Objective:Exploring the establishment of an objective and scientific evaluation index system for the construction of key medical disciplines in medical institutions in Shanxi Province.Methods:Literature review, Delphi method, and analytic hierarchy process were jointly adopted to screen the indicators and construct the evaluation index system of key medical disciplines in medical institutions in Shanxi province.Results:Two rounds of expert consultation were carried out, and the response rate was higher than 90%, and the expert authority coefficient was ≥0.75. Four primary indicators, 10 secondary indicators, and 41 tertiary indicators were established and given weights at all levels. The four primary indicators were medical operation 25.46%, scientific research management 36.01%, medical education 27.36%, and basic conditions 11.17%. The medical operation showed no significant difference from the original indicators, but its specific content was closer to the core indicator system of public hospitals′ performance evaluation reflecting social service capacity. The proportion of scientific research management increased by 12.5% and medical education increased by 17.39%. The results of the comprehensive quantitative evaluation of medical education and basic condition were P<0.05, respectively. The average score of discipline construction increased from 78.8, with excellent disciplines accounting for 56.66%, good accounting for 23.3%, qualified accounting for 6%, and unqualified accounting for 13.3%, to an overall average of 85.89, of which 76.7% were excellent, subjects accounting for 16.7% were good, 3% were qualified, and 3% were unqualified. Conclusions:The evaluation index system provided a quantitative tool for the evaluation of the construction of key medical disciplines in medical institutions in Shanxi Province. The expert authority and consistency were high and the index system was scientific. The weight coefficient of ″scientific research management″ in the index system was the highest, followed by medical education, in line with the evaluation purpose. The application of the system clarified the goal of current discipline construction, motivated the construction of scientific research management, promoted the transformation of achievements to a certain extent, and improved social service capacity.

Objective:To survey the satisfaction and employment intention of general practice residents (GPRs) in Shanxi Province.Methods:A cross-sectional questionnaire survey was conducted in May 2021 among GPRs in Shanxi Province through the residency training information management platform. The questionnaire included general demographic information, clinical competency and independent practice ability, the status of the training base, their satisfaction with the training, career prospects and employment intention. The survey results were analyzed.Results:A total of 452 questionnaires were distributed, and 434 valid ones were recovered with an effective recovery rate of 96.02%. The age of respondents was (27.4±4.6) years, there were 155 GPRs (35.71%) enrolled in 2018, 131 GPRs (30.18%) in 2019, and 148 GPRs (34.10%) in 2020. A total of 286 GPRs (65.9%) thought that they were able to independently complete some procedures such as abdominal puncture, lumbar puncture, chest puncture, and bone puncture, and the proportion of GPRs who were able to complete the above procedures increased with the training time (49.3%(73/148), 70.2%(92/131), and 78.1%(121/155) in 2020, 2019, and 2018 batches, respectively, χ2=29.39, P<0.001); 372 respondents (85.7%) thought that they were able to independently receive patients with common diseases and make preliminary diagnosis and treatment, while there was no significant difference in the proportion of GPRs enrolled in 2020, 2019, and 2018 ( χ2=3.35, P=0.188); 425 GPRs (97.9%) expressed that the base arranged rotation according to the training syllabus; 390 GPRs (89.9%) thought that the proportion of knowledge and skill assessment in the final examination was appropriate. The survey showed that 70 GPRs (16.1%) thought that the number of cases and types of diseases in the teaching base fully met the requirements of the training program, 144 GPRs (33.2%) thought that mostly met the requirements, 197 GPRs (45.4%) thought that basically met the requirements, 22 GPRs (5.1%) thought that most of them did not meet the requirements, and 1 GPR (0.2%) thought that completely did not meet the requirements. Most of the respondents (368 (84.8%)) reported that they received guidance from clinical instructors for medical record writing; 174 (40.1%) and 172 (39.6%) GPRs were very satisfied or satisfied with general practice teachers and teaching base instructors; 207 GPRs (47.7%) were satisfied with accommodation (or subsidies), while 38 GPRs (8.3%) were very dissatisfied; 203 GPRs (46.8%) were satisfied with basic salary and benefit, while 35 GPRs (8.1%) were very dissatisfied. For general practice as the career, 88 GPRs (20.3%) liked it very much, 255 GPRs (58.8%) liked it, 67 GPRs (15.4%) did not like it very much, and 24 GPRs (5.5%) disliked it. For the prospects of general practice, 108 GPRs (24.9%) considered it very optimistic, 219 GPRs (50.5%) considered it relatively optimistic, 92 GPRs (21.2%) considered it not very optimistic, and 15 GPRs (3.5%) considered it very pessimistic. Regarding employment intentions, 174 GPRs (40.1%) intended to choose municipal hospitals, 170 GPRs (39.2%) to choose county level hospitals, only 9 GPRs (2.1%) to choose village clinics. Conclusions:The survey indicates that for GPRs the most dissatisfied aspects are the salary and benefit, as well as the living conditions during their training; after completing the contract, most GPRs hope to work in hospitals at county and above levels.

