Preventive care in general practice.

Preventive care is an integral component of general practice teaching in all Australian medical schools. While curriculum time and teaching methods vary, the overriding emphasis remains on integrating both epidemiological and behavioural science approaches into the primary care setting. Preventive aspects are stressed during attachments with general practitioners. Use of appropriate theoretical frameworks and models allows the role of the general practitioner in disease prevention to be formalized. Undergraduate teaching is further reinforced by programs within the Family Medicine Programme at a vocational training level, and the Royal Australian College of General Practitioners at a continuing medical education level.     

A training programme for rural general practice

An improvement in methods of training graduates for general practice has been recommended as a result of several investigations into the problems faced by rural medical practitioners. This paper describes a rural vocational training programme conducted by the Family Medicine Programme in North Queensland. The programme combines educational support, professional support and mentorship with a medical educator experienced in rural practice. The educational support is partly chosen by members of the rural group, and is designed to meet needs of group members and the communities they serve. The cost of such a programme is high, due to travel and communication over long distances, but is justifiable if it improves recruitment and retention of rural practitioners.     

乡村医生注册培训考试分析及教学内容探讨

2006年在全省首次乡村医生注册培训结束后，浙江省乡村医生培训学校通过时杭州市和宁波市乡村医生注册培训考试的分析，针对在注册培训考试中出现的问题以及各市卫生行政部门、乡村医生培训教育单位和乡村医生反映的教学内容不合理等，在今后乡村医生的注册培训过程结合我省社会主义新农村建设、卫生强县和社区卫生服务工作的要求，按照《国务院乡村医生管理条例》的要求，制订出适应乡村医生工作需要和社区卫生服务的培训计划，切实解决乡村医生培训中的实际困难，调动乡村医生培训学习的积极性，为农村社区卫生服务提供更多更好的卫技人才。     

A new hospital general practice teaching unit

The formation of the latest General Practice Teaching Unit in an Australian hospital is part of a national trend to teach undergraduates and post-graduates about some parts of general practice using patients separated at triage from the accident and emergency departments. Planning this unit required much negotiating between several institutions and a set of guidelines on organisational relationships was created. Innovative features of the Modbury General Practice Teaching Unit include payment of teachers to attend compulsory medical education workshops, dividing the Family Medicine Programme trainee's time between the unit and a neighbouring practice and payment of non-academic general practitioner teachers by the South Australian Government, which eliminates the risk that service interferes with teaching. The Modbury General Practice Teaching Unit is currently the only hospital based unit of this kind in South Australia.     

建立乡村医生实践教学体系的研究与实践

临床实践教学是培养乡村医生的重要环节,建立完善的实践教学体系是社区医学专业建设的重要内容,是培养乡村医生的重要保证.本文从社区医学专业实践教学的特点出发,对北京卫生学校实施乡村医生学历教育、工学结合实践教学体系的建立进行了研究与实践探索,并对完善乡村医生实践教学体系提出了思路和建议.     

以全科医学方向培养在职乡村医生的探索

为了适应农村社区卫生服务发展的需要，探索为农村培养全科型医生的途径和方法。我们将在职乡村医生进行全科医学方向培养，介绍培养目标、课程设置、学习方式与教学安排等，提出在职乡村医生进行全科型教育的政策方向、教育形式、教材与实习基地建设等方面建议。     

