解析《以全科医生为重点的基层医疗卫生队伍建设规划》

《以全科医生为重点的基层医疗卫生队伍建设规划》中提出，要在三年内培养6万名全科医生，基本实现城市每万名居民有1～2名全科医生，农村每个乡镇卫生院有1名全科医生。这是我国政府第一次正式提出要为农村培养全科医生，也是政府在医疗保健方面缩小城乡差别的重大决策。     

农村地区全科医生培养途径与方法探讨

结合我国农村卫生工作的现状，要建立一支适应我国国情的农村全科医生队伍，必须充分发挥多种教育形式的作用，在农村现有医疗力量的基础上，加强全科医学教育，同时培养一批高素质、受过正规高等教育的全科医生来逐步取代农村现有的卫生工作人员，使我国农村卫生工作向高层次、专业化、标准化方向发展。     

新医改背景下农村订单定向免费医学生培养机制创新策略研究

农村订单定向免费医学生培养工作是在国家颁布的《以全科医生为重点的基层医疗卫生队伍建设规划》之下采取的医疗人才培养措施,在教育部、人力资源社会保障部、卫健委共同监督与协作之下实施的人才培养计划。全科医学涵盖了临床医学、预防医学、康复医学、人文社会科学等一系列系统性的临床医学学科,全科医生是医生当中的全能人才。本文针对农村订单定向免费医学生培养机制创新意义以及医学生选择农村订单定向免费医学生培养的原因进行详细分析,其目的是结合农村医学生实际情况,制定出农村订单定向免费医学生培养机制创新策略,为我国农村医疗卫生事业发展提供新思路。     

“全科医生制”且行且难走一年

记者从卫生部了解到,2012年是全科医生规范化培养制度正式实施的第一年。去年7月,《国务院关于建立全科医生制度的指导意见》颁布,提出到2012年,使全国每个城市社区卫生服务机构和农村乡镇卫生院都有合格的全科医生;再经过几年努力,基本形成统一规范的全科医生培养模式和首诊在基层的服务模式;     

对加强农村全科医生培养的几点思考

为适应农村卫生服务发展需要,尽快完善农村基层医生的知识结构,提高业务水平,使之尽早成为合格的全科医生,是深化农村卫生改革所面临的新课题。针对农村全科医生队伍建设的现状,提出了如何培养"下得去、用得上、留得住、干得好"的合格的实用型全科医生的一些思考,探索一条培养农村全科医学人才之路。     

“3+2”助理全科医生责任目标年薪管理平台建设的实践与探索

"3+2"助理全科医生人才培养是国家根据农村医疗卫生服务实际需求,加快面向基层的全科医生培养。上海市嘉定区华亭镇社区卫生服务中心借助信息化手段,开展基于全面预算管理和标化工作量的助理全科医生责任目标年薪制管理平台建设,旨在探索适合助理全科医生岗位特点的绩效考核方法,在基层卫生工作中充分发挥助理全科医生的能力,科学规划助理全科医生职业生涯,培养"下得去、用得上和干得好"的高素质郊区适宜全科医学人才。     

建立全科医生制度值得期待

6月22日召开的国务院常务会议上,为全科医生制度的建立和发展提出了目标,2012年,全国每个城市社区卫生服务机构和农村乡镇卫生院,都将有合格的全科医生。再经过几年努力,基本形成统一规范的全科医生培养模式和首诊在基层的服务模式,基本实现城乡每万名居民有2至3名合格的全科医生。     

国外全科医生培养方式及其对我国高等院校的启示

本文通过比较和分析部分国家社区全科医生培养在学科教育、毕业后教育和继续教育等方面的经验和做法,以及由此对我国高等院校培养农村社区全科医生在课程体系、师资力量、社区实践基地等领域产生的启示,笔者尝试探索建立适合我国国情的农村社区全科医学人才＂定单式＂培养模式,向社会输送能适应基层医疗工作的高素质的全科医学人才。     

确保“首诊在基层”

7月7日,《国务院关于建立全科医生制度的指导意见》出台。《指导意见》明确提出：到2012年,使每个城市社区卫生服务机构和农村乡镇卫生院都有合格的全科医生;再经过几年努力,基本形成统一规范的全科医生培养模式和首诊在基层的服务模式;到2020年,我国将初步建立起充满生机和活力的全科医生制度,基本实现城乡每万名居民有2～3名合格的全科医生     

