社区卫生服务机构全科医师胜任力实证研究

目的 构建我国社区卫生服务机构的全科医师胜任力模型.方法 通过文献查阅分析及相关专家的深度访谈,初步建立包含16项因子的全科医师胜任力模型,并设计包含16项胜任特征的调查量表.选择江苏省镇江市7个区的社区卫生服务机构的部分医务人员进行全科医师胜任力问卷预调查(n=55)和实证研究(n=201).采用Likert五级量表进行度量,要求调查对象判断各个胜任特征的重要程度,并根据重要程度从5～1进行记分；采用SPSS和LISREL软件对调查量表收集的数据进行探索性因子分析和验证性因子分析.结果 探索性因子分析显示:各胜任力特征项的载荷系数均达到0.5以上,总体α系数在0.9以上,人力资本、心理资本和关系资本3个因子的方差解释量为84.876％,说明最表具有良好的信度和效度.实证性因子分析显示:人力资本是全科医师最为主要的胜任力特征,其中非专业知识的修养、综合管理能力和分析判断能力更为重要；事业心是心理资本最为重要的胜任特征；在关系资本方面,最为影响全科医师绩效的胜任特征是与签约的社区居民的关系.结论 构建的全科医师胜任力模型得到了验证,具有较高的拟合度和稳定性.

Empirical research on competency of general practitioners in community health service institutions

Objective To establish the model of competency of general practitioners in community health service institutions in China.Methods Through analysis of literatures and in-depth interviews of experts,the model of competency of general practitioners containing 16 factors was initially established,and the questionnaire including 16 items of competency was designed.Questionnaire survey(n=55) and empirical research(n=201) on competency of general practitioners were conducted among medical staffs selected from community health service institutions in 7 districts in Zhenjiang of Jiangsu Province.Five-point Likert scale was adopted,and the respondents were asked to determine the importance of each competency by rating from 5 to 1.The data collected from questionnaire survey were processed with exploratory factor analysis and confirmatory factor analysis by SPSS software and LISREL software.Results Exploratory factor analysis revealed that the load factor of each competency was up to 0.5,Cronbach’s alpha was up to 0.9,and the explained variance of three factors of human capital,psychologic capital and relational capital was 84.876%,which demonstrated that the scale had a favorable reliability and validity.Confirmatory factor analysis indicated that human capital was the most important competency of general practitioners,among which non-professional knowledge,integrated management capability and analytical skill were more important.Enterprise was the most important competency of the psychological capital.In terms of relational capital,the relation with the signed community inhabitants had the most significant impact on performance of the general practitioners.Conclusion The established model of competency of general practitioners in community health service institution is verified,which has a high degree of fit and stability.