社区全科医师不同临床岗位胜任力的同质性和差异性研究

背景　全科医师是社区卫生服务机构的关键人才，在机构内多个岗位发挥着重要作用，然而目前针对全科医师能力的评估，缺乏对岗位所需具备的能力、特质等的考量，不利于全科人才选拔和培养。目的　探讨全科医师不同临床岗位胜任力指标体系的同质性和差异性，为机构管理者为各岗位匹配最佳全科人才提供参考。方法　于2018年10月-2019年6月，对上海市嘉定区社区卫生服务中心全科人才就职的各岗位优秀执业者、管理者进行访谈和专家咨询，先通过一对一半结构化访谈归纳出全科医师各岗位胜任力指标，再结合访谈结果和文献回顾研制专家咨询问卷，通过专家咨询，采用界值法和会议研讨筛选评价指标，梳理出全科医师不同临床岗位胜任力指标体系。结果　各岗位专家咨询的权威程度均大于0.70，除了全科门诊二级指标的Kendall's W值（0.437）大于0.4外，其他各岗位各级指标的Kendall's W值均小于0.4（P<0.01）。全科门诊、中医门诊、病房、妇女保健、儿童保健、家庭医生、家庭医生助理、预防保健各岗位胜任力指标均包括全部一级指标和除教学科研能力、团队管理能力外的全部二级指标。病房、家庭医生、预防保健岗位胜任力二级指标较其他岗位多了团队管理能力指标，家庭医生助理岗位胜任力二级指标较其他岗位则缺少了教学科研能力指标。结论　全科岗位的同质性是由社区卫生服务的特点和各岗位目前的主要执业群体决定的，差异性是由各个岗位的职责和工作特点决定的。岗位的同质性可以为机构管理者选拔人才提供人才初筛的条件，而岗位之间的差异性则是机构管理者选拔合适人才的关键。

Similarities and Differences of Position-specific Competencies among Community General Practitioners

Background　General practitioners（GPs） are the key workforce in community health organizations，delivering important services in various positions. However，current tools for assessing GPs' competencies are not conducive to the selection and training of GPs due to lack of assessment of competencies and attributes according to the position. Objective　To explore the similarities and differences of systems for assessing the competencies of GPs serving in different positions，to provide a reference for managers of medical institutions to allocate GPs to the appropriate position. Methods　This study was conducted during October 2018 and June 2019. Assessment indicators for GPs' competencies were explored by individual semi-structured interviews with high-quality GPs serving in various positions from community health centers（CHCs），Shanghai's Jiading District. Then the indicators were screened using the boundary value method according to the results of a Delphi consultation survey with experts（consisting of highly qualified and experienced GPs serving in different positions and managers of CHCs） using a questionnaire developed by our research group based on the above-mentioned interviews and literature review. And finally，assessment systems for position-specific competencies of GPs were developed. Results　The authoritative coefficient for experts according to the position were greater than 0.70，and the Kendall's W for experts according to the position were less than 0.4 except the secondary index of general outpatient service with 0.437（P<0.01）. The systems for assessing the competencies of GPs working as outpatient physician，TCM outpatient physician，inpatient physician，women' healthcare physician，child healthcare physician，family physician，family physician assistant，and preventive care physician included all the primary level indicators and all secondary level indicators except assessment indictors for teaching and research ability and team management ability. The systems for assessing the competencies of GPs working as inpatient physician，family physician and preventive care physician had team management ability，a secondary level indicator，while other systems had not. And the system for assessing the competencies of GPs working as family physician assistant was the only system without teaching and research ability，a secondary level indicator. Conclusion　The similarities of positions for GPs are determined by the characteristics of community health services and the attributes of the main practice groups for each position，and the differences are determined by the specific duties and characteristics of positions. The common and specific requirements for GPs' competencies of the positions may be used as the criteria for the initial and final selection of appropriate GPs，respectively.