Continuing medical education for general practitioners in North Devon

The establishment of a continuing medical education system for established Principals in a semi-rural area is described. The essential requirement is a 'link man' in each general practice in the area. Clinical tutors, course organisers and regional advisers are all actively involved to produce a regional educational policy.     

Continuing medical education for general practitioners--a Northern Ireland plan.

Following the introduction of the 1990 contract for general practitioners and the new postgraduate education allowance, the Northern Ireland Continuing Medical Education Group, comprising the clinical tutors from four Belfast hospitals and members of the University department of general practice, was established to provide high quality co-ordinated continuing medical education for general practitioners. A questionnaire was sent to all general practitioners in Northern Ireland to find out their needs and preferences with regard to continuing education. The responses indicate the value of small group discussion as well as the traditional lecture and the important role of local hospital consultants in providing education. Therapeutics, recent advances in medicine and learning new skills are all desirable topics. The group intends to use this information in the provision of courses for general practitioners in the province.     

Anesthesia training for family practitioners

The 1988 CMA report on anesthesia training for general practitioners/family physicians outlined recommendations about the provision of anesthesia services, the educational process for the family practitioner anesthetist, including educational objectives, as well as comments on continuing medical education and maintenance of competence.     

区域医疗联合体内全科医师医学继续教育培训模式的研究

为在区域医疗联合体内探索建立满足医疗需求的全科医师职后继续教育模式,通过文献研究、统计分析和问卷调查,回顾了国内外全科医师的培训现状,调查了瑞金一卢湾医疗联合体（试点）人口情况、疾病谱变化、社区医师现状,同时对上海市原卢湾辖区内社区居民进行问卷调查。研究结果发现,社区全科医师数量尚无法满足广大居民的医疗需要,同时居民希望全科医师的诊疗水平能够不断提高以适应复杂性综合疾病的诊治要求,提高社区全科医师医疗资源的使用率。因此,强化现有社区全科医师的继续教育培训,提高其诊疗水平对区域医疗联合体顺利实施将起到决定性作用,也是完善城市医疗服务体系的基础性工程。     

Findings of a national survey of the role of general practitioners in the treatment of opiate misuse: extent of contact with opiate misusers

With the recent unprecedented growth in the spread of drug misuse in the United Kingdom the role of the general practitioner has become more and more prominent, both in response to demands for treatment and as the focus of national policy on drug misuse. Although general practitioners may be the first contact, few data are available on the extent of their contact with drug misusers. A postal survey was carried out in mid-1985 of a 5% national sample of general practitioners in England and Wales concerning their role in and views on the treatment of opiate misusers, including the extent of their contact with such patients during a four week period. Of the 1166 general practitioners surveyed, 845 replied, a response rate of 72%. The results show that roughly one in five general practitioners in England and Wales attended an opiate misuser during this four week period, seeing an estimated 6000 to 9000 patients, one third of whom were "new" to the general practitioner. A cautious estimate of between 30,000 and 44,000 new cases of opiate misuse presenting to general practitioners in a year is suggested, with some adjustment necessary because of double counting. A wide variation in the prevalence of consultations among regional health authorities was found, and several of the regions with a high prevalence are outside the London area. The scale of contact thus confirms the importance of the general practitioner in the national response to drug misuse.     

Nurse practitioners in primary care III. The southern Ontario randomized trial

A group of nurses who formerly had performed office functions received a special university-based educational program designed to prepare them to assume much of primary care management as nurse practitioners. The associated family physicians would shift their role to general supervision and attention to difficult clinical problems. To test this new form of practice, two complementary randomized trials have been conducted in south-central Ontario. The particular trial reported here was intended to assess the influence of the educational program on the changing roles of the professional personnel. The nurses of 14 family medical practices, with the physicians' support and commitment to participation, applied for the new training. Seven applicants were randomly selected to receive the training and their corresponding practices became the experimental group, while the remaining nurses and practices were retained as controls. During the subsequent year of investigation important changes occurred in professional roles of the experimental group. Nurse practitioners spent more time in clinical activities than conventional office nurses. The shift was not at the expense of time devoted to clinical work by physicians. Doctors delegated more professional activities to nurse practitioners than to conventional nurses. Except for remuneration (affected by legal constraints) job satisfaction among experimental physicians and nurses remained high after one year of experience with the new method.     

