的态度和看法 | |
| 引用本文： | 连思晴,夏瑀,张锦枝,韩晓宁,迟春花,Michael D Fetters. 基于混合研究方法对比两个全科培训基地全科住院医师对培训的态度和看法[J]. 中国全科医学, 2020, 23(19): 2366-2373. DOI: 10.12114/j.issn.1007-9572.2020.00.413 |
| 作者姓名： | 连思晴 夏瑀 张锦枝 韩晓宁 迟春花 Michael D Fetters |
| 作者单位： | 1.100034北京市，北京大学第一医院全科医学科 2.518036广东省深圳市，北京大学深圳医院全科医学科 3.100034北京市，北京大学第一医院心内科 4.48109 Mixed Methods Program and Department of Family Medicine，University of Michigan，Ann Arbor，Michigan，USA*通信作者：迟春花，主任医师，教授，博士生导师；E-mail：chichunhua2012@163.com |
| 摘 要： | 背景 中国正在完善分级诊疗和家庭医生制度，全科医生人才培养是实现这一制度的核心因素，目前我国全科医生缺口40万，全科住院医师规范化培训是培养高质量全科医生的主要途径。目的 通过混合研究方法广而深地了解来自两个城市的两个医院全科住院医师对其接受的全科规范化培训看法的异同，探讨不同规范化培训模式下可能带来的益处。方法 应用混合研究方法进行横断面研究。于2019年4月，采用整群抽样法抽取北京大学第一医院和北京大学深圳医院全科住院医师作为研究对象。两个医院均是“5+3”全科住院医师规范化培训基地，其中北京大学第一医院为“四证合一”的试点基地。结果 北京大学第一医院共发放问卷39份，回收有效问卷35份，有效回收率89.7%；北京大学深圳医院共发放84份问卷，回收有效问卷70份，有效回收率为83.3%。总体上，全科住院医师感觉到由于选择了全科专业而受到歧视，感觉作为全科医师能力不足。许多住院医师提到教学医师的教学态度较差。北京的住院医师比深圳的住院医师对培训更满意（P=0.001），并觉得全科教学医师有足够的知识（P<0.001）和更合适的教学态度（P=0.004），并且北京大学第一医院住院医师5项工作愿景得分均低于北京大学深圳医院，差异具有统计学意义（P<0.05）。结论 这些中国全科住院医师了解培训中需要改进的内容及培训的长项。北京全科住院医师对教学及工作满意度更高，其可以获得高水平教学医师的培训，并可以获得相关证明，提示教育改革可以增强培训力度并促进住院医师有更好的工作愿景。这些发现提示中国的住院医师面临着和国际相类似的情况，同时，也提示规范化培训教学课程的改革可能会带来益处。 |
| 关 键 词： | 全科医生 教育 医学 规范化培训 混合研究方法 |
Comparison of General Practice Residents'Attitudes and Perceptions about Training in Two Programmes in China:a Mixed Methods Survey |
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| LIAN Siqing,XIA Yu,ZHANG Jinzhi,HAN Xiaoning,CHI Chunhua,Michael D Fetters. Comparison of General Practice Residents'Attitudes and Perceptions about Training in Two Programmes in China:a Mixed Methods Survey[J]. Chinese General Practice, 2020, 23(19): 2366-2373. DOI: 10.12114/j.issn.1007-9572.2020.00.413 | |
| Authors: | LIAN Siqing XIA Yu ZHANG Jinzhi HAN Xiaoning CHI Chunhua Michael D Fetters |
| Affiliation: | 1.Department of General Practice，Peking University First Hospital，Beijing 100034，China2.Department of General Practice，Peking University Shenzhen Hospital，Shenzhen 518036，China3.Cardiology Department，Peking University First Hospital，Beijing 100034，China4.Mixed Methods Program and Department of Family Medicine，University of Michigan，Ann Arbor，Michigan 48109，USA*Corresponding author：CHI Chunhua，Chief physician，Professor，Doctoral supervisor；E-mail：chichunhua2012@163.com |
| Abstract: | Background China is improving the hierarchical medical system and family doctor system,during which general practitioners serve as a core supplier of hierarchical medical services and family doctor services.Currently,there is a shortage of 400000 general practitioners,which can be solved mainly by fostering high-quality general practitioners with standard general practice residency training program.Objective To perform an extensive and in-depth comparative survey analysis of general practice(GP)residents'attitudes about their residency training in two programmes conducted by two hospitals in different cities of in China using mixed methods,and to discuss the possible benefits of different training patterns.Methods A mixed methods survey was administered cross-sectionally.Participants were GP residents selected by cluster sampling from Peking University First Hospital and Peking University Shenzhen Hospital,two bases for fostering residents.The two training programmes are similar in most regards according to current GP training policy of 5 years'undergraduate degree in medicine and 3 years of postgraduate GP residency training—but differing as the Beijing programme has adopted educational innovations(piloting the'Four-Certificates-In-One'option)beyond the nationally prescribed standard curriculum used by the second Shenzhen programme.Results Of the 123 GP trainees,105(85.4%)were eligible,35(89.7%)in the innovative Beijing programme and 70(83.3%)in the standard training Shenzhen programme.Overall,residents felt discrimination because of specialty choice,and that they lacked competency as a general practitioner.Many residents commented faculty had negative teaching attitudes.Beijing residents were more satisfied than Shenzhen residents with their training(P=0.001),and felt teaching faculty had sufficient knowledge(P<0.001),and appropriate attitudes towards teaching(P=0.004).Beijing residents more strongly agreed on five items about good future job prospects(all P<0.05).Conclusion Higher satisfaction with faculty teaching and job optimism in Beijing where GP residents receive training from specifically qualified faculty,and can earn special certification,suggest that the educational innovations enhance training and promote positivity about job prospects.These findings imply that GP residents in China face many training challenges that are similar to other international reports,while also implicating benefits of using an innovative curricular approach. |
| Keywords: | General practitioners Education,medical Standardized training Mixed methods survey |
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