中医全科医学诊疗实践及发展优势

我国中医全科医学起步较晚,至今仍处于探索阶段。本文聚焦中医全科医学诊疗实践,从中医全科医学诊疗理念与实践模式、诊疗技术在社区的应用、发展优势及现存问题等几方面进行阐述,以期对中医全科医学发展现状有一个较为全面的认识,促进中医全科医学发展成为实用价值高、服务能力强、广泛渗透基层的中医实践学科。中医全科医学诊疗理念和实践模式特点为提倡以“人”为中心的整体观念、辨证论治的个体化综合干预、治未病的预防养生理念及重视服务家庭与社区。中医全科医学诊疗技术在社区服务中的应用主要为慢性非传染性疾病(以下简称慢病)管理以及体质辨识和调养方法、膏方治疗冬病夏治、中医适宜技术筛选应用等社区健康问题的中医药干预。中医全科医学发展优势主要体现在有利于慢病防治,助力医养结合;容易立足社区和家庭,促进构建和谐医患关系;简便效廉,有利于节约医疗成本;有利于中医理论向临床应用的转化,促进中西医融合等方面。同时,中医全科医学发展还存在人才教育及培养体系尚需完善、中医全科医生队伍数量不足、结构不完善、岗位缺乏吸引力;中医全科医学学科建设依然薄弱;中医全科医学在社区卫生服务的研究仍不足等问题需要解决。      

Part-time medical training: 15 years' experience in the Oxford region

Part-time training of doctors with domestic commitments has taken place successfully in the Oxford region since 1966; 249 doctors have now passed through such training schemes and a further 120 are currently training part-time. Two training schemes are now offered for doctors at senior house officer and registrar level: one of six to eight sessions a week for those undertaking recognised training aiming for consultant or principal in general practice posts, the other of one to two sessions a week providing ad hoc training for those unable for personal reasons to follow a recognised training programme. For doctors at senior registrar level, part-time training entails five to eight sessions a week. Of the 115 doctors who have left the schemes and are now in career posts in the United Kingdom, 19% are now consultants, 30% in other hospital posts, 27% in general practice, and 18% are clinical medical officers; overall, 71% of those in career posts are working part-time. This experience shows that part-time training can be successful and that there is a continuing need for part-time career posts.     

Rural background and clinical rural rotations during medical training: effect on practice location

BACKGROUND: Providing health care services in rural communities in Canada remains a challenge. What affects a family medicine resident's decision concerning practice location? Does the resident's background or exposure to rural practice during clinical rotations affect that decision? METHODS: Cross-sectional mail survey of 159 physicians who graduated from the Family Medicine Program at Queen's University, Kingston, Ont., between 1977 and 1991. The outcome variables of interest were the size of community in which the graduate chose to practise on completion of training (rural [population less than 10,000] v. nonrural [population 10,000 or more]) and the size of community of practice when the survey was conducted (1993). The predictor or independent variables were age, sex, number of years in practice, exposure to rural practice during undergraduate and residency training, and size of hometown. RESULTS: Physicians who were raised in rural communities were 2.3 times more likely than those from nonrural communities to choose to practise in a rural community immediately after graduation (95% confidence interval 1.43-3.69, p = 0.001). They were also 2.5 times more likely to still be in rural practice at the time of the survey (95% confidence interval 1.53-4.01, p = 0.001). There was no association between exposure to rural practice during undergraduate or residency training and choosing to practise in a rural community. INTERPRETATION: Physicians who have roots in rural Canada are more likely to practise in rural Canada than those without such a background.     

社会主义新农村建设下的医学专科教育改革探讨

医学专科教育培养人才的目标是为基层和广大新农村培养合格的应用性人才。随着我国社会主义新农村建设的飞跃发展,农村的医疗卫生保健需求和卫生资源不足之间的矛盾日益突出。构建和谐社会和建设社会主义新农村,为农村社区培养"下得去、留得住、用的上"的实用型医学人才,已经成为医学专科学校办学的主要任务,所以医学专科学校应准确定位,找准办学的目标,深化医学专科教育改革,建立培养技能实用型人才模式,以达到国家卫生部的要求,加快学校的发展。     

Coping with increasing numbers of medical students in rural clinical schools: options and opportunities

The critical shortage of the rural medical workforce in Australia continues. There is pressure on medical schools to produce not only more doctors, but to supply them in geographical areas of need. The latest policy to tackle these problems will increase medical student numbers while the supply of clinical teachers and patients for teaching remains static. This challenges the traditional apprenticeship model for learning medicine. Coupled with this is the requirement of medical schools to provide compulsory rural clinical placements for all students. The success of rural clinical schools and University Departments of Rural Health (UDRH) is increasingly apparent, but they must find new strategies to maintain a quality clinical experience and exposure to rural lifestyle for all medical students. The dilemma is providing this quality rural experience to all medical students in the immediate future. We suggest approaches to meet this challenge at a policy, organisational, student and teaching level.     

