对我国乡村医生教育的思考

截止2000年底，我国乡村医生大规模的普训任务已基本完成，乡村医生数量不足问题基本得到解决，素质状况也有改善。但目前我国乡村医生素质仍然较低，不能很好适应新形势下农村卫生工作及农民健康的需求。文章通过分析我国目前乡村医生的教育现状，认为我国应结合《2001-2010年全国乡村医生教育规划》，进一步开展乡村医生教育工作，并在此基础上总结了几点乡村医生教育的具体措施。     

余姚市乡村医生现状分析和管理对策

余姚市共有431名乡村医生，分布在全市21个乡镇行政村。乡村医生队伍存在年龄结构不合理、总体文化程度和专业素质偏低、管理制度不健全等问题。建议改革乡村医生培养模式，加强在岗乡村医生学历教育，提高乡村医生队伍素质。     

21世纪我国乡村医生教育初探

乡村医生教育是我国成人医学教育的重要组成部分 ,也是社区医学教育体系中的内容之一。在全球经济与社会加快发展 ,人类健康素质提高的新世纪 ,全面提高乡村医生素质 ,加速我国乡村医生教育进程 ,是目前发展我国农村卫生事业亟待解决的课题。1　乡村医生教育现状90年代初 ,为适应新时期卫生工作的改革和发展 ,满足广大农村居民医疗保健需求 ,卫生部召开了全国首届乡村医生教育研讨会 ,会后颁发了《1991- 2 0 0 0年全国乡村医生教育规划》(以下简称“十年规划”) ,提出了对全国乡村医生实施系统化、正规化中等医学教育的战略目标 ,要求到 2 0…     

医院管理专业本科生培养中存在的问题及对策

我国目前医院实行的一般是“医生型院长”管理模式，管理来自医疗第一线，用于考虑医院管理的时间有限，专业素质与水平有限，市场分析判断能力有限。因此，创办适应需求的医院管理专业，培养新时期的医院管理人才是大势所趋。     

四川省农村三级卫生服务网网底现状与思考

通过对村医疗点基本情况调查分析，结果显示：村医疗点集体办比例不高，乡村医生专业素质偏低，设备简陋，药品质量难以保证，乡村医生报酬较低。为此，提出乡村一体化管理是解决这一系列问题的有效途径，并建议村医疗点要转变观念建立新的服务模式，有关部门要积极推进乡村医生教育达标工作。     

大连市乡村医生继续教育正式启动

为了进一步贯彻和落实中共中央、国务院《关于进一步加强农村卫生工作的决定》和国务院《乡村医生从业管理条例》精神，培养一支具有较高思想道德素质和医疗专业素质的农村卫生队伍，大连市卫生局、大连市财政局和大连市发展和改革委员会联合下发了《大连市乡村医生继续医学教育管理办法》，明确提出以继续教育的形式对乡村医生进行在岗培训，为在乡村医生中开展“正规化、系统化、高质量、高实效”的培训工作进行了有益的尝试和探索。     

五年来中国乡村医生教育改革发展的研究

五年来中国乡村医生教育改革发展的研究中国医科大学中国乡村医生培训中心（１１０００１）黄进初，于洪昭，吕兴权，李雅娟乡村医生教育是我国医学教育的重要组成部分，承担着培养和提高乡村医生素质的重耍任务，改革开放以来，我国农村经济得到了迅速的发展，全国各地都...     

连云港市乡村医生继续教育培训与需求情况调查

目的：通过了解连云港市乡村医生继续教育培训与需求情况，为更好地开展乡村医生继续教育培训提供参考依据。方法：2021年9—10月，采用随机抽样法选取连云港市所辖各县（区） 6个乡镇卫生院、24个村卫生室具有中专以上学历的乡村医生210人作为调查对象，进行问卷调查。结果：目前乡村医生继续教育的培训机构、培训时长、培训方式、培训内容与乡村医生的实际需求有较大差异，无法满足乡村医生对继续教育的需求。结论：应从合理配置优质医疗资源、采取多元化的教学策略、发挥网络优势、加强人文素质培养等方面入手，满足乡村医生继续教育培训需求，从而提升乡村医生的职业素养。     

