结合"妇产科与妇女保健"教学谈全科医师转岗培训的教学体会

目的：探讨全科医生转岗培训中教学中存在的问题及解决对策.方法：对全科医学特点,全科医师岗位培训对象特点,教学现状进行总结分析.结果：转变师资及学员观念、明确培训目的、了解学员的特点、精选教学内容、加强实践性教学等是提高全科医师岗位培训的质量关键.结论：在教学实践工作中进行总结,了解学员特点及岗位培训要求,以需求为导向设计课程内容,才能更好地完成全科医师岗位培训教学任务.     

PDCA循环在全科医师规范化培养社区带教管理中的应用研究

目的 探讨PDCA循环模式在全科医师规范化培养社区带教管理的应用效果.方法 选取2018年1-10月在静安区某两家全科医师规范化培养社区教学基地学员16例为对照组,再选取2019年1-10月学员16例为观察组.对照组学员以传统模式开展全科医师社区培训,观察组采用PDCA循环管理模式进行全科医师社区培训质量控制管理.项目结束后,对两组全科学员的教学效果、满意度及患者对学员满意度进行比较.结果 观察组全科学员的理论知识和操作技能考试成绩明显高于对照组(P<0.05),满意度高于对照组(P<0.05),且患者对全科学员满意度高于对照组(P<0.05).结论 PDCA循环管理模式可改善全科医师规范化培养社区基地带教质量,提高学员带教满意度及患者对学员的满意度.     

淮安市全科医师岗位培训效果调查分析

目的 为了解全科医师岗位培训效果及相关影响因素．探计进一步提高培训质量，强化培训效果的方法和途径．健全科医师岗位培训更具有针对性和实用性．切实提高学员的社区卫生服务能力。方法 采用问卷调查和个人访谈的方式调查全科医师培训效果。结果 学员认为全科匡师培训对其今后的工作有帮助．对设置的课程和教学方法等基本认可。结论 应进一步规范全科医师岗位培训，根据学员的实际情况，优化课程设置，改进教学方式．切实提高全科医师的实际工作能力。     

全科规范化培训医师心理健康状况及其影响因素研究

目的:调查南京市全科医师规范化培训学员的心理健康状况,探讨其影响因素,为进一步完善全科医师的规范化培训提供参考.方法:选取106名南京市2021年1-3月期间在培的全科医师规范化培训学员为研究对象,以现场发放填写症状自评量表(SCL-90)的方式进行调查,最终数据采用SPSS 19.0进行统计分析.结果:106名全科医师规范化培训学员的总分数明显高于全国常模,男性学员的总分数明显高于女性学员(P<0.05);最高学历为专科、参与意愿一般及不愿意参与的学员得分明显高于本科及研究生学员、愿意参加培训的学员(P<0.05);培训时长超过1年和对现有的培训制度和工资水平表示满意的学员,其各项因子得分及总分明显低于培训时长少于1年和对相关制度不满意的学员(P<0.05).结论:全科医师规范化培训学员的心理健康状况差于全国常模,并与学员的学历、参与培训的意愿、培训时长以及对培训制度及工资状况满意度等因素有关.     

山西省社区全科医师岗位培训需求分析

目的:通过分析培训需求,为改进全科医师岗位培训组织工作提供依据.方法:整群抽取2011年山西省第二期全科医师岗位培训全体学员300名,以调查问卷的方式搜集培训需求数据,对结果进行统计学分析.结果:现有岗位培训工作模式基本符合参训人员的培训需求,但职称、专业、单位性质分组均显示不同背景学员在部分培训需求上有所不同.结论:要针对培训学员群体特点,提高培训组织的针对性,保证培训取得良好效果.     

