社区卫生技术人员知识与技能需求及影响因素分析

通过对社区卫生服务站社区卫生技术人员知识与技能需求调查分析 ,表明社区卫生技术人员知识与技能不能满足城市居民日益增长的医疗保健需求 ,大部分社区卫生知识与技能的掌握程度一般 ,急需培训的课程主要是预防保健专业知识 ,急需提高的社区卫生服务技能主要是社区康复技能、急诊社区处理、心理学、社会医学、预防医学、健康教育、流行病学方法等。社区卫生知识与技能的掌握程度与培训需要有关。本次调查为社区卫生服务人员继续教育提供了参考依据     

Linking undergraduate medical education to primary health care

Under graduate medical education aims at producing doctors who are competent in preventive, promotive and curative knowledge and skills. The community medicine curriculum in All India Institute of Medical Sciences, New Delhi has been designed with this objective in view. Students are given community oriented training in urban and rural settings whereby students are taught to carry out various activities under the guidance of faculty members. This curriculum has evolved over many years and provides ample exposure to the students to understand the health problems, and health system of the country especially at the primary and secondary level. There is a sequential teaching of community medicine, which starts from fourth semester through internship. Successful training in community medicine lies outside the walls of the department and the involvement of other partners like the community, health systems etc contribute largely.     

浅论县医院在社区服务中的地位与方法

县医院在社区卫生服务中处于技术指导中心。全科医学培训基地、组织和协调及县城社区服务参与者的地位。县医院要搞好社区卫生服务、一是搞好人力资源重组；二是全力做好社区卫生机构外部的合作；三是采取多种形式对社区卫生服务人员和基层医生进行培训，并实现思想观念转变和知识与技能的更新。     

Community medicine in the training of family physicians.

Family practice residency programs are encouraged to include community medicine training in their curriculum, but there is little agreement as to what community medicine is or what would constitute appropriate training. Community medicine is most commonly defined as a discipline concerned with the identification and solution of health care problems of communities or other defined populations. The inclusion of training experiences in the identification and solution of health care problems of communities has two basic advantages for family practice residency programs: it fosters a contextual approach in the care of individual patients and it builds knowledge and skills for those who will work with communities in future practices. An example of curricular content is included. A survey was conducted in order to determine what residency programs teach in the field of community medicine. The results show that few of the responding programs include the areas which most clearly relate to community medicine. It is hoped that the report of these results, the rationale presented for including community medicine in the training of family physicians, and the suggested outline of curricular content will further encourage and assist family practice residency programs to incorporate such training in their curricula.     

The art of public health medicine

This paper discusses the two dimensions of public health medicine competence--science and art--and explores the reasons for the importance of public health medicine artistry within an organisational context. The skills of artistry are identified as political and people management and it is noted that although the science dimension is vital, without the skills that comprise artistry, public health physicians are inadequately prepared to tackle the work of improving the health of the population. It is recommended that these skills should become an integral component of public health medicine training.     

The Need to Train Physicians for Rural Primary Health Care in Latin America: Some Family Medicine Experiences*

ABSTRACT: Training strategies to prepare physicians for rural primary care generally have not been a feature of medical education in Latin America. The emergence of family medicine as a specialty discipline has resulted in a number of primary care educational initiatives which are designed to give students or residents the knowledge and skills necessary to practice in rural settings. Specific programs in Mexico, Colombia, Chile, and Argentina are identified and discussed. These programs were selected because they raise a number of educational and manpower planning issues which teachers of family medicine and rural primary care need to address if the long-term viability of these programs is to be achieved. These issues include: the role of the community as an educational laboratory, the supervision of community-based learning experiences, the development of strong clinical and community health promotion skills, the reinforcement of positive primary care learning throughout training, and the development of rural health role models. Manpower planning issues to be addressed include: developing a more precise identity for the primary care physician, a re-examination of the pasantia or year of required community service, developing closer ties between the medical schools and the Ministries of Health and other institutional employers of physicians, and encouraging successful programs to share their experiences with others.     