谈中等卫生专业学校的PHC教育

目前,我国乡村医生的系统化教育、在职培训和函授教育多由职业卫校、职工中专和县卫校承担。全日制普通中等卫生专业学校是我国中等医学教育的主要力量,师资力量强、办学条件好、教学质量高。因此,中等卫生专业学校除应通过与县办卫校、职工中专建立起协作关系,对乡村医生的教育、培训工作进行指导外,还应充分挖掘内在潜力,在乡村医生的教育和为农村培养“实用型”卫生人才方面有所作为。     

乡村一体化的发展、问题与对策

对乡村一体化管理的由来、发展及各利益主体进行了描述，介绍了各地乡村一体化的成功管理经验。并分析了目前乡村一体化进程中存在的问题。这些问题主要包括：乡村医生的积极性不高、专业素质偏低、乡镇卫生院人员的专业技术和管理水平不高、各部门问缺乏协调、卫生费用上涨及合作医疗制度不稳定等。探讨了产生这些问题的较深层次的原因，提出了相关政策建议。     

家庭医生签约服务模式下农村基层医务人员工作内容比较研究

目的:了解家庭医生签约服务模式下农村基层医务人员的工作内容和职责分工现状,为进一步完善职责分工和签约服务模式提供依据。方法:2019年7月采用典型抽样、分层抽样和方便抽样相结合的方法,选取江苏省3个县(区)18个乡镇参与家庭医生签约服务的乡镇卫生院医生、护士、公卫医生、村卫生室医生进行问卷调查;采用描述性分析、卡方检验进行分析。结果:家庭医生签约服务模式下,乡镇卫生院医生主要参与疾病诊疗护理(91.8%)、健康教育(67.6%)、转诊服务(50.5%)、慢性病患者健康管理(50.5%)等工作;护士主要参与疾病诊疗护理(85.0%)、健康教育(61.5%)工作;公卫医生主要参与预防接种(65.9%)、老年人健康管理(51.2%)、慢性病患者健康管理(51.2%)工作;村卫生室医生主要参与医疗服务和绝大部分公共卫生服务项目。结论:家庭医生签约服务模式下农村基层医务人员的工作任务范围广,既参与医疗服务又参与公共卫生服务,促进了医防融合,但存在护士公共卫生服务职能未充分发挥、公卫医生对自身工作职责不清、村卫生室医生工作负担较重等问题。     

The Organizational Structures and Human Resources Allocation of Infectious Disease Surveillance System in Rural China

Objective

To understand the structure and capacity of current infection disease surveillance system, and to provide baseline information for developing syndromic surveillance system in rural China.

Introduction

To meet the long-term needs of public health and social development of China, it is in urgency to establish a comprehensive response system and crisis management mechanism for public health emergencies. Syndromic surveillance system has great advantages in promoting early detection of epidemics and reducing the burden of disease outbreak confirmation (1). The effective method to set up the syndromic surveillance system is to modify existing case report system, improve the organizational structures and integrate new function with the traditional system.

Methods

Since August 2011, an integrated syndromic surveillance project (ISSC) has been implemented in China. Before the launching of the project, a cross-sectional study was carried out in Fengxin County and Yongxiu County of Jiangxi province during October 11 to 18, 2010. Institution information were investigated in the county hospital, township hospital and County Center for Disease Control and Prevention (CDC) to understand the performance of existing case report system for notifiable infectious diseases with regard to its structure, capacity and data collection procedure. Health care workers from each township hospital and village health station were questionnaire interviewed for information on qualification of human resources, basic healthcare delivery condition, hardware and software needs for ISSC.

Results

An internet-based real-time (quasi real-time) case report system for notifiable infectious diseases, based on the three-tier public health service System, had been established in these two counties since 2004. The farthest end of net user in case report system was township hospital. Blood routine test, urine routine test, B ultrasound and electrocardiogram were available in all township hospitals. There was no laboratory equipment in village health stations in these two counties. All the township hospitals in these two counties were equipped with land-line telephones and desktop computers. The internet covers all township hospitals in both counties. Most clinical doctors in township hospital(TH) and village health station(VHS) were male. The age of doctors ranged from 21 to 72 years old, with the average at 42 and median at 40 years. The village health workers were significantly older, less educated and served in health care longer than the township hospital doctors. In Yongxiu County, 95.6% of the village health stations were equipped with computers, including private-owned computers, and 80.7% of them had access to the internet; while in Fengxin County, 66.5% of the village health stations possessed computers, among which most were private property of village doctors, and only 44.2% of them had access to the internet.

