上海市城区郊区全科医生继续医学教育现状调查及培训方式需求分析

目的 调查上海市城区和郊区全科医生继续医学教育现状及培训方式需求,比较两者间差异.方法 2011年7月至2012年5月,采用自行设计的问卷对参加“上海市家庭医生临床能力培训”和“上海市全科医生临床能力评估”的全科医生进行调查.结果 市区组710人,男性33.0％,平均年龄（36.7±6.8）岁；郊区组843人,男性33.2％,平均年龄（36.6±5.1）岁.84.6％的市区组和85.6％的郊区组被调查者曾参加过全科医学继续教育学习班.两组对继续医学教育整体效果的总体满意程度差异无统计学意义（Z=-0.895,P=0.371）,其中满意和非常满意的比例分别为45.1％、13.8％和49.5％、9.1％；郊区组对继续医学教育增强全科医学基本理论（Z=-2.296,P=0.022）、增强基本操作技能（Z=-2.013,P =0.044）和继续医学教育教材（Z=-2.819,P=0.005）的总体满意程度高于市区组.两组均认为脱离社区实际需求是继续医学教育中存在的最主要问题,差异无统计学意义（60.3％比65.2％,x2=3.213,P=0.082）；郊区组中认为培训时间太短（19.7％比11.0％,x2=18.045,P＜0.05）、课程内容太少（7.5％比4.3％,x2=5.747,P=0.019）、领导不重视（14.3％比6.5％,x2=19.95,P＜0.05）的比例高于市区组,认为课程内容重复（24.8％比34.8％,x2=15.327,P＜0.05）、培训时间太长（16.4％比28.2％,x2=26.055,P＜0.05）的比例低于市区组.两者选择最多的教学方法均为案例分析（73.3％比78.0％,x2=0.635,P=0.426）,差异无统计学意义.郊区组选择理论授课的比例高于市区组（63.6％比50.8％,x2=6.712,P=0.010）,选择问题导向学习的比例低于市区组（43.1％比51.9％,x2=4.273,P=0.010）.结论 上海市城郊全科医生对继续医学教育整体效果基本满意,认为脱离社区实际需求是当前的突出问题；两者对继续医学教育的评价和培训方式的需求存在差异,应区别对待.

Training needs of continuing medical education for gereral practitioners in urban and suburban of Shanghai

Objective To assess the continuing medical education （CME） and training needs for gereral practitioners （GPs） in urban and suburb of Shanghai. Methods Gereral practitioners in urban （ n = 710） and suburb （n = 843） of Shanghai attending two municipal training programs were interviewed with self-designed questionnaire during July 2011 to May 2012. Results Urban group included 710 GPs whose mean age were （36. 7 ＋6.8）y and 33.0% were male. Suburban group had 843 GPs whose mean age were （36.6 _＋ 5. 1 ）y and 33.20/o were male. The survey showed that 84. 6% of urban group and 85.6% of suburban group had attended CME before. There was no statistical difference in the overall satisfaction of CME between two groups （ Z = - 0. 895, P = 0. 371 ）. The propotion of satisfied and very satisfied was 45.1% and 13.8% in urban groupt, while it was 49.5% and 9. 1% in suburb group. The overall satisfaction rates of enhancing basic theories （ Z = - 2. 296, P = 0. 022） and skills （ Z = - 2. 013, P = 0. 044） and CME textbooks （Z = -2. 819, P =0. 005） were higher in suburban group than those in urban group. Both of them agreed that the contents of CME were divorced from reality of practice （60. 3% vs. 65.20/o , X2 =3. 213, P =0. 082）. The percentages of complain of insufficient training time （ 19.7% vs.11.0% ,X2 =18.045, P〈0.05） and contents （7.5% vs. 4.3%, X2 =5.747, P=0.019）, and weak leadership commitment （14. 3% vs. 6. 5% , X2 = 19.95, P 〈 0. 05） were higher in suburban group than those in urban group. On the contrary, the delivery of repeated contents （24. 8% vs. 34. 8% , X2 = 15. 327, P 〈 0. 05） and long training time （ 16.4% vs. 28.2% , X2 = 26. 055, P 〈 0. 05 ） were lower in suburban group than those in urban group. Using case study in the teaching was the common choice of both groups （73.3% vs. 78.0% , X2 =0. 635, P =0. 426）. Compared to urban group, suburban group was more likely to choose lecture of theory （ 63.6 % vs. 50. 8 % , X2 = 6. 712, P = 0. 010 ） rather than problem based learning （43. 1% vs. 51.9%,X2 =4. 273, P = 0. 010）. Conclusions Both urban and suburban GPs in Shanghai are generally satisfied with the CME programs. There are some discrepancies in training needs of CME between urban and suburben area in Shanghai, indicating that the CMB programs need to be designed according to the needs of trainees in urban or suburb areas.