我国基层全科医生队伍现状和继续医学教育内容需求分析

目的 调查目前基层全科医生队伍现状以及继续医学教育内容需求情况,为进一步改善基层全科医生配置和继续医学教育政策提供依据。 方法 采用整群随机抽样和方便抽样相结合的方法,2017年5月在我国东中西部13个省共抽取54家基层医疗卫生机构作为样本单位,对其中全科医生共670人进行问卷调查,采用EpiData 3.1录入数据并核对。 结果 调查机构平均每万人口全科医生数量为3.46人,东部地区最高,为4.12人,中部和西部分别只有1.45人和1.93人。不同省份平均每万人口全科医生数差异较大,以湖南省最低,平均只有0.76人;江苏省和浙江省最多,分别有5.55人和5.75人,是湖南的7倍多。参与调查的全科医生,年龄主要集中在30~50岁,学历以本科为主,占70.51%;中级职称最多,占43.97%。另外,城市地区基层全科医生学历比农村地区高,高级职称全科医生占比在东部地区最高。继续医学教育内容需求调查发现,疾病诊疗、合理用药和急诊急救等医疗服务相关内容需求较大;但不同地区、学历和职称的全科医生需求有所不同,高职称、高学历的全科医生更愿意接受新理论新技术等方面的继续医学教育内容。 结论 目前我国平均每万人口全科医生数已达标,但却存在明显的区域性差异。近些年基层全科医生的学历层次和职称水平不断提高,但不同地区发展也不平衡。另外,根据需求,应针对不同地区、职称和层次的全科医生开展不同的继续医学教育内容。      

北京市社区卫生服务机构全科医生培训现状与需求调查

目的：了解北京市社区卫生服务机构全科医生培训现状和培训需求,为进一步完善我市相关培训提供依据。方法通过问卷调查对北京市所有社区卫生服务机构全科医生进行调查。结果①北京市社区卫生服务机构全科医生学历以专科以上为主占84.72%,职称以初级和中级为主。②61.4%的全科医生接受过不同形式的全科医学培训。③95.54%的医务人员有不同程度的进修意愿,91.65%的社区卫生服务机构愿意派医务人员参加培训。结论社区卫生服务机构及其全科岗位医务人员具有较强的培训需求,但培训内容与形式需要进一步完善,建议今后要深入做好岗位和个人培训需求调查,完善培训内容,同时多采用短期实践培训的方式。     

我国基层全科医生继续医学教育现状调查

目的 调查基层全科医生继续医学教育师资、形式和内容现状以及存在的问题,为进一步改善全科医生继续医学教育政策,提高现有基层全科医生服务能力提供依据。 方法 采用整群随机抽样和方便抽样相结合的方法,于2017年5月在我国东中西部13个省共抽取54家基层医疗卫生机构作为样本单位,采用自行设计的问卷对其全科医生共670人进行问卷调查,采用Epidata 3.1录入数据并核对,使用SAS 9.1统计学软件进行统计分析,P<0.05为差异有统计学意义。 结果 师资:主要来自三级医院及专科医院,占49.85%;来自基层医疗卫生机构的师资较少,只有9.88%;与其他地区相比,东部地区来自基层医疗卫生机构的师资最多,占11.98%。形式:以学术讲座、培训班和网络学习等形式为主;操作实践和实地参观等开展较少,只占8.96%;网络学习形式在西部和农村地区开展更多。内容:主要集中在合理用药和疾病诊疗等方面,80%以上的全科医生都有参加。另外发现,目前基层全科医生对继续医学教育师资、形式和内容的满意度均处于较低的水平,分别是59.28%、49.32%和53.07%;并且不同地区、学历和职称的全科医生满意度有所不同,高级职称全科医生满意度最低。 结论 基层全科医生对继续医学教育的整体满意度较低。基层全科医生继续医学教育应兼顾不同地区和不同层次全科医生的需求,开展不同的培训内容;丰富形式,增加继续医学教育吸引力;另外还要加强基层医疗卫生机构师资的培养。      

