《中国全科医学》稿约

《中国全科医学》杂志是经国家科委批准，由卫生部主管的国内首家公开出版发行的全科医学学术性刊物。本刊为半月刊，中国标准连续出版物号：ISSN 1007-9572，CN 13-1222／R；邮发代号：80-258。本刊宗旨：研究中国全科医学发展的现状、特点和趋势；交流全科医学临床研究和临床实践经验：普及全科医学理论知识，全面提高广大医务人员的“全科意识”。主要读者为基层广大医务工作者及从事全科医学的科研、教学及社区医务人员。1、本刊设有栏目：述评、专家论坛、全科医疗专题研讨、论著、全科医学教育、全科医疗／社区卫生服务工作研究、…     

《中国全科医学》稿约

《中国全科医学》杂志是经国家科委批准，由卫生部主管的国内首家公开出版发行的全科医学学术性刊物。本刊为半月刊，中国标准连续出版物号：ISSN1007-9572，CN13-1222／R；邮发代号：80-258。本刊宗旨：研究中国全科医学发展的现状、特点和趋势；交流全科医学临床研究和临床实践经验；普及全科医学理论知识，全面提高广大医务人员的“全科意识”。主要读者为基层广大医务工作者及从事全科医学工作的科研、教学及社区医务人员。1、本刊设有栏目：述评、专家论坛、全科医疗专题研讨、论著、课题研究、全科医学教育、全科医疗／社区卫生服…     

我看全科医疗中的医患关系

全科医学模式下的医患关系不等同于医院中的医患关系。处理好全科医疗中医患关系,对提高医疗质量、医疗服务水平,促进全科医学的发展有不可忽视的作用。我在从事全科医疗的工作中,就如何建立良好的医患关系体会如下。     

浅谈全科医疗模式防治社区慢性病的效果

探讨全科医疗模式防治社区慢性病的效果。方法：从2008年起对本辖区试点社区7000人口开展社区慢性病全科医学综合防治实践,并与2007年进行慢性病登记率、建档管理率、知识知晓和治疗率及病情控制效果对比。结果：运用社区慢性病全科医疗模式防治模式后,居民慢性病登记率、建档管理率、知识知晓和治疗率及病情控制情况均明显提高。结论：在社区慢性病防治工作中,全科医疗模式的成效显著,具有推广价值。     

全科专业住院医师规范化培训毕业学员追踪调查研究

目的 调查浙江大学医学院附属第一医院（简称“浙大一院”）全科专业住院医师规范化培训（简称“全科住培”）学员毕业后工作状况及对住培的看法,为今后全科住培提供参考。方法 于2017年10～11月采用自行设计的“浙大一院全科住培毕业学员调查问卷”,通过微信对2008～2017年浙大一院全科住培毕业学员进行追踪调查,调查内容包括基本信息,对全科住培的看法和满意度,毕业后参与医疗、科研、教学和管理等工作情况。结果 本研究纳入毕业学员18人,男6人,女12人,平均年龄（31±2）岁。77.8%的学员表示对全科住培满意,全部学员均表示有必要参加全科住培,88.9%的学员表示全科住培对自我提升有帮助。83.3%的学员在综合性医院或社区卫生服务中心从事全科工作。83.3%的学员从事临床工作,38.9%的学员承担了各类教学工作。结论 全科住培毕业学员对全科住培的认可度较高,对后续工作有所帮助。     

全科医生如何进行社区儿童健康维护(一)

全科医生工作在社区,为社区居民提供全科医疗服务,社区居民都将有自己的全科医生。国外全科医疗成功实践提示,全科医生20%～25%的时间将在社区从事儿童健康维护方面的工作。根据全科医疗连续性、综合性、可及性等原则要求,全科医生必须了解社区儿童的健康状况及给儿童父母的咨询提供意见和建议,必须掌握社区儿童健康维护的基本知识。全科医生如何进行社区儿童健康维护系列讲座将指导全科医生学习卫生部新颁布的《全国儿童保健工作规范(试行)》及如何开展社区儿童健康维护,掌握儿童健康维护的手段,指导父母对孩子的教育方法。     