建立全科医生制度值得期待

6月22日召开的国务院常务会议上,为全科医生制度的建立和发展提出了目标,2012年,全国每个城市社区卫生服务机构和农村乡镇卫生院,都将有合格的全科医生。再经过几年努力,基本形成统一规范的全科医生培养模式和首诊在基层的服务模式,基本实现城乡每万名居民有2至3名合格的全科医生,更好地为群众提供连续协调、方便可及的基本医疗卫生服务。计划到2020年争取通过多种途径培养30万名全科医。     

乡村振兴背景下乡村基层全科医生人才培养策略探讨

“健康乡村建设”是乡村振兴战略的重要内容,其实施的关键为加强乡村基层全科医学人才队伍建设。文章立足于乡村百姓卫生健康服务实际需求,针对乡村基层全科医学人才培养,建议既要全面落实、用足用好乡村全科人才激励政策,又要紧密围绕临床规范诊疗、急诊应急、亚专长能力培养、公共卫生、心理健康、中医药服务等领域全力提升乡村全科医生卫生健康专业服务水平,同时还要持续增强乡村全科医生人文素养、沟通协调、政策解读等综合管理服务能力。通过上述举措,着力培养一支“未病善防,小病善治,大病善识,急病善转,慢病善管”的防治结合、复合型乡村全科医学人才队伍,切实发挥乡村全科医生“健康乡村建设”主力军的作用。     

江西省农村药品质量的调查与分析

目的:科学和准确地分析江西省农村药品“两网”建设与药品质量的关系。方法:根据对江西省农村药品随机抽样调查[1]与评估的结果,深入分析农村药品质量。结果:江西省农村零售药品质量合格率较高。结论:农村“两网”建设促进了农村药品质量的提高。     

The emergency medicine training needs of rural general practitioners

This study aimed to identify the emergency medicine training needs of rural general practitioners (GPs) in the catchment area of the Hunter Rural Division of General Practice. The GPs were surveyed using a questionnaire in which they were asked about their confidence levels in a number of specific emergency medicine skills, and about the areas of emergency medicine that they saw as priorities for upskilling. More than a third of GPs who were responsible for on-call work at the hospital indicated that they had low levels of confidence in a number of their emergency medicine skills, in particular skills relating to paediatric emergencies, cardiovascular emergencies, and respiratory emergencies. These emergency medicine domains were also seen as high priorities for upskilling by the majority of the respondents. The study shows that rural doctors need the opportunity to access emergency medicine training that provides upskilling not only in the management of clinical problems, but also in practical procedures.     

Selection of medical students and the maldistribution of the medical workforce in Queensland, Australia

ABSTRACT: The relative shortage of both general practitioners and specialists providing medical services to rural areas disadvantages people living in the country. This maldistribution of the medical workforce is due in part to the medical education system. The selection and socialisation of medical students, the adequacy of training for rural practice and the continuing support of rural doctors must all be addressed. While progress is being made in vocational training and continuing support of rural practice, aspects of undergraduate education continue to contribute to the shortage of rural practitioners.
The school and home addresses of 1991 school leavers in the 1992 intake into first year medicine at the University of Queensland were analysed and compared with those previously reported. Results indicated that students from rural backgrounds remain underrepresented despite previous recommendations to redress the disproportionately low number of rural students entering medical school. Changes to the selection of medical students aimed at increasing the number of rural students entering the course are discussed. This issue needs to be addressed in conjunction with many other factors contributing to the maldistribution of general practitioners if the shortage of rural medical practitioners is to be ultimately corrected.     

Where is the evidence that rural exposure increases uptake of rural medical practice?

Australian Government initiatives to address medical workforce shortages in rural Australia include increasing the intake of students of rural background and increasing exposure to rural medicine during training. Rural-orientated medical training programs in the USA that selectively admit students from rural backgrounds and who intend to practise as family practitioners have demonstrated success in increasing uptake of practice in rural/underserved areas. However, in examining the specific contribution of rural exposure towards increasing uptake of rural practice, the evidence is inconclusive, largely due to the failure to adjust for these critical independent predictors of rural practice. This paper identifies this evidence gap, examines the concept of rural exposure, and highlights the need to identify which aspects of rural exposure contribute to a positive attitude towards rural practice, thereby influencing students to return to rural areas. The cost of rural exposure through student placements is not insignificant, and there is a need to identify which aspects are most effective in increasing the uptake of rural practice, thereby helping to address the medical workforce shortage experienced in rural Australia.     

