全科醫(yī)師教育培訓(xùn)與評估PPT模板（課件分享）

1、1全科醫(yī)師教育培訓(xùn)與評估PPT模板2全科醫(yī)師教育培訓(xùn)與評估 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據(jù)統(tǒng)計，所有到醫(yī)院就診的患者中只有據(jù)統(tǒng)計，所有到醫(yī)院就診的患者中只有5%左右需要專左右需要?？漆t(yī)師的診治，而人群中科醫(yī)師的診治，而人群中8090%的健康問題可以的健康問題可以由以全科醫(yī)師（家庭醫(yī)師）為骨干的社區(qū)衛(wèi)生服務(wù)隊(duì)由以全科醫(yī)師（家庭醫(yī)師）為骨干的社區(qū)衛(wèi)生服務(wù)隊(duì)伍來解決伍來解決 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發(fā)達(dá)國家的實(shí)踐經(jīng)驗(yàn)也告訴我們：控制醫(yī)療費(fèi)用，有效利發(fā)達(dá)國家的實(shí)踐經(jīng)驗(yàn)也告訴我們：控制醫(yī)療費(fèi)用，有效利用有限的醫(yī)療保險資源的關(guān)鍵措施是發(fā)展以全科醫(yī)師為骨用有限的醫(yī)療保險資源的關(guān)鍵措施是發(fā)展以全科醫(yī)師為骨干的社區(qū)衛(wèi)生服務(wù)干的社區(qū)衛(wèi)生服務(wù)l近近1010年來，我們致力于畢業(yè)后全科醫(yī)師的教育培訓(xùn)，探索年來，我們致力于

4、畢業(yè)后全科醫(yī)師的教育培訓(xùn)，探索建立新型的全科醫(yī)師教育培訓(xùn)與評估模式建立新型的全科醫(yī)師教育培訓(xùn)與評估模式 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在綜合性教學(xué)醫(yī)院進(jìn)行全科醫(yī)師規(guī)范化培訓(xùn)的探索，建立在綜合性教學(xué)醫(yī)院進(jìn)行全科醫(yī)師規(guī)范化培訓(xùn)的探索，建立

7、適應(yīng)生物心理社會醫(yī)學(xué)模式的新型教學(xué)方式，取代專適應(yīng)生物心理社會醫(yī)學(xué)模式的新型教學(xué)方式，取代?？漆t(yī)學(xué)以知識和技能掌握為重點(diǎn)、以疾病為中心的傳統(tǒng)教科醫(yī)學(xué)以知識和技能掌握為重點(diǎn)、以疾病為中心的傳統(tǒng)教學(xué)模式學(xué)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對象對象 以高等院校臨床醫(yī)學(xué)本科畢業(yè)，有志于從事社區(qū)衛(wèi)生以高等院校臨床醫(yī)學(xué)本科畢業(yè)，有志于從事社區(qū)衛(wèi)生服務(wù)工作的醫(yī)師為培訓(xùn)對象服務(wù)工作的醫(yī)師為培訓(xùn)對象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 參考發(fā)達(dá)國家和地區(qū)的培訓(xùn)要求，結(jié)合我院多年的住院醫(yī)師參考發(fā)達(dá)國家和地區(qū)的培訓(xùn)要求，結(jié)合我院多年的住院醫(yī)師培訓(xùn)經(jīng)驗(yàn)，制定全科醫(yī)師規(guī)范化培訓(xùn)大綱和要求、考核內(nèi)容和培訓(xùn)經(jīng)驗(yàn)，制定全科醫(yī)師規(guī)范化培訓(xùn)大綱和要求、考核內(nèi)容和評估方法。在教學(xué)實(shí)施過程中不斷接受來自培訓(xùn)者和受訓(xùn)者的評估方法。在教學(xué)實(shí)施過程中不斷接受來自培訓(xùn)者和受訓(xùn)者的反饋意見，對培訓(xùn)和考核的方法、內(nèi)容進(jìn)行改進(jìn)和完善反饋意見，對培訓(xùn)和考核的方法、內(nèi)容進(jìn)行改進(jìn)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培訓(xùn)方法培訓(xùn)方法 Training Methodsl分理論學(xué)習(xí)、臨床輪轉(zhuǎn)和社區(qū)實(shí)踐三個階段分理論學(xué)習(xí)、臨床輪轉(zhuǎn)和社區(qū)實(shí)踐三個階段 l理論課程分別由資深全科醫(yī)師和?？漆t(yī)師擔(dān)任授課，理論課程分別由資深全科醫(yī)師和?？漆t(yī)師擔(dān)任授課，并邀并邀請美、英、中國臺灣等地的資深全科醫(yī)師來訪講學(xué)請美、英、中國臺灣等地的資深全科醫(yī)師來訪講學(xué)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臨床輪轉(zhuǎn)要求病區(qū)主治以上醫(yī)師帶教，由我院全科醫(yī)學(xué)臨床輪轉(zhuǎn)要求病區(qū)主治以上醫(yī)師帶教，由我院全科醫(yī)學(xué)科負(fù)責(zé)教學(xué)的醫(yī)師（副高職稱）全程監(jiān)控，及時掌握學(xué)科負(fù)責(zé)教學(xué)的醫(yī)師（副高職稱）全程監(jiān)控，及時掌握學(xué)員的反饋信息，與帶教老師協(xié)調(diào)員的反饋信息，與帶教老師協(xié)

