商丘市乡村基层医生继续教育现状的调查与研究

目的分析农村基层医生继续教育现状,发现乡村基层医生教学教育中存在的问题,寻求适合农村基层医生继续教育的方式。方法对170个乡村基层医生的基本情况、接受继续教育的愿望、培训项目和内容、培训的形式和妨碍继续教育的因素等方面开展问卷调查。结果学历普遍偏低,大部分医生都没有职称或者仅有初级职称,个体诊所从医人员是乡村医师的主体,44.71%的人无执业医师资格;67%～79%认为常见病多发病的诊断和治疗、执业医师(助理执业)医师考试辅导、临床用药和专题讲座的的继续教育很必要;对继续教育有强烈愿望的占63.53%;接受函授和短期培训继续教育方式的占50%和32.35%;缺乏适宜继续教育形式和医务繁忙,无时间和精力及缺乏规范化要求是妨阻碍乡村医生参继续教育的主要因素。结论乡村医师继续教育的管理要规范,培训目标要明确,内容要有针对性,教学模式要快捷方便,才能使农村基层医生不断提高专业知识和技术水平。     

The gynaecological work by GPs in Brittany

The aim of this study is to evaluate the gynaecological work done by general practitioners (GPs) in Brittany and the clarify the role that they play in screening for female cancers. Gynaecology represents approximately 10% of the total activity reported by the respondents; however, wide variations have also been noted. This raises important questions on issues such as the competence of these practitioners in this area and equity in access to care and screening, which could potential lead to problems. A large majority of the participating GPs (87%) identified prevention and screening as their primary specific roles to carry out in the care of their female patients. The main reasons for seeking gynaecological consultation are contraception and hormone replacement therapy, and these are the two themes for which GPs request further medical training and continuing education possibilities. Gynaecological work done within the scope of general practice can be hindered by various factors or obstacles: some stem from the doctors themselves (inadequate skills, little interest in this speciality), or rather may be linked to their working conditions (dealing with several reasons for a patient seeking consultation at the same time), while others are a result of how women (or even the doctors themselves) view the tests (reluctance or lack of confidence in the doctors' ability to carry them out properly). In order for GPs to be more involved and implicated in this field, there would need to be the introduction of an efficient and adapted training as well as compatible and effective continuing education programmes suitable to respond to the needs and requirements of the GPs practicing in this area.     

'Swallowing the medicine': determining the present and desired modes for delivery of continuing medical education to rural doctors

ABSTRACT: A National Needs Assessment of the continuing professional educational needs of Australian rural medical practitioners was conducted on a model previously successfully used in Queensland. The objective was to describe and quantify the continuing education needs of rural medical practitioners in order that service providers might more expeditiously set educational curricula in continuing medical education (CME) provision. A major component of the study was to determine which modes of CME delivery rural doctors currently use and which they would prefer to use. Rural doctors were perceived to be slow to access new technologies and training may be required in order for the doctors to use them.     

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.     

Who are the providers of postgraduate medical education?

Summary. The view, background and motivation of providers of medical education was studied using a structured questionnaire which was sent to all those who organized courses for the Postgraduate Education Allowance in the West of Scotland. Two hundred and twenty-five replies were received from 254 course providers, giving an 88.6% response rate; 51.8% of course providers were general practitioners, 24.1% hospital consultants, 2% were from the pharmaceutical industry, 3.6% from commercial companies, 2.6% health board administrators, 1% general practitioners also running commercial companies, 14.9% others. Only 29.3% had training for organizing courses, although 68.7% thought special training was important. 43% used a combination of GPs and hospital consultants at their courses and a considerable number continued to organize lecture style courses. 32.8% used pre-course material and 50.7% used post-course assessment. 21.5% of providers had to provide their own secretarial back-up. The provision of continuing medical education is haphazard. The new contract has increased the amount of education available without addressing the needs of the providers. Proper training, planning and evaluation of courses, adequate funding, protected time and good secretarial back-up are required for good, meaningful and relevant continuing medical education.     

What makes ‘place’ attractive to overseas‐trained doctors in rural New Zealand?

The present paper investigates what keeps doctors 'in place' in New Zealand rural communities and what prompts their departure from practice. The study is based on in-depth interviews conducted with nine overseas-trained medical practitioners within rural areas in New Zealand during 2004. A thematic analysis was undertaken. The resulting narratives reveal the unintended circumstances under which respondents often arrived in their rural communities, as well as some of the 'pull' factors which a more relaxed rural lifestyle offers. Recurring themes relating to the attractiveness of place include community loyalty and the enjoyment of 'fully practicing medicine'. Themes which corroded the attractiveness of place included 'entrapment', lack of choice in secondary schooling, restricted spousal employment opportunities, the lack of cultural and entertainment activities, and difficulties accessing continuing medical education. The authors conclude that addressing the question of what makes 'place' attractive to overseas-trained general practitioners in rural New Zealand requires an understanding of place as context rather than mere location.     

