Developing Community Pediatrics in China：Necessity，Feasibility，and Recommendations Derived from the US Training System for Community Pediatricians

doi:10.12114/j.issn.1007-9572.2021.00.188

Abstract

Abstract: Considering the increasing demand for children's health care，including preventive care，and the prominent difficulty of caring children with special health care needs，the development of community pediatrics is the key to dealing with these problems. We discussed the feasibility of developing community pediatrics in China from aspects of national political direction，actual demand for community pediatric care in care needers，and expected development of community pediatric care of the care providers. Moreover，seeing that the US experience of developing community pediatrics is quite quotable，after reviewing the US development of training system for community pediatricians，we put forward suggestions on developing community pediatrics in China，including the training patterns，goals，contents and settings as well as types of educators.

Key words: Community health services, General practice, Community pediatrics, Training

摘要： 中国儿童医疗保健需求激增，儿童疾病预防需求增长，保障有特殊医疗健康需求儿童的困难性突出，而美国社区全科儿科的发展有效解决了儿童基本医疗保健难点。因此，本研究旨在从国家政策导向、需方对社区儿科的实际需求、供方对社区儿科的期望论证社区儿科在中国发展的可行性；并借鉴美国社区儿科医生培养体系的发展经验，从培养模式、目标、内容、形式等多角度为中国社区儿科发展提供思路和理论依据。

关键词: 社区卫生服务, 全科医学, 社区儿科, 培养

CHEN Chen,PENG Qihua,SHI Jianwei, et al. Developing Community Pediatrics in China：Necessity，Feasibility，and Recommendations Derived from the US Training System for Community Pediatricians　[J]. Chinese General Practice, 2021, 24(19): 2472-2476. DOI: 10.12114/j.issn.1007-9572.2021.00.188.
陈晨,彭麒桦,石建伟等. 基于美国社区儿科医生培养体系探索中国引入社区儿科的必要性、可行性及发展建议[J]. 中国全科医学, 2021, 24(19): 2472-2476. DOI: 10.12114/j.issn.1007-9572.2021.00.188.

