Improved training in primary health care: field follow-up essential

A strategy was developed for the evaluation of a management course for medical officers assigned to rural hospitals in the Sudan. The training program on primary care and rural hospital management was designed by the Faculty of Medicine of the University of Gezira, the Center for Population and Family Health of Columbia University, and the Sudanese Ministry of Health. The 3-week training program was designed to deal with: primary care strategy and priority measures such as immunization, oral rehydration, nutrition and growth monitoring, antenatal care, the identification and referral of high-risk pregnancies, and child-spacing; the planning, implementation and evaluation functions of management, using the community as a learning laboratory; and the selected policies and rules of the Ministry of Health, with emphasis on the control of epidemics an the management of drug supplies and information reporting systems. Assessment tools were introduced during the training for use during field visits to trainees 3-5 months later. These follow-up visits involved both conversational interviews and structured data collection. During the field visits 26 rural medical officers gave information on locations of hospitals and durations of assignments; areas served; hospital and primary care unit personnel, vehicles, petrol allowances, refrigeration, maternal and child health records, immunization equipment and supplies, and drugs; road conditions and distances between regional hospitals and outlying units; key events since training; primary care and hospital problems, assessment of needs and resources, objectives and strategies for the next 12 months; 12-month implementation plans and training activities undertaken or planned; planning and perception of supervision; supervisory visits made to rural hospitals by senior officers of the Ministry of Health; use of training materials; management audit exercies; trainees' impressions of the course; and support given by projects of the Ministry of Health or nongovernmental organizations. The field assessment revealed that 60-80% of the trainees were using newly learned techniques and initiating new primary care activities and viewed the fieldvisits as supportive and important to continuation with their new undertakings.     

城乡协同医疗模式对培养基层医务人员的价值分析

分析西部宜宾基层医务人员业务素质现状、传统培养模式的弊端和继续教育的特点,提出通过建设医疗卫生信息平台,推动城乡数字化协同医疗服务,改进基层医疗机构继续医学教育的方式和途径,加强对医务人员的业务培训,促进城市大、中型医疗机构对农村基层医务人员进行继续医学教育,妥善解决西部基层医务人员时间有限、经费紧张、师资不足等问题,提高医务人员业务素质,全面巩固基层医疗的"战斗堡垒"作用。     

城乡基层医疗机构常见病卫生技术利用比较分析

目的了解城乡基层医疗机构住院病人常见病卫生技术利用情况,提出建议。方法根据预调研结果,确定城乡基层医疗机构住院病人前10位常见病为研究对象;运用多阶段分层随机抽样,抽取8家城乡基层医疗机构;通过系统抽样,抽取样本医疗机构样本病种住院病历,统计住院病人基本信息及卫生技术利用情况。结果社区卫生服务中心住院病人的住院天数、检查项目、化验项目及药物使用大部分高于乡镇卫生院。结论相关部门应加大农村卫生事业投入;基层医疗机构应加强适用性基础设施建设及常规设备的配置与更新,贯彻与落实基本药物制度;各级卫生行政部门及基层医疗机构应加强医务人员基本卫生技术培训等。     

Teaching and learning population and preventive health: challenges for modern medical curricula

OBJECTIVES: This study aimed to formally identify medical students' attitudes towards population and preventive health issues addressed in the University of Queensland's Bachelor of Medicine, Bachelor of Surgery (MBBS) programme, in response to informal student reports that population and preventive health issues were largely just matters of "common sense". METHODS: Year 2 medical students were surveyed in 1999 and 2000 using a custom-designed instrument incorporating Likert scales and requests for qualitative responses. A sample of students participated in semistructured interviews. RESULTS: A total of 341 students (71%) responded to the survey. Students' attitudes towards general population health issues were overwhelmingly positive, and more than 60% of students reported having a more positive attitude towards psychosocial and preventive health issues than they had when they commenced the MBBS programme. Just over half of the students, however, considered population and preventive health issues to be matters of common sense. Students reported poor role modelling by the faculty in relation to population and preventive health issues, with only 41% of students indicating they perceived a positive attitude towards psychosocial and preventive health issues in the School of Medicine. Qualitative data indicated that some students fear that the opportunity cost of dedicating study time to population and preventive health issues might endanger their future clinical knowledge, skills and management of patients. CONCLUSIONS: These findings have important implications for modern medical curricula. The challenge in teaching population health issues is to balance students' needs to understand and apply the principles of population and preventive health and the biopsychosocial model of patient care, with the need for them to be confident they will be able to practise safely if they do so.     