天津市河东区社区卫生技术人员培训现状及需求的研究

目的了解天津市河东区社区卫生技术人员的培训现状及需求,以期为将来制定社区卫生技术人员的培训政策提供借鉴。方法以天津市河东区从事社区卫生服务工作的专业技术人员为研究对象,对其培训的课程内容、形式、时间安排、需求等进行问卷调查。采用SPSS 13.0统计软件对所收集的资料进行统计分析。结果共调查了288名社区卫生技术人员,对培训总的满意度为73.26%。全科医生对培训的满意度为76.47%,护理人员为72.73%,药检放人员为64.29%。全科医生随着职称级别的增高,对培训的不满意程度有增高的趋势,初、中、高级职称人员的不满意率分别为22.08%、24.49%、30.00%。在初级职称人员中,全科医生、社区护士相对于药检放人员的满意度稍高。结论社区医生、护士对培训内容、形式、时间等基本满意,药检放人员对全科岗位培训的满意度较低;不同职称级别、不同科室人员对培训有不同的看法。应开展分层培训,重视社区护士及医技人员的培训,注重培训过程及效果的评估、考核。     

三级医院中全科医学的定位和作用

2010年3月国家颁发的《以全科医生为重点的基层医疗卫生队伍建设规划》中提出,鼓励三级医疗机构建立全科医学科。2014年6月上海市卫计委批复同意同济大学附属杨浦医院(上海市杨浦区中心医院)设立全科医学执业科目,医院设立全科医学科,开设全科门诊与全科病房。全科医学科致力于健康管理、慢病管理、全科医学人才培训与学术研究等,是上海2家具备全科医学诊疗资质的三级医院之一。本文通过介绍同济大学附属杨浦医院全科医学科开设1年来门诊和病房的临床实践、总结与社区卫生服务中心的各项合作、开展多层次的人才培养和面向我国全科医学发展与社区卫生服务的科学研究这四大方面分析三级医院中全科医学的临床功能定位,即体现在为患者提供连续性、综合性,符合全科思维、全科理念的具有人文关怀的医疗服务过程;指明三级医院建立全科医学科的必要作用,为大医院与社区卫生服务中心搭建沟通桥梁,并促使双向转诊顺利进行;指导社区全科医生理论和临床知识的学习,为广大全科医生搭建高层次培训平台;探讨构建三级医院与社区卫生服务中心协同发展模式,强调三级医院的全科医学科在区域卫生协同发展中产生的重要作用,实现资源互补和资源利用最大化,推进医疗机构间的互相协作、协同发展。      

Addressing general practice workforce shortages: policy options

There is an ongoing shortage of general practitioners in Australia, accompanied by a decline in the popularity of general practice as a career choice. Many factors influence the career choice of junior doctors and medical students, including role models, the quality of clinical attachments during training, remuneration, and flexibility of training and working hours. Evidence-based strategies that could increase the number of doctors choosing general practice as a career include longer and higher-quality general practice attachments during medical school and the early postgraduate years, and emphasising the positive aspects of general practice, such as flexibility. General practice would become a more attractive choice if remuneration was in line with hospital specialties.     

Medical teaching in rural Australia: should we be concerned about the international medical graduate connection?

The two rural workforce strategies of rural clinical schools and deployment of international medical graduates (IMGs) geographically overlap in Australia's large expanse of under-served rural and remote areas. We used the Rural Clinical School of Western Australia (RCSWA) as a model to examine the relative numbers of IMG clinical academics, and the contribution of IMGs to rural clinical school development and education. IMGs have established six of 10 rural clinical school sites, maintained an academic presence, and continue to staff the RCSWA in high proportions. In a fragile rural work ecology, WA's IMGs are contributing to both meeting current workforce needs and the education of future rural doctors. The "double debt" Australia owes to IMGs, stemming from the rich cross-fertilisation of these two workforce strategies, should be acknowledged.     