References

［1］LASSI Z S，KUMAR R，BHUTTA Z A．Reproductive，Maternal，Newborn，and Child Health：Disease Control Priorities，Third Edition（Volume 2）［M］．Washington ：The International Bank for Reconstruction and Development/The World Bank，2016.
［2］HUTCHINS V L，GRASON H，ALIZA B，et al．Community Access to Child Health（CATCH） in the historical context of community pediatrics［J］．Pediatrics，1999，103（6）：1373-1383.
［3］DUPLESSIS H M，BOULTER S C，CORA-BRAMBLE D，et al．The pediatrician's role in community pediatrics［J］．Pediatrics，2005，115（4）：1092-1094．DOI：10.1542/peds.2004-2680.
［4］GRUEN R L，PEARSON S D，BRENNAN T A．Physician-citizens-public roles and professional obligations［J］．JAMA，2004，291（1）：94-98．DOI：10.1001/jama.291.1.94.
［5］国家卫生健康委员会.2018中国卫生健康统计年鉴［M］．北京：中国协和医科大学出版社，2018.
［6］国家卫生健康委办公厅关于印发社区医院基本标准和医疗质量安全核心制度要点（试行）的通知［EB/OL］．（2019-06-12）
［2020-09-13］．http://www.nhc.gov.cn/yzygj/s3593g/201906/ca5f96ecfd1741b6a7efdf6938fe060f.shtml?from=timeline.
［7］原国家卫生计生委，国家发展和改革委员会，教育部，等．关于印发加强儿童医疗卫生服务改革与发展意见的通知
［EB/OL］．（2016-07-15）［2020-09-13］．http://www.qgetyy.com/newsShow.asp?dataID=368.
［8］王亮生．某市二级以上综合医院儿科医疗服务状况分析［D］．福州：福建医科大学，2018.
［9］汪方，杨庆，王秋根，等．骨盆创伤全生命周期临床数据库构建初步探讨［J］．中华创伤杂志，2011，27（4）：307-310．DOI：10.3760/cma.j.issn.1001-8050.2011.04.006.
［10］魏登军，陈婷，黎夏，等．国内外全科医学发展比较与探讨［J］．中国社会医学杂志，2017，34（5）：432-435．DOI：10.3969/j.issn.1673-5625.2017.05.004.
WEI D J，CHEN T，LI X，et al．Analysis of the development of the domestic and foreign general medicine［J］．Chinese Journal of Social Medicine，2017，34（5）：432-435．DOI：10.3969/j.issn.1673-5625.2017.05.004.
［11］PALFREY J S，TONNIGES T F，GREEN M，et al．Introduction：addressing the millennial morbidity-the context of community pediatrics［J］．Pediatrics，2005，115（4）：1121-1123．DOI：10.1542/peds.2004-2825b.
［12］刘侃，刘钰晨．法国全科医生在儿科领域的作用及其对我国的启示［J］．中国全科医学，2018，21（1）：5-9．DOI：10.3969/j.issn.1007-9572.2018.01.002.
LIU K，LIU Y C．The role of general practitioners in pediatrics in france and its enlightenment to China［J］．Chinese General Practice，2018，21（1）：5-9．DOI：10.3969/j.issn.1007-9572.2018.01.002.
［13］PALFREY S J．Transforming child health care［J］．Pediatrics，2013，132（6）：1123-1124．DOI：10.1542/peds.2013-3096.
［14］PALFREY J S，HAUSER-CRAM P，BRONSON M B，et al．The brookline early education project：a 25-year follow-up study of a family-centered early health and development intervention［J］．Pediatrics，2005，116（1）：144-152．DOI：10.1542/peds.2004-2515.
［15］BERRY J G，BLOOM S，FOLEY S，et al．Health inequity in children and youth with chronic health conditions［J］．Pediatrics，2010，126：s111-119．DOI：10.1542/peds.2010-1466D.
［16］NEWACHECK P W，STRICKLAND B，SHONKOFF J P，
et al．An epidemiologic profile of children with special health care need［J］．Pediatrics，1998，102（1）：117-123．DOI：10.1542/peds.102.1.117.
［17］SZILAGYI P G，SHONE L P，KLEIN J D，et al．Improved health care among children with special health care needs after enrollment into the state children's health insurance program［J］．Ambulatory Pediatrics，2007，7（1）：10-17．DOI：10.1016/j.ambp.2006.09.006.
［18］SIA C，TONNIGES T F，OSTERHUS E，et al．History of the medical home concept［J］．Pediatrics，2004，113（5）：1473-1478.
［19］HOMER C J，KLATKA K，ROMM D，et al．A review of the evidence for the medical home for children with special health care need［J］．Pediatrics，2008，122（4）：e922-937．DOI：10.1542/peds.2007-3762.
［20］国务院．关于印发中国妇女发展纲要和中国儿童发展纲要的通知［EB/OL］．（2011-08-08）［2020-09-13］．http://www.gov.cn/zwgk/2011-08/08/content_1920457.htm.
［21］姚弥，齐建光，闫辉，等．北京市某三甲医院普通儿科门诊就诊现况调查及分析［J］．中国全科医学，2015，18（11）：1288-1292．DOI：10.3969/j.issn.1007-9572.2015.11.014.
YAO M，QI J G，YAN H，et al．Investigation and analysis of service status of general pediatric outpatient department of a third-grade class-a hospital in Beijing［J］．Chinese General Practice，2015，18（11）：1288-1292．DOI：10.3969/j.issn.1007-9572.2015.11.014.
［22］黄文娟，周仲华，郭敬柱，等．某综合医院全科门诊中儿童患者就诊原因和诊断分析［J］．中华全科医师杂志，2013，12（7）：556-558．DOI：10.3760/cma.j.issn.1671-7368.2013.07.023.
HUANG W J，ZHOU Z H，GUO J Z，et al．Reasons for encounter and diagnosis of pediatric patients at general practice clinic affiliated to a tertiary hospital［J］．Chinese Journal of General Practitioners，2013，12（7）：556-558．DOI：10.3760/cma.j.issn.1671-7368.2013.07.023.
［23］何能清，廖小兵，段学燕，等．深圳市社区卫生服务机构儿童医疗服务利用与分析［J］．中华全科医师杂志，2013，12（7）：545-546．DOI：10.3760/cma.j.issn.1671-7368.2013.07.018.
HE N Q，LIAO X B，DUAN X Y，et al．Utilization and analysis of health services for children at a community health service center in Shenzhen［J］．Chinese Journal of General Practitioners，2013，12（7）：545-546．DOI：10.3760/cma.j.issn.1671-7368.2013.07.018.
