全科医师教育培训与评估PPT模板（课件分享）

1、1全科医师教育培训与评估PPT模板2全科医师教育培训与评估 Training and Assessment for General Practitioners 祝墡珠教授祝墡珠教授Zhu Shanzhu Zhu Shanzhu Faculty of General Practice, Faculty of General Practice, FuDan Medicine InstituteFuDan Medicine InstituteDepartment of General Practice, Department of General Practice, ZhongShan Hospit

2、al affiliated to ZhongShan Hospital affiliated to FuDan UniversityFuDan University3背景背景 Background：l据统计，所有到医院就诊的患者中只有据统计，所有到医院就诊的患者中只有5%左右需要专左右需要专科医师的诊治，而人群中科医师的诊治，而人群中8090%的健康问题可以的健康问题可以由以全科医师（家庭医师）为骨干的社区卫生服务队由以全科医师（家庭医师）为骨干的社区卫生服务队伍来解决伍来解决 lAccording to the recent statistics, only 5% of the patien

3、ts who go to hospital need the health-care from specialists, and 80%90% health problems can be solved by GPs-based community health-care system 4l发达国家的实践经验也告诉我们：控制医疗费用，有效利发达国家的实践经验也告诉我们：控制医疗费用，有效利用有限的医疗保险资源的关键措施是发展以全科医师为骨用有限的医疗保险资源的关键措施是发展以全科医师为骨干的社区卫生服务干的社区卫生服务l近近1010年来，我们致力于毕业后全科医师的教育培训，探索年来，我们致力于

4、毕业后全科医师的教育培训，探索建立新型的全科医师教育培训与评估模式建立新型的全科医师教育培训与评估模式 lThe experience gained in developed countries The experience gained in developed countries reinforces the idea that to develop GPs-based reinforces the idea that to develop GPs-based health-care in community setting is a crucial health-care in comm

5、unity setting is a crucial measure to reduce medical costs and make use of measure to reduce medical costs and make use of the limited resources of Medicare more effectively the limited resources of Medicare more effectively lIn the recent decade, we have devoted ourselves to In the recent decade, w

6、e have devoted ourselves to training GPs and developing a workable system for training GPs and developing a workable system for GPs training and assessment in the past decadeGPs training and assessment in the past decade5研究目的研究目的 Research Objective：l在综合性教学医院进行全科医师规范化培训的探索，建立在综合性教学医院进行全科医师规范化培训的探索，建立

7、适应生物心理社会医学模式的新型教学方式，取代专适应生物心理社会医学模式的新型教学方式，取代专科医学以知识和技能掌握为重点、以疾病为中心的传统教科医学以知识和技能掌握为重点、以疾病为中心的传统教学模式学模式lTo develop a new efficient system for standardized To develop a new efficient system for standardized GPs training in comprehensive teaching hospital, GPs training in comprehensive teaching hospita

8、l, corresponding with biological-psychological-social corresponding with biological-psychological-social medical pattern and reforming the disease-oriented medical pattern and reforming the disease-oriented traditional system which focuses solely on medical traditional system which focuses solely on

9、 medical knowledge and skills knowledge and skills 6研究方法研究方法 Research Methodl对象对象 以高等院校临床医学本科毕业，有志于从事社区卫生以高等院校临床医学本科毕业，有志于从事社区卫生服务工作的医师为培训对象服务工作的医师为培训对象lObjects We recruit students graduated from medical universities as our trainees, who have obtained bachelor degrees in clinical medicine, and willi

10、ng to become GPs7l方法方法 参考发达国家和地区的培训要求，结合我院多年的住院医师参考发达国家和地区的培训要求，结合我院多年的住院医师培训经验，制定全科医师规范化培训大纲和要求、考核内容和培训经验，制定全科医师规范化培训大纲和要求、考核内容和评估方法。在教学实施过程中不断接受来自培训者和受训者的评估方法。在教学实施过程中不断接受来自培训者和受训者的反馈意见，对培训和考核的方法、内容进行改进和完善反馈意见，对培训和考核的方法、内容进行改进和完善 lMethodsMethods We tried to work-out a new set of regulations, a We

11、tried to work-out a new set of regulations, a curriculum for standardized GPs training, the curriculum for standardized GPs training, the methods of examination and assessment, which drew on methods of examination and assessment, which drew on GPs training methods in the developed country and GPs tr

12、aining methods in the developed country and district, as well as the long-term residents district, as well as the long-term residents training experience of our hospital .During the training experience of our hospital .During the process, we tried to improve the methods of teaching process, we tried