全科医生是家庭成员一辈子的健康保护神,是国家卫生服务支出的守门人[1],也是引导专科医疗的经济人.《国务院办公厅关于改革完善全科医生培养与使用激励机制的意见》[2](国办发〔2018〕3号)要求到2020年,合格的全科医生应达到2～3名/万居民,到2030年达到3～5名/万居民.然而在全科医师培养过程中存在全科医生"招不来、下不去、留不住"[3]、参培后岗位胜任力(尤其是社区为导向的服务能力)提升不明显[4]等实际问题亟待解决.山西省于2014年全面开展全科住院医师规范化培训工作,运行7年来,不断建章立制、完善举措、加强基地建设,培养了一批批合格的全科医生.为完善本省全科医师培养工作,提升培训质量,确保全科医生岗位胜任力,2020年向全科专业住院医师规范化培训学员发放《2020年山西省全科住院医师规范化培训现状及满意度调查》,共823名全科住培生参加了问卷调查.对问卷进行系统分析有利于发现现存全科医师人才培养中的问题并及时调整.

目的 为进一步加强山西省住院医师规范化培训(简称住培)过程管理,提升住培质量提供依据.方法 依托第三方团队,参照中国医师协会相关评估内容,设计省级评估方案,组建专家库,组织团队分组,以17个基地的综合管理、内科、外科、全科为重点进行评估.评估后,对17个接受评估的基地主任、内科、外科、全科3类专业基地主任发放问卷,探索其对本年度住培省级评估的满意度及建议.结果 问卷的信效度评价较满意,Barlett's球性检验P<0.01,总问卷的Cronbach'sα系数为0.99,评分型条目(Q 1-Q 6)具有较高的内在一致性.Q1-Q6得分的分布均非正态,均P<0.01,其分数分别为(8.02±3.23)分、(7.85±3.32)(7.72±3.28)分、(8.05±3.20)分、(8.66±3.04)分、(8.16±3.32)分.其中评估组专家的专业水平得分,显示管理等评估专家组的专业性有待提升.参评人意见建议生成的词云图,亦显示评估专家组专业水平亟待提高.结论 参评人充分肯定2020年度省级评估工作,对评估标准、专家的客观性及公正廉洁程度、评估组织情况表示满意.今后工作中要提升第三方评估队伍的专业水平,严格专家库遴选标准,加大评估专家培训力度,将先进省市优秀的评估专家纳入本省专家库,发挥带动和牵引作用,把省级评估工作进一步规范化、常态化.

住院医师规范化培训是国家医疗改革的重要内容之一,以培养合格的住院医师为目标.山西省人民医院作为非直属教学医院,成为国家首批培训基地后,通过完善顶层设计,以"一个目标,两大措施,三条路径"的模式开始了对住院医师岗位胜任力的规范化培训的探索与实践.即以岗位胜任力为培养目标,以"双师制(临床带教老师与责任导师)"和模拟医学教育为切入点,针对非直属教学医院师资力量薄弱、教学经验缺乏的问题,利用多种形式着力进行师资培训;同时利用临床技能中心,依托各种形式的技能竞赛,对住院医师分门别类地进行临床实践技能培训;以临床病例为中心,整合课程体系,对住院医师的临床思维能力进行培训等.通过以上途径,逐步从"重知识、轻实践"的传统教学模式转变为多维度的岗位胜任力的教学模式,激发了住院医师的内在动力,实现了"教学相长",初步建立了"岗位胜任力"的住培教学体系与框架,并取得了一定的成效.

A Survey on the current general practice residency training was carried out in January 2018 among 1 114 general practitioners (GPs) who attended the standardized residency training program during 2014-2017.Basic information was obtained from the management department,other information was obtained from questionnaire.Total 1089 valid questionnaires were received with a retrieval rate of 97.8％.The survey showed that the ratios of male trainees,trainees aged 20-30 years and with bachelor degree were increasing during 2014-2017.The participants were more satisfied with the teaching quality in general hospital bases than that in community practice bases.Participants suggested to improve teaching quality,add teaching contents of humanity courses and TCM knowledge.Only14.4％(157/1 089) participants choose GPs as their career because liked this specialty.And 77.7％(846/1 089) GPs understood the main work of GP.There were 81.4％(887/1 089) participants wanted to work in;77.7％(846/1 089) participants thought that the prospect of general practice would be excellent or good.Increasing income,professional promotion and a sense of social recognition were their wishes.Standardized residency training is crucial for general practitioners to upgrade their quality and competence,to improve training quality and to develop incentive policies are necessary.

为摸清怀柔区是否有莱姆病存在,我们于2000年9月份,在汤河口镇、碾子乡选取两个村进行了莱姆病调查.