Recent Developments in General Practitioners' Competence Evaluation

doi:10.12114/j.issn.1007-9572.2020.00.314

Abstract

Abstract: The evaluation of general practitioners'（GPs'） ability is a systematic project，which plays an important role in the development of general medicine，the construction of GPs team and the progress of community health in China.This paper systematically reviews the similarities and differences of GPs' competence assessment in the United States，the United Kingdom，Australia and Canada，as well as the advantages and disadvantages of the main assessment methods for GPs' competence in China，such as institutional self-assessment，physician performance assessment，professional title assessment and appointment，and regular physician performance assessment，and the research progress in competency assessment，comprehensive ability assessment and clinical ability assessment in China. On this basis，this paper puts forward suggestions for the evaluation of GPs' ability in China：unifying the evaluation standards，standardizing the assessment process；setting reasonable indicators，focusing on empirical research；conducting normal management，dynamic assessment，and scientific assessment. In addition，this paper introduces the TSH（theory-skill-humanity） competence evaluation model proposed by Shanghai Shanggang Community Health Center，which will be an important method for GPs' competence evaluation in line with the general medicine development of China.

Key words: General practitioners, Employee performance appraisal, Educational measurement, Community health services, Review

摘要： 全科医生能力评价是一项系统工程，对我国全科医学发展、全科医生队伍建设及社区卫生事业进步具有重要作用。本文系统梳理了美国、英国、澳大利亚、加拿大全科医生考核的异同点，以及我国全科医生能力评价主要方式（机构自行考核、医师绩效考核、职称评聘、医师定期考核）的优缺点和在胜任力评价、综合能力评价、临床能力评价方面的研究进展。在此基础上，提出了针对我国全科医生能力评价的建议：统一评价标准，规范考核流程；设定合理指标，注重实证研究；常态管理，动态考核，科学评价。另外，本文介绍了由上海市上钢社区卫生服务中心提出的TSH（理论知识-theory、操作技能-skill、人文关怀-humanity）全科医生能力评价模型，认为其将是符合我国全科医学发展的全科医生能力评价方法。

关键词: 全科医生, 雇员能力评价, 教育考核, 社区卫生服务, 综述

LIU Pingyang,WANG Haitang,DU Zhaohui. Recent Developments in General Practitioners' Competence Evaluation　[J]. Chinese General Practice, 2020, 23(25): 3220-3225. DOI: 10.12114/j.issn.1007-9572.2020.00.314.
刘平阳,王海棠,杜兆辉. 全科医生能力评价研究进展[J]. 中国全科医学, 2020, 23(25): 3220-3225. DOI: 10.12114/j.issn.1007-9572.2020.00.314.