四川省城乡居民就医路径及医疗机构选择的影响因素研究

目的 通过纵向随访数据分析四川省城乡居民的就医路径特征和就医机构选择的影响因素。方法 从四川省第五次卫生服务调查的样本区(县)中抽取1个城市点和1个农村点,监测居民3个月的卫生服务利用行为,定性描述居民就医路径特征,采用重复测量资料的多水平Logistic模型分析就诊医疗机构选择的影响因素。结果 患病后,城市点以遵医嘱治疗为主,农村点则以就诊为主;就诊时,城市以县(市、区)级医疗机构为主,农村以基层医疗机构为主;影响就诊医疗机构选择的因素有就业状况、是否患有慢性疾病。结论 四川省城乡居民就医路径特征不同,城市居民就诊机构的流向存在不合理分布。应加强城市点分级诊疗制度的推行,规范城市居民就医行为。     

Training doctors for the year 2000

The World Health Organization's strategy, Health for All by the Year 2000, presents a challenge to those responsible for training doctors. Doctors are needed who are concerned to promote health not just treat disease. A review of the medical undergraduate curriculum is required to achieve this. We describe a small step towards this by the restructuring of a community medicine teaching programme so that students are introduced to health promotion and the principles of Health for All.     

Primary care consultation skills training: implementing a new training programme for senior house officers in an accident and emergency department

Senior house officers (SHOs) in Accident and Emergency (A&E) departments see many patients who present with primary care problems. Until now, most SHOs have lacked postgraduate training in primary care skills to enable them to meet these patients' needs effectively. This paper describes an innovative training programme that has been developing at King's College Hospital, London. It identifies a new opportunity for general practitioners to contribute to the postgraduate medical education of hospital junior medical staff. The training programme was designed to give A&E SHOs protected time in which to reflect on strengths and weaknesses in relation to primary care consultations and learn from their experiences. Its aim was to improve the assessment and management of patients, and to encourage a problem solving approach within the A&E setting. The programme, established in 1992, was developed through collaboration between the departments of A&E Medicine and General Practice and Primary Care. Evaluation has been a central theme in its development, and has been used to ensure that the training meets the needs of each individual set of SHOs and of the department. It has been used in establishing agreement about the training's value and benefits. The authors discuss some of the methodological difficulties encountered in evaluating this type of educational initiative.     

A community-based learning experience for medical students

A programme in which medical students are attached to Children's Institutions for one year is described. The students' role embraces a medical and psychosocial component in which students conduct clinics, screening programmes and health education as well as develop relationships with individuals and groups of children. This experiential learning programme enables medical students to obtain an understanding of children's needs and work through their own feelings which are aroused when confronted with children who have been deprived and abused.     

我国全科医学教育培训的现状及若干问题思考

发展全科医学教育和培训是我国卫生体制改革和医疗保障制度改革相配套的一项重大举措．通过对我国全科医学培训教育的形式及现状的分析和总结，提出目前我国的全科医学教育和培训在学习国外经验的基础上，要发展中国特色的全科医学教育，并加大在校医学生教育及农村卫生服务人员培训的力度。     

An evaluation of training in family health for medical students and internes in Sri Lanka

The results of an evaluation of an integrated training programme in family health for medical students and intern medical officers in Sri Lanka are presented.
The course objectives were translated into expected student competences in specific tasks and the responses of the internes obtained using a semistructured questionnaire. While the course had reinforced the students' awareness and commitment on the need for actively promoting family health it had not provided the expected competences in many tasks to the level of confidence that was anticipated. A number of deficiencies in the training programme in medical school as well as during the medical interneship become evident and these have been discussed with the respective authorities with a view to effecting satisfactory improvements.     

Meeting the needs of rural populations through interdisciplinary partnerships

This article describes the organization and outcomes of a Rural Health Outreach Initiative (RHOI) designed to increase collaboration between the medical education and health care delivery sectors to improve the quality of health care delivery and health outcomes in rural communities. Two inter-related partnership strategies were utilized in rural communities to address the health and social service needs of rural populations. The partnerships were created through the efforts of a rural health professions education program located in a community-based medical school. The two partnership models were implemented at the same time and target the same rural populations. Both strategies relied upon interdisciplinary collaborations to achieve their goals and outcomes. One strategy involved the creation of partnerships among rural medical students and the projects they initiate, using the model of community oriented primary care (COPC). The second strategy involved the establishment of partnerships by a variety of rural, community-based entities that resulted from a three-year Health Resources and Services Administration Rural Health Outreach grant that supported a "mini-grant" program. This article summarizes the process and results of these innovative collaborations that occurred at two levels: (1) between health and service institutions representing multiple disciplines and (2) between academic institutions and local communities. Specific attention is given to projects that resulted from the work of the partnerships that address the needs of older adults residing in the rural communities. The two strategies are compared and implications for the success of similar efforts are discussed.     

