高等医学院校全科医学教育的实践与探索

全科医学是一门以人为本,以健康为中心,面向个人、家庭与社区,提供连续性、综合性、协调性医疗卫生保健服务的医学学科.面对新的挑战,全科医学与全科医生显示出明显的优势.为适应医学科学的发展和地方医疗卫生事业发展的要求,近年来广州医学院在临床医学专业学生中大力开展全科医学教育,积极进行多种形式的全科医学教育的实践与探索,取得了良好的效果.     

浅谈基层全科医学人才培养

我国基层医疗卫生服务人员整体结构不合理、学历层次偏低、职称不高、专业不突出,已成为制约基层医疗卫生事业发展的瓶颈。地方医学院应紧紧抓住历史赋予的机遇,加快全科医学人才培养,提高基层医疗卫生人员的执业水平,造就一支高素质全科医学人才队伍。桂林医学院根据国家的战略需求,及时研究和探索全科医学学科建设,推进全科医学教育进程,创新全科医学人才培养模式,加快全科医学人才的培养。     

顺应社会需求培养基层全科医学人才

我国基层医疗卫生服务人员整体结构不合理、学历层次偏低、职称不高、专业不突出,已成为制约基层医疗卫生事业发展的瓶颈.地方医学院应紧紧抓住历史赋予的机遇,加快全科医学人才培养,提高基层医疗卫生人员的执业水平,造就一支高素质全科医学人才队伍.桂林医学院根据国家的战略需求,及时研究和探索全科医学学科建设,推进全科医学教育进程,创新全科医学人才培养模式,加快全科医学人才的培养.     

全科医师岗位培训的实践与体会

随着我国医疗卫生制度改革的不断深入,社区卫生服务已成为我国医疗卫生改革的重要举措,与此同时,全科医学教育工作也在全国范围内迅速发展起来。全科医学教育是医学教育的新领域,如何适应卫生制度的改革和医学模式的转变,培养适合中国国情的高素质的全科医生,是目前摆在我们面前亟待解决的问题。从我国全科医学教育的实际情况出发,     

专科临床医学专业全科医学概论课程教学的研究与实践

加强临床医学专业专科生的全科医学教育,符合我国医疗卫生改革和基层医疗保健服务发展的需要.菏泽医学专科学校把全科医学概论作为全科医学教育的核心课程,在临床医学专业专科生教学中进行了多方面的改革与实践探索,尤其是引入了以培养全科医学诊疗模式和动手实践能力为主的实训课程,并在3届学生中进行了课程评价和意见征求.     

2005国际全科医学／家庭医学教育论坛

2005年国际全科医学/家庭医学教育论坛是根据2005年国际全科医学/家庭医学学术大会录音整理。全科医学教育是全科医学发展非常重要的方面,目前已经是全科医学发展的瓶颈所在并成为全科医学学术界研讨的焦点,为了宣传本次大会的宗旨,推动全科医学教育的发展,我们仅选取其中与本次论坛主题即全科医学教育有关的内容进行整理,通过本期论坛希望专家和同道参与、关注和研究中国的全科医学教育。     

从卫生经济学的角度看全科医学教育的发展

医学教育的目的是为人们日益增长和不断变化的卫生服务需求，培养高素质的医疗卫生服务人才。从卫生经济学的角度看，全科医生的教育和培养便是满足这种社会需求的最佳途径。从卫生事业改革和发展、健康素质与生命质量的提高、全科医学发展前景3个方面来谈谈全科医学教育。     

英国全科医学人才培养及对我国的启示

全科医生被称为居民健康“守门人”,近年越来越受到全社会的广泛关注.但全科医学人才培养因为受到多种因素制约,不同国家、不同制度,其人才培养方式各不相同.通过对英国全科医学人才培养模式的研究,探讨我国如何利用现有医学教育、医疗卫生资源,创建适合我国实际的全科医学人才培养模式,从而推动我国医疗卫生事业的发展.     

澳大利亚全科医学人才培养体系的现状与启示

澳大利亚全科医疗卫生服务体系是世界上性价比最高的医疗卫生体系之一。对澳洲全科医疗卫生服务体系的总体概况、全科医师培养体系改革及其课程设置进行研究,为中国全科医学教育的建设与发展提供有益的借鉴。     

全科医学教师教学能力标准研究现状

全科医学教育在我国还是一门新兴学科,全科师资的教学水平、专业能力以及人文素养等直接影响着我国未来全科医生的整体素质.优秀的全科教师队伍是促进全科医学发展的重要前提,也是提升基层医疗卫生服务质量的必由之路.全科师资教学能力标准的建设是全科医学教学建设中的关键一环.本文通过文献回顾,总结国际全科医学教师教学能力标准研究现状,为推动我国全科医学和学科教育教学的不断完善提供参考.     

A survey of postgraduate training for family practice

The results of a survey of Canadian primary care physicians for the Canadian Medical Association (CMA's) Task Force on Education for the Provision of Primary Care Services are reported. Recent Canadian medical school graduates in primary care practice reported that the three major training routes (rotating and mixed internships and family medicine residencies) each prepared them differently for practice. The graduates of 2-year family medicine residencies were more satisfied with their preparation than were the graduates of the other major training routes. A 2- or 3-year family medicine residency was preferred by 50% of the respondents, although only 33% of them had actually taken one of these routes. There was considerable agreement in the respondents' assessments of the types of postgraduate education needed for primary care practice. The results of this survey were consistent with the recommendations in the final report of the CMA's task force.     

Quality of care in family practice: does residency training make a difference?