References

［1］尹文生，吴蔚．知识素养及其要素模型［M］．武汉：华中科技大学出版社，2017：7-8.
［2］潘莹，于德华，陆媛，等．基于文献分析的全科医生综合能力评价指标体系构建研究［J］．中国全科医学，2016，19（s1）：248-250.
PAN Y，YU D H，LU Y，et al．Construction of comprehensive ability evaluation index system of general practitioners based on the literature analysis［J］．Chinese General Practice，2016，19（s1）：248-250.
［3］熊春华，姜靓翎．基于岗位胜任力的加拿大全科医师能力框架述评［J］．赤峰学院学报（汉文哲学社会科学版），2018，39（12）：166-168．DOI：10.13398/j.cnki.issn1673-2596.2018.12.046.
XIONG C H，JIANG L L．Review of Canada general practitioners competency framework based on post competency［J］．Journal of Chifeng University（Philosophy and Social Science Chinese Edition），2018，39（12）：166-168．DOI：10.13398/j.cnki.issn1673-2596.2018.12.046.
［4］戴汉军，蔡小军．美国以能力为基础的住院医师培训探析［J］．中华医学教育杂志，2012，32（4）：635-637．DOI：10.3760/cma.j.issn.1673-677X.2012.04.054.
DAI H J，CAI X J．The analysis of the competency-based residency training program in the United States of America［J］．Chinese Journal of Medical Education，2012，32（4）：635-637．DOI：10.3760/cma.j.issn.1673-677X.2012.04.054.
［5］陈韶华，王筝扬．基于岗位胜任力的美国全科医学住院医师milestones评价系统解读与思考［J］．全科医学临床与教育，2018，16（2）：121-126．DOI：10.13558/j.cnki.issn1672-3686.2018.02.001.
CHEN S H，WANG Z Y．Milestones evaluation：competency assessment in family medicine residency in USA［J］．Clinical Education of General Practice，2018，16（2）：121-126．DOI：10.13558/j.cnki.issn1672-3686.2018.02.001.
［6］杨人灵，郭伟，姜悦，等．国内外全科医师规范化培训考核评价现状［J］．医学研究杂志，2015，44（6）：176-178.
［7］胡滨．国内外住院医师规范化培训考核评价模式的研究［J］．卫生软科学，2013，27（8）：480-482.
［8］陈丽英，方力争．英国全科住院医生教学模式和考核评价体系的探讨［J］．全科医学临床与教育，2016，14（4）：361-362．DOI：10.13558/j.cnki.issn1672-3686.2016.04.001.
［9］卢永平，王军．英国QOF经验对我国全科医生职称评审指标体系构建的启示［J］．中国社区医师，2019，35（6）：182-183，185.
LU Y P，WANG J．The enlightenment from QOF in Britain to the establishment of title assessment index system of generalpractitioners in China［J］．Chinese Community Doctors，2019，35（6）：182-183，185．
［10］史超．澳大利亚全科医学教育对上海全科医生培养的启示［J］．上海医药，2013，34（10）：20-22.
［11］EGGLESTONE D．Standard setting for fellowship exam［EB/OL］．（2013-05-01）［2019-12-13］．http://www.gp10.com.au/slides/thursday/slide25.pdf.
［12］王欣怡，崔爽，段丽萍．澳大利亚全科医学教育考核评估体系及启示［J］．中国全科医学，2014，17（29）：3407-3409．DOI：10.3969/j.issn.1007-9572.2014.29.001.
WANG X Y，CUI S，DUAN L P．Inspiration and reference of Australian general practice education assessment system［J］．Chinese General Practice，2014，17（29）：3407-3409．DOI：10.3969/j.issn.1007-9572.2014.29.001.
［13］RACGP．QI&CPD program：2017—2019 triennium handbook for general practitioners［EB/OL］．［2019-12-22］．https://www.racgp.org.au/education/professional-development/qi-cpd.
［14］李展宗，江黎黎，杨辉．澳大利亚全科医学持续职业发展教育项目及其对我国深圳市全科医学发展的启示［J］．中国全科医学，2019，22（4）：451-456．DOI：10.12114/j.issn.1007-9572.2019.04.017.
LI Z Z，JIANG L L，YANG H．Implication of continuing education programs for general practice in Australia to general practice development in Shenzhen，China［J］．Chinese General Practice，2019，22（4）：451-456．DOI：10.12114/j.issn.1007-9572.2019.04.017.
［15］Working Group on Curriculum Review．CanMEDS-FM 2009
［EB/OL］．［2019-12-01］．https://www.cfpc.ca/uploadedFiles/Education/CanMeds%20FM%20Eng.pdf.
