专科-全科联合教学查房模式应用于全科医师培养的效果分析

目的 探讨专科-全科联合教学查房（CSGR）模式在全科医师培养中的应用效果与价值.方法 以高血压教学查房为例,于2012年6-12月选取在培的北京市全科医师转岗培训学员（60人）和北京市全科医师规范化培训学员（26人）共86人为研究对象,按照学员性别、年龄、学历、职称及查房前高血压知识测试总成绩进行分层随机分组：试验组47人,采用由心内科师资与全科师资共同主持的CSGR模式;对照组39人,采用单纯心内科高血压教学查房模式.查房后对两组学员进行教学查房效果评价问卷调查,再次以相同试题测试高血压知识水平,并进行综合评价与分析.结果在家庭与心理因素问诊、强调预防为主理念、健康教育指导等12项查房效果评价指标方面,试验组得分均高于对照组（Z值分别为-2.668,-2.482,-2.269,均P〈0.05）;在对全科理念讲解的满意度方面,试验组优于对照组 （χ2=12.340,P〈0.01）;试验组学员查房后高血压知识总成绩（18.70±2.96）分]较查房前（16.52±2.72）分]明显提高（t=5.043,P〈0.01）,对照组查房前后总成绩提高差异无统计学意义;97.8%（44/45）的试验组学员对CSGR模式在合作、教学、医疗方面的价值表示认同.结论 CSGR模式可充分利用专科和全科两方面优势,针对性地开展教学查房,可以有效提高教学查房的效果和质量,有助于全科医师临床能力与全科临床思维的培养,在全科医生的培训中有一定的推广价值.

Evaluation of combined specialist/generalist teaching rounds model in training of general practitioners

Objective To evaluate the application of Combined Specialist/Generalist Teaching Rounds （CSGR） Model in training of general practitioners （GPs）. Methods This study was based on the teaching rounds of hypertension. Eighty six GP trainees, who receive training courses from June to December 2012, were enrolled in the study. Forty seven trainees were randomly assigned to received CSGR model （study group） conducted by one cardiologist and one general practice mentor; while other 39 trainees were assigned to received the teaching round model （control group ） conducted by one cardiologist. A comprehensive analysis was made based on a self-administered teaching rounds evaluation questionnaire and hypertension knowledge test among two groups after teaching rounds. Results Scores of 12 teaching rounds evaluation items in study group were significantly higher than those in control group, including inquiry of family factors, highlighting the importance of prevention and guidance of health education （ Z = - 2. 668, -2. 482, -2. 269 respectively, all P 〈 0. 05 ）. GPs in study group were more satisfied with general practice concept teaching than GPs in control group （ X2 = 12. 340, P 〈 0.01 ）. The average total score of hypertension knowledge in study group increased significantly after CSGR than before. （ 18.70 ± 2.96 vs. 16. 52± 2. 72, t = 5. 043, P 〈 0. 01 ） ; meanwhile there was no significant improvement in control group. 97.8% （44/45）GPs in study group identified with the cooperative, educational and medical value of CSGR model. Conclusion CSGR model takes the advantages of specialist and general practice, it can improve the quality and effectiveness of teaching rounds, enhance GP trainees clininical abilities and their clinical think of genernal practice.