四川省县乡农村卫生人员继续医学教育现状调查

目的了解四川省农村卫生人员继续医学教育现状,为评估和改善现有农村继续医学教育体制提供依据。方法采用文献调研、专家咨询、问卷调查和小组访谈等方法,对四川省射洪县和仪陇县的12个乡镇卫生院163名卫生技术人员和224个村卫生站的230名乡村医生进行调查。结果大多数乡村卫生人员参与了继续医学教育培训,主要的培训方式是在职学习,其平均每周参与培训的时间在4h左右。58.9%的乡村卫生人员未主动制定过个人继续医学教育计划,70%以上的人认为参加了在职培训后对实际工作有指导作用;参与继教培训的费用80%以上由个人支付。结论农村卫生人员继教需求大,但应选择适合的培训内容和方式。国家及相关单位应加大对农村卫生人员继续医学教育培训的资金投入,采用多种方式改进农村卫生人员继续医学教育的状况,完善继教的评估和管理体制。     

Performance-based assessment in continuing medical education for general practitioners: construct validity

The use of performance-based assessment has been extended to postgraduate education and practising doctors, despite criticism of validity. While differences in expertise at this level are easily reflected in scores on a written test, these differences are relatively small on performance-based tests. However, scores on written tests and performance-based tests of clinical competence generally show moderate correlations. A study was designed to evaluate construct validity of a performance-based test for technical clinical skills in continuing medical education for general practitioners, and to explore the correlation between performance and knowledge of specific skills. A 1-day skills training was given to 71 general practitioners, covering four different technical clinical skills. The effect of the training on performance was measured with a performance-based test using a randomized controlled trial design, while the effect on knowledge was measured with a written test administered 1 month before and directly after the training. A training effect could be shown by the performance-based test for all four clinical skills. The written test also demonstrated a training effect for all but one skill. However, correlations between scores on the written test and on the performance based test were low for all skills. It is concluded that construct validity of a performance-based test for technical clinical skills of general practitioners was demonstrated, while the knowledge test score was shown to be a poor predictor of competence for specific technical skills.     

Investigation into the attitudes of general practitioners in Staffordshire to medical audit.

OBJECTIVES--To investigate the attitudes of general practitioners to medical audit, and any associations between their attitudes and their personal characteristics. DESIGN--Postal questionnaire survey. SETTING --Staffordshire, United Kingdom. SUBJECTS--870 Staffordshire general practitioners. MAIN MEASURES--Agreement or disagreement and associations between the attitudes to 16 statements about audit and the doctors' personal or practice characteristics--namely, sex, number of years since qualification, practice list size, number of partners, and the practices' experience of audit. RESULTS--601 Staffordshire general practitioners (69%) responded. There was most agreement with the statements that audit is time consuming (86%), that ongoing training and education is needed (71%), that there is a compulsion applied on doctors to audit (68%), and that extra resources for audit should be provided by the medical audit advisory group (65%). There was considerable disagreement (53% of general practitioners) with the statement that ?government policy to expect general practitioners to do audit will enhance the population's health.? The median response by the 601 general practitioners was four positive responses out of 14 statements about audit (two of the 16 statements could not be graded positive or negative to audit). Women doctors generally had more positive attitudes towards audit, and so had those working with smaller mean list sizes, those in larger partnerships, and those in practices that had carried out audit for a longer time. CONCLUSIONS--There was a generally negative attitude to medical audit, but it was encouraging that those doctors with the most experience of audit obtained the most job satisfaction from it. IMPLICATIONS--More effort is needed to convince general practitioners of the value of audit. Without this, attempts to involve other members of the primary care team in multidisciplinary clinical audit are unlikely to be effective. Successful audits that are shown to be cost effective as well as leading to improvements in patient care should be publicised and replicated. A higher proportion of resources should be devoted to audit.     

