中国全科医学 ›› 2022, Vol. 25 ›› Issue (22): 2706-2713.DOI: 10.12114/j.issn.1007-9572.2022.0228

所属专题: 全科医学教育专题研究

• 全科医学教育专题研究 • 上一篇    下一篇

住院医师规范化培训对订单定向医学生执业医师资格考试通过率的影响研究

李明月1,2, 左延莉3,*(), 张发斌4, 王子岳2, 程昊哲1,2, 刘晓云2   

  1. 1100191 北京市,北京大学公共卫生学院
    2100191 北京市,北京大学中国卫生发展研究中心
    3530021 广西壮族自治区南宁市,广西医科大学全科医学院
    4810011 青海省西宁市,青海大学医学院
  • 收稿日期:2022-03-28 修回日期:2022-06-08 出版日期:2022-08-05 发布日期:2022-06-23
  • 通讯作者: 左延莉
  • 李明月,左延莉,张发斌,等. 住院医师规范化培训对订单定向医学生执业医师资格考试通过率的影响研究[J]. 中国全科医学,2022,25(22):2706-2713.[www.chinagp.net]
    作者贡献:李明月、刘晓云负责文章的构思与设计;李明月负责数据处理与分析、撰写论文,并对文章负责;王子岳、程昊哲、刘晓云负责研究的实施和管理;李明月、王子岳、程昊哲负责数据收集与整理;左延莉、张发斌负责文章指导、质量控制与审校。
  • 基金资助:
    美国中华医学基金会项目(CMB 18-294)

Effect of Residency Standardized Training on the Pass Rate of the Practicing Physician Examination in Medical Graduates of Rural Compulsory Services Program

Mingyue LI1,2, Yanli ZUO3,*(), Fabin ZHANG4, Ziyue WANG2, Haozhe CHENG1,2, Xiaoyun LIU2   

  1. 1School of Public Health, Peking University, Beijing 100191, China
    2China Center for Health Development Studies, Peking University, Beijing 100191, China
    3Department of General Medicine, Guangxi Medical University, Nanning 530021, China
    4Medical College of Qinghai University, Xining 810011, China
  • Received:2022-03-28 Revised:2022-06-08 Published:2022-08-05 Online:2022-06-23
  • Contact: Yanli ZUO
  • About author:
    LI M Y, ZUO Y L, ZHANG F B, et al. Effect of residency standardized training on the pass rate of the practicing physician examination in medical graduates of rural compulsory services program[J]. Chinese General Practice, 2022, 25 (22) : 2706-2713.

摘要: 背景 为加强农村地区卫生人才队伍建设,我国于2010年开始实施农村订单定向医学生培养项目。2015年,国家要求订单定向毕业生在毕业后须参加为期3年的住院医师规范化培训(简称住培)。 目的 了解订单定向毕业生参加住培情况,分析住培对执业医师资格考试通过率的影响,探究住培对订单定向毕业生培养和农村基层卫生人力的意义,为订单定向毕业生的高质量培养提供政策建议。 方法 2015年开始,在我国中西部3个省份共抽取4所承担订单定向培养项目的高校,建立订单定向毕业生队列,并按照班级1∶1选取同年毕业的普通临床毕业生作为对照,每年进行追踪随访。利用描述性分析展示订单定向毕业生参加住培的情况、执业医师资格考试通过率,并与普通临床毕业生比较。采用Cox回归分析参加住培对执业医师资格考试通过率的影响。 结果 2015—2019届订单定向毕业生中分别有86.69%(228/263)、86.78%(361/416)、87.79%(381/434)、91.08%(388/426)、94.43%(356/377)表示毕业后愿意参加住培,同届普通临床毕业生毕业后愿意参加住培的比例分别为72.20%(200/277)、58.75%(151/257)、70.42%(169/240)、73.23%(145/198)、61.03%(83/136);2015—2019届订单定向毕业生实际参加住培的比例分别为99.02%(202/204)、97.10%(301/310)、94.99%(322/339)、89.91%(285/317)、69.45%(241/347),同届普通临床生的参加比例分别为67.57%(100/148)、66.12%(80/121)、74.79%(89/119)、43.33%(39/90)、34.62%(27/78)。2015—2017届订单定向毕业生执业医师资格考试通过率达到99.23%(259/261)、94.86%(351/370)、91.74%(311/339),同届普通临床生的通过率分别为97.74%(173/177)、95.87%(116/121)、88.24%(105/119)。Cox回归结果显示,校正人口学变量、家庭经济状况、学医意愿、医学教育情况、参加住培相关因素后,参加住培组通过执业医师资格考试的概率是未参加住培组的1.23倍〔95%CI(1.02,1.49),P=0.031〕。 结论 订单定向毕业生住培参加意愿、住培参加比例、执业医师资格考试通过率均较高。参加住培能提高医学毕业生的能力,对通过执业医师资格考试有促进作用。

关键词: 全科医生, 订单定向医学生, 教育,医学, 住院医师规范化培训, 执业医师资格考试

Abstract:

Background

To strengthen the construction of health talents team in rural areas, a national compulsory services program (CSP) was started in 2010 in China. In 2015, the state required graduates of the CSP to participate in a 3-year standardized training for residents (residency) upon graduation.

Objective

To understand the participation of CSP graduates in residency, analyze the effect of residency on the pass rate of the practicing physician's examination for CSP graduates, and explore the significance of residency on the training of CSP graduates and the rural primary health workforce, so as to provide policy recommendations for the high-quality training of CSP graduates.

Methods

Starting in 2015, a cohort of CSP graduates was established from a total of 4 colleges undertaking CSP training programs in 3 provinces in the Midwest of China, and 1∶1 general clinical graduates who graduated the same year were selected as controls and followed up annually. Descriptive analysis was used to show the status of CSP graduates' participation in residency, the pass rate of the examination for practicing physicians, and to compare them with those of general clinical graduates. Stratified Cox regression was used to analyze the effect of attending residency on the pass rate of practicing physician exams.

Results

86.69% (228/263), 86.78% (361/416), 87.79% (381/434), 91.08% (388/426), 94.43% (356/377) of the 2015—2019 CSP graduates stated that they were willing to participate in training after graduation, and 72.20% (200/277), 58.75% (151/257), 70.42% (169/240), 73.23% (145/198), 61.03% (83/136) of the same general clinical graduates stated that they were willing to participate in training after graduation. The actual participation proportions of CSP graduates in 2015—2019 in residency were 99.02% (202/204), 97.10% (301/310), 94.99% (322/339), 89.91% (285/317), 69.45% (241/347), 67.57% (100/148), 66.12% (80/121), 74.79% (89/119), 43.33% (39/90), 34.62% (27/78), respectively. The pass rate of practicing physician examination in 2015—2017 CSP graduates reached 99.23% (259/261), 94.86% (351/370), 91.74% (311/339), while the pass rate of same general clinical students was 97.74% (173/177), 95.87% (116/121), 88.24% (105/119), respectively. Cox regression results showed that after adjusting for demographic variables, family economic status, intention of studying medicine, medical education, and factors related to attending the residency, the probability of attending the residency group passing the practitioner's examination was 1.232 times higher than that of not attending the residency group 〔95%CI (1.02, 1.49), P=0.03〕.

Conclusion

CSP graduates' willingness to participate in residency training, the proportion of participation, and the pass rate of the qualifying examination for practicing physicians were all high. Participating in residency training can improve the ability of medical graduates and has a promoting effect on passing the qualifying examination of practicing physicians.

Key words: General practitioners, Target admission medical graduates, Education, medical, Standardized residency training, Practicing physician examination