16、調(diào)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培訓(xùn)方法培訓(xùn)方法 T

18、raining Methodsl社區(qū)實(shí)踐期間，學(xué)員由所在社區(qū)的資深醫(yī)師帶教。帶教老師先由我科社區(qū)實(shí)踐期間，學(xué)員由所在社區(qū)的資深醫(yī)師帶教。帶教老師先由我科統(tǒng)一進(jìn)行全科醫(yī)學(xué)理論的培訓(xùn)，并通過電話聯(lián)系、每半年度集中座談統(tǒng)一進(jìn)行全科醫(yī)學(xué)理論的培訓(xùn)，并通過電話聯(lián)系、每半年度集中座談等方式及時反映社區(qū)帶教過程中遇到的問題。學(xué)員則每周回我科集中等方式及時反映社區(qū)帶教過程中遇到的問題。學(xué)員則每周回我科集中1次，利于雙向交流次，利于雙向交流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學(xué)年結(jié)束，舉行學(xué)員座談會，聽取學(xué)

20、員意見和建議，學(xué)年結(jié)束，舉行學(xué)員座談會，聽取學(xué)員意見和建議，改進(jìn)培訓(xùn)方法改進(jìn)培訓(xùn)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培訓(xùn)內(nèi)容和期限培訓(xùn)內(nèi)容和期限Training Contents and Schedule Training Contents and Schedule l培訓(xùn)圍繞以下六方面的能力培養(yǎng)培訓(xùn)圍繞以下六方面的能力培養(yǎng)1.1.患者的照顧患者的照顧2.2.醫(yī)學(xué)知識的掌握醫(yī)學(xué)知識的掌握3.3.實(shí)踐中的學(xué)習(xí)和提高實(shí)踐中的學(xué)習(xí)和提高4.4.人際交流人際交流5.5.職業(yè)道德職業(yè)道德6.6.立足于衛(wèi)生保健系統(tǒng)的醫(yī)療行為立足于衛(wèi)生保健系統(tǒng)的醫(yī)療行為, ,為期為期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培訓(xùn)內(nèi)容和期限培訓(xùn)內(nèi)容和期限 Training Contents and ScheduleTraining Contents and Schedulel理論課程理論課程2 2個月，包括全科醫(yī)學(xué)概論、預(yù)防醫(yī)學(xué)、綜合課程個月，包括全科醫(yī)學(xué)概論、預(yù)防醫(yī)學(xué)、綜合課程（社區(qū)診所的管理、社區(qū)合理用藥、老年病學(xué)、醫(yī)患交流技（社區(qū)診所的管理、社區(qū)合理用藥、