Medical education for a multicultural society

Australian medical education has not kept pace with Australia's increasingly multicultural society. Feedback from ethnic community organizations suggests that medical students and specialist trainees in medicine are not learning how to understand, to interact with and to treat patients in culturally appropriate ways. The first part of this paper reviews the problem and considers some perspectives in transcultural medicine and clinically applied medical anthropology. The second part proposes some areas in which medical schools can take the initiative in developing interdisciplinary teaching programmes at undergraduate and graduate levels. These programmes should provide minimal standards to enable any medical graduate to practise with patients of any cultural background and, in addition, will encourage some students to pursue more specialized studies in transcultural medicine and medical anthropology. It is suggested that new developments should be integrated with appropriate university departments such as anthropology.     

全科医学系在社区与医院间作用的多维构架分析——以同济大学医学院全科医学系为例

目的 目前,我国许多地区医学院校都已开设或拟建立全科医学系,培养全科人才,组建全科师资队伍。本文的目的是以同济大学医学院全科医学系为例,建立系统模型,为国内其他地区建立全科提供指导,模式的建立不仅提升基层医疗服务水平,加大对基层全科医生培养力度,还为培养社区全科师资提供保障,使全科医学专业系统化发展。 方法 本研究基于实证研究,介绍同济大学医学院全科医学系所在同济大学附属杨浦医院及其他附属医院与11家社区卫生服务中心在教育、科研和人才培养等方面的合作起到的多维作用,总结归纳特点、特色,搭建构架体系。 结果 同济大学医学院全科医学系确立了完善的组织机制体系,形成自身模式,搭建社区与医院的沟通桥梁,依靠附属医院较高的医疗和科研力量,通过全科医学系的教学资源和培训等手段,带动社区各项工作的发展。 结论 全科医学系的作用在于,发挥其教学的核心指导作用,推动社区的临床、科研和教学的发展,培养优秀全科师资队伍。同济大学医学院全科医学系,为其他高校设立全科医学系提供模式化指导。但还要看到全科医学尚处于起步阶段,机遇与挑战并存,我们要砥砺前行,分析国内全科医学建设存在的问题,同时借鉴国外优秀经验,发挥全科医学系应有的作用。      

美国乡村医学教育计划对我国当前全科医师人才培养的启迪

分析美国乡村医学教育计划的成功经验,结合我国实际国情剖析现今全科医师短缺的现状和原因,提出加快培养高素质全科医师人才的建议和思路.     

从澳大利亚等西方国家全科医学发展史引发的思考

本文回顾了澳大利亚、北美等西方国家全科医学发展的历史,重点考察了这些国家的医学教育中全科医生培训的演变过程,与医院的专科培训的关系,全科医学专业组织的建立过程和发展经历,政府在全科医学发展中的作用。通过比较,讨论和分析历史沿袭下来的因素对我国医学发展方向及全科医学发展的影响,以医院为基础的医学教育和医院提供大量“一般服务”的矛盾,医学权威结构的状况及其对全科医学发展的影响,并提出几点政府支持全科医学发展的建议。     

Training Australian Defence Force Medical Officers to civilian general practice training standards--reflections on military medicine and its links to general practice education and training

This article examines military medicine and its links to civilian general practice education and training, drawing attention to the variations and difficulties in, and successful approaches for, training Australian Defence Force (ADF) Medical Officers. Military medicine has been an area of change over the 10 years of the Australian General Practice Training (AGPT) program. Crisis situations like those in Timor Leste and Afghanistan have focused attention and recognition on the importance of primary health care in the work of the ADF. To train doctors in military medicine, there are several different models at different locations around Australia, as well as large variations in military course and experience recognition and approvals between AGPT regional training providers. At times, the lack of standardisation in training delays the progress of ADF registrars moving through the AGPT program and becoming independently deployable Medical Officers.