Training needs in adolescent medicine of practising doctors: a Swiss national survey of six disciplines

OBJECTIVE: To assess and compare the training needs in adolescent medicine of doctors within 6 specialties as a basis for the development of pre/postgraduate and continuing medical education (CME) training curricula. DESIGN: Cross-sectional postal survey. SETTING: Switzerland. PARTICIPANTS: National, representative, random sample of 1857 practising doctors in 6 disciplines (general practitioners, paediatricians, gynaecologists, internists, psychiatrists, child psychiatrists) registered with the Swiss Medical Association. MAIN OUTCOME MEASURES: Perceived importance of and training interest in 35 topics related to adolescent medicine listed in a self-administered, anonymous questionnaire. RESULTS: A total of 1367 questionnaires were returned, representing a response rate of 73.9%. Clear interest in adolescent medicine was reported by 62.1% of respondents. Topics perceived to be the most important in everyday practice were functional symptoms (71.4%), acne (67.1%), obesity (64.6%), depression-anxiety (68.1%) and communication with adolescents (61.7%). Differences between disciplines were especially marked for gynaecologists, who expressed interest almost exclusively in medical topics specific to their field. In contrast, other disciplines commonly reported a keen interest in psychosocial problems. Accordingly, interest in further training was expressed mostly for functional symptoms (62.4%), eating disorders (56.3%), depression-anxiety (53.7%) and obesity (52.6%). Issues related to injury prevention, chronic disease and confidentiality were rated as low priorities. CONCLUSIONS: Regardless of discipline, Swiss primary care doctors expressed a strong interest in adolescent medicine. Continuing medical education courses should include both interdisciplinary courses and discipline-specific sessions. Further training should address epidemiological and legal/ethical issues (e.g. injury prevention, confidentiality, impact of chronic conditions).     

Dissemination of genetic counseling and prenatal diagnosis: impact of the physicians' knowledge

This article presents a survey carried out among 2,549 doctors (general practitioners, pediatricians, obstetricians and gynecologists) practicing in two south of France "departements" (administrative subdivisions): Bouches-du-Rh?ne and Hautes-Alpes. The influence of socio-demographic and professional characteristics on knowledge of prenatal diagnosis indicators is studied here for each specialty. While knowledge among general practitioners is apparently a product of their formal education, among gynecologists and obstetricians the most important factor seems to be professional experience. In France, the GP is a central figure in referrals for genetic counselling and prenatal diagnosis, hence the importance of improving his training and possibilities of continuing education.     

Does formal approval of educational courses guarantee quality?

OBJECTIVES: To assess whether organizers of continuing medical education for general practitioners used principles of adult learning when designing their meetings. DESIGN: A questionnaire study of organizers of approved educational meetings for general medical practitioners (GPs). SETTING: South East Scotland. SUBJECTS: Organizers of educational meetings. RESULTS: Organizers often failed to use principles of adult learning in the construction of their meetings. Organizers with prior training in medical education were, however, significantly more likely to adopt these principles. CONCLUSIONS: Given concern about the quality of educational meetings as assessed by their educational impact, formal approval is not an indicator of quality. Postgraduate bodies should use explicit criteria both in the development and approval of continuing educational meetings.     

Research in general medicine,role of the medical thesis

General practice doctors are naturally presented as being actors on the front lines of public health. The ability of general practitioners to be aware of and deal with public health questions largely depends upon their training. Perhaps one could consider the general practitioner's thesis as a preparatory analytical work within the area of their future field of practice. Do these theses serve to provide food for thought on general practice and its contribution to public health, and if not, could they? An analysis conducted within four medical schools in western France demonstrates that the work produced for general medicine identified as such only constitutes a fraction of the overall number of medical (non-university) theses (approximately 5%). Two possible explanations may be put forward. First, on the one hand, the theses highly depend on the context of the training and the work produced is a direct result of this. Second, on the other hand, the current methods of indexing notes in the university databases does not enable general medicine to be clearly seen and visibly recognised as an academic discipline. Two questions then remain: Can medical theses be considered as research? Should research in general medicine be carried out solely by general practitioners? It is vital that resources from outside the medical field be raised and mobilised for general practice research, whose themes are multi-disciplinary and not only clinical.     

Continuing Education: A Survey Among General Practitioners

A survey of perceptions of continuing education—content,methods and current provision—was undertaken among allestablished general practitioners in one health region of theUK using a postal questionnaire. Interviews were conducted witha small random sample of respondents and with a larger sampleof non-respondents to the questionnaire. Data from the questionnaireand interviews demonstrated overall a wide diversity of contentand methods of continuing education perceived as appropriate,with duration of experience and involvement in undergraduateteaching or postgraduate training as significant determinants.The findings are used to review, critically, current provisionof continuing education for general practice and to suggestways in which future provision might reflect the range of educationalneed perceived by doctors.     