24、老年病學(xué)、醫(yī)患交流技巧及計算機(jī)應(yīng)用課程等）和專業(yè)英語巧及計算機(jī)應(yīng)用課程等）和專業(yè)英語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臨床輪轉(zhuǎn)臨床輪轉(zhuǎn)2626個月，包括內(nèi)、外、婦、兒、急診科、五官科、皮個月，包括內(nèi)、外、婦、兒、急診科、五官科、皮膚科、眼科、康復(fù)科、中醫(yī)科、膚科、眼科、康復(fù)科、中醫(yī)科、CDCCDC等等l社區(qū)實(shí)踐社區(qū)實(shí)踐2020個月個月l輪轉(zhuǎn)期間每月安排學(xué)員集中輪轉(zhuǎn)期間每月安排學(xué)員集中1 1次，講授臨床醫(yī)學(xué)進(jìn)展次，講授臨床醫(yī)學(xué)進(jìn)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考核和評估考核和評估 Examination and AssessmentExamination and Assessmentl圍繞上述圍繞上述6 6方面的能力培養(yǎng)，制定相關(guān)知識、技能和態(tài)度要求，以及相應(yīng)的考核和方面的能力培養(yǎng)，制定相關(guān)知識、技能和態(tài)度要求，以及相應(yīng)的考核和評估表格：如病史質(zhì)量評估表、臨床能力考評表、醫(yī)師接診評估表、文獻(xiàn)綜述評評估表格：如病史質(zhì)量評估表、臨床能力考評表、醫(yī)師接診評估表、文獻(xiàn)綜述評估表、醫(yī)患交流患者評估表、醫(yī)患交流患者家屬評估表、同事評

30、價表、職業(yè)道德估表、醫(yī)患交流患者評估表、醫(yī)患交流患者家屬評估表、同事評價表、職業(yè)道德評價表等，每半年考評評價表等，每半年考評1 1次，由全科教學(xué)組完成對學(xué)員的考評次，由全科教學(xué)組完成對學(xué)員的考評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考核和評估考核和評估 Examination and AssessmentExamination and Assessmentl階段考核：各階段培訓(xùn)結(jié)束后，由我科組織相階段考核：各階段培訓(xùn)結(jié)束后，由我科組織相應(yīng)的理論和臨床技能考核，并將考核結(jié)果記錄應(yīng)的理論和臨床技能考核，并將考核結(jié)果記錄在培訓(xùn)手冊上在培訓(xùn)手冊上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綜合考核：培訓(xùn)結(jié)束后，要求學(xué)員完成以社區(qū)為基礎(chǔ)的論綜合考核：培訓(xùn)結(jié)束后，要求學(xué)員完成以社區(qū)為基礎(chǔ)的論文一篇，通過論文答辯并結(jié)合既往考評結(jié)果，成績合格者文一篇，通過論文答辯并結(jié)合既往考評結(jié)果，成績合格者將獲得衛(wèi)生部頒發(fā)的全科醫(yī)師規(guī)范化培訓(xùn)合格證書將獲得衛(wèi)生部頒發(fā)的全科醫(yī)師規(guī)范化培訓(xùn)合格證書

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結(jié)果結(jié)果 Resultsl建立全科醫(yī)師規(guī)范化培訓(xùn)的模式建立全科醫(yī)師規(guī)范化培訓(xùn)的模式l制定相應(yīng)的教學(xué)大綱、教學(xué)計劃、教學(xué)管理文件和教學(xué)效果評制定相應(yīng)的教學(xué)大綱、教學(xué)計劃、教學(xué)管理文件和教學(xué)效果評估方法估方法l主編多部全科醫(yī)師培訓(xùn)教材：如全科醫(yī)學(xué)概論（第二版）；主編多部全科醫(yī)師培訓(xùn)教材：如全科醫(yī)學(xué)概論（第二版）；全科醫(yī)學(xué)導(dǎo)論（第一版）；社區(qū)常見健康問題（第二全科醫(yī)學(xué)導(dǎo)論（第一版）；社區(qū)常見健康問題（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從從20002000年年1212月至月至20052005年年9 9月舉辦了月舉辦了6 6期畢業(yè)后全科醫(yī)期畢業(yè)后全科醫(yī)師

