上海市全科医师培训历程

1994年起,上海市卫生局依托上海职工医学院、原上海医科大学、原上海第二医科大学开展了全科医师概念培训,主要内容为40学时的全科医学基本概念。1997年起,对全市基层医疗服务机构的临床医师进行600学时的以理论为主的全科医师岗位培训,培训主     

上海市卫生系统全科医师培养培训工作的历史回顾与未来发展展望

本文回顾了上世纪九十年代初以来上海市全科医师培训工作的实践和探索,总结分析了我市全科医师培训工作的实践经验和工作特色,并对未来工作发展进行了前瞻性思考.     

区域性综合医院全科医师规范化培训基地建设的实践与体会

闸北区中心医院创新工作机制,将全科医师规范化培训全部纳入住院医师规范化培训范畴,通过整合资源、招贤纳才、完善制度、加强管理、科学培养等培训了一批优秀的全科人才,初步摸索出一套行之有效的全科医师培训方法。     

上海市郊区全科医师轻度认知障碍相关知识培训需求调查研究

目的 ：对上海市嘉定区全科医师的轻度认知障碍相关知识培训需求开展调查并分析其影响因素。方法 ：于2022年2月1日—2月15日期间选取上海市嘉定区13家社区卫生服务中心所有从事临床一线工作的全科医师作为调查对象，采用《全科医师轻度认知障碍相关知识培训需求调研问卷》对其进行调查。结果 ：399名全科医师中，43.61%参加过轻度认知障碍相关知识培训，90.23%认为有必要开展轻度认知障碍相关知识培训，84.21%对轻度认知障碍相关知识培训的需求较高。多元逐步Logistic回归分析，结果显示，职称、轻度认知障碍相关知识培训经历、对开展轻度认知障碍相关知识培训的态度是对全科医师轻度认知障碍相关知识培训需求具有统计学意义的影响因素（P <0.05）。结论 ：全科医师轻度认知障碍相关知识培训需求较高，应进一步完善全科住院医师规范化培训大纲，建立全专联合的疾病健康管理教育体系，制订符合社区全科医师诊疗服务特点的培训内容。     

从我院全科医师规范化培训现状论全科医师规培的重要性

发展社区卫生服务机构能够更好的为国民健康服务,引进和稳定全科医生是其重要内容,而全科住院医师规范化培训是培养高素质全科医师的根本途径。我院自接收全科医师规范化培训以来,培养了一批批合格的全科医师,投入于社区卫生服务。回顾分析我院2009～2018年全科医师规范化培训的历程,通过不断地改进、发展,全科医师规范化培训基地逐步健全,教学逐步趋向稳态。目前已有37名通过招生进入规培程序的毕业生结业,已经很好地投入到社区卫生服务中,为人民健康服务一线贡献力量。全科医师规培是建立全科医学教育体系的核心,是培养全科医师、提高我国社区卫生服务工作水平的主要措施和主要途径。     

山西省全科医师规范化培训满意度影响因素分析

<正>随着我国卫生事业的发展,分级诊疗的推进,医疗资源下沉及群众对医疗水平要求的不断提高,我国迫切需要大力发展全科医学事业~([1])。2012年以后国内各省陆续开展了"5+3"的全科医师规培工作~([2]),山西省于2014年开始在全省范围内开展全科医师规范化培训工作,其中太原市内共有五所省级培训基地。本研究旨在通过调查太原市五所省级培训基地2014—2016年规培工作实施情况及学员对规培工作的满意度,通过数据分析寻找对山西省全科医师规范化培训满意度的影响因素,有针对性地提出科学的管理意见和干预措施,为下一步工作改进提供理论依据。     

社区卫生机构全科医师系统培训模式探索

社区卫生服务机构卫生技术人员培养特别是全科医师的培养成为机构人才梯队建设工作中的重点任务。全科医师的培养重点是在于医师知识结构的全面性,同时也要在中心辖区实际情况和专业特长等方面有所侧重。全科医师的答疑能力、专科能力、应急能力以及沟通能力建设是社区卫生服务机构提供优质、高效服务的重要基础。另外,将系统培训与绩效改革的相关联,实现了全科医师系统培训体系的完整性和可行性。     

全科医师临床思维训练的探讨

通过对全科医师临床培训的现状分析,总结全科医师临床思维特点,改革全科医师临床思维训练模式,调整全科医师教学内容,优化教学结构。我科急诊医学教学的综合创新模式中,将讨论式教学、情景式教学和迷你临床演练评估引入了全科医师临床思维培训。     

以需求为切入的全科医师临床技能强化训练的效果评价

目的：通过对全科医师技能培训的需求调查,筛选出中心全科医师最迫切希望提升的8项技能,经过培训与考核,让全科医生基本掌握8项技能。方法：对中心30名45周岁以下全科医师进行技能需求问卷调查,筛选出需求前8项的技能,以2个月1项技能的速度进行强化培训。结果：30名参加培训的全科医师培训前、后成绩差异有统计学意义（P＜0.01),技能明显得到提升。结论：基于社区卫生服务中心实际需求的培训能大幅度提高全科医师的操作技能,满足社区卫生服务中心临床需求。     