山东省菏泽市全科医师岗位培训效果分析

目前,我国全科医师教育采取高校全科医学学历教育、毕业后全科医学教育、全科医师岗位培训、全科医师继续医学教育等多种形式。根据山东省全科医师岗位培训的规范要求,菏泽市于2008年6月-2009年6月开展首批全科医师岗位培训工作,共有86人参加。在培训结束前,以这些学员为调查对象,就全科医师培训的效果进行调查分析和评价。现报告如下。     

菏泽市全科医师岗位培训效果分析

目的分析全科医师培训效果,探索全科医师培训模式。方法对菏泽市首批全科医师培训学员进行调查,采用自行设计的调查问卷,共回收86份。结果学员平均年龄(34.65±7.24)岁,有94.19%的学员愿意参加岗位培训,对培训的教学水平、教学内容、教学方法、课程安排和培训管理等满意度都达到95.00%以上,大多数学员能够基本掌握或掌握所学的知识,有83.72%的学员认为参加培训对今后工作很有帮助或有帮助。结论岗位培训后学员能掌握基本知识与技能,对培训模式给予了积极评价,但在师资、教材和继续教育等方面还存在一些问题有待解决。     

我们承担全科医师急诊急救培训的做法和体会

北京急救中心作为全市 11家全科医学培训基地之一的单位 ,于 1999年 9月初承担了首届全科医学骨干班学员的急诊、急救专业培训任务。对此 ,我们就如何建立全科医学培训模式 ,以达到和满足社区卫生服务需求进行了探索。一、我们开展全科医师培训的做法(一 )采用有的放矢的教学方法 :对于全科医师培养事先应了解全科医师培训目标、内容和工作特点及学员所具有的水平。尔后制订有的放矢、切实可行的培训方案。学员来中心时 ,首先集中岗前教育。岗前培训的内容 :讲授现代急救医学新进展 ;讲授中心急救医疗工作概况和急救专业特点与要求。通过教…     

上海市浦东新区全科医师岗位技能培训效果调查

目的调查分析上海市浦东新区全科医师岗位技能培训工作效果。方法以浦东新区2004年9月至2006年1月参加全科医师岗位技能培训的学员为对象，采用问卷调查和座谈会形式进行调查。结果学员普遍认为岗位技能培训对自己的工作有帮助，92．30％的学员认为基本掌握了教学大纲的要求，71.80％的学员认为培训后自身业务有较大提高。结论现行的全科医师岗位技能培训模式是科学可行的，培训后学员能掌握基本业务知识和全科技能，培训中还需加强全科观念教育，强化临床实际操作，融入全科团队的实践。     

军事院校毕业男学员人体成分检测调查

目的：通过测量各军事院校毕业班男学员的人体成分,掌握各军事院校毕业学员的人体成分分布状况,并为建立相关标准提供依据。方法按飞行院校、分流院校、合训院校、技术院校和士官学校分层抽取5631名男性毕业学员,对其进行人体成分检测,根据结果划定5％～95％分布上下限。并对其进行横向比较。结果各军事院校横向比较,技术院校和士官在人体成分组成上更合理,而飞行学员和海军合训人员则存在体脂偏高,瘦体重、骨质、肌肉百分比偏低的现象。结论①军校毕业学员总体表现为体脂较少,肌肉和骨质较多,因而需建立一套符合军校毕业学员的人体成分标准;②飞行员、海军等军种,需加强基础体能训练,此外还需加强特别肌群的训练。     

James Mackenzie, General Practitioner: a modest contribution to the archaeology of clinical reason

This paper focuses on the work of the influential general practitioner and heart specialist, James Mackenzie (1853–1925), and seeks to reconstruct - using some of the perspectives broadly associated with actor-network theory as well as Michel Foucault's work on clinical medicine - the epistemological rationality of his medical programme as a particular kind of network of knowledge. The paper concludes with a brief discussion of some of the implications of this analysis both for the sociological study of medical knowledge, and for our contemporary ideals of medical practice.     

