面向基层中医全科人才核心技能培养体系构建初探

农村订单定向医学生免费培养计划是国家为基层培养应用型医学人才的重大教育策略,我校从2012年开始探索培养面向基层农村订单免费中医学本科生,即中医全科医学人才,从课程体系改革、实践教学改革、人才评价体系改革等方面进行了积极探索。本文以已有人才培养成果和经验为基础,初步构建与实践了面向基层中医全科医学人才核心技能培养体系,...     

农村订单定向医学生培养模式的探索与实践

2010-2012年国家开展农村订单定向医学生免费培养工作,重点为乡镇卫生院及以下的医疗卫生机构培养从事全科医疗的卫生人才.要为农村基层培养出“下得去,留得住,用得上”的实用型全科医学人才,广西医科大学在农村订单定向医学本科生培养模式上进行了全面的探索和实践.     

基于“能力本位教育”的农村社区全科医学专业实践教学体系研究

为培养农村社区"下得去、留得住、用得上"的实用型全科医学人才,本研究以"能力本位教育"理念为指导,确立定向农村社区全科医学人才必备的"社区综合卫生服务能力",构建"人文素质模块、岗位技能模块、科研创新模块"等三模块的实践教学内容体系和"临床实践基地和社区实践基地"一体化综合实践教学平台,创建"学校教育、医院教育、社区实践"三位一体、三年融通的实践教学新模式,以期充分发挥实践教学在人才培养中的作用。     

农村订单定向医学生人才培养方案构建与探索

2010年国家开展农村订单定向医学生培养工作,重点为乡镇卫生院及以下的医疗卫生机构培养从事全科医疗的卫生人才。文章依据国家对基层卫生人才培养目标和能力定位,以基层医疗卫生工作岗位需求为导向,设置模块化的教学体系,探索和构建"3.5+1.5"农村订单定向免费医学生的人才培养方案。     

五年制免费定向临床医学生课程设置的调查研究

国家发改委等五部委制定了《关于开展农村订单定向医学生免费培养工作的实施意见》,从2010年起,连续3年在高等医学院校开展免费定向医学生培养工作,重点为乡镇卫生院及以下的医疗卫生机构培养从事全科医疗的卫生人才。本校承担"五年制"乡镇及社区医务人员定向培养任务,解决当前基层医疗人才严重不足的问题。为了使培养的人才成为"学得实、下得去、用得上、干得好、留得住"的全科型临床医学人才,制订出科学合理的培养方案,作者就赣州市基层医疗卫生单位医疗人员对五年制免费定向临床医学生课程设置的意见和建议进行了调查。     

面向农村社区开展大专层次的全科医学教育的可行性

我国卫生人才资源分布不均衡、结构失调且现行培养模式与需求不协调,农村社区卫生人才短缺、总体素质不高,特别是全科医学人才严重匮乏,农村社区卫生发展严重滞后.根据这一现状的迫切需要,应充分发挥医学大专院校实用、快速、灵活、专业、面向基层的办学特色,在临床医学教育中开展大专层次的面向农村社区的全科医学教育,培养"下得去、用得上、留得住、干得好"的合格实用型全科医生,探索一条农村社区全科医学人才培养之路.     

鄂南某高校实施农村订单定向免费医学生培养的探索与实践

农村订单定向免费医学生培养是构建全科医师培养体系的重要组成部分。目前,我国基层医疗单位医学人才总量不足,综合素质普遍较差,为基层培养并输送高质量人才已成为医学教育改革的重心。经过多年的探索与实践,鄂南某高校医学院在农村订单定向免费医学生培养上进行全面的改革与创新,初步构建以岗位责任和胜任力为导向的免费医学生人才培养模式。     

