Objective:To construct a post competency index system for rural general practice assistant physicians.Methods:On the basis of previous literature research and behavioral event interviews, the questionnaire of Delphi consultation was designed. Two rounds of Delphi expert consultation were conducted from October 2019 to January 2020 to develop an index system of post competency for rural general practice assistant physicians, and the analytic hierarchy process methods was used to calculate the weight of each index.Results:A total of 26 experts were included, with an average age of (48.7±8.6) years and an average working seniority of (22.8±8.8) years. After 2 rounds of consultation, the competency index system was developed, including 6 first level items and 60 seconds level items. The positive coefficient of experts in the 2 rounds was 87% and 100%, respectively; the expert authority coefficient was 0.7-1.0; the coordination coefficient was 0.312 and 0.241, respectively ( P<0.001). According to the order of weight, the first level items were basic medical and health services (0.311 1), basic public health services (0.196 0), medical knowledge and lifelong learning (0.196 0), interpersonal communication and team cooperation (0.138 6), professional quality (0.102 8), information utilization and management ability (0.055 5). The top 2 secondary indexes were clinical expertise (0.079 2), learning awareness and ability (0.055 3). The last 2 secondary indexes were achievement orientation (0.001 6) and inductive thinking (0.002 0). Conclusion:A post competency index system for rural general practice assistant physicians has been preliminary constructed in this study, which may provide reference for the selection, training and assessment of relevant medical workers.

Objective:To survey the competency characteristics of rural general practitioners using behavioral event interview.Methods:The competency characteristics of rural general practitioners were extracted by literature research method, and the behavior event interviews were conducted with 18 rural general practitioners nationwide from January to April 2019. According to the interview results, the items were modified and refined. On this basis, the benchmark competencies and excellent competencies of rural general practitioners were extracted.Results:A total of 45 885-second audio recordings and 174 523-word transcripts were obtained from the interviews. Eight identification competencies and 10 benchmark competencies were extracted. Identification competencies included "professionalism, altruism and dedication, love and compassion, visiting a patient at home, establishing good relationships, achievement-oriented, having expertise, and mastering community population dynamics and health status actively". Benchmark competencies included "diagnosis and treatment of common diseases, basic medical skills, learning consciousness and ability, solving medical problems with traditional Chinese medicine, health care for focal groups, rational administration of drug, referral services, managing chronic non communicable diseases, understanding health care system and related policies, and emergency treatment ability".Conclusions:This study preliminarily obtains the identification competencies and benchmark competencies of rural general practitioners. Managers can improve the service quality of rural general practitioners according to these elements.

国家卫生健康委要求,所有负责全科医学住院医师规范化培训的临床基地(综合医院)〔临床住培基地(综合医院)〕必须独立设置全科医学科.但科室开设以后,应该如何配置与建设,相关研究开展较少.目前,许多新开设的全科医学科正在套用其他医学专科的配置与建设评价标准,这些标准与全科医学学科特色不相适应,已经对其发展形成制约.本课题组通过文献检索、专题小组讨论和德尔菲专家咨询构建了临床住培基地(综合医院)全科医学科配置与建设评价模型,包含6个一级指标、22个二级指标、78个三级指标及其评价标准,凸显了全科医学科的建科宗旨,体现了全科医疗的基本原则,强调了基层医疗的指导与提升,为指导和规范综合医院全科医学科的建设提供了借鉴和思考.

General practitioners are the gatekeepers of health care system, the comprehensive competence of general practitioners is closely related to the quality of health service and health level of the people; therefore it is important to establish and improve the training and evaluation system for post competency of general practitioners. This paper introduces the post competency models of general practitioners at home and abroad, and analyzes their similarities and differences. Hopefully, it would provide reference for build up a better post competency model for general practitioners in China.

Objective:To explore the competency for the assistant general practitioners in China to provide theoretical support for the construction of the post competence model of assistant general practitioners and training and evaluation of assistant general practitioners.Methods:During January 22 to June 18, 2019, Using snowball sampling method and behavioral event interviews, 23 general practitioners and assistant general practitioners were interviewed in China, including 14 general practitioners in the superior performance group and 9 assistant general practitioners in the average performance group. The interview contents were coded and analyzed, and the statistical methods of t test and rank sum test of two independent samples were used to screen competency characteristics and construct the competence model of assistant general practitioners.Results:The total classification consistency and the total coding reliability coefficient was respectively 0.79, 0.87. 59 competency characteristics of assistant general practitioners were obtained including 3 differentiated competency characteristics "Understanding the medical and health system and related policies", "Critical thinking skills" and "General practitioner clinical thinking" and 10 baseline competency characteristics. There was no statistically significant difference between the average performance group and the superior performance group in the total frequency of competency [(29.4±12.7) times to (23.4±7.0) times, t=1.27, P=0.22]. Conclusion:The preliminary competency characteristics of assistant general practitioners have good reliability and can provide references for further exploration of the competency model.