13、 to improve the methods of teaching and the content of the training courses and and the content of the training courses and assessment step by step through collecting assessment step by step through collecting constructive feedback from the trainers and the constructive feedback from the trainers an

14、d the trainees trainees 8培训方法培训方法 Training Methodsl分理论学习、临床轮转和社区实践三个阶段分理论学习、临床轮转和社区实践三个阶段 l理论课程分别由资深全科医师和专科医师担任授课，理论课程分别由资深全科医师和专科医师担任授课，并邀并邀请美、英、中国台湾等地的资深全科医师来访讲学请美、英、中国台湾等地的资深全科医师来访讲学lThe training process involved 3 phases: academic learning, clinical rotation and community practicelSenior GPs and

15、 specialists assumed the teaching tasks together in academic curriculum. At the same time, we invited sophisticated GPs coming from Taiwan, UK, US to hold a course of lectures9l临床轮转要求病区主治以上医师带教，由我院全科医学临床轮转要求病区主治以上医师带教，由我院全科医学科负责教学的医师（副高职称）全程监控，及时掌握学科负责教学的医师（副高职称）全程监控，及时掌握学员的反馈信息，与带教老师协调员的反馈信息，与带教老师协

16、调lAttending doctors in wards took charge of Attending doctors in wards took charge of trainees clinical rotation and adjunct trainees clinical rotation and adjunct professor of Department of General Practice, professor of Department of General Practice, with responsibility for training, supervised t

17、he with responsibility for training, supervised the whole course, who would learn from the feedback whole course, who would learn from the feedback from trainees in time and coordinate with the from trainees in time and coordinate with the supervisors of all wardssupervisors of all wards10培训方法培训方法 T

18、raining Methodsl社区实践期间，学员由所在社区的资深医师带教。带教老师先由我科社区实践期间，学员由所在社区的资深医师带教。带教老师先由我科统一进行全科医学理论的培训，并通过电话联系、每半年度集中座谈统一进行全科医学理论的培训，并通过电话联系、每半年度集中座谈等方式及时反映社区带教过程中遇到的问题。学员则每周回我科集中等方式及时反映社区带教过程中遇到的问题。学员则每周回我科集中1次，利于双向交流次，利于双向交流lDuring community practice, the senior physicians in community would supervise our trai

19、nees, who received the academic training of General Practice in advance and reflected the existing problems in trainees practice through frequent telephone communication and rap sessions every half an year. Trainees came back to our hospital every week so as to communicate with us11l学年结束，举行学员座谈会，听取学

20、员意见和建议，学年结束，举行学员座谈会，听取学员意见和建议，改进培训方法改进培训方法lWhen academic year was over, we would hold a When academic year was over, we would hold a session for trainees, collecting constructive session for trainees, collecting constructive ideas and suggestions, to improve training ideas and suggestions, to improv

21、e training methodsmethods12培训内容和期限培训内容和期限Training Contents and Schedule Training Contents and Schedule l培训围绕以下六方面的能力培养培训围绕以下六方面的能力培养1.1.患者的照顾患者的照顾2.2.医学知识的掌握医学知识的掌握3.3.实践中的学习和提高实践中的学习和提高4.4.人际交流人际交流5.5.职业道德职业道德6.6.立足于卫生保健系统的医疗行为立足于卫生保健系统的医疗行为, ,为期为期4 4年年lIt took 4 years to perform the training based

22、 on six aspects as It took 4 years to perform the training based on six aspects as follow: patient care, medical knowledge, practice-based learning follow: patient care, medical knowledge, practice-based learning and improvement, interpersonal communication skills, and improvement, interpersonal com

23、munication skills, professionalism and health-care system-based practice professionalism and health-care system-based practice 13培训内容和期限培训内容和期限 Training Contents and ScheduleTraining Contents and Schedulel理论课程理论课程2 2个月，包括全科医学概论、预防医学、综合课程个月，包括全科医学概论、预防医学、综合课程（社区诊所的管理、社区合理用药、老年病学、医患交流技（社区诊所的管理、社区合理用药、

24、老年病学、医患交流技巧及计算机应用课程等）和专业英语巧及计算机应用课程等）和专业英语lAcademic courses took 2 months, including Panorama of Academic courses took 2 months, including Panorama of General Practice, Preventive Medicine, comprehensive General Practice, Preventive Medicine, comprehensive courses (such as management of clinic in co

25、mmunity, courses (such as management of clinic in community, rational prescription in community clinic, Geriatrics, rational prescription in community clinic, Geriatrics, skills of physician-patient communication and skills of physician-patient communication and computer application as well) and med