Conclusions

The current case report system, with full coverage and stable human resource, has established a solid basis for developing syndromic surveillance system in rural China. The syndromic surveillance system could play its role in early detection of infectious disease outbreaks in rural area where laboratory service for infectious disease diagnosis are not available. However, the lack of computerized patient registration in village and township health care facilities and incomplete internet coverage in rural area and relatively low quality of human resource in village level should be taken into consideration seriously before establishing the syndromic surveillance system in rural China.     

Understanding the shortage of village doctors in China and solutions under the policy of basic public health service equalization: evidence from Changzhou

As the most important public health service providers in rural China, village doctors are facing a new challenge of heavier workload resulting from the recent policy of public health service equalization. Studies on the shortage of village doctors, mainly based on the national statistics, have so far been very broad. This study conducted detailed field surveys to identify specific factors of and potential solutions to the shortage in village doctors. Eight hundred forty‐four village doctors and 995 health decision makers and providers were surveyed through a questionnaire, and some of them were surveyed by in‐depth face‐to‐face interviews and focus group interviews. Opinions on the shortage in village doctors and the potentially effective approaches to addressing the problem were sought. Some village doctors (51.3%) were at least 50 years old. Some village doctors (92.3%) did not want their children to become a village doctor, and the main reasons were “low salary” and “lack of social security”. Village doctors felt that it was difficult to provide all the required public health services. Local residents indicated that they established good relationships with village doctors. Some health decision makers and providers (74.0%) thought that they needed more village doctors. The shortage in village doctors presents a major obstacle toward the realization of China's policy of public health service equalization. The aging of current village doctors exacerbates the problem. Policies and programs are needed to retain the current and attract new village doctors into the workforce. Separate measures are also needed to address disparities in socioeconomic circumstance from village to village. Copyright © 2014 John Wiley & Sons, Ltd.     

山东省村卫生室医疗功能相对弱化形成机理分析

目的了解新医改形势下村卫生室医疗功能出现相对弱化的原因及其作用机制。方法于2015年10—11月,采用目的性抽样方法,选取了山东省乡村医生、乡镇卫生院管理人员以及卫生行政部门管理人员共38人进行访谈。在此基础上,运用扎根理论,对新医改形势下村卫生室医疗功能出现弱化的原因及其作用机制进行系统梳理与描述性分析。结果编码形成了29个一级范畴和21个二级范畴。随着新医改政策的实施,村卫生室获得的经济支持、政策支持和技术支持明显增加,然而在新医改政策非预期负面效应、外部扰动力叠加累积效应和支持力低效供给效应的综合作用下,乡村医生队伍出现情感耗竭、工作满意度下降、积极性下降等现象;加之村卫生室药品使用受限、设备不足,乡村医生业务能力不高,农村居民信任不足,导致村卫生室医疗服务功能相对弱化。结论村卫生室医疗功能的弱化是三类原因综合作用的结果,这种状态的长期存在将进一步增加农村卫生服务体系的脆弱性,不利于分级诊疗制度的贯彻落实。建议优化基本药物制度,建立对村卫生室基本医疗服务和基本公共卫生服务的综合考核机制,强化医保资金战略购买能力,优化财政补偿机制,完善乡村医生培训机制,促进村卫生室的可持续发展。     

蒲江县农村慢性病防治知识调查

目的了解蒲江县农村慢性病防治知识了解情况,为防治提供依据。方法采用随机抽样方法对蒲江县4镇18岁以上农村居民慢性病防治知识了解情况及对4镇的全部村医进行慢性病防治管理情况进行了解。结果调查了村民9 286人、村医39人。村民:知识来源主要是电视(92.32%);对相关知识的了解不足;20.11%的人认为有必要定期健康体检。村医对慢性病防治知识回答正确率为52%,85%的认为慢性病的防治与自己关系不大,80%的工作时间用于疾病的治疗。结论蒲江县农村居民对慢性病防治知识了解不足,对知识的了解医务人员起着积极作用,今后工作中应首先加强村医对慢性病的防治管理。     