农村订单定向免费本科医学教育人才培养模式的实践与探讨

目的 以国内西部全科医生主要培养模式改革为出发点,结合国家卓越医生教育培养计划实施政策,分享西安医学院经过多年的实践与探索获得的全科医学教育教学经验,并介绍西安医学院构建"农村订单定向免费医学生培养模式"的具体做法。 方法 回顾西安医学院"农村订单定向免费本科医学教育人才培养模式"的具体实施过程,主要涉及成立专项工作小组、修订人才培养方案、创建优秀教学团队、改革教学方法、注重实践教学、加强实践考核、推动实践基地建设等多方面做法。 结果 为培养出适应基层且胜任岗位需要的全科医生,修订后的人才培养方案最大特点在于突出学生面向基层的医疗卫生综合服务能力的培养。结合全科应用型医疗人才的专业特点,进一步优化课程比例,专业课学分比例高达79%。在削减了总学时数的基础上,实现了主干课程的理论和见习学时比为1:1。通过推行"3.5+1.5"的培养模式,整体延长实践教学时间来提升学生的岗位胜任力,为学生毕业后尽快适应基层医疗卫生工作奠定了基础。2017年,第一届毕业生参加全国执业医师资格考试的通过率为99.4%。 结论 本研究可为开展农村订单定向人才培养的相关单位和部门提供参考,同时对推进医学教育改革和医疗卫生改革具有一定的指导意义。为进一步完善"农村订单定向免费本科医学教育人才培养模式",我们将继续从"四位一体"教育教学平台的构建、临床教学质量保障体系的修缮、智能化实训平台的打造这三方面展开实践。      

构建面向农村基层全科医学人才培养的实践教学体系

实践教学作为全科医学教育的关键环节,其好坏直接影响着为农村基层社区输送医学人才的质量。如何培养农村基层"下得去、用得上"的应用型全科医生,河北联合大学经过不断探索,在"3.5+1+0.5"的人才培养模式上整合教学内容,优化课程设置,加大实践教学的学时比例,经过推行"校地共育"、建设"三级阶梯式"实践基地网络等,最终形成了以"农村社区综合卫生服务能力培养"为核心的全科医学人才培养的实践教学体系。     

加强面向农村基层全科医学人才培养的实践基地建设

实践教学是全科医学教育的关键环节,农村订单、定向全科医学生的实践能力的高低直接关系着为农村基层社区输送医学人才的质量。实践基地是进行实践教学的重要场所,为了培养面向农村基层的"下得去、用得上,干得好"的应用型全科医生,河北联合大学经过不断探索,采用"政府-学校-社区"共建的模式,推行"校地共育",最终形成了"三级阶梯式"实践基地网络,并取得了较好的实效。     

A training programme for rural general practice

An improvement in methods of training graduates for general practice has been recommended as a result of several investigations into the problems faced by rural medical practitioners. This paper describes a rural vocational training programme conducted by the Family Medicine Programme in North Queensland. The programme combines educational support, professional support and mentorship with a medical educator experienced in rural practice. The educational support is partly chosen by members of the rural group, and is designed to meet needs of group members and the communities they serve. The cost of such a programme is high, due to travel and communication over long distances, but is justifiable if it improves recruitment and retention of rural practitioners.     

Regionalisation of general practice training--are we meeting the needs of rural Australia?

The concept of "social accountability" has underpinned the development of many medical education programs over the past decade. Success of the regionalisation of the general practice training program in Australia will ultimately be measured by the ability of the program to deliver a sufficient rural general practice workforce to meet the health needs of rural communities. Regionalisation of general practice training in Australia arose from the 1998 recommendations of the Ministerial Review of General Practice Training. The resultant competitive structure adopted by government was not the preferred option of the Review Committee, and may be a negative influence on rural workforce, as the competitive corporate structure of regional training providers has created barriers to meaningful vertical integration. Available data suggest that the regionalised training program is not yet providing a sustainable general practice workforce to rural Australia. The current increase in medical student and general practice training places provides an opportunity to address some of these issues. In particular, it is recommended that changes be made to registrar selection processes, the rural pipeline and vertical integration of training, and training for procedural rural practice. To achieve these goals, perhaps it is time for another comprehensive ministerial review of general practice training in Australia.     

医学生对全科医学教育需求现状的调查与分析

目的 了解在校医学生对全科医学的认知状况,探讨开展全科医学教育的必要性.方法 以本校临床医学系和护理系在校专科生作为抽样调查对象,自行设计并发放问卷,对不同专业医学生对全科医学的学习意愿、对全科医师择业意愿等进行调查并进行描述性统计学分析.结果 超过半数的学生认为在校学习期间有必要开设全科医学教育课程;临床专业94.60％的学生赞成设置全科医学培养方向,护理专业只有53.92％的学生持支持态度;临床专业有56.44％的学生可以接受到农村社区就业,而护理专业只有41.18％的学生愿意到农村社区.结论 大多数在校医学生择业方向明确,认为有必要接受全科医学教育;建议政府出台相关政策吸引更多医学生加入全科医师行列.     