40、規(guī)范化培訓(xùn)，共招收師規(guī)范化培訓(xùn)，共招收165165名學(xué)員。迄今有名學(xué)員。迄今有7070名學(xué)員名學(xué)員完成培訓(xùn)，通過各項(xiàng)考核，獲得全科醫(yī)師規(guī)范化培完成培訓(xùn)，通過各項(xiàng)考核，獲得全科醫(yī)師規(guī)范化培訓(xùn)合格證書訓(xùn)合格證書 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討論討論 Discussionl目

42、前，全科醫(yī)師規(guī)范化培訓(xùn)仍處出于探索階段，培養(yǎng)目前，全科醫(yī)師規(guī)范化培訓(xùn)仍處出于探索階段，培養(yǎng)合格的全科醫(yī)師是社區(qū)衛(wèi)生服務(wù)可持續(xù)發(fā)展的關(guān)鍵。合格的全科醫(yī)師是社區(qū)衛(wèi)生服務(wù)可持續(xù)發(fā)展的關(guān)鍵。我院全科醫(yī)學(xué)科多年來致力于全科醫(yī)學(xué)教育，旨在培我院全科醫(yī)學(xué)科多年來致力于全科醫(yī)學(xué)教育，旨在培養(yǎng)高素質(zhì)的全科醫(yī)師，充實(shí)全科醫(yī)師及其師資隊(duì)伍養(yǎng)高素質(zhì)的全科醫(yī)師，充實(shí)全科醫(yī)師及其師資隊(duì)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全科醫(yī)師教育培訓(xùn)的重點(diǎn)在于培養(yǎng)全科醫(yī)師提供合理、全科醫(yī)師教育培訓(xùn)的重點(diǎn)在于培養(yǎng)全科醫(yī)師提供合理、有效、人性化醫(yī)療照顧的能力，以及尋找、評價和利用有效、人性化醫(yī)療照顧的能力，以及尋找、評價和利用最佳醫(yī)療方案，解決患者健康問題的能力，以適應(yīng)社區(qū)最佳醫(yī)療方案，解決患者健康問題的能力，以適應(yīng)社區(qū)衛(wèi)生服務(wù)

44、發(fā)展的需求衛(wèi)生服務(wù)發(fā)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討論討論 Discussion 綜合性教學(xué)醫(yī)院有著得天獨(dú)厚的教學(xué)條件，在全科醫(yī)學(xué)的教育培訓(xùn)中擔(dān)負(fù)不綜合性教學(xué)醫(yī)院有著得天獨(dú)厚的教學(xué)條件，在全科醫(yī)學(xué)的教育培訓(xùn)中擔(dān)負(fù)不可或缺的責(zé)任可或缺的責(zé)任 全科醫(yī)學(xué)教育離不開?？漆t(yī)師的作用，然專科醫(yī)師若未經(jīng)過相關(guān)的全科知識全科醫(yī)學(xué)教育離不開?？漆t(yī)師的作用，然專科醫(yī)師若未經(jīng)過相關(guān)的全科知識培訓(xùn)，其?？漆t(yī)療的臨床思維方式在一定程度上將影響全科醫(yī)師的培訓(xùn)質(zhì)培訓(xùn)，其專科醫(yī)療的臨床思維方式在一定程度上將影響全科醫(yī)師的培訓(xùn)質(zhì)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目前的培訓(xùn)評估

48、大多通過調(diào)查問卷的方式，缺目前的培訓(xùn)評估大多通過調(diào)查問卷的方式，缺乏客觀標(biāo)準(zhǔn)，培訓(xùn)的優(yōu)劣將難以彰顯乏客觀標(biāo)準(zhǔn)，培訓(xùn)的優(yōu)劣將難以彰顯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討論討論 Discussionl由于目前全科醫(yī)師的社會地位不高，經(jīng)濟(jì)收入低下，導(dǎo)由于目前全科醫(yī)師的社會地位不高，經(jīng)濟(jì)收入低下，導(dǎo)致培訓(xùn)生源不足，生源質(zhì)量得不到保障；培訓(xùn)過程中學(xué)致培訓(xùn)生源不足，生源質(zhì)量得不到保障；培訓(xùn)過程中學(xué)員流失員流失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