河南大型综合医院首批全科住院医师规范化培训学员毕业前现况调查研究

背景　全科住院医师规范化培训（住培）学员作为住培的参与主体，其对住培的现况反馈评价可直接反映培训的效果和质量，影响全科相关政策研究制定。目的　分析大型综合医院全科住培教育情况，查找存在的问题及产生的原因，为今后更好地做好全科住培工作提供参考，并逐步完善全科住培教育，为国家培养高水平的全科医生。方法　于2018年5-6月，采用整群抽样法选择郑州大学第一附属医院2018年6月结业的全部全科学员共200例为调查对象。通过无记名问卷调查和书面访谈了解住培学员情况。问卷主要包括5部分：全科住培学员的基本情况，全科学员的住培情况，对全科理念的了解情况，对全科住培情况的反馈，全科学员就业的基本情况。结果　共发放调查问卷200份，回收有效问卷200份，问卷有效回收率为100.0%。7.5%（15/200）的学员在2年内未通过执业医师考试；10.5%（21/200）的学员延期结业；94.3%（182/193）的学员在住培3年中受到导师良好的培养和影响；通过3年的全科住培，对全科非常了解的学员比例达到了83.0%（166/200），愿意从事全科工作的学员比例提升到了83.0%（166/200）；在扎根基层全科工作的信心程度方面，仅有14.5%（29/200）的学员表示很有信心；113例订单定向学员中，52.2%（59/113）愿意回到基层工作，但3年后仅10.6%（12/113）的学员愿意留在基层；26例已找到工作的社会全科学员中，88.5%（23/26）继续从事临床工作，其中在三级甲等医院工作的学员占21.7%（5/23）；15例委培学员中93.3%（14/15）的学员单位是县级医院。21例延期结业的学员中有61.9%（13/21）是因为休产假而延期，执业医师考试未通过和身体原因各占19.0%（4/21）。结论　住培基地应加强学员基础知识、临床技能和全科理念的综合培养，进一步提高全科学员的职业认同感，推广规范双导师制的培养模式，提升学员的综合竞争力，加强带教师资队伍建设，多方面保障全科住培效果，依据全科就业真实状况，探寻提高基层全科岗位吸引力的方法。

Investigation and Analysis of the First Batch of Graduated General Practice Trainees from Large General Hospitals in Henan Province

Background　General practitioners（GPs） make up the bulk of the participants of standardized GP training（hereinafter referred to as GP training）. Their feedback and evaluations on the GP training directly reflect the effect and quality of this training and may influence the formulation of related policies of the general practice. Objective　This article analyzes the situation of general practice education in large-scale general hospitals，and tries to find out the existing problems and causes，in order to provide a reference for better GP training in the future and gradually improve the GP education，and to cultivate high-level GPs for the country. Methods　A total of 200 GPs who graduated in June of 2018 from the First Affiliated Hospital of Zhengzhou University were selected by cluster sampling from May to June in 2018. Anonymous questionnaires and written interviews were used to understand the situation of the GP training. The questionnaire mainly included five parts of the basic situation of GPs，the situation of GP residency，the understanding of general practice，the feedback of GP training，and the basic situation of GP's employment. Results　A total of 200 questionnaires were distributed，and 200 valid questionnaires were recovered. The effective recovery rate was 100.0%. And 7.5%（15/200） of the trainees did not pass the medical licensing examination；10.5%（21/200） of the trainees delayed their graduation；and 94.3%（182/193） of the trainees were well trained and influenced by the tutors during the three years of residency. After three years of residency，the proportion of trainees who had a good understanding of the general practice improved to 83.0%（166/200）. The proportion of trainees willing to engage in the work of general practice reached to 83.0%（166/200）. About the confidence in rooting in grassroots work，only 14.5%（29/200） of trainees showed confidence. Of the 113 order-oriented trainees，52.2%（59/113） were willing to return to the grassroots work. For their career plan after three years，only 10.6%（12/113） of the trainees were willing to stay at the grassroots level. Among 26 social GP graduates who have found jobs，88.5%（23/26） continued to engage in clinical work，of which 21.7%（5/23） worked in the tertiary hospitals. Among 15 consigned GP graduates，93.3%（14/15） were mainly from county hospitals. And 61.9%（13/21） of the 21 trainees who had postponed graduation due to maternity leave，and the percentage of trainees who failed to pass the examination or had physical reasons were both 19.0%（4/21）. Conclusion　The GP training should strengthen the comprehensive training of trainees from the aspects of basic knowledge，clinical skills and the general practice concept to further enhance their sense of professional identity，promote and standardize the training mode of dual-tutor system，and improve the comprehensive competitiveness of trainees. It is necessary to strengthen the construction of the faculty and ensure the effectiveness of GP training in various aspects，and to explore ways to increase the attractiveness of GP posts at grassroots level based on the true employment status of GP.