天津市全科医生继续教育需求情况分析

目的:调查天津全科医生现状和对继续教育的需求状况,分析发现全科医生继续教育的需求点,为今后培训教学计划的制定、培训实施及教材的编写提供依据。方法:采用随机抽样的方法,对市内六区180名在职全科医生,采用自行设计的问卷进行调查。调查涉及被调查者基础资料、全科医学基础概念、继教需求等三方面18个相关问题。统计数据用SPSS10.0及Excel进行分析。结果:被调查者180人,100%的被调查者对继续教育有强烈需求;在需要培训科目的前四项选择(按需求程度排序,共720人次)上,希望接受临床医学等专业技术培训的达到61.5%;希望接受医学新观念、新学科以及电脑、外语等相关学科和工具学科培训的占38.5%。对继续教育的单位支持率占93.9%,其中只提供时间的单位占61.7%。结论:本次调查的基本目的在于为合理制定全科医生CME培训计划、教材的编写提供依据;促使全面提高市内在职全科医生专业素质、理论观念;根据不同需求,开展有针对性的继续教育。     

老年病学继续医学教育在培养高素质社区医疗全科医师中的作用

继续医学教育是医学教育的重要组成部分。加强全科医师的继续医学教育则是提高基层医疗卫生服务所面临的紧迫任务。具有综合学科特点的老年病学科在全科医师继续医学教育中拥有得天独厚的优势,应充分认识并积极发挥其作用,推动我国社区医疗服务健康发展。     

The consultant's role in continuing medical education of general practitioners: the case of rheumatology

Consultant rheumatologists were surveyed by questionnaire about their contribution to the continuing education of general practitioners, and 84% (203/243) replied. Altogether 157 respondents had participated in some form of teaching, 147 in collective teaching sessions such as lectures and 99 in the teaching of small groups. Arthritis comprised 44% of the rheumatological topics taught; there was a noticeable lack of teaching on problems commonly encountered in general practice, such as soft tissue rheumatism and injury and back pain, and on clinical skills including examination and injection of joints. Eighty eight respondents made comments and suggestions. The favoured educational strategies were small group teaching, apprenticeship schemes, and interchange between general practitioners and consultants about shared cases. This contrasts with what was typically done--namely, formal lectures on rheumatoid arthritis in postgraduate medical centres. These findings raise questions about the continuing education of consultants themselves as well as about the consultants' role in teaching others.     

订单定向培养乡镇卫生院全科医生的实践与思考

海南医学院实施6种订单定向全科医生培养模式,建设全科医学“三级”实践基地和“三结合”全科医学师资队伍,建立多部门协作、统筹协调的医学教育管理体制和运行机制,逐步完善院校教育、毕业后教育和继续教育有效衔接的三个阶段的医学教育体系,构建了为乡镇卫生院培养全科医生的人才培养体系.     

加拿大家庭医生签约服务模式及对我国全科医学发展的启示

目前我国家庭医生签约式服务存在签约率未达标、服务质量未达到预期效果等问题,其根源在于契约双方的信任危机、权责不明及制度保障的缺失或落实不到位。本文通过整理文献,介绍加拿大家庭医生签约服务模式,包括签约及转诊流程、社区诊所运行模式、全科医学病房及继续教育等,并基于我国家庭医生签约服务现状提出相关建议。     

乡镇全科医生继续医学教育需求的调查与分析

目的了解乡镇卫生院全科医生对继续医学教育的需求。方法采用自行设计的问卷调查表对随机抽取的桂林市乡镇全科医生进行调查。结果在参加继续医学教育的乡镇卫生院全科医生中,69.05%为了提高业务水平,45.23%为了提高理论水平,24.60%为了获得学历或证书,15.87%为了完成任务,2.38%为了晋升职称;培训形式多样,选择脱产学习者占50.00%,进修学习者占33.33%,专题培训者占20.00%,函授学习者占13.49%,继续学分教育者占11.90%,学术会议者占4.76%,自学网络培训者占3.97%。结论建立合理的继续医学教育机制,采取多种培训形式开展继续教育,有利于提高乡镇全科医生的职业素质。     