Public policy and the supply of primary care physicians

The decline in general practice, the arrested growth of family medicine training programs, and the increased subspecialization of internal medicine and pediatrics are responsible for the continuing decrease in the proportion of physicians in the United States who practice a primary care specialty. Since 1963, the number of physicians has more than doubled, but the ratio of office-based primary care physicians to the national population has decreased. This trend has been especially pronounced in rural areas and impoverished urban communities. There is evidence that the proportion of young physicians entering primary care specialties is declining. Medical education has become increasingly reliant on service income, making it difficult to fund training in primary care specialties. Grants for graduate training in primary care specialties have not increased with inflation, and outright elimination of these programs is under consideration. Public programs that fund medical education must be reformed to improve the geographic and specialty distribution of physicians.     

专科层次临床医学专业和临床医学专业(全科医学方向)学生的全科医师职业趋向调查

目的了解专科层次临床医学专业和临床医学专业(全科医学方向)学生的全科医师职业趋向,评价两个专业的课程和培养模式对学生职业选择的影响。方法采用结构式问卷调查2010级临床医学专业学生102人、临床医学专业(全科医学方向)学生76人。了解学生对所学课程的兴趣、对全科医师工作环境和就业前景的认知、毕业后的职业选择等。结果临床医学专业(全科医学方向)学生对全科医师的职业定位、工作认同优于临床医学专业学生。结论专科层次临床医学专业应采取全科医学方向进行培养,通过课程和培养模式改革来改变学生的职业趋向,引导学生树立服务基层、走向社区、扎根农村的全科医师职业理想。     

General practice in Australia 2020: "robust and ready" or "rudderless and reeling"?

The future role and structure of Australian general practice remains uncertain, despite a decade of seemingly constant change following the release of the National Health Strategy papers. Some of the suggested change strategies (such as rural Practice Incentive Payments and practice accreditation) have been implemented; others (such as general practitioner involvement with area health authorities in delivering national goals and targets for communities) still await attention. An overarching vision for our health care system in 2020 and general practice's role within it are still to be clearly enunciated. Australia is at variance with other Western countries, such as the United Kingdom, Canada and New Zealand, which have spent significant time refocusing their health systems to deal with an ageing population with an increased burden of chronic disease. Health bureaucrats and governments need to invest strategically in operational primary care now. This will require the active commitment of general practice's national bodies to articulate and actively promote a shared vision for Australian general practice.     

Alberta''s Rural Physician Action Plan: an integrated approach to education, recruitment and retention

This paper describes the development and characteristics of a comprehensive, integrated and sustained program for the education, recruitment and retention of physicians for rural practice in Alberta--the Rural Physician Action Plan. The participation of key stakeholders (including government, the provincial medical association, the licensing authority, faculties of medicine, practising rural physicians and regional health authorities) and a sustained program budget have been key organizational issues for success. Critical to the effectiveness of this program has been the focus on professional and lifestyle issues targeting 3 distinct groups: physicians in training, physicians in practice, and rural communities and health authorities. Substantial program funding since 1991-92 of up to $3 million per year has increased rural-based activities significantly. For example, 87% of medical students and 91% of residents in family medicine in Alberta now experience 4 weeks or more of rural practice. The authors believe that the historic issues and recent trends militating against recruitment and retention of rural physicians will continue unchecked without comprehensive and sustained approaches such as Alberta's Rural Physician Action Plan.     

Contribution of general practitioner hospitals in Scotland

The results of a survey of 64 Scottish general practitioner hospitals showed that in 1980 these hospitals contained 3.3% of available staffed beds in Scotland; 13.6% of the resident population had access for initial hospital care, and 14.5% of Scottish general practitioners were on their staffs. During the year of the survey they discharged 1.8% of all non-surgical patients, treated almost 100 000 patients for accidents and emergencies and 140 000 outpatients, and 4.4% of all deliveries in Scotland were carried out in the hospitals surveyed. Most communities which are served by general practitioner hospitals in Scotland are rural and on average are more than 30 miles from their nearest district general hospital. The contribution that these small hospitals make to the overall hospital workload has not previously been estimated. It has been shown nationally to be small but not inconsiderable . In terms of the contribution to the health care of the communities they serve it cannot and should not be underestimated.