26、ical specialized computer application as well) and medical specialized EnglishEnglish14l临床轮转临床轮转2626个月，包括内、外、妇、儿、急诊科、五官科、皮个月，包括内、外、妇、儿、急诊科、五官科、皮肤科、眼科、康复科、中医科、肤科、眼科、康复科、中医科、CDCCDC等等l社区实践社区实践2020个月个月l轮转期间每月安排学员集中轮转期间每月安排学员集中1 1次，讲授临床医学进展次，讲授临床医学进展 lClinical rotation took 26 months, including departmen

27、t Clinical rotation took 26 months, including department of Internal Medicine, Surgery, Gynecology & Obstetrics, of Internal Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Emergency, ENT, Dermatology, Ophthalmology, Pediatrics, Emergency, ENT, Dermatology, Ophthalmology, Rehabilitat

28、ion, Traditional Medicine, CDC and Rehabilitation, Traditional Medicine, CDC and Psychology etc.Psychology etc.lCommunity practice took 20 monthsCommunity practice took 20 monthslWe held a seminar every month to introduce the We held a seminar every month to introduce the advancement of clinical med

29、icine for traineesadvancement of clinical medicine for trainees15考核和评估考核和评估 Examination and AssessmentExamination and Assessmentl围绕上述围绕上述6 6方面的能力培养，制定相关知识、技能和态度要求，以及相应的考核和方面的能力培养，制定相关知识、技能和态度要求，以及相应的考核和评估表格：如病史质量评估表、临床能力考评表、医师接诊评估表、文献综述评评估表格：如病史质量评估表、临床能力考评表、医师接诊评估表、文献综述评估表、医患交流患者评估表、医患交流患者家属评估表、同事评

30、价表、职业道德估表、医患交流患者评估表、医患交流患者家属评估表、同事评价表、职业道德评价表等，每半年考评评价表等，每半年考评1 1次，由全科教学组完成对学员的考评次，由全科教学组完成对学员的考评lAccording to the 6 aspects we mentioned above, we worked-out relevant According to the 6 aspects we mentioned above, we worked-out relevant requirements of knowledge, skills and attitudes, as well as ex

31、amination requirements of knowledge, skills and attitudes, as well as examination and assessment forms respective: such as case history quality and assessment forms respective: such as case history quality assessment form, clinical ability testing form, literature and review assessment form, clinica

32、l ability testing form, literature and review assessment form, physician-patient communication assessment form, assessment form, physician-patient communication assessment form, patients relative-based communication assessment form, co-workers patients relative-based communication assessment form, c

33、o-workers evaluation form and professional morality evaluation form etc. These evaluation form and professional morality evaluation form etc. These examinations and assessments were performed by educational group of our examinations and assessments were performed by educational group of our departme

34、nt and relevant professionals every half an yeardepartment and relevant professionals every half an year16考核和评估考核和评估 Examination and AssessmentExamination and Assessmentl阶段考核：各阶段培训结束后，由我科组织相阶段考核：各阶段培训结束后，由我科组织相应的理论和临床技能考核，并将考核结果记录应的理论和临床技能考核，并将考核结果记录在培训手册上在培训手册上lStage examinations: When every phase

35、was over, our department would organize examinations of corresponding academic knowledge and clinical skills, recording the traines scores on the manuals17l综合考核：培训结束后，要求学员完成以社区为基础的论综合考核：培训结束后，要求学员完成以社区为基础的论文一篇，通过论文答辩并结合既往考评结果，成绩合格者文一篇，通过论文答辩并结合既往考评结果，成绩合格者将获得卫生部颁发的全科医师规范化培训合格证书将获得卫生部颁发的全科医师规范化培训合格证书

36、lComprehensive examinations: When the whole training Comprehensive examinations: When the whole training was over, trainees were required to hand in a paper was over, trainees were required to hand in a paper based on community setting. Those who went through based on community setting. Those who we

37、nt through the defending smoothly and past assessments were the defending smoothly and past assessments were eligible will acquire qualification certificates eligible will acquire qualification certificates for GPs training issued by the Healthcare for GPs training issued by the Healthcare MinistryM

38、inistry18结果结果 Resultsl建立全科医师规范化培训的模式建立全科医师规范化培训的模式l制定相应的教学大纲、教学计划、教学管理文件和教学效果评制定相应的教学大纲、教学计划、教学管理文件和教学效果评估方法估方法l主编多部全科医师培训教材：如全科医学概论（第二版）；主编多部全科医师培训教材：如全科医学概论（第二版）；全科医学导论（第一版）；社区常见健康问题（第二全科医学导论（第一版）；社区常见健康问题（第二版）等版）等 lFormulated a training pattern for GPsFormulated a training pattern for GPslWorked