深圳市社区儿童保健医生中医药服务能力现状分析

目的了解深圳市社区儿童保健医生中医药服务能力现状,为提高社区儿童保健医生水平提供科学依据。方法采用随机抽样的方法抽取深圳市两个行政区,对所有社区健康服务中心工作时间满1年的儿童保健医生进行调查。结果共调查142名儿童保健医生。临床医生、社区护士及公卫医师常用养生保健内容与方法知晓率比较差异有统计学意义(P<0. 05)。女性养生保健理念及体质养生保健知晓率显著高于男性(均P<0. 05)。临床医生、社区护士及公卫医师养生保健理念及饮食养生保健知晓率比较差异均有统计学意义(均P<0. 05)。142名调查对象中,在对儿童家长进行中医保健指导时,内容正确性平均得分为(8. 31±1. 04)分,手法正确性平均得分为(5. 83±2. 50)分,指导针对性平均得分为(7. 04±1. 82)分。结论深圳市儿童保健医生中医健康素养及中医保健技术水平偏低,应加强儿童保健医生的中医药科普水平及具体操作技能培训。     

Competencies for population-based clinical managers: A survey of managed care medical directors

Background: The evolution of American health care into integrated systems of delivery and finance requires a specialized set of population-based skills for physicians. The field of preventive medicine represents one source of this expertise. Specific competencies for the emerging area of managerial medicine have not been well delineated.Methods: Using concept documents from the Residency Review Committee for Preventive Medicine and the American Board of Preventive Medicine, a list of proposed competencies for managerial medicine was identified. Surveys were mailed to medical directors of all members of the American Association of Health Plans and to a random sample of diplomates of the American Board of Preventive Medicine. Respondents were asked to rate the importance of these competencies for a population-oriented clinician manager.Results: Areas rated highly by medical directors included health services research (including outcomes research), quality assurance and improvement, health risk assessment and reduction, programmatic skills, and clinical preventive skills. Responses from preventive medicine specialists were similar, but placed lower emphasis on these skills.Conclusion: Despite its limited response rate, this survey may be useful in the implementation of specialty training in managerial medicine. Residency training programs may choose to emphasize specific content areas that reflect the priorities expressed by physicians actively involved in management.     

Survey of leadership skills needed for state and territorial health officers,United States, 1988.

As part of efforts to develop training and career development experiences to enhance leadership skills among public health officials, the Public Health Foundation, Association of State and Territorial Health Officials, National Association of County Health Officials, United States Conference of Local Health Officers, and Public Health Practice Program Office, Centers for Disease Control and Prevention, conducted a training needs assessment survey in 1988. Fifty-five State and territorial health officers were asked about potential knowledge, skills, and abilities (KSAs) that a prospective or new health officer might require in performing his or her job. Thirty-eight health officers returned completed questionnaires, a 69 percent response rate. For each KSA, respondents assigned scores from 1 (low) to 5 (high) to three different variables: the KSA''s importance to job, as an initial ability of a new health officer, and as a desired ability for someone in that job. Of 78 KSAs, those scoring in the top 25 percent for importance to job were identified, and individual composite scores were calculated using the formula: (importance to job) x (desired ability minus initial ability). The top 10 mean composite scores ranged from 7.55 to 10.40 and were in five competence areas: public image (working with the community) (3 KSAs); policy development and program planning (3 KSAs); interpersonal skills (2 KSAs); agency management (1 KSA); and legal issues (1 KSA). These skills are not commonly acquired in schools of medicine or public health. Public health agencies should develop programs to assure that persons with leadership potential are identified early and given guided experiences and mentors, as well as specific training and education. Additional studies of public health officers are needed to develop and strengthen leadership KSAs among new health officers.     

Medical Training in Community Medicine: A Comprehensive, Academic, Service-Based Curriculum

The University of Pennsylvania's Family Practice Residency includes a significant community medicine component in order to accomplish the goals of addressing the health-related needs of the university's neighbors; exposing residents to the knowledge, skills and attitudes necessary to address the health needs of a community; and encouraging health careers with a community focus. It is my belief that these goals further the agenda of the National Institute of Medicine and Healthy People 2000 and 2010. Longitudinal and block community medicine experiences were established to accomplish these goals. This article describes and discusses three measurable outcomes of this curriculum: (1) individual resident projects, (2) resident class projects and (3) significant career foci in community medicine among resident graduates. I believe that our community medicine program exemplifies medical training in a community setting and furthers the national health agenda.     

Community Medicine in India — Which Way Forward?