Teaching nutrition to medical doctors: the potential role of the State Registered Dietitian

Medical doctors ought to have a sound knowledge of nutrition, but it is clear that most do not. Teaching nutrition to medical doctors should start during undergraduate training. Dietitians have a vital role to play—acting as consultants for the course, in formulating learning objectives, teaching, organizing practical sessions, assisting with clinical demonstrations and writing exam questions. Dietitians could also be encouraged to become more involved in the clinical training of medical students by assuming a more active role in the provision of seminars, grand rounds, clinical case presentations and conferences. Finally, dietitians may attract more medical doctors to nutrition conferences and meetings if these are registered for CME (continuing medical education) and PGEA (postgraduate education allowance). The dietitian has a unique role and responsibility for teaching nutrition to medical doctors. The task ahead is a difficult one, but if successful will surely result in improvements to the nutritional status of both patients and the general public.     

Data-linked groups: a method for continuing professional education

The relationship is reviewed between standards of performance and the objectives of continuing education. The difficulties of providing continuing medical education which has objectives derived from appropriate standards are illustrated by reference to general practice.
A method is described in which a number of small groups of general practitioners attend separate but simultaneous evening meetings linked to a coordinating centre by a viewdata system. In this way the same problems from general practice are presented to each group. Participants respond first as individuals then contribute to group discussion, led by a tutor, from which a consensus approach to each problem emerges. This is transmitted and received along with those from other groups, at the coordinating centre. All responses to a problem are combined there and made available to the groups on viewdata later in the evening. The validity of the exercise is discussed in relation to the type of problem used, the group-consensus and the combining of responses from a number of groups.
The method appears to be attractive to general practitioners, relevant to their work and capable of providing continuing education based on appropriate standards of performance.
Its possible application to continuing education in other disciplines is referred to.     

Urgent referrals to a specialist by family physicians—Is the “urgency” real: A prospective study

Bulgaria is currently changing its health care system to be in line with European standards. The availability of well-trained general practitioners is crucial for the success of the new health strategy. Training in general practice is becoming an essential part of medical education and, under the guidance and with financial support of PHARE Project experts, departments of General Practice are being introduced in Bulgarian Medical Schools. General Practice is becoming an official discipline in undergraduate, postgraduate and continuing education processes.

In this difficult process, Pleven Medical School has a range of reasons for giving a new face to doctors of the 21st century.

The authors present their position on the necessity of reforms in medical education and their attempt to bring the future doctor nearer the specific needs of the population, understanding the patient as a bio-psychosocial identity.     

IS AUSTRALIAN RURAL PRACTICE CHANGING? FINDINGS FROM THE NATIONAL RURAL GENERAL PRACTICE STUDY

ABSTRACT: The National Rural General Practice Study (NRGPS) was the first comprehensive national study covering rural and remote general practitioners throughout Australia. It was undertaken in 1996–1997 and drew on data from existing sources such as the Australian Bureau of Statistics and the Australian Institute of Health and Welfare, together with a postal survey of general practitioners in rural and remote areas. There was a 75% response rate to the survey, which covered professional issues, personal and social issues, personal background, patient issues, recruitment and retention programs and changing health services. Overall, the study findings confirmed those of previous individual State-based studies in the early 1990s and showed that there had been some changes since those previous studies. In particular, access to continuing medical education has improved, the rural medical workforce appears to be ageing, the proportion of women rural doctors is increasing and the projected length of stay in rural practice is decreasing. Whereas in the early 1990s the projection for rural doctor numbers was continuing decline, the NRGPS projected overall numbers in rural practice as staying approximately the same over the next 5 years. In the light of these trends, the challenge is to implement targeted initiatives that improve the recruitment and retention of rural and remote general practitioners.     

部分省市医生满意度调查

为了解国内不同执业状况医生的满意度水平，调查了广东、山西、四川3个省的656位医生，同时组织了12次小组访谈，涉及的医生来自农村和城市的国有医疗机构和民营医疗机构。结果发现3个省的医生满意度水平，不论是在农村还是城市，国有医疗机构还是民营医疗机构都很低。仅有少数医生对其目前的工作(27％)、收入(8％)和技术水平(30％)感到满意。国有医疗机构工作的医生(81％)比民营医疗机构的医生(69％)更感到他们工作所得的报酬过低。大多数医生对他们能享有的继续医学教育的机会过少(82％)和能享有的与其他医生交流的机会过少（71％)感到不满意。仅有60％的医生对其与患者之间的关系表示满意。53％的医生认为如果可以选择，宁愿在民营医疗机构工作。仅有32%的医生评价目前的医疗服务体系“好”或“很好”。调查中发现最突出的问题是非法行医、虚假广告和假药对医疗服务市场造成的不良影响未得到有效控制。患者支付能力被医生们列为目前医疗服务体系中最重要的问题，超出了医疗可及性和医疗质量。绝大多数医生认为不论是国有医院还是民营医院都需要更多的规范和调整。