The teaching of medicine at the University Centre for Health Sciences Yaounde,Cameroon: its concordance with the Edinburgh Declaration on Medical Education

Summary. The University Centre for Health Sciences (UCHS) or as it is referred to in French ‘Centre Universitaire des Sciences de la Santé’ (CUSS), became functional in 1969 with the enrolment of the first group of students. The objective of this training programme was to produce a scientifically sound, multipurpose doctor who would be fully operational in a rural setting with minimal equipment and supplies ( Monekosso 1970, 1972 ). The graduate had to be able to adapt readily to new situations and improvise whenever possible, calling for a high degree of competence and initiative. The training strategies adopted by UCHS in 1969 which met this requirement were later found to be in close concordance with the tenets of the World Conference on Medical Education held in Edinburgh in 1988, the Edinburgh Declaration. While some of the terminology may not have been worked out at the time, the programme developed embraced some new concepts hitherto untried or undeveloped:

• — the problem-solving approach in the first to the sixth year;
• — an integrated teaching approach during the first to sixth year of medical training;
• — an integrated medicine internship in district hospitals in the sixth year;
• — a community-based training approach throughout the training;
• — team training of three different health professionals;
• — competency-based training;
• — health services linked research;
• — health services linked training ( Monekosso & Quenum 1978 ).

The concordance of this programme to the Edinburgh Declaration is of great interest in realizing the World Federation for Medical Education programme and implementing the Edinburgh Declaration. The involvement of the three innovative medical schools in the planning stage of the curriculum explains this concordance.     

天津市居民住院医疗机构选择及影响因素

目的了解天津市近10年来不同医疗机构入院人数和病床使用率的变化,分析影响居民选择住院机构的因素,为制定区域卫生规划,优化区域卫生资源配置提供参考.方法利用天津市1998年至2008年卫生统计年鉴和1993年至2008年四次卫生服务调查数据,采用SPSS16.0的描述性统计和有序多分类logistic回归对数据进行分析.结果 1998年至2008年间,与二级及以上医院和农村卫生院相比,社区卫生服务中心(站)的入院人数和病床使用率增幅最小,且社区卫生服务中心和农村卫生院的病床使用率一直低于二级及以上医院;居民选择住院医疗机构的影响因素有住院费用、性别、职业类型、征求治疗方案意见、地区分类.结论天津市需要加强社区卫生服务中心(站)建设,提高基层医疗卫生服务机构能力建设.     

健康中国下的医养结合服务模式研究

本研究以文献回顾分析和问卷调查方式对我国医养结合服务机构性质、服务模式、基本配置、服务内容和医疗质控等内容进行系统研究,结果显示我国医养结合机构目前存在专业人才缺乏、机构开展诊疗项目不能满足老人就医需求、医疗保险和新型合作医疗保险受限、部分老人存在着养老思想落后固化等问题。未来应该适度放宽医保政策,将医养结合服务项目就诊费用纳入医保报销范围,加强医养结合机构医护人员的培训,增加对老年服务机构的资金投入。     

区域医疗服务信息云平台的设计与实现

目的:设计区域医疗服务信息云平台,探索应用先进信息技术提升联勤保障部队医院为基层部队服务保障的水平和能力。方法:该云平台与区域内主要卫生机构的网络互通主要依托专网专线实现,软件开发采用客户端/服务器(Client/Server,C/S)架构,使用Visual Studio C#语言编程。整个云平台包含医疗管理模块、医疗服务模块和健康管理模块3个部分。结果:该云平台具有医疗保障卡年审、诊前预约和检查开单、诊后随访、健康宣教、疾病预防控制、健康管理等功能,实现了官兵健康保障的闭环管理。结论:区域医疗服务信息云平台较好地满足了部队基层卫生机构业务工作和官兵医疗保健的需要,有利于提高联勤保障部队医院卫勤保障的综合能力。     

An inter-university community child health clinical placement programme for medical students