上海面向全国招收培养社区全科医生

记者从上海市卫生局获悉，为了在2010年完成构建一支为社区医疗卫生服务的l000名全科医师的人才队伍目标，上海不断加大力度．给出比较优厚的条件，面向全国招生并进行规范化、高质量的培养。近日，2008级上海全科医师规范化培养举行开学典礼，这次招生开班的全科医师学员达154人。上海全科医师培养不断完善，先后制定了《上海市全科医师规范化培养细则》、《临床轮转手册》、《社区实践手册》、《考核管理办法》、《学员人事管理规定》等教学和人事管理文件，并在全市建立了10个全科医师规范化培养临床基地、30个社区基地。     

上海市2010年进入住院医师规范化培训基地受训医师培训现状调查

目的:了解上海高校附属医院住院医师规范化培训的实施现状,为卫生行政部门完善培养制度提供依据.方法:对上海市4所高等医学院校15家附属医院应届受训医师从4个方面进行问卷调查,收集数据进行统计分析.结果:住院医师规范化培训工作得到各医院的高度重视,取得了一定的效果,但教学计划实施、保障措施落实、临床技能培养等在调研过程中反映出比较突出的问题.结论:应加强对培训环节的质量监督,重点提升培训者临床实践技能,加大培训投入是推动住院医师培训制度健康发展的有力保障.     

上海市2010年进入住院医师规范化培训基地受训医师培训现状调查

目的：了解上海高校附属医院住院医师规范化培训的实施现状,为卫生行政部门完善培养制度提供依据。方法：对上海市4所高等医学院校15家附属医院应届受训医师从4个方面进行问卷调查,收集数据进行统计分析。结果：住院医师规范化培训工作得到各医院的高度重视,取得了一定的效果,但教学计划实施、保障措施落实、临床技能培养等在调研过程中反映出比较突出的问题。结论：应加强对培训环节的质量监督,重点提升培训者临床实践技能,加大培训投入是推动住院医师培训制度健康发展的有力保障。     

上海市中医临床药师规范化培训模式探索和实践

目的： 适应上海市医政工作新形势和临床药学学科发展新需求,探索和实践上海市中医临床药师规范化培训模式。方法： 参考上海市西医通科临床药师在职规范化培训模式,制定上海市中医临床药师规范化培训方案,组织开展培训工作。培训工作结束后,对培训基地和学员进行了调研,参考调研结果对培训方案进行调整。部分基地在完成培训大纲要求外,对培训内容和形式进行了拓展与实践。结果： 培训工作主要由师资培训、基地遴选、学员培训、调研和改进四部分组成,其中学员培训包括集中理论知识培训、门诊抄方、审方实践和临床实践。首期遴选出4家医院作为首批中医临床药师培训基地,第一、二期分别有31名和40名学员通过考核取得培训合格证书。参考调研结果,增加了门诊审方、门诊抄方和临床实践时间,门诊审方增加了中药饮片处方点评内容。曙光医院基地通过课堂授课、知识手册学习以及参观实践,加强对学员理论知识和实践技能的培训。结论： 上海市中医临床药师规范化培训模式是可行的,为本市二、三级医院培养了一批中医临床药师,加强了医疗机构临床药师队伍建设,使临床药学服务体系更加完善。     

上海地区医疗机构开展药学咨询服务的现状与分析

目的：探讨影响医疗机构药学咨询服务工作的各种因素。方珐：通过分层随机抽样．对上海51家医院的所有药学人员共发出调查问卷910份，回收有效问卷759份(回收率83．4％)，并进行统计分析。结果：药学咨询服务的开展受到了包括药学人员个人因素与外部环境等诸多因素的影响。结论：开展药学咨询服务应当在制度上予以明确，领导上予以重视；建立临床药学人才的培养基地；提高药学人员的沟通技巧。     

A comprehensive package of support to facilitate the treatment of problem drug users in primary care: an evaluation of the training component

Since the early 1980s, government policy documents and specialist reports have encouraged the involvement of general practitioners (GPs) in the treatment of problem drug users. In spite of such policy initiatives, their involvement has been patchy and slow. In response to this apparent reluctance, the London Boroughs of Brent and Harrow established the substance misuse management project (SMP) to support and train GPs in the management of substance misuse. The SMP is a GP-led project that provides ongoing support, shared-care protocol, primary care team training, treatment audits and financial reimbursements. In 1996, the SMP worked with GPs who were not currently involved in treating problem drug users, and those who were providing only minimal interventions. This paper evaluates the training and support given to these GPs and examines changes in their practice. A pre- and post-test survey was undertaken of GP knowledge, attitudes and levels of activity. A structured questionnaire was administered to all GPs before training (n=40) and re-administered between 6 and 9 months following training. SMP audit data were also reviewed to validate any reported changes in practice. All GPs initially reported insufficient knowledge to manage problem drug users. One-fifth were unaware they could prescribe methadone, and nearly half believed drug problems should be treated by specialist services. Post-training, the GPs had increased their levels of treatment activity and reported greater confidence and willingness to treat. This study demonstrates the potential to involve GPs in the treatment of problem drug users. The training was part of a package that included ongoing support sessions, team training, audits of treatment and financial reimbursements. It is proposed that, whilst training is a necessary condition, a more comprehensive package of support is needed to facilitate the treatment of problem drug users in primary care.     