Today, the Community Medicine professionals in India feel both “confused” and “threatened” by the mushrooming of schools of public health and departments of family medicine. The phenomenon of identity crisis and low-self esteem is not a recent one, nor is it restricted to India. The disciplines of community medicine and public health have evolved differently and despite some overlaps have differences especially in the need for clinical training. The core of the issue is that while the community medicine fraternity is keen to retain its clinical tag, what differentiates it from clinicians is the use of public health approach. I believe the strength of community medicine is that it bridges the gap between traditional fields of public health and clinical medicine and brings community perspective into health. The perceived threat from non-medical persons led public health is largely a result of us undervaluing our strength and our inability to foster partnership on equal footing with non-clinicians. While departments of community medicine have a fully functional rural or urban field practice area used for training at primary level care, these can serve as an excellent platform for training in secondary level care required for family medicine. National needs dictate that all three disciplines are required for improvement of population health, whether these are housed together or separately can be left to individual institutions to decide as long as they enable collaborations between them. We need to strengthen community medicine and market it appropriately to ministries of health.     

Developing leaders in public health: the role of executive training programs

The growing complexity of the nation's health care system is creating new challenges and opportunities for public health officials, and a renewed concern for leadership training among these officials. A focus group conducted with public health officials at local, state, and national levels reveals perceptions about the predominant trends effecting public health practice, the leadership skills required for effective public health practice, and the strategies that are needed for providing appropriate leadership training to public health executives. Officials indicate that public health practice is undergoing substantial changes in response to the growth of managed care and integrated delivery systems, changes in public health funding sources and levels, and efforts to privatize the delivery of public health services. The skills identified as critical for effective leadership in this environment include the ability to guide organizational behavior and cultivate interorganizational relationships; apply scientific knowledge to public health problems, and build and sustain community coalitions. In light of these skills, public health officials identify four essential components of an optimally effective executive training program in public health leadership: exposure to the core scientific disciplines within public health; exposure to organization theory and management science; training in community development and empowerment; and training in ethics and social justice. All of the officials agree with the need for distance learning programs for executives in public health leadership, and most officials also support the need for doctoral-level training in public health practice.     

康复医学科在综合医院中如何定位的现状调研

根据近年病残人的康复需求状况,对本市已建或拟建昨医学科的综合医院,从学科设置、康复专业人员梯队、医教研业务运转现状以及医疗卫生改革对学科影响进行调研分析,表明社会对康复需求日益增大,但康复专业人员紧缺,康复医疗面窄,社区康复网络不健全,康复医学科发展的层次将是衡量一个医院现代医学诊疗水平的重要标志之一。     

Training for skills

The World Federation for Medical Education Summit in Edinburgh in 1993 called for bold, clear, attractive and feasible strategies to equip doctors with the skills for the future of health care. There was special emphasis on skills for problem-solving, ethical and evidence-based medicine, effective communication, health promotion and illness prevention, and to educate and be educated. There were also skills for the shaping of the future of health services to form partnerships with other professionals and communities, to promote primary health care and to respond to culture and context. Strategies for effective training for skills include linking them to knowledge and attitude, selection of students of aptitude and motivation, training through practice with feedback, training teachers and assessors, and the reinforcement of skills after graduation. This presentation describes practical examples of these strategies in action to address each of the identified skills, all of them based on experience in the real world in Australia and Nigeria.     

Developing applied medical anthropology in Third World countries: problems and actions.

Recognition of the usefulness of ethnographic research in Third World community health projects and programs developed rapidly during the 1980s. As a result, the various agencies and organizations promoting community health programs (UNICEF, WHO, NGOs) have greatly increased their recruiting of social scientists, particularly medical anthropologists, for research and other programmatic activities in primary health care, child survival (especially diarrhea, acute respiratory infections, maternal and child nutrition, infectious disease, and AIDS). However, it has proved very difficult to identify well-trained anthropologists and/or other social scientists for these roles, particularly in Third World countries. This paper examines some of the background of this problem, and presents examples of methodological training (in both qualitative and quantitative research techniques) that seek to increase the skills of social scientists and other researchers in the arena of international community health.     

The Most Important Skills Required by Local Public Health Departments for Responding to Community Needs and Improving Health Outcomes

In 2017, Public Health 3.0 was introduced, providing recommendations that expand traditional public department functions and programs. Operationalizing the framework requires that local health departments invest in the requisite professional skills to respond to their community’s needs. The purpose of this paper is to determine the professional skills that are most important for local health departments to respond to large public health issues and challenges that are having a major impact on their communities. The study used a cross-sectional assessment of the education and training needs of local public health departments in Nebraska following the principles of practice-based systems research. The assessment was designed to assess the training and education needs of local health department staff members. The questions measured the perceived importance of and respondent’s capacity across 57 core competencies for public health professionals modified from the Council on Linkages Between Academia and Public Health Practice. A total of 104 staff members from seven local health departments were requested to complete the assessment and 100% of the individuals responded to and completed the assessment. Twenty-eight skills were identified as the most important skills needed for local health departments. The skills were themed and categorized into four domains. (1) Data, Evaluation, and Quality Improvement, (2) Community Engagement and Facilitation, (3) Systems Thinking and Leadership, and (4) Policy and Advocacy. The results from this analysis provide direction to strengthen and transform the public health system into one that is connected, responsive, and nimble. Additionally, it also highlighted a glaring omission that Equity, Diversity, and Inclusion should be included as the fifth domain.