RETENTION OF RURAL DOCTORS

ABSTRACT: The saddest feature of rural medicine is the continuous loss of trained doctors from the bush. The rural medical workforce depends on the recruitment, training and retention of medical practitioners. While considerable funding and research effort has been directed to recruitment and training, minimal attention seems to have been paid to the retention of medical practitioners by either researchers or governments. The effectiveness of the major efforts of universities, governments and organizations of rural doctors to improve the medical workforce through recruitment and training is set at risk by high rates of attrition. Regrettably there is a dearth of literature on the retention of rural doctors. This paper seeks to review the literature to identify significant factors causing doctors to leave rural practice and to stimulate a search for solutions.     

Towards evidence-based general practice in rural and remote Australia: an overview of key issues and a model for practice

There is an extensive global move towards evidence-based practice intended to increase the quality and effectiveness of health care. However there are barriers and issues when rural general practitioners attempt to incorporate evidence-based medicine in their practice. Key issues affecting the uptake of evidence-based medicine by rural general practitioners include the gaps in the scientific evidence relevant to general practice, time limitations, and the cost of Internet access, geographical isolation from centres of evidence-based practice and limited training opportunities. General practitioner consultations may involve multiple, ill-defined problems and the patients' views about their treatment may conflict with an evidence-based treatment approach. Rural general practitioners may require additional supports to access information from research through Internet-based resources, accessible summaries of evidence or clinical practice guidelines. In addition a model to assist rural general practitioners use evidence-based medicine is suggested. This model may enable the clinical decision-making process to integrate clinical experience, patient preferences and an understanding of the rural context of practice with the best available evidence, to in turn produce best practice.     

The John Flynn Placement Program: evidence for repeated rural exposure for medical students

Objective: This paper reports on an evaluation of the John Flynn Placement Program (JFPP) for medical students. JFPP aims for medical students to experience both rural medicine and rural life as a way of increasing rural career intentions. Design: Medical students experience two weeks a year over four years with a rural doctor. Students are evaluated at the end of each placement for clinical and social experiences and career intent. They are followed up annually to monitor career intent. Mentors are evaluated annually on clinical and rural experiences during a placement. Setting: The Australian Government has several initiatives to encourage recruitment into rural medicine. One initiative is the JFPP. Students from all medical schools are placed with experienced general practitioners in rural and remote areas 4–7 locations across Australia. Participants: Evaluation data from 1450 placements from 2005–2009 are reported. Outcome measures: Data are presented highlighting evaluation of student and mentor perceptions of clinical and social experiences. Longitudinal tracking data provide an indication of the success of the program in terms of recruitment into the rural workforce. Results: Overall mean for clinical and rural experiences is extremely positive for both students and mentors. After four JFPP placements 65% of students intend to work in rural areas. After one JFPP experience 9% indicate intent to practise as a rural general practitioner while after their fourth JFPP nearly 20% are indicating intent to practise as a rural general practitioner. Conclusions: Longitudinal experiences, such as the JFPP, are positively influencing intention to enter the rural workforce but the impact of urban centric vocational training might be negating this impact.     

SEVERE EMERGENCIES IN RURAL GENERAL PRACTICE

ABSTRACT: The objective of this study was to examine the frequency, nature, management and outcomes of life-threatening emergencies in rural general practice in the Hunter region of Australia in order to help assess the need for training in, and provision of, emergency medical services. Emergencies seen by 18 rural general practitioners over a period of 1 month in 1988 in four different towns in the Hunter region are described. All emergency and after hours attendances during the study period were recorded by the doctors at the time. A measurement of severity validated against the opinion of specialists in appropriate fields was applied for each case. This paper undertakes detailed analysis of data for those patients with life-threatening illness. Of the total of 1196 emergency attendances recorded, very urgent problems comprised 2.3% and life-threatening problems comprised 6.1%. These 59 patients had a wide range of diagnoses, the most common being cardiovascular disease, abdominal pain and respiratory distress. The rural doctors treating the patients required a large range of skills, not normally needed by city general practitioners. It was concluded that severe emergencies occur frequently in rural practice and involve a wide range of diagnoses, the most common being medical problems such as cardiovascular disease. Rural doctors require adequate facilities and special skills in emergency medicine to treat these people.