全病程管理在全科医师规范化培训中的实践效果研究  

Effectiveness of Whole-course Management in the Practice of Standardized Training of General Practitioners

作　　者：朱颖菲 张聿炜[1] 罗荧荃[2] 许琰[2] ZHU Yingfei;ZHANG Yuwei;LUO Yingquan;XU Yan(International Medical Department,the Second Xiangya Hospital of Central South University,Changsha 410001,China;Department of General Practice,the Second Xiangya Hospital of Central South University,Changsha 410001,China)

机构地区：[1]中南大学湘雅二医院国际医疗部,湖南省长沙市410001 [2]中南大学湘雅二医院全科医学科,湖南省长沙市410001

出　　处：《中国全科医学》2024年第7期794-800,共7页Chinese General Practice

基　　金：湖南省科学技术厅科普专题项目(2018ZK4037);中南大学学位与研究生教育教学改革研究项目(2023152);中南大学教育教学改革研究项目(2022jy196)。

摘　　要：背景全病程管理是指“以患者为中心”的照护模式,贯穿患者的全病程整体服务体系,旨在提高患者就医满意度,改善就医体验,更好地实施疾病全程管理。全病程管理模式已在多个医学领域如精神类疾病治疗方面取得显著成效,但全病程管理教学模式运用于全科医师培训中研究较少。目的探讨全病程管理教学模式在全科医师规范化培训中的实践效果。方法2022年5月选取中南大学湘雅二医院2020级、2021级和2022级接受国家规范化培训的全科医师60名为研究对象,同时选取30名全病程管理教学导师,每名导师带教2名全科医师,即研究组和对照组全科医师各1名,以减少导师个人因素的影响,确保研究结果更客观。将2020级、2021级、2022级全科医师各级随机分成对照组和研究组,研究组运用全病程管理教学模式,对照组采用传统授课教学模式,各年级推选1名小组长。经过为期9个月(2022年7月—2023年3月)培训后从疾病诊断能力、治疗效果评价、患者管理能力、团队协作能力、自我学习能力、教学能力6个项目进行考评。同时采用自行设计的满意度问卷调查表对全科医师所负责的患者进行调查,3名患者对同一责任全科医师进行评分后取平均分。结果2020级研究组疾病诊断能力、患者管理能力、自我学习能力、教学能力评分高于对照组(P<0.05);2021级研究组疾病诊断能力、团队协作能力、自我学习能力、教学能力评分高于对照组(P<0.05);2022级研究组疾病诊断能力、患者管理能力、团队协作能力、自我学习能力、教学能力评分高于对照组(P<0.05)。满意度结果:2020级和2021级研究组沟通方式、隐私保护、制定诊疗方案/检查知情权、操作给药前解释宣教、治疗效果和操作技能、耐心答疑解惑、责任心/服务态度、廉洁行医、医疗公平公正、出院指导满意度评分高于对照组(P<0.05);2022�Background Whole-course management refers to a patient-centered care model over the entire course of patients,aimed at patients'satisfaction with medical care,improving the whole course management of the disease.The whole-course management model has achieved significant success in various medical fields,such as the treatment of mental health disorders.However,its application in the general practitioner training has been rarely studied.Objective To investigate the practical effectiveness of the whole-course management teaching model in standardized training for general practitioners.Methods A total of 60 general practitioners of grades 2020,2021 and 2022 who received national standardized training at Xiangya Second Hospital of Central South University.Additionally,30 mentors specializing in total disease management were selected,with each mentor supervising two general practitioners,one from the research group and one from the control group,in order to minimize the impact of personal factors of mentors and ensure more objective research results.All levels of general practitioners of grades 2020,2021 and 2022 were randomly divided into the research and control groups.The research group adopted whole-course management teaching mode while the control group followed the traditional lecture-based learning(LBL)model,with one team leader selected from each grade.After a nine-month training period(July 2022 to March 2023),participants were evaluated on 6 items of diagnostic capability,treatment effect evaluation,patient management ability,teamwork ability,self-learning capability,and teaching ability.Simultaneously,a self-designed satisfaction questionnaire was also used to investigate patients under the care of these general practitioners.The average score was calculated based on ratings from three patients per general practitioner.Results Diagnostic capability,patient management ability,self-learning capability,and teaching ability scores of grade 2020 in the research group were high than those of the control group(P<0.

关 键 词：教育 专业 再培训 全病程管理 全科医生 规范化培训 医患沟通 病人满意度 

分 类 号：R192[医药卫生—卫生事业管理]