     

An experimental evaluation of interdisciplinary training in intervention with sexually abused adolescents

Effective intervention in cases of sexual abuse of adolescents requires both knowledge of medical and other indicators and interviewing skills to facilitate disclosure. Public health settings are one place where the knowledge and skills of the health and social work professions can be effectively used to identify and protect adolescent victims. Interdisciplinary training was found to enhance requisite skills in this area. The experimental evaluation of a brief, state-wide, in-service training program found significant improvement in posttest knowledge of relevant indicators and interviewing skills and an increase in the number of cases identified and reported.     

The experience of community health workers training in Iran: a qualitative study

ABSTRACT: BACKGROUND: The role of Community Health Workers (CHWs) in improving access to basic healthcare services, and mobilising community actions on health is broadly recognised. The Primary Health Care (PHC) approach, identified in the Alma Ata conference in 1978, stressed the role of CHWs in addressing community health needs. Training of CHWs is one of the key aspects that generally seeks to develop new knowledge and skills related to specific tasks and to increase CHWs' capacity to communicate with and serve local people. This study aimed to analyse the CHW training process in Iran and how different components of training have impacted on CHW performance and satisfaction METHODS: Data were collected from both primary and secondary sources. Training policies were reviewed using available policy documents, training materials and other relevant documents at national and provincial levels. Documentary analysis was supplemented by individual interviews with ninety-one Iranian CHWs from 18 provinces representing a broad range of age, work experience and educational levels, both male and female. RESULTS: Recognition of the CHW program and their training in the national health planning and financing facilitates the implementation and sustainability of the program. The existence of specialised training centres managed by district health network provides an appropriate training environment that delivers comprehensive training and increases CHWs' knowledge, skills and motivation to serve local communities. Changes in training content over time reflect an increasing number of programs integrated into PHC, complicating the work expected of CHWs. In-service training courses need to address better local needs. CONCLUSION: Although CHW programs vary by country and context, the CHW training program in Iran offers transferable lessons for countries intending to improve training as one of the key elements in their CHW program.     

Who is to follow the specialist in community medicine (child health)?

Summary The 1974 reorganization recognized the need for coordination of the helath, education and social services for children, and under the collaborative arrangements it was agreed that each area health authority should appoint a community physician—specialist in community medicine (child health)—to perform this function, who would have advisory and executive functions in relation to the school health service. A number of influences are currently operating which jeopardize the continuation of the preventive child health services, particularly the school health service. These influences result from the increased number of district health authorities, the policy by which labelled community medicine posts are no longer acceptable, and the reduction in the number of community physicians with the necessary skills and experience in paediatrics and child health. It is essential that there should be appointed by every district health authority a doctor with the necessary skills and experience to undertake these advisory and executive tasks in relation to the preventive and district medical officer should be responsible for ensuring that within the team of community physicians there is a member with the necessary experience and skills in relation to child health, who is acceptable to the local authority/education authority. This community physician could be employed by a single district, or by several districts under interdistrict collaboration arrangements. Based on a paper submitted to the North West Thames Regional Health Authority's Working Party on Community Medicine.     

Benefits of comprehensive reproductive health education in family medicine residency

Given the high prevalence of unintended pregnancy and early pregnancy failure, family physicians frequently encounter these clinical problems. Early abortion care and miscarriage management are within the scope of family medicine, yet few family medicine residency programs' curricula routinely include training in these skills. Comprehensive reproductive health education for family physicians could benefit patients by improving access to safe care for unintended pregnancy and early pregnancy loss and by improving continuity of care, especially for rural and low-income women. By promoting reflection on conflicts between personal beliefs and responsibility to patients, training in options counseling and abortion care fosters patient-centered care and informed decision making. Managing pregnancy loss and termination also improves skills in patient-centered counseling and primary care gynecology. Multiple studies document the feasibility and success of several training models for abortion and miscarriage management in family medicine. Incorporating comprehensive reproductive health care into family medicine residency training enables family physicians to provide a full range of reproductive health services.