As the proportion of physicians who enter residency training in family practice steadily increases, so does the need to evaluate the impact of their training and postgraduate education on the quality of care in their practices. We audited the practices of 120 randomly selected family physicians in Ontario, who were separated into four groups: nonmembers of the College of Family Physicians of Canada (CFPC), members of the CFPC with no certification in family medicine, certificated members without residency training in family medicine and certificated members with residency training in family medicine. The practices were assessed according to predetermined criteria for charting, procedures in periodic health examination, quality of medical care and use of indicator drugs. Generally the scores were significantly higher for CFPC members with residency training in family medicine than for those in the other groups, nonmembers having the lowest scores. Patient questionnaires indicated no difference in satisfaction with specific aspects of care between the four groups. Self-selection into residency training and CFPC membership may account for some of the results; nevertheless, the findings support the contention that residency training in family medicine should be mandatory for family physicians.     

A comprehensive patient care system for the family practice

Family and Community Health Associates (FACHA) has incorporated an in-house, on-line computerized medical information system into a two-office, three-physician family practice medicine group. A Basic Four System 610 minicomputer is utilized to store all the medical, pharmaceutical, financial, and scheduling records. A SOAP-formated encounter form is used to collect the data. Five medical reports are printed prior to each patient encounter. Evaluations of the use and the benefits of this system are presented. A cost study, which calculated the cost of maintaining a computer-stored patient record, showed that a patient record could be updated and maintained for $1.32. A quality of care evaluation revealed that the preaudit of the computer-generated medical reports increased patient compliance to health maintenance suggestions. Another quality of care evaluation revealed that computer-generated flow charts did not significantly improve the diastolic blood pressure value of chronic hypertensive patients.     

Career and practice profiles of Alberta medical graduates (1973-85) practising in Alberta.

This collaborative study examined the career choices and practice locations of the 940 (58%) of the Alberta medical students graduating between 1973 and 1985 who remained in Alberta. Of the 686 practising graduates slightly less than two-thirds were in family/general practice; the remainder were in a specialty. More women (76%) than men (60%) had chosen family/general medicine. The women graduates spent about 10 hours less a week on patient care than their male colleagues. Personal and professional factors were cited most often as determinants of practice location. Approximately 20% of the practising graduates chose to locate in small towns or rural areas. Accessibility to consultants and opportunities for continuing medical education were reported as vital prerequisites for more physicians to move to smaller Alberta centres. These findings provide a starting point for studies designed to determine how Alberta medical school graduates are contributing to patient care within the province.     

Women in medicine: practice patterns and attitudes.

Increasing numbers of women are entering medicine in Canada. In 1959 women accounted for 6% of the medical school graduates, but by 1989 they accounted for 44%. Although there has been little systematic investigation of the impact of this increase on Canada's health care system, there are grounds for believing that female physicians bring with them distinctive values and interests, which may be reflected in the way they conduct their professional practices. We used data from a recent national survey of 2398 Canadian physicians to examine differences between women and men in their practices and their attitudes toward health care issues. Significant differences were found in the organization and management of the practices. Women preferred group over solo practice and were overrepresented in community health centres, health service organizations and centres locaux de services communautaires in Quebec. One-third of the women, as compared with half of the men, were in specialties. Even after adjusting for differences in workloads the incomes of the women were significantly lower than those of the men. Only minor differences were observed in the assessment of the health care system and alternative modes of organizing health care services. We believe that the differences were due to the double workload of women as professionals and family caregivers and the powerful socialization effects of medical education. As women overcome their minority status in the medical profession, differences between the sexes may become more apparent. Thus, the extent and effects of the progressive increase in the number of women in Canadian medicine should be assessed on an ongoing basis.     

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.     

21世纪中国乡村家庭临终照护的伦理展望

展望21世纪,乡村全科医生、家庭临终照护,将成为医学目的的重要内容。中国乡村的家庭临终照护,作为临终关怀的重要形式将展现其广阔的前景。家庭临终照护是医学目的的崭新内容,应尊重在中国文化背景下的临终病人的祈望,有利于老人及家庭的利益,有利于社会卫生资源的公正分配。在乡村家庭临终照护的生命伦理实施中,乡村全科医生具有良好的伦理素质和技能。中国有70多万个乡村,共计120万左右的乡村全科医生。他们来自农村,扎根农村,坚持为乡村服务。他们以患者为中心,以家庭为单位提供全方位的医疗、预防、心理等服务。全面规划、组织培训:①把中国农村临终关怀事业列入老年医疗保健的总体规划,制定家庭临终照护的政策;②有组织、有计划地对乡村全科医生开展培训,使他们在伦理道德、心理素质、专业水平上适应医学目的的要求     

Factors determining patients' satisfaction in a family practice residency teaching center

A primary function of family medicine teaching centers is to provide residents with ongoing experiences with patients and their families. A critical issue in maintaining a stable patient population for such teaching is patient satisfaction. In the study reported here, the authors examined the factors determining patients' satisfaction. A questionnaire was mailed to a representative sample of 10 percent of the patients in a family practice in a family medical center. Seventy-eight percent of the sample responded; these respondents were representative of the sample population. Four variables were identified as significant in determining the patients' satisfaction: whether the patients felt that the time spent with their identified family physician was adequate and that the physician's explanations regarding their health care and the teaching program were clear; whether the patients felt comfortable in expressing their concerns about the teaching program to the permanent staff members; whether the patients had a positive attitude regarding the teaching program; and whether the patients felt that their identified family physician was available to them.     

广州市开展全科医学教育的探索与实践

根据我市医疗卫生服务体制改革现状和社区卫生服务的需求,确立我市开展全科医学教育培训工作的指导思想、总体目标、基本原则和工作思路。与本市各高等医学院校及医疗卫生机构合作开展多形式、多层次的全科医学教育,以加强对全科医师知识与技能的培养。