［24］于果，齐建光，姚弥，等．从一次义诊看北京市社区儿童就医需求及其影响因素［J］．中国社会医学杂志，2016，33（1）：62-64．DOI：10.3969/j.issn.1673-5625.2016.01.020.
YU G，QI J G，YAO M，et al．Children's medical needs in community and related influencing factors in Beijing：a perspective from free consultations［J］． Chinese Journal of Social Medicine，2016，33（1）：62-64．DOI：10.3969/j.issn.1673-5625.2016.01.020.
［25］秦江梅，林春梅，张丽芳，等．我国基层医疗卫生机构儿科资源及医疗服务能力现状研究［J］．中国全科医学，2019，22（13）：1511-1515．DOI：10.12114/j.issn.1007-9572.2019.00.214.
QIN J M，LIN C M，ZHANG L F，et al．Pediatric resources and medical service delivery capability in primary healthcare institutions in China［J］．Chinese General Practice，2019，22（13）：1511-1515．DOI：10.12114/j.issn.1007-9572.2019.00.214.
［26］姚弥，齐建光，迟春花，等．北京市社区卫生服务中心全科医生接诊儿童情况及其相关培训调查研究［J］．中国全科医学，2016，19（3）：313-316．DOI：10.3969/j.issn.1007-9572.2016.03.015.
YAO M，QI J G，CHI C H，et al．Research of general practitioners' reception of children and related training in community health service centers in Beijing［J］．Chinese General Practice，2016，19（3）：313-316．DOI：10.3969/j.issn.1007-9572.2016.03.015.
［27］刘晓君，吴明洋，张琎，等．我国基层全科医学的建设现状与政策研究［J］．中国卫生事业管理，2017，34（1）：47-50，80．DOI：CNKI:SUN:ZWSG.0.2017-01-017.
LIU X J，WU M Y，ZHANG J，et al．Research on the current situation and policy of general practice construction in primary health care institutions in China［J］．Chinese Health Service Management，2017，34（1）：47-50，80．DOI：CNKI:SUN:ZWSG.0.2017-01-017.
［28］鲁建华，陈融，王青青．美国全科医生培养模式对综合性医院全科医生培养的启迪［J］．全科医学临床与教育，2013，11（1）：50-51+55．DOI：10.3969/j.issn.1672-3686.2013.01.016.
［29］What education is required to be a pediatrician?［EB/OL］．
［2020-09-13］．https://learn.org/articles/What_Education_Is_Required_to_Be_a_Pediatrician.html.
［30］American Board of Pediatrics．Contact an ABMS member board［EB/OL］．［2020-09-13］．https://www.abms.org/member-boards/contact-an-abms-member-board/american-board-of-pediatrics/.
［31］BAZEMORE A W，MAKAROFF L A，PUFFER J C，et al．Declining numbers of family physicians are caring for children［J］．J Am Board Fam Med，2012，25（2）：139-140．DOI：10.3122/jabfm.2012.02.110203.
［32］MAKAROFF L A，XIERALI I M，PETTERSON S M，et al．Factors influencing family physicians' contribution to the child health care workforce［J］．Ann Fam Med，2014，12（5）：427-431．DOI：10.1370/afm.1689.
［33］GARFUNKEL L C，SIDELINGER D E，REZET B，et al．Achieving consensus on competency in community pediatrics［J］．Pediatrics，2005，115（4）：1167-1171．DOI：10.1542/peds.2004-2825N.
［34］WAGNER J，ABDEL-RAHMAN S M．Pediatric pharmacokinetics［J］．Pediatrics in Review，2013，34（6）：258-269．DOI：10.1542/pir.34-6-258.
［35］BRASEL K J，BRAGG D，SIMPSON D E，et al．Meeting the accreditation council for graduate medical education competencies using established residency training program assessment tools［J］．American Journal of Surgery，2004，188（1）：9-12．DOI：10.1016/j.amjsurg.2003.11.036.
［36］Education ACfGM．ACGME program requirements for graduate medical education in family medicine［M］．Chicago：ACGME，2014.
［37］BODAGH N，BLOOMFIELD J，BIRCH P，et al．Problem-based learning：a review［J］．British Journal of Hospital Medicine，2017，78（11）：c167-170．DOI：10.12968/hmed.2017.78.11.C167.
［38］HAMMOND J．Simulation in critical care and trauma education and training［J］．Current Opinion in Critical Care，2004，10（5）：325-329．DOI：10.1097/01.ccx.0000140950.47361.c9.
［39］PARK Y S，HYDERI A，HEINE N，et al．Validity evidence and scoring guidelines for standardized patient encounters and patient notes from a multisite study of clinical performance examinations in seven medical schools［J］．Academic Medicine，2017，92（11）：s12-20．DOI：10.1097/ACM.0000000000001918.
［40］GARFUNKEL L C，SIDELINGER D E，REZET B，et al．Achieving consensus on competency in community pediatrics［J］．Pediatrics，2005，115（4）：1167-1171．DOI：10.1542/peds.2004-2825N.
［41］陈黎伟，何森，陆婷婷．基于素质拓展训练的医学生思想政治教育模式探析［J］．教育教学论坛，2015，7（17）：34-35．DOI：10.3969/j.issn.1674-9324.2015.17.016.
［42］贾雪梅，朱俊勇，雷宏博，等．我国全科医学培养现状与思考［J］．中国高等医学教育，2018，257（5）：14-15，21．DOI：10.3969/j.issn.1002-1701.2018.05.003.
JIA X M，ZHU J Y，LEI H B，et al．Current situation of general practice education in China and some thoughts on it［J］．China Higher Medical Education，2018，257（5）：14-15，21．DOI：10.3969/j.issn.1002-1701.2018.05.003.
［43］The American Board of Pediatrics. About ABP［EB/OL］．
［2020-09-13］．https://www.abp.org/content/about-us.

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