农村地区建立传染病症状监测系统的可行性——以江西省2县为例

目的：从村卫生室服务能力入手,探索在农村地区建立传染病症状监测系统的可行性。方法：通过问卷调查和小组访谈分析江西省2个县15个乡镇155家村卫生室的资源配置以及253名村医开展传染病症状监测的能力,以及相应的期望和建议。结果：“一村一所”管理模式下的村卫生室门诊量大,病人集中,更适合症状监测的开展;网络直报是症状监测数据报告的首选方式,但有12．5％的村卫生室负责人不会使用电脑;村医接触最多的五种传染性疾病是上感、其他感染性腹泻、流行性腮腺炎、水痘和痢疾,分别有84．6％和71．5％的村医能够通过临床症状诊断流行性腮腺炎和水痘;75．9％的村医发现传染病人后会立即报告乡镇卫生院,77．1％的村医参与过传染病的调查核实。结论：依托村卫生室构建传染病症状监测系统具有可行性,但需完善村卫生室管理模式,提高卫生服务可及性;明确目标监测疾病,促进资源的有效利用;充分利用信息网络技术,搭建症状监测报告平台;大力推进乡村一体化管理,完善监测信号响应机制。     

Factors influencing the provision of public health services by village doctors in Hubei and Jiangxi provinces,China

Problem

The Chinese central government launched the Health System Reform Plan in 2009 to strengthen disease control and health promotion and provide a package of basic public health services. Village doctors receive a modest subsidy for providing public health services associated with the package. Their beliefs about this subsidy and providing public health services could influence the quality and effectiveness of preventive health services and disease surveillance.

Approach

To understand village doctors’ perspectives on the subsidy and their experiences of delivering public health services, we performed 10 focus group discussions with village doctors, 12 in-depth interviews with directors of township health centres and 4 in-depth interviews with directors of county-level Centers for Disease Control and Prevention.

Local setting

The study was conducted in four counties in central China, two in Hubei province and two in Jiangxi province.

Relevant changes

Village doctors prioritize medical services but they do their best to manage their time to include public health services. The willingness of township health centre directors and village doctors to provide public health services has improved since the introduction of the package and a minimum subsidy, but village doctors do not find the subsidy to be sufficient remuneration for their efforts.

Lessons learnt

Improving the delivery of public health services by village doctors is likely to require an increase in the subsidy, improvement in the supervisory relationship between village clinics and township health centres and the creation of a government pension for village doctors.     

山西省乡村医生健康知识需求及现状调查

目的：了解目前村卫生所卫技人员（以下简称乡村医生）对健康知识的需求和掌握情况,为下一步分析通过《健康生活报》对乡村医生进行健康知识教育的效果提供依据。方法：采用自编的《健康讲坛栏目读者需求调查表》对山西省9个市、200个村卫生室的200名乡村医生进行基线调查和相关健康知识测试。结果：共收回有效问卷177份。存在学历偏低、年龄偏大、女乡医偏少现象;专业素质差,以取得乡村医生证为主;日常主要获得健康知识的途径依次是上级培训、报纸、杂志及电视等;目前乡村医生迫切需要的健康知识为常见慢性病、儿童营养、急救急诊、药品知识等;关注的慢性病主要是高血压、冠心病、精尿病;健康知识测试结果显示成绩普遍低下,及格率只有29．4％。结论：应结合乡村医生现状．广开渠道开展健康知识的宣传及教育,提高乡医的健康知识水平和技能。     

Health care utilisation in India

India has a plurality of health care systems as well as different systems of medicine. The government and local administrations provide public health care in hospitals and clinics. Public health care in rural areas is concentrated on prevention and promotion services to the detriment of curative services. The rural primary health centers are woefully underutilized because they fail to provide their clients with the desired amount of attention and medication and because they have inconvenient locations and long waiting times. Public hospitals provide 60% of all hospitalizations, while the private sector provides 75% of all routine care. The private sector is composed of an equal number of qualified doctors and unqualified practitioners, with a greater ratio of unqualified to qualified existing in less developed states. In rural areas, qualified doctors are clustered in areas where government services are available. With a population barely able to meet its nutritional needs, India needs universalization of health care provision to assure equity in health care access and availability instead of a large number of doctors who are profiting from the sicknesses of the poor.