The Use of Primary Care Services by the Chinese Population Living in England: Examining inequalities

Objective To assess general practitioner consultation among Chinese people compared with the general population and other minority ethnic groups, and to investigate the factors associated with general practitioner consultation among the Chinese population. Design. Survey of a representative sample of Chinese people aged 1674 living in private households in metropolitan areas of England. One thousand and twenty-two people who defined themselves as 'of Chinese origin' were interviewed. General practitioner consultations were analysed in relation to self-reported general health and long-standing illness or disability, gender, age, social class, country of birth, whether the respondent spoke English, use of traditional Chinese medicine, and the ethnicity and gender of the respondent's general practitioner. Results The self-reported general health status of Chinese people is similar to that of the general population and better than that of other minority ethnic populations. The level of general practitioner consultation by Chinese people is low compared with the general population and with other minority ethnic groups. Within the Chinese population, general practitioner consultation is related to gender, self-reported health status and the ability to speak English. Ability to speak English is the strongest positive predictor of general practitioner consultations. Conclusion Chinese people in England are less likely than people from other minority ethnic groups to consult their general practitioner, even after their relative health status is taken into consideration. Use of general practitioners by Chinese people in England is associated with a number of factors, of which the strongest predictor is the ability to speak English. Chinese people who speak English are more likely than those who do not, to consult their general practitioner. Health service providers should accommodate the needs of this group by providing access to advocacy services.     

荷兰医改及对我国构建整合型健康服务体系的启示

本文介绍了荷兰卫生服务体系概况,重点阐述了荷兰新医改后的全科医生首诊制度、"有管理的竞争模型"健康保险体系、长期照护体系典型政策范例。借鉴荷兰改革经验,提出推进我国卫生服务体系整合实践的策略。建议:以提高全科医生职业吸引力作为改革起点,全科医生队伍建设先行,筑牢改革根基;立法先行、以市场机制作为改革抓手,搭建公共政策规制与市场激励相容的改革框架,形成一套富有管理的、有竞争性、有活力的中国健康保险体系;在积极健康老龄化背景下,以整合理念建设适合我国国情的老年人长期照护体系;承接我国移动互联领域的资源基础,依托智慧治理破解医改难题。     

Who enrolls in a general practitioner model? The behavioral model of health services use and general practitioner-centered care in Germany

Since July 2009, statutory health insurance companies in Germany are obliged to offer a so-called general practitioner model. By strengthening the general practitioner??s position, these models should optimize healthcare especially for people with higher demands for health services. So far, little is known about which patients participate in the model. Our study??s aim was to describe correlates of enrollment based on the behavioral model of health services use. The data were obtained from the Robert Koch Institute??s 2006 telephone health survey. Variables influencing enrollment in the general practitioner models were determined through logistic regression models. Main indicators for enrollment were age above 60 years, lower social status, lower income status, and living in less populated areas. Insured persons with a higher demand for medical services were more often enrolled in general practitioner models. Most of them had consulted their general practitioner very frequently even before the general practitioner model was introduced.     

对高等医科院校全科医生培养的思考

培养合格的全科医生是我国社区卫生事业发展的关键。高等医科院校作为培养高素质医学人才的摇篮,应担负起为社会培养全科医生的责任。文章通过探讨高校如何充分发挥自身优势,建立完善的、多层次的具有中国特色的全科医生培养体制,为高等医科院校的教育改革提供有益的思考。     

Far from easy and accurate - detection of metabolic syndrome by general practitioners

Background

Smokers attribute respiratory symptoms, even when severe, to everyday causes and not as indicative of ill-health warranting medical attention. The aim of this pilot study was to conduct a structured vignette survey of people attending general practice to determine when they would advise a person with respiratory symptoms to consult a medical practitioner. Particular reference was made to smoking status and lung cancer.

Methods

Participants were recruited from two general practices in Western Australia. Respondents were invited to complete self-administered questionnaires containing nine vignettes chosen at random from a pool of sixty four vignettes, based on six clinical variables. Twenty eight vignettes described cases with at least 5% risk of cancer. For analysis these were dubbed 'cancer vignettes'. Respondents were asked if they would advise a significant other to consult a doctor with their respiratory symptoms. Logistic regression and non-parametric tests were used to analyse the data.