全科医疗在养老机构的应用

目的：探讨全科医疗在养老机构应用的方式和作用。方法：论述全科医疗在养老机构应用的时代背景、理论依据和目的，提出了在养老机构中应用全科医学的方式和具体做法。结果：全科医学在养老机构的应用主要包括：建立医疗合同、建立以问题为导向的健康档案、老年病的整体治疗与预防、老年心理卫生与社区诊断、临终关怀等。结论：全科医疗在养老机构的应用将为老年人提供更为完善的综合性服务，有着广阔的发展前景。     

上海市社区全科师资基本能力评估指标体系的建立

目的探讨建立上海市社区全科师资基本能力的评估指标体系,以规范社区全科师资队伍的建设和管理。方法对190名上海市12个区县从事全科临床医疗、社区卫生服务行政管理及全科医师规范化在培学员行问卷调查,了解社区全科师资应该具备的基本能力;根据问卷调查结果拟定“社区全科师资基本能力评估指标体系”评议表,选择从事全科医疗、全科教学、公共卫生事业及卫生行政管理等28位专家,进行两轮德尔菲法咨询,经数据统计分析咨询结果、意见汇总确立评估指标体系。结果建立的社区全科师资基本能力评估指标体系,包括5个一级指标（综合素质、能力和个人愿望,教育和工作背景,个人职业发展能力,全科医疗工作能力,全科医学教学能力）和57个二级指标。两轮咨询的专家积极系数均为100％,专家权威程度均为0．85,指标重要性协调系数分别为0．190和0．225（均P〈0．01）。结论采用德尔菲专家咨询法初步建赢了上海市社区全科师资基本能力评估指标体系,多方位、多角度评价社区全科师资应当具备的基本能力,可作为将来设立社区全科师资准入标准的基础。     

“误诊分析与临床提示”栏目征稿启事

“误诊分析与临床提示”栏目是《中国全科医学》杂志的特色栏目之一,为继续保证和提高该栏目的质量,更好地服务于广大社区卫生工作者,特向全国从事全科医学、社区医学、临床医学的专家、学者、医务工作者征集相关稿件。征稿内容：社区医疗中躯体、心理疾病中常见病、慢性病、老年病、精神疾病等方面的误诊、误治病例分析,使临床医师能够从中获取最有效的经验教训,以提高临床诊疗水平。     

河南省非订单定向全科住院医师规范化培训结业学员的就业状况及影响因素研究

背景 全科医生数量和质量是人力资源管理的两个重要维度,其中,医生数量的新增、保持和流失,是全科人力动态规划、管理和评价的重要考量,也是全科住院医师规范化培训(简称全科住培)的绩效指标。探讨全科住培学员的就业状况及影响因素,可以为今后住培政策和激励机制的制定提供参考,但目前针对非订单定向全科住培学员的相关研究较为缺乏。目的 了解河南省非订单定向全科住培学员的就业状况,分析学员结业后未从事全科医学相关工作的原因,从而为完善培训管理和人力资源激励机制提供参考。方法 于2021年8月,采用分层随机整群抽样法,在河南省选取2014—2017年入培且已结业的非订单定向全科住培学员326例进行问卷调查。问卷由课题组自行设计,主要内容为学员的基本信息、全科住培情况、目前工作情况及结业后从事与未从事全科医学相关工作的原因。问卷通过“问卷星”平台发放,由学员自行填写。结果 共发放问卷326份,回收有效问卷271份(83.1%)。结业后,从事全科医学相关工作者77例(28.4%),从事非全科医学相关工作者194例(71.6%)。多因素Logistic回归分析结果显示,年龄、文化程度、生源类型、全科住培基地所...     

全科医学专业病理生理学教学中的问题及对策

全科医学专业是针对全科医生的培养需求设立的新专业,如何做好全科医学专业学生医学专业课教学工作是教学改革中的新课题。病理生理学是医学基础和临床联系的桥梁课,也是培养医学生临床思维能力的必修课。根据军医大学全科医学专业学生文化课基础知识差、学生来源、毕业后参加定向分配等特点,在病理生理学教学中采取“调整授课内容、突出课程重点”“灵活选择教学方法、加强师生互动”“发挥网络多媒体教学优势,开设专题病例讨论”等方法,取得较好教学效果。但如何调整病理生理学教学内容使其更适合全科医学生的培养目标,如何合理设置各门医学专业基础课的顺序等,仍是以后需进一步探索的问题。     

Correlates of certification in family medicine in the billing patterns of Ontario general practitioners.