BACKGROUND: Inpatient teaching no longer reflects the full spectrum of paediatric practice and community-based programmes with clearly defined aims and evaluation of learning are becoming increasingly important. Competition for community resources poses threats to the delivery of effective community child health learning programmes by individual medical schools. OBJECTIVES: To develop and evaluate a combined inter-university, child-focused, active learning programme in community child health. METHODS: A total of 55 postgraduate-entry medical students from the Flinders University of South Australia and 97 undergraduate-entry University of Adelaide students were placed with 25 community child health agencies and instructed to assess services from a client perspective by tracking one child and family through multiple agency contacts. Following each placement, achievement of specific programme aims was evaluated by students and agency staff using a 7-point Likert scale. RESULTS: Students and agency staff indicated substantial achievement of programme aims. Mean agency ratings were significantly higher than student ratings for three aims: students' experiencing a wider spectrum of health care problems than in teaching hospitals (5.7 +/- 1.5 versus 4.9 +/- 1.6, P < 0.001); the importance of social and environmental factors (5.9 +/- 1.0 versus 5.2 +/- 1.4, P < 0.001), and the importance of coordinating care (6.0 +/- 1.0 versus 5.2 +/- 1.2, P < 0.001). Ratings from undergraduate-entry students differed from those of postgraduate-entry students only with respect to the importance of social and environmental factors (4.8 +/- 1.4 versus 5.7 +/- 1.1, P < 0.001). CONCLUSIONS: The new collaborative Community Child Health Programme substantially achieved learning aims and demonstrated effective integration of postgraduate- and undergraduate-entry medical students from two universities.     

Community-based projects in rural internships: an alternative approach

Supervision of medical interns posted to various primary health centres and rural health training centres by specialists in preventive and social medicine and other clinical disciplines is becoming less and less effective for a number of unavoidable reasons. Because of lack of proper and timely guidance, interns feel that during the 6-month rural internship they do not get enough experience of rural life. In order to provide them with learning experiences in community medicine and orient them in the social dynamics of the community, a new approach involving interns in small community-based projects, probably for the first time, was tried on a pilot basis at the Rural Health Training Centre (RHTC), Sirur, a field practice area of B.J. Medical College, Pune, Maharashtra, India. Interns working at RHTC Sirur completed these community-based projects successfully. Identification of problems, study design analysis and drawing conclusions, based on observation, were all undertaken by the interns under the guidance of the staff of the Department of Preventive and Social Medicine, B.J. Medical College. The opinion poll at the end of the rural internship revealed that 76% of interns considered this experience valuable for improving their knowledge and skills, and 56% though that interaction during these projects was beneficial to the community as well. This experience with community-based projects for interns during their rural posting provides them with an opportunity for interaction with the community.     

Women and health care in rural Pakistan

The provision of medical facilities to rural areas is a major objective of development in Pakistan and the government has undertaken several programs to train and deploy auxiliary health workers on a large scale. Programs to train lady health visitors, dispensers and sanitary inspectors, have been in operation for decades and their graduates have a place in the workforce. Currently the Government is developing a Basic Health Program to train auxiliary health workers and to establish a network of rural health facilities throughout the country. The research here reported was meant to help plan this program.The 4 week study was conducted in four districts of the Punjab and North West Frontier Provinces. We first interviewed women patients of rural dispensaries in the four districts to determine their views of their needs and of the constraints of the purdah system when seeking health care. We then interviewed principals of medical colleges and training institutes, who were in a position to assess the availability of women to enter the medical workforce and female mid-level health workers who were currently serving in their posts.Finally, since allopathic medical institutions compete with indigenous medical specialists, we interviewed two hakims and a homeopathic physician to obtain their view of rural health needs, as well as their potential for contributing to a broad based rural health care system.     

Reforming higher specialist training in the United Kingdom--a step along the continuum of medical education

OBJECTIVES: The requirement to align the arrangements for postgraduate training in the United Kingdom with those elsewhere in the European Community provided the opportunity to review and reform our arrangements for higher specialist training. This paper describes the case for change--the strengths and deficiencies of the traditional pattern of postgraduate medical training, demographic influences in the medical workforce and the need for a more structural or planned approach to training. CONCLUSIONS: Over the past 5 years substantial progress has been made: the introduction of new regulatory arrangements and a new higher specialist training grade; the development of a managed and flexible system for delivering training to standards set by the Royal Colleges and which can accommodate the needs of those pursuing academic and research medicine; and the opportunity for trainees' progress to be measured against published curricula. The significant programme of change has been underpinned by careful workforce planning and the publication of comprehensive guidance. Significant reform of higher specialist training has been achieved. This paper also makes the case for a more strategic approach to planning and developing medical education across the continuum, from entry to medical school until retirement, which can guide medical education and improve patient care into the next millennium.     

分级诊疗制度实施中医院检验科如何提供区域检验服务的思考

随着我国分级诊疗制度的实施,三级医院检验科面临分级诊疗带来的挑战和机遇。理性评估检验科的优势、劣势、机会和威胁,积极响应国家政策的号召,适时调整学科发展的方向,集医学检验之优势资源,整合检验设备,发挥在医学服务、技术创新、质量管理和人才培养等方面的引领作用,积极探索并大力发展区域医学检验机构和尝试分级检验模式,服务基层群众,提升检验行业的公信力和竞争力;以拓展服务领域,开创良好的检验医学发展前景。