Results

Three hundred questionnaires were distributed and one hundred and forty completed responses were collected over six weeks. The majority (70.3%) of respondents were female aged forty and older. A history of six weeks' of symptoms, weight loss, cough and breathlessness independently increased the odds of recommending a consultation with a medical practitioner by a factor of 11.8, 2.11, 1.40 and 4.77 respectively. A history of smoking independently increased the odds of the person being thought 'likely' or 'very likely' to have cancer by a factor of 2.46. However only 32% of cancer vignettes with a history of cigarette smoking were recognised as presentations of possible cancer.

Conclusion

Even though a history of cigarette smoking was more likely to lead to the suggestion that a symptomatic person may have cancer we did not confirm that smokers would be more likely to be advised to consult a doctor, even when presenting with common symptoms of lung cancer.     

Medical mall founders' satisfaction and integrated management requirements

Medical malls help provide integrated medical services and the effective and efficient independent management of multiple clinics, pharmacies and other medical facilities. Primary care in an aging society is a key issue worldwide and the establishment of a new model for primary care in Japanese medical malls is needed. Understanding the requirements of integrated management that contribute to the improvement of medical mall founders' satisfaction levels will help provide better services. We conducted a questionnaire survey targeting 1840 medical facilities nationwide; 351 facilities responded (19.1%). We performed comparative analyses on founders' satisfaction levels according to years in business, department/area, founder's relationship, decision‐making system and presence/absence of liaison role. A total of 70% of medical malls in Japan have adjacent relationships with no liaison role in most cases; however, 60% of founders are satisfied. Integrated management requirements involve establishing the mall with peers from the same medical office unit or hospital, and establishing a system in which all founders can participate in decision‐making (council system) or one where each general practitioner (GP) independently runs a clinic without communicating with others. The council system can ensure the capability of general practitioners to treat many primary care patients in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd     

Care provided by general practitioners to patients with psychotic disorders: a cohort study

Background

There is a decline in the relative numbers of general practitioners in Germany. Earlier research showed that the professional relationship between general practitioners and specialists is overshadowed by conflicts which could influence medical students not to choose a career in general practice. The aim of the study is to analyse potential discrepancies between general practitioners' self-perception of their professional role and their social self-image in relation to medical specialists and to identify potential barriers that might prevent medical students from becoming a general practitioner.

Methods

A qualitative study design consisting of 16 interviews with general practitioners was chosen. Data analysis was carried out using the qualitative content analysis by Philipp Mayring.

Results

There is a discrepancy between general practitioners' professional self-perception and how they perceive they are viewed by specialists. General practitioners communicate a positive self-perception of their professional role. While general practitioners think that specialists in outpatient care have a positive view on general practice, it is assessed to be negative by specialists working in hospitals and as medical teachers.

Conclusion

The negatively influenced social self-image may originate particularly from "badmouthing" general practitioners at universities and in hospitals. "Badmouthing" demonstrates the importance of the consideration of psychological aspects in medical teachers and hospital specialists acting as role models. Negative comments should be considered as an important factor in influencing medical students and trainees' career choices. These aspects should be more integrated in future medical education curricula.     

Contribution of specialists to antenatal care in France: impact on level of care during pregnancy and delivery.

This study was based on a survey of a national sample of births in France in 1981 which included 5508 women. Four pathways of antenatal care were defined according to the stage of pregnancy at first intervention of a specialist, as opposed to a general practitioner, in the care of the pregnancy. Taking into account the sociodemographic and medical characteristics of the women in a logistic regression, a large number of antenatal visits, an ultrasound examination, and hospitalisation during pregnancy were more frequent when the degree of specialisation of the pathway increased. But the influence of pathways was less significant for deliveries. Caesarean section rates, for example, did not vary according to pathway. However, induction of labour and intrapartum electronic fetal monitoring were less frequent among women cared for solely by a general practitioner than among those who had consulted a specialist at least once during pregnancy. The increase in medical care and the role of the specialist in antenatal care are discussed.