There is conflicting evidence as to whether physicians who are certified in family medicine practise differently from their noncertified colleagues and what those differences are. We examined the extent to which certification in family medicine is associated with differences in the practice patterns of primary care physicians as reflected in their billing patterns. Billing data for 1986 were obtained from the Ontario Health Insurance Plan for 269 certified physicians and 375 noncertified physicians who had graduated from Ontario medical schools between 1972 and 1983 and who practised as general practitioners or family physicians in Ontario. As a group, certificants provided fewer services per patient and billed less per patient seen per month. They were more likely than noncertificants to include counselling, psychotherapy, prenatal and obstetric care, nonemergency hospital visits, surgical services and visits to chronic care facilities in their service mix and to bill in more service categories. Certificants billed more for prenatal and obstetric care, intermediate assessments, chronic care and nonemergency hospital visits and less for psychotherapy and after-hours services than noncertificants. Many of the differences detected suggest a practice style consistent with the objectives for training and certification in family medicine. However, whether the differences observed in our study and in previous studies are related more to self-selection of physicians for certification or to the types of educational experiences cannot be directly assessed.     

国内外全科医学教育现况与展望

随着人口老龄化加重和医学模式转变——从单纯的＂生物模式＂向＂生物-心理-社会医学＂模式转变,以及社区卫生服务工作的深入发展,全科医学和全科医学教育的重要性日益明显。本文阐述了全科医学发展历史和国内外的全科医学教育发展状况,比较各种教育模式的特点。国外的经验主要比较了美国、英国、澳大利亚、法国等国的全科教育情况,国内比较了北京、上海、深圳以及香港、台湾等地区的教育现况。通过比较分析为相关政策的制定提供文献基础。目前我国的全科教育工作已初具规模,从国家级的全科教育培训中心到各地的全科教育机构都进行积极的探索。     

案例教学法在全科医学专业内科学教学中的应用

目的 全科医学是一门新的综合的医学临床学科,以人为主体。全科医生是提供全科医疗服务的主体。全科医学教育主要是培养熟悉全科医疗诊疗模式、掌握全科医学基础知识及临床技能的人才。内科学是医学生必须掌握的专业知识领域,是全科医学教学不可缺少的部分。本文对案例教学法(case-based learning)在全科医学专业内科学教学中的应用进行初步探索,为以后的教学提供参考和借鉴。 方法 在全科医学内科学教学中引入案例教学法,具体实施过程中,以教师为指导者,精心选择真实案例。教师首先给学生讲授内科学理论知识,在学生对知识点熟悉和掌握的基础上引入案例,学生们围绕案例进行分组讨论,且每个同学都参与到讨论中去,从而通过这个过程锻炼学生的自身能力。教师再组织学生进行课堂讨论并进行指导,最终做出结论。学生的评价及课后成绩为该教学模式的考核体系。 结果 案例教学法可增加学生学习兴趣和学习热情,提高学生学习主动性和积极性,锻炼学生的语言和文字表达能力,增进团队协作互助,培养学生的临床思维能力及综合能力。 结论 案例教学法是一种适合普通高等医学院校全科医学内科学的教学方法,有利于培养合格的全科医生,可以在今后的教学中推广。      

Trends in evolution of specialty choice. Comparison of US medical school graduates in 1983 and 1987

This study describes the evolution of specialty choices among US medical school seniors in 1983 and 1987. Its purposes were to determine the specialty interests of the 1987 cohort as these 11,264 students proceeded through medical school and to compare their evolving specialty plans with those of the 10,321 US medical school seniors in 1983. As the 1987 cohort advanced through medical school, they became increasingly interested in general and subspecialty internal medicine, psychiatry, obstetrics and gynecology, anesthesia, radiology and rehabilitation medicine and less interested in family practice, general surgery, pathology, and public health. Compared with the 1983 cohort, 1987 seniors were significantly less likely to choose general internal medicine and more likely to choose internal medicine and pediatric subspecialties. Similar proportions of each cohort of seniors chose family practice. Between 1983 and 1987, men's interest in pediatrics, general surgery, and obstetrics and gynecology declined, while their interest in the surgical subspecialties, anesthesia, and rehabilitation medicine increased.     