39、out a training curriculum, scheme, Worked out a training curriculum, scheme, administration and assessing methodsadministration and assessing methodslPublished several textbooks for GPs trainingPublished several textbooks for GPs training19l从从20002000年年1212月至月至20052005年年9 9月举办了月举办了6 6期毕业后全科医期毕业后全科医师

40、规范化培训，共招收师规范化培训，共招收165165名学员。迄今有名学员。迄今有7070名学员名学员完成培训，通过各项考核，获得全科医师规范化培完成培训，通过各项考核，获得全科医师规范化培训合格证书训合格证书 lFrom Dec.2000 to Sep.2005, standardized GPs From Dec.2000 to Sep.2005, standardized GPs training courses have been run for 6 times, training courses have been run for 6 times, in which 165 studen

41、ts have been enrolled and in which 165 students have been enrolled and 70 students have passed all the examinations 70 students have passed all the examinations and acquired the qualification certificates and acquired the qualification certificates for GPs trainingfor GPs training20讨论讨论 Discussionl目

42、前，全科医师规范化培训仍处出于探索阶段，培养目前，全科医师规范化培训仍处出于探索阶段，培养合格的全科医师是社区卫生服务可持续发展的关键。合格的全科医师是社区卫生服务可持续发展的关键。我院全科医学科多年来致力于全科医学教育，旨在培我院全科医学科多年来致力于全科医学教育，旨在培养高素质的全科医师，充实全科医师及其师资队伍养高素质的全科医师，充实全科医师及其师资队伍lAt present, we are still exploring the standardized GPs training. Qualified GPs are crucial for the sustainable develo

43、pment of community health-care system. We devoted ourselves in the past decade to training eligible GPs so as to enforce the team of GPs and trainers21l全科医师教育培训的重点在于培养全科医师提供合理、全科医师教育培训的重点在于培养全科医师提供合理、有效、人性化医疗照顾的能力，以及寻找、评价和利用有效、人性化医疗照顾的能力，以及寻找、评价和利用最佳医疗方案，解决患者健康问题的能力，以适应社区最佳医疗方案，解决患者健康问题的能力，以适应社区卫生服务

44、发展的需求卫生服务发展的需求lThe training for GPs should focus on developing The training for GPs should focus on developing students comprehensive ability (including students comprehensive ability (including offering rational, effective and individual offering rational, effective and individual health-care as we

45、ll as managing health problems health-care as well as managing health problems through assessing and adopting best medical through assessing and adopting best medical methods), accommodating to the need of community methods), accommodating to the need of community health-care servicehealth-care serv

46、ice22讨论讨论 Discussion 综合性教学医院有着得天独厚的教学条件，在全科医学的教育培训中担负不综合性教学医院有着得天独厚的教学条件，在全科医学的教育培训中担负不可或缺的责任可或缺的责任 全科医学教育离不开专科医师的作用，然专科医师若未经过相关的全科知识全科医学教育离不开专科医师的作用，然专科医师若未经过相关的全科知识培训，其专科医疗的临床思维方式在一定程度上将影响全科医师的培训质培训，其专科医疗的临床思维方式在一定程度上将影响全科医师的培训质量量lGPs training can best be done in comprehensive teaching hospitals w

47、here there are superior educational resources, which will help to enhance GPs training programslSpecialists play an important role in General Practice education, whose special medical ideas will effect the quality of GPs training unless they receive academic education from experienced GPs 23l目前的培训评估

48、大多通过调查问卷的方式，缺目前的培训评估大多通过调查问卷的方式，缺乏客观标准，培训的优劣将难以彰显乏客观标准，培训的优劣将难以彰显lIn general, we assess the training In general, we assess the training quality by questionnaire, lack o quality by questionnaire, lack o objective standard, which couldnt objective standard, which couldnt evaluate the merits and weakne

49、ss evaluate the merits and weakness objectively of training patternobjectively of training pattern24讨论讨论 Discussionl由于目前全科医师的社会地位不高，经济收入低下，导由于目前全科医师的社会地位不高，经济收入低下，导致培训生源不足，生源质量得不到保障；培训过程中学致培训生源不足，生源质量得不到保障；培训过程中学员流失员流失lAt present, GPs social status and income arent satisfied, on account of which, therere not enough trainees for GPs training and the quality of trainees couldnt be ensured, furthermore a part of trainees will leave school during the