［16］李文惠，陈校云，余中光，等．加拿大医学教育模式对我国医师培养的启示［J］．中国高等医学教育，2015，29（6）：122-123.
［17］纪婷婷，孟纪蕊，张群，等．我国医师能力评价研究述评［J］．中国社会医学杂志，2019，36（3）：295-298．DOI：10.3969/j.issn.1673-5625.2019.03.021.
JI T T，MENG J R，ZHANG Q，et al．Research on the assessment of physician's competence in China［J］．Chinese Journal of Social Medicine，2019，36（3）：295-298．DOI：10.3969/j.issn.1673-5625.2019.03.021.
［18］李觅琼，吴玉苗，朱捷，等．基于Delphi法的家庭医生服务能力评估体系的建立［J］．中国全科医学，2019，22（16）：1989-1995．DOI：10.12114/j.issn.1007-9572.2019.00.193.
LI M Q，WU Y M，ZHU J，et al．Development of a family doctor performance evaluation system using the Delphi method［J］．Chinese General Practice，2019，22（16）：1989-1995．DOI：10.12114/j.issn.1007-9572.2019.00.193.
［19］王芳．全科医生综合素质评价指标体系的构建研究［D］．青岛：青岛大学，2017：12-13.
［20］袁林林，邵雨辰，任乐濛，等．新医改以来我国社区卫生服务机构人员绩效考核实施进展［J］．中国全科医学，2018，21（28）：3417-3422，3429．DOI：10.12114/j.issn.1007-9572.2018.28.003.
YUAN L L，SHAO Y C，REN L M，et al．Implementation progress in performance appraisal for the staff of community health institutions in China after new health reform［J］．Chinese General Practice，2018，21（28）：3417-3422，3429．DOI：10.12114/j.issn.1007-9572.2018.28.003.
［21］杜晖，曹文芳，朱红英．以标化工作量为基础的绩效考核评价体系对社区卫生综合改革的推动作用［J］．智慧健康，2017，3（4）：27-30．
［22］王思敏，徐伟，崔子丹，等．美国加利福尼亚州以价值为本的按绩效付费项目及其对我国全科医生绩效考核体系和激励机制的启示［J］．中国全科医学，2019，22（13）：1522-1527．DOI：10.12114/j.issn.1007-9572.2019.00.215.
WANG S M，XU W，CUI Z D，et al．The enlightenment of value-based pay for performance program in California on improving the performance evaluation system and incentive mechanism of general practitioners in China［J］．Chinese General Practice，2019，22（13）：1522-1527．DOI：10.12114/j.issn.1007-9572.2019.00.215.
［23］王艳斌，欧阳昭连，陈薇，等．我国全科医师职称评审现状［J］．中国全科医学，2014，17（13）：1569-1570．DOI：10.3969/j.issn.1007-9572.2014.13.031.
WANG Y B，OUYANG Z L，CHEN W，et al．The status quo of the title assessment of general practitioners in our country［J］．Chinese General Practice，2014，17（13）：1569-1570．DOI：10.3969/j.issn.1007-9572.2014.13.031.
［24］郑宇．从考核机构角度谈医师定期考核中存在的问题及完善路径［J］．江苏卫生事业管理，2018，29（2）：235-237．DOI：10.3969/j.issn.1005-7803.2018.02.036.
［25］吴晓红，金跃明．关于医师定期考核工作中的问题与建议［J］．白求恩医学杂志，2015，13（6）：667-669．
［26］EPSTEIN R M．Defining and assessing professional competence［J］．JAMA，2002，287（2）：226．DOI：10.1001/jama.287.2.226.
［27］陆志敏，陆萍．全科医生岗位胜任力指标的探索性分析［J］．中国全科医学，2019，22（28）：3495-3500．DOI：10.12114/j.issn.1007-9572.2019.00.389.
LU Z M，LU P．Exploratory analysis of competency indicators for general practitioners［J］．Chinese General Practice，2019，22（28）：3495-3500．DOI：10.12114/j.issn.1007-9572.2019.00.389.
［28］张利平，郑文贵，李望晨，等．多属性决策技术在全科医生核心胜任力综合评价中的应用研究［J］．中国卫生事业管理，2016，33（2）：137-141.
ZHANG L P，ZHENG W G，LI W C，et al．Discussing the application of multi-attribute decision in the comprehensive evaluation of general practitioners' core competency［J］．Chinese Health Service Management，2016，33（2）：137-141.
［29］韩颖，王晶，郑建中，等．全科医生岗位胜任力评价指标体系的构建研究［J］．中国全科医学，2017，20（1）：15-20．DOI：10.3969/j.issn.1007-9572.2017.01.004.