Effects of residency training in family medicine v. internship training on professional attitudes and practice patterns.

OBJECTIVES: To determine whether the professional attitudes and practice patterns of physicians with residency training in family medicine differ from those of generalists with internship training. DESIGN: Mail survey conducted in 1985-86. SETTING: Province of Quebec. PARTICIPANTS: A stratified random sample of French-speaking family and general practitioners who graduated after 1972 (325 physicians with residency training and 304 with internship training) (response rate 82%). MAIN RESULTS: Physicians with residency training were 3 years younger on average than those with internship training, were more likely to be female (38% v. 18%, p less than 0.001) and were more likely to work on a salaried basis in CLSCs (public community health centres) (36% v. 14%, p less than 0.001). Even after these confounding factors were controlled for, physicians with residency training seemed to be more sensitive to the psychosocial aspects of patient care and tended to attach more importance to informing patients about useful materials and resources concerning their health problems. They were not, however, more likely to value health counselling or integrate it in medical practice. CONCLUSION: Our findings provide some evidence that the new requirement that physicians complete a residency in family medicine to obtain medical licensure in general practice in Quebec may foster a more patient-centred approach to health care.     

高等中医教育发展方向的几点思考

中医本科教育应以“通专结合”的模式开展教育,使中西医两种理论在学生身上溶为一体。学校必须从教学型向教学科研型转化,使传统教育内容在现代化教育的环境里焕发活力。     

医学生基础课与专业课成绩的相关性分析

目的分析医学生普通基础课、专业基础课及专业课学习成绩的相关性,为学校教改工作提供依据。方法以川北医学院临床医学专业二○○二级本科毕业班学生共计206名的普通基础课、专业基础课及专业课学习成绩作为研究对象,用教育统计学中相关性原理,分析医学生普通基础课、专业基础课及专业课学习成绩的相关性。结果医学普通基础课与医学专业基础课,医学专业基础课与桥梁课、临床课,它们成绩间呈正相关。结论提示我们在今后教学过程中,加强医学基础课的教学是十分重要的。正确处理好医学基础课和医学专业课的关系,深刻认识医学基础课与医学专业课之间纵向的密切联系,加强医学基础课这一环节的教学是学生顺利地完成医学专业课的学习,确保培养目标实现的重要步骤。     

Impact of general practice / family medicine clerkships on Japanese medical students: Using text mining to analyze reflective writing

Background: In order for general practice / family medicine clerkships to be improved in undergraduate medical education, it is necessary to clarify the impacts of general practice / family medicine clerkships. Using text mining to analyze the reflective writing of medical students may be useful for further understanding the impacts of clinical clerkships on medical students. Methods: The study involved 125 fifth-year Fukushima Medical University School of Medicine students in the academic year 2018-2019. The settings were three clinics and the study period was 5 days. The clerkships included outpatient and home visits. Students’ reflective writing on their clerkship experience was collected on the final day. Text mining was used to extract the most frequent words (nouns) from the reflective writing. A co-occurrence network map was created to illustrate the relationships between the most frequent words. Results: 124 students participated in the study. The total number of sentences extracted was 321 and the total number of words was 10,627. The top five frequently-occurring words were patient, home-visit, medical practice, medical care, and family. From the co-occurrence network map, a co-occurrence relationship was recognized between home-visit and family. Conclusion: Data suggest that medical students may learn the necessity of care for the family as well as the patient in a home-care setting.     

Academic family medicine in Canada.

Fifty years ago family practice in Canada had no academic presence. Stimulated by a number of general practitioners and with the support of the Canadian Medical Association, the College of General Practitioners of Canada (CGPC) was founded in 1954. In 1962, conferences on education for general practice attended by the Association of Canadian Medical Colleges and the CGPC led to pilot postgraduate residencies in family practice supported by Department of National Health and Welfare. The first certification examination was held in 1969 and, by 1974, all Canadian medical schools had a family medicine residency program. Today departments of family medicine contribute substantially to undergraduate education in all 16 schools. In Canada, the medical profession, governments and the medical schools have demonstrated the importance they place on appropriate education for family physicians.