How well are general practice trainees prepared for paediatric prescribing?

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
• Children make up a significant proportion of a general practitioner's (GP's) prescribing workload.
• The realisation that children cannot be assumed to be little adults and may require specialized prescribing and therapeutic knowledge is relatively recent.
• Off-label medicines, which have been associated with an increased frequency of adverse drug reactions, are commonly prescribed by GPs to children.
WHAT THIS STUDY ADDS
• The majority of GP trainees believe that their undergraduate and postgraduate training in paediatric therapeutics is insufficient for their coming requirements in primary care.
• Approximately one-third of GP trainees do not undertake any paediatrics training prior to starting work as a GP.
• Off-label and unlicensed prescribing are the most poorly covered areas of paediatric therapeutics in universities/university hospitals.
• Those trainees who do undergo paediatric training during their vocational years report increased paediatric prescribing confidence.
AIMS AND METHODOLOGY We invited 232 General Practice Trainees to complete an on-line questionnaire to assess how they rated their training for the task of paediatric prescribing and therapeutics in the community.
RESULTS Of the 166 (71%) respondents who completed the questionnaire, 26.5% recalled specific teaching about paediatric prescribing and 59.6% covering one or more relevant topic during their undergraduate years. Undertaking a paediatric post during vocational training was associated with greater prescribing confidence ( P  < 0.001); however, 35% of respondents were not intending to undertake such a post.
CONCLUSION This study suggests that many GP trainees perceive their paediatric prescribing training as inadequate.     

Implementing screening interventions in community pharmacy to promote interprofessional coordination of primary care – A mixed methods evaluation

BackgroundScreening is a critical component of efforts to reduce the population burden of cardiovascular disease (CVD), by facilitating early use of cost-effective prevention and treatment strategies. While international evidence suggests that screening in community pharmacies improves screening access and identifies at-risk individuals, concerns from medical organisations about the absence of interdisciplinary coordination and related lack of continuity of care with general practice have significantly contributed to reluctance from some stakeholders to endorse, and engage with, pharmacy-based screening initiatives. The Cardiovascular Absolute Risk Screening (CARS) study was designed to address these challenges and promote an interprofessional approach to screening for cardiovascular disease risk by pharmacists. This study describes the impact of the CARS implementation model on interdisciplinary coordination and continuity of care.MethodsIn addition to clinical training, pharmacists at eleven participating pharmacies were provided with implementation training, resources and support to promote interprofessional coordination. Completion of training and pharmacy implementation plans, both of which highlighted GP engagement strategies, were pre-requisites for screening commencement. Using mixed methods approaches, data were analyzed from screening records (n = 388), researcher interviews with patients at 6–10 weeks post-screening (n = 248, 64%), and pharmacist interviews (n = 10).ResultsScreening records suggested that 94% of screened individuals were advised to seek formal GP assessment, and 98% consented to sharing of results. Among interviewed participants, 81% recalled direct pharmacist action to facilitate GP engagement. Among interviewees who had seen their GP already (n = 70), 79% reported that their GP was aware of the results (another 16% were uncertain). Pharmacists reported positive GP feedback stemming from efforts at early engagement, but an absence of ongoing collaboration.ConclusionsUse of implementation planning by pharmacists, alongside clinical training, can effectively promote an interdisciplinary coordination focus by pharmacists.     

Medication review: whose job it is?

Pharmacists are able to identify pharmaceutical care issues (PCIs) and resolve them better than normal care GPs, if trained, supported and given similar time, are also able to identify and resolve PCIs Nurses trained in identifying medication‐related problems are able to identify some PCIs Given limited availability of pharmacist time, training of GPs and nurses in reviewing medication should be considered A proportion of patients prefer to have GP reviews, therefore GP training in this area would be of benefit     

General practitioners' detection and management of patients with a dual diagnosis: implications for education and training

General practitioners (GPs) are in a unique position to detect and manage patients with co-morbid mental health and substance use disorders (dual diagnosis). It has been estimated that over 30% of patients presenting to general practice have a diagnosable mental disorder and 12% have dual diagnosis. Unfortunately, between 30 and 50% of these problems go undetected in general practice. Limited GP education and training in mental health may account for this deficit, with a little over 8% of GPs receiving any formal postgraduate training in mental health. Prior to developing an educational resource for GPs, the present study aimed to establish baseline estimates of GP treatment practices with patients who have dual diagnosis. Two GP division-wide surveys of screening, assessment and treatment for dual diagnosis were conducted one year apart. In addition, five GPs conducted a clinical audit of 508 patient consultations. Results indicate that without ongoing targeted interventions, patient management activities such as GP counselling, use of screening devices, referral to specialist services, coordination and use of EPC items are not likely to improve and are at risk of declining. [Marshall KL, Deane FP. General practitioners' detection and management of patients with a dual diagnosis: implications for education and training. Drug Alcohol Rev 2004;23:455-462]