HAN Y，WANG J，ZHENG J Z，et al．Construction of evaluation index system of post competency of general practitioners［J］．Chinese General Practice，2017，20（1）：15-20．DOI：10.3969/j.issn.1007-9572.2017.01.004.
［30］陆萍，戈园园，钱志龙，等．基于岗位胜任力的家庭医生综合能力考评办法开发研究［J］．中国全科医学，2020．［Epub ahead of print］．DOI：10.12114/j.issn.1007-9572.2020.00.075.
LU P，GE Y Y，QIAN Z L，et al．Development of a comprehensive ability assessment method for family doctors based on post competency［J］．Chinese General Practice，2020．［Epub ahead of print］．DOI：10.12114/j.issn.1007-9572.2020.00.075.
［31］叶腾飞，潘小炎．基于层次分析法的广西城市社区全科医生能力评价指标体系的构建研究［J］．中国全科医学，2014，17（7）：752-755．DOI：10.3969/j.issn.1007-9572.2014.07.006.
YE T F，PAN X Y．Construction of evaluating index system based on the AHP on the competence of urban general practitioner in Guangxi［J］．Chinese General Practice，2014，17（7）：752-755．DOI：10.3969/j.issn.1007-9572.2014.07.006.
［32］潘莹，陈宇革，王朝昕，等．基于人才培养的上海市某区全科医生综合能力评价研究［J］．中国全科医学，2020．［Epub ahead of print］．DOI：10.12114/j.issn.1007-9572.2020.00.072.
PAN Y，CHEN Y G，WANG Z X，et al．Personal development-oriented comprehensive ability evaluation for general practitioners：a survey from a district of Shanghai［J］．Chinese General Practice，2020．［Epub ahead of print］．DOI：10.12114/j.issn.1007-9572.2020.00.072.
［33］陈丽芬，路孝琴.全科医师临床能力的评价体系［J］．中华全科医师杂志，2014，13（8）：617-619．DOI：10.3760/cma.j.issn.1671-7368.2014.08.001.
［34］WEINGARTEN M A，YAPHE J，BLUMENTHAL D，et al．A comparison of videotape and audiotape assessment of patient-centredness in family physicians' consultations［J］．Patient Educ Couns，2001，45（2）：107-110．DOI：10.1016/s0738-3991(00)00199-3.
［35］陈丽芬，贾建国，路孝琴．列斯特评估量表及其在全科医生应诊能力评价中的应用［J］．中国全科医学，2016，19（4）：447-450．DOI：10.3969/j.issn.1007-9572.2016.04.018.
CHEN L F，JIA J G，LU X Q．Leicester assessment package and its application in the assessment of the consultation ability of general practitioners［J］．Chinese General Practice，2016，19（4）：447-450．DOI：10.3969/j.issn.1007-9572.2016.04.018.
［36］许龙龙，苏婷婷，王爽，等．社区全科医生临床基本能力评估指标体系的初步研究［J］．中国全科医学，2013，16（34）：3358-3361．DOI：10.3969/j.issn.1007-9572.2013.28.022.
XU L L，SU T T，WANG S，et al．A preliminary study on the assessment index system of clinical core competencies for the community general practitioners［J］．Chinese General Practice，2013，16（34）：3358-3361．DOI：10.3969/j.issn.1007-9572.2013.28.022.
［37］王美荣，杜娟，刘英杰，等．全科医学规范化培训应诊能力评价指标体系探索［J］．医学教育管理，2019，5（5）：449-454．DOI：10.3969/j.issn.2096-045X.2019.05.014.
［38］CHIN M，LAGASSE R S．Assessment of competence：developing trends and ethical considerations［J］．Curr Opin Anaesthesiol，2017，30（2）：236-241．
［39］NASCA T J，PHILIBERT I，BRIGHAM T，et al．The next GME accreditation system：rationale and benefits［J］．N Engl J Med，2012，366（11）：1051-1056．DOI：10.1056/NEJMsr1200117.
［40］上海市浦东新区上钢社区卫生服务中心．全科医生能力分级显示装置：中国，CN201820372663.X［P］．2018-11-09.
［41］李娅玲，韩笑阳，罗冬梅，等．上海市浦东新区潍坊社区卫生服务中心实训中心的建设与发展［J］．中华全科医师杂志，2017，16（1）：36-38．
LI Y L，HAN X Y，LUO D M，et al．Building and development of training center in Weifang Community Health Service Center of Shanghai Pudong New Area［J］．Chinese Journal of General Practitioners，2017，16（1）：36-38．