民营医疗门诊部医务人员继续教育现状分析及对策

目的 通过对辖区民营医疗门诊部人员继续教育现状调查,掌握民营医疗门诊部人员继续教育现状和需求,分析问题及影响因素,为卫生行政主管部门制定可行的继续教育方案提供依据.方法 采用自行设计的问卷对深圳市某区辖区内176家民营医疗门诊部的1 050名医务人员进行问卷调查.结果 民营医疗门诊部医务人员对继续教育重要性认知仅有58％,其中性别、年龄、职称、学历、工作岗位对认知均有影响,且影响差异均有统计学意义（P＜0.05）;影响继续教育实施的主要因素是缺乏继续教育途径.结论 民营医疗门诊部医务人员继续教育工作急需有关部门高度重视,建议卫生行政部门尽快出台相关政策,为民营机构医务人员提供更多继续教育机会.     

全科医师情绪智力与工作绩效研究

目的:了解全科医师情绪智力与工作绩效的关系,为完善全科医师培养体系提供依据。方法:运用情绪智力量表、工作绩效量表对广东省492名全科医师进行测试。结果:全科医师情绪智力得分126.8112.04,工作绩效得分90.3810.72;全科情绪智力与工作绩效存在中等程度显著正相关,全科医师情绪智力能解释工作绩效25.6%的变异。结论:加强全科医师情绪智力的培养有助于提高工作绩效。     

General practitioners' recognition and management of psychiatric illness

All 53 of the general practitioners from one community health area of the Hunter region of New South Wales were interviewed about patients with psychiatric illnesses who had presented to their practices. Four main themes were covered: personal data which included details of medical and psychiatric training and experience; attitudes to psychiatric illness; pharmacological management; and the effectiveness of existing services. Ninety-four per cent of the general practitioners felt that dealing with psychiatric problems was an integral part of their role as a general practitioner and 60% of the general practitioners believed that their management of these problems was adequate. Patients with personality problems and those with hypochondriasis were identified as their most difficult patient groups, while inability to refer quickly was cited as the major obstacle to successful psychiatric treatment. An increased awareness of the hazards of psychotropic drugs and of the proper uses of these agents existed. Finally, private psychiatrists and the mental hospitals were criticized for not providing an adequate back-up service for this group of general practitioners.     

英国全科医师制度分析与启示

分析英国的全科医师在英国国家卫生服务系统中所发挥的作用,发现在英国有规范的全科医学教育体系,完善的全科医师培训制度,明确的全科医师工作职责和考核指标,紧密的初级和二级医疗联合体系,强有力的经济保障措施以及高度的职业认同感。提示我国在深化医疗改革进程中,要做好基本医疗服务,必须加快推进全科医师培养,提高社区全科医师的业务综合能力;建立全科医师首诊制度,促其做好健康守门人;提高全科医师待遇,增加其职业认同感;同时要加强信息化建设,建立健全社区首诊、双向转诊的通畅体制。     

Newly registered elderly patients: who are they and why such delay in the transfer of their medical records?

The time taken to transfer the records of elderly patients registering with a new general practice was investigated. Thirty five (5%) of a total of 671 patients aged 75 and over were entered as new patients on to the age-sex register of an urban group practice during one year. Twenty nine had moved into the area and six had changed their general practitioner for personal and other reasons. An average of 141 (range 71-296) days elapsed before dispatch of their medical records to the new practice. During this period an average of 3.5 (range 0-15) consultations with a general practitioner were recorded, indicating the need of such patients for medical care. The long delays were caused by the processing of medical records at the central register and the transfer of records between family practitioner committees and general practitioners. Delays were most apparent in the time taken for general practitioners to dispatch the necessary documents to the family practitioner committees, and these should be minimised. The use of a summary card written and updated by the general practitioner and retained by the patient would facilitate continuing care should patients change to a new practice. Meanwhile, assessment of elderly patients after registration with a new practice by a member of the primary health care team may identify problems before the records have been transferred and may help the resettlement of these high risk elderly patients.