背景 国家卫生健康委要求,所有负责全科医学住院医师规范化培训的临床基地(综合医院)〔临床住培基地(综合医院)〕必须独立设置全科医学科.但国内对于如何设置和建设综合医院全科医学科尚缺乏研究和共识.目的 基于德尔菲法构建临床住培基地(综合医院)全科医学科配置与建设评价模型.方法 2018年11月—2020年5月,由9名研究者组成研究团队,通过文献检索纳入各类资料15篇并提炼评价指标和评价标准,通过专题小组讨论对综合医院全科医学科的定位与评价指标进行深入分析并提炼具体指标和标准,综合结果 形成德尔菲专家咨询问卷(第一轮).然后从全国各地区选取专家45名,以E-mail或现场发放问卷的方式邀请专家参加3轮德尔菲专家咨询,对初步设计的评价体系进行指标筛选、权重设计和评价标准修改.结果 经过三轮专家咨询,构建了包含6个一级指标(基础条件、医疗技术队伍、医疗服务能力与水平、医疗质量状况、教学、科研)、22个二级指标、78个三级指标及其评价标准在内的三级指标评价模型.专家积极系数分别为84.4％(38/45)、92.1％(35/38)、91.4％(32/35),专家权威系数为0.94,第三轮咨询后,专家协调系数为0.716,协调性检验P<0.001.结论 本研究完整和透明地报告了中国医科大学附属第一医院全科医学科研究组开发和完善临床住培基地(综合医院)全科医学科配置与建设评价模型的方法 、过程和经验.

背景在临床住培基地(综合医院)开设全科医学科是国家卫健委为推动全科医学发展提出的新举措.然而目前,由于国内尚未出台标准化的临床住培基地(综合医院)全科医学科评价体系,许多医院的全科医学科正在延用专科科室的评价标准,而这些标准与全科医学的学科特色不相适应.此外,全科医学科定位不明确、全科医学挂靠在其他临床科室的情况也较常见.建立健全医院全科医学科的评价体系,已经成为当前亟待解决的新要求.目的探讨临床住培基地(综合医院)全科医学科的定位及其评价指标.方法于2019年3月29—31日,在第六届海峡两岸全科医学大会召开期间,采用目的性抽样法,邀请数名来自不同省市的综合医院全科医学科的科室负责人参加专题小组讨论会议两次.本课题工作小组人员共6名.两次会议的调查对象为同一批专家,第一次参会专家人数为7名,第二次参会专家为4名.会议前期,初步拟定评价综合医院全科医学科的5个一级指标,分别为"基础条件""医疗技术队伍""医疗服务能力与水平""医疗质量状况"和"科研与教学",并以此为基础制定了第一次会议的讨论提纲.在第一次会议结束之后,研究人员对会议内容及时分析和整理,在此基础上拟定了第二次会议的讨论提纲,再次归纳考核指标.会议由主持人主持,全程使用录音,并在结束后及时进行转录、编码和分析.结果临床住培基地(综合医院)全科医学科的定位是培养基层全科医生.将综合医院全科医学科的一级指标修改为"基础条件""医疗技术队伍""医疗服务能力与水平""医疗质量状况"和"教学与科研".其中"基础条件"包括病房规模及床位数、门诊规模、发展环境、相关科室能够满足全科住培轮转需要、合作的基层医疗服务机构能够满足全科住培轮转需要、场地和设备能够满足全科住培轮转需要;"医疗技术队伍"包括学科带头人和学科骨干、医师队伍、护理队伍;"医疗服务能力与水平"包括总体水平、诊治能力、辐射能力;"医疗质量状况"参照医院一般要求;"教学与科研"包括全科医学住院医师规范化培训、研究方向、科研项目和科研成果.结论明确了临床住培基地(综合医院)全科医学科的定位,并对其评价指标进行了归纳性分析,为进一步完善和构建评价指标体系提供了参考依据.

Medical education bears the heavy responsibility of training clinical talents for medical and healthcare services. To satisfy development needs of the "Healthy China" strategy, alleviate the scarcity of medical talents, and improve the quality of talents output in higher medical education, it is urgent to establish a complete, scientific, and effective teaching quality assurance system based on the particularity and regularity of higher medical education, thus to ensure the reform and development of medical education and gradually improve the quality of personnel training. This paper analyzes the main problems existing in the quality assurance system of higher medical education in China and proposes targeted countermeasures and suggestions, thereby providing references for further exploration and construction of a multi-level, scientific, and sound education quality assurance system that is suitable for the current situation of medical education in China.