中国全科医学 ›› 2023, Vol. 26 ›› Issue (31): 3908-3914.DOI: 10.12114/j.issn.1007-9572.2022.0629

• 论著 • 上一篇    下一篇

欠发达地区全科医生岗位胜任力评价指标体系研究

周冬冬1,2,3, 葛许华1,2,4,*()   

  1. 1200092 上海市,同济大学医学院全科医学系
    2200092 上海市,同济大学附属杨浦医院全科医学科
    3315000 浙江省宁波市第一医院全科医学科
    4200092 上海市全科医学与社区卫生发展研究中心
  • 收稿日期:2022-08-26 修回日期:2023-06-09 出版日期:2023-11-05 发布日期:2023-06-21
  • 通讯作者: 葛许华

  • 作者贡献:周冬冬进行文章的构思与设计、数据收集及整理、结果的分析与解释,撰写论文,并负责论文的修订;葛许华进行研究的实施与可行性分析,负责文章的质量控制及审校,对文章整体负责,监督管理。
  • 基金资助:
    同济大学研究生医学教育管理专项项目(2021YXGL14); 上海市医药卫生发展基金会课题(SE1201933)

The Evaluation Index of Post Competence of General Practitioners in Less-developed Areas

ZHOU Dongdong1,2,3, GE Xuhua1,2,4,*()   

  1. 1Academic Department of General Practice, School of Medicine, Tongji University, Shanghai 200092, China
    2Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai 200092, China
    3Department of General Practice, Ningbo First Hospital, Ningbo 315000, China
    4Shanghai General Practice and Community Health Development Research Center, Shanghai 200092, China
  • Received:2022-08-26 Revised:2023-06-09 Published:2023-11-05 Online:2023-06-21
  • Contact: GE Xuhua

摘要: 背景 国内关于全科医生岗位胜任力评价指标的研究主要来自东部经济发达地区,而我国地区间医疗资源配置不平衡、医疗水平差距较大,现有全科医生岗位胜任力评价指标在农村地区或者欠发达地区的适用性可能不足。 目的 构建可用于评判欠发达地区全科医生岗位胜任力的指标体系,为欠发达地区全科医学人才培养、考核、评价提供参考依据。 方法 通过文献研究法初步构建欠发达地区全科医生岗位胜任力评价指标体系。于2021年1—6月,采用目的抽样法,从在欠发达地区从事全科临床工作者、在州/县/乡镇从事全科临床实践/卫生行政管理工作者,以及参与过东西部对口帮扶且曾在欠发达地区挂职的全科医生中遴选18名咨询专家。分别运用专家咨询法、层次分析法完成欠发达地区全科医生岗位胜任力评价指标筛选工作、各指标权重的确定工作。 结果 两轮专家咨询问卷的有效回收率均为100.0%,专家熟悉、判断、权威系数分别为0.76、0.84、0.80,肯德尔协调系数分别为0.24(χ2=297.543,P<0.001)、0.26(χ2=322.083,P<0.001)。建立了包含4个一级指标、20个二级指标、44个三级指标的欠发达地区全科医生岗位胜任力评价指标体系。一级指标"医疗服务能力""公共卫生服务能力""组织管理和应对能力""职业素养"的权重分别为0.350 9、0.109 1、0.189 1、0.350 9;二级指标中,组合权重位列前4位的指标分别为"业务素质"(0.177 1)、"学习思维能力"(0.126 5)、"基层沟通协调"(0.118 6)、"常见病、多发病诊治"(0.108 9);三级指标中,组合权重位列前4位的指标分别为"工作中与患者、同事、上级医院医生文明沟通、友好交流"(0.118 6)、"人文关怀"(0.098 9)、"掌握心肺复苏术(CPR)、除颤术、导尿术等临床适宜技术"(0.088 3)、"常见病、多发病诊断和治疗"(0.081 7)。 结论 本研究构建的欠发达地区全科医生岗位胜任力评价指标体系具有实用性和科学性,可为欠发达地区全科医生岗位胜任力评价提供科学依据。

关键词: 欠发达地区, 全科医生, 岗位胜任力, 评价指标, 社区卫生服务

Abstract:

Background

Domestic studies on post competency evaluation indexes of general practitioners mainly focus on economically developed areas in the east. While the applicability of existing evaluation indexes of post competency of general practitioners in rural areas or less-developed areas may be insufficient due to unbalanced allocation of medical resources and large disparities in medical levels among different regions in China.

Objective

To construct an evaluation index system for the post competency of general practitioners and to provide reference for the training, assessment and evaluation of general practitioners in less-developed areas.

Methods

An evaluation index system for the post competency of general practitioners in less-developed areas was constructed preliminarily through literature research. From January to June of 2021, 18 consultant experts were selected respectively from general practice clinical workers practicing in less-developed areas, general practice/health administration workers in provinces/counties/towns and general practitioners who had participated in the counterpart support in the east-west counterpart support and worked in less developed areas by purposive sampling method. The expert consultation and hierarchical analysis were used to complete the screening of evaluation indexes of post competency of general practitioners and determine the weight of each index in less-developed areas.

Results

The effective recovery rate of two rounds of expert consultation questionnaires were 100.0%; the familiarity, judgment and authority coefficients were 0.76, 0.84 and 0.80; the Kendall coordination coefficients were 0.24 (χ2=297.543, P<0.001) and 0.26 (χ2=322.083, P<0.001). The evaluation index system for the post competency of general practitioners in less-developed areas was constructed consisting of 4 primary indexes, 20 secondary indexes and 44 tertiary indexes. The weights of primary indexes including "medical service capacity" "public health service capacity" "organizational management and coping ability" and "professionalism" were 0.350 9, 0.109 1, 0.189 1 and 0.350 9, respectively. The top 4 combination weighted indexes in secondary indexes were "professional quality" (0.177 1), "learning and thinking ability" (0.126 5), "communication and coordination in primary care" (0.118 6), "diagnosis and treatment of common diseases" (0.108 9). The top 4 combination weighted indexes in tertiary indexes were "civilized communication and friendship exchange with patients, colleagues and physicians at superior hospitals" (0.118 6), "humanistic care" (0.098 9), "mastering clinical appropriate technology such as cardiopulmonary resuscitation (CPR), defibrillation and catheterization" (0.088 3), "diagnosis and treatment of common and frequently-occurring diseases" (0.081 7) .

Conclusion

The evaluation index system for the post competency of general practitioners in less-developed areas constructed in the study have practicability and scientificity, which can provide scientific basis for the evaluation of post competency of general practitioners in less-developed areas.

Key words: Less-developed areas, General practitioners, Post competency, Evaluation index, Community health services