[1]	ZHANG Hanzhi, GE Xuhua, LU Yuan, JIN Hua, GUO Aizhen, CHEN Yuge, MA Linlin, PAN Ying, YU Dehua. Exploration and Differential Analysis of Continuing Education of General Practitioners' Clinical Thinking Ability Based on Working Competence [J]. Chinese General Practice, 2023, 26(34): 4315-4321.
[2]	YAO Yuzhong, MA Xiaojun, SONG Huan, ZHONG Yu. The Management Effect of Diabetes "1358 model" on Community Diabetes Patients Based on "Precision Management Combining General Care and Specialty Care" [J]. Chinese General Practice, 2023, 26(34): 4308-4314.
[3]	QIN Fengyin, ZHANG Qishan, LAI Jinjia, HUANG Yimin, HAN Guoyin, SUN Xinglan, WANG Fen, TAN Yibing. Current Status and Influencing Factors of the Intention to Screen for High-risk Stroke among Community Residents in Guangdong [J]. Chinese General Practice, 2023, 26(34): 4283-4289.
[4]	HAO Aihua, ZENG Weilin, LI Guanhai, XIA Yinghua, CHEN Liang. Current Situation of the Construction of Family Doctor Team: an Investigation Based on the Perspective of General Practitioners [J]. Chinese General Practice, 2023, 26(34): 4261-4268.
[5]	LI Dianjiang, PAN Enchun, SUN Zhongming, WEN Jinbo, WANG Miaomiao, WU Ming, SHEN Chong. The Current Status and Influencing Factors of Clinical Inertia in Type 2 Diabetes Patients in Community [J]. Chinese General Practice, 2023, 26(34): 4296-4301.
[6]	HUANG Jinling, ZENG Zhirong. The Logic and Trend of Urban Community Health Service Policies in China [J]. Chinese General Practice, 2023, 26(34): 4239-4245.
[7]	YANG Hui, HU Ruwei, LIU Ruqing, LU Junfeng, WU Jinglan. Relationship between Community Health Service Experience and Glycemic Control Outcomes in Patients with Diabetes Mellitus [J]. Chinese General Practice, 2023, 26(34): 4290-4295.
[8]	XU Jian, DAI Fangfang, PAN Wenlei, HUANG Qian, LU Ping, WANG Jianfeng, JIA Huan, YANG Yuqi, HUANG Jiaoling. Visual Analysis of Hotspots and Cutting-edge Trends of Community TCM Service Research in China in the Context of Healthy China [J]. Chinese General Practice, 2023, 26(34): 4343-4350.
[9]	LI Qianqian, CHEN Xunrui, ZHANG Wenying, YUAN Haihua, ZHANG Yanjie, JIANG Bin, LIU Feng. Demand and Influencing Factors for Community Health Services during Chemotherapy of Patients with Advanced Cancer [J]. Chinese General Practice, 2023, 26(33): 4173-4180.
[10]	YIN Zhaoxia, MAO Lidong, ZHANG Baoshuang, HUANG Yin, FENG Yang, WANG Yunfei. Spectrum of Outpatient Illnesses in Children Contracting Family Doctor Services in Shenzhen's Community Settings and Related Implications for Standardized Residency Training of General Practitioners [J]. Chinese General Practice, 2023, 26(33): 4218-4224.
[11]	YU Dehua. Scientific Research Conception Guided by General Practice Thinking [J]. Chinese General Practice, 2023, 26(31): 3872-3876.
[12]	HONG Yuchun, WU Hua, DU Yishan, LI Shuran, SUN Wenmin, YE Mingyu, ZHANG Yongjian, LI Yang. Development of General Practice Diagnostic Terminology and Coding and Empirical Study on Its Application [J]. Chinese General Practice, 2023, 26(31): 3896-3901.
[13]	ZHOU Yingda, ZHUO Shuxiong, YANG Xi, JIN Hua, YU Dehua. Implementation Status and Strategy Research on the Construction of Clinical Pathways for Diagnosis and Treatment of Medically Unexplained Disease in Community General Practice [J]. Chinese General Practice, 2023, 26(31): 3939-3944.
[14]	ZHOU Dongdong, GE Xuhua. The Evaluation Index of Post Competence of General Practitioners in Less-developed Areas [J]. Chinese General Practice, 2023, 26(31): 3908-3914.
[15]	PU Haifeng, WANG Yinsheng, YU Changyin, CHEN Lingli, XIAO Xue, ZHANG Nian, CHEN Chuying, ZHU Jiming. Current Situation, Problems, and Strategies of Continuing Medical Education for Rural Order-oriented General Practitioners in Guizhou Province [J]. Chinese General Practice, 2023, 26(28): 3551-3558.