Page 83 - 2023-04-中国全科医学

·468· http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn February 2023, Vol.26 No.4

the quality of essential medical services. Objective To develop an inner competency rating scale for GPs and to assess its
psychometric properties，providing certain reference for improving GPs' competencies. Methods By use of literature review
and behavioral event interviews results，the draft of the General Practitioner Inner Competency Rating Scale（GPICRS）
was developed. Then in September to December 2021，the draft was tested by a survey with a national random sample of 380
（88.2%）GPs. Its rationality was verified by item purification，exploratory factor analysis，confirmatory factor analysis and
reliability and validity tests. The weighted average method was used to evaluate the inner competency of GPs. The total and
dimensions scores of the GPICRS were compared by demographics. Results Three hundred and thirty-five GPs who returned
responsive questionnaires were included for analysis. The formal scale consists of 14 items in 4 dimensions：work motivation，
self-efficacy，medical humanities and professional qualities. The value of KMO（0.737）and result of Bartlett's Test of Sphericity
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（χ =592.715，P<0.001）derived from the exploratory factor analysis，suggested that the data sample was appropriate for factor
analysis. Four common factors with an eigenvalue >1.000 were extracted，and the percent of total variance explained by which
was 58.861%. The results of confirmatory factor analysis showed that the fitting indicators of the four-factor model were acceptable
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（χ /df=2.834，RMSEA=0.074，GFI=0.922，PGFI=0.623，NFI=0.889，TLI=0.903，CFI=0.924）. When it comes to
the formal scale，the Cronbach's α was 0.851. The Cronbach's α for each of its dimensions ranged from 0.757 to 0.809. The
standardized regression coefficient of each item was greater than 0.500，and the AVE for each dimension was above 0.500. And the
CR value for each dimension was greater than 0.700. The arithmetic square root of AVE was greater than the correlation coefficient
between the factors. The average total GPICRS score of the 335 GPs was 4.15，which was at a good level，and GPICRS score
varied across GPs by different characteristics（gender，age group，professional title，etc.）. Conclusion Our GPICRS could
effectively evaluate the inner competency of GPs，which may contribute to the decision-making in primary care and the personal
development of GPs. In the future，efforts can be made to improve the comprehensive capability of GPs from the following four
aspects：self-cognition and occupational identity，theoretical knowledge and practical application，professional ability and work
attitude，organizational support and social recognition.
【Key words】 General practitioners；Implicit competence；Development of scale；Competency evaluation；
Community health services

推动全科医学深入发展和高质量全科医生培养已成 面对广大社区居民的职业特殊性要求其更应注重内隐素
为提升基层卫生服务能力、推进分级诊疗制度建设的重 质的提升。全科医生为社区居民长期提供基本医疗和公
要措施。全科医生作为优质基层卫生服务的主要提供者， 共卫生服务，日常工作中需注重与居民保持高效沟通、
在提升基层卫生服务质量中发挥着重要作用 ［1］ 。胜任 维系与签约居民建立的良好互动与信任关系；服务对象
力评价结果能较好地反映全科医生个人的综合素质，并 主要是老年人和儿童，而此类群体的医疗服务需求以常
为其培训、培养和考核评价提供一定的依据 ［2-3］ 。广义 见病、多发病、慢性病诊治为主，因此与综合性 / 专科
的胜任力包括内隐胜任力和外显胜任力两方面；“洋葱 医院的专科医生多致力于攻克重大疾病不同，全科医生
模型”将胜任力概括成三层结构，从内到外依次是个人 更重要的是能够为居民提供常见病的治疗方案，以及连
特质、态度与价值观、知识与技能 ［3］ ，其中个人特质、 续、综合的诊疗与照护服务。这些特点对全科医生的内
态度与价值观属于内隐胜任力范畴。内隐素质是个体价 隐胜任力提出了较高的要求。
值观、动机、特质的集中体现，内隐层面的胜任力是深 不少发达国家学者已对全科医生岗位胜任力展开了
层次、易被忽略但又十分关键的 ［4］ ，会长期影响全科 丰富的研究，并构建了适合本国国情的、成熟的岗位胜
医生的行为、绩效，具有持久性。同时相关研究也认为： 任力模型 ［7］ 。然而，现有关于全科医生胜任力的研究
依据胜任素质培养和评价的难度排序，个人特质、态度 大部分强调应着力提升全科医生的知识和技能水平，忽
和价值观位列知识技能之前 ［5］ 。不同胜任素质培养和 略了全科医生内隐素质的重要性；也鲜有学者开发用于
评价难度的差异性也决定了胜任素质研究和提升的关注 评估全科医生内隐胜任力水平的量表。因此，本文基于
点应有所侧重。 文献分析和行为事件访谈，确定全科医生内隐胜任力量
我国居民的健康管理意识正在逐步增强，居民对基 表（GPICRS）的初始条目，并借助 SPSS 25.0 和 AMOS
层医疗卫生机构服务能力的要求也随之变化。具备提供 17.0 软件对调查结果进行统计分析，旨在编制一套具有
预防保健等服务所需的基本专业知识与技能，以及责任 一定指导意义的全科医生内隐胜任力测量工具，以期助
感、信念感、效能感等内隐层面素质的综合性全科人才 力分级诊疗制度建设的推进和基层卫生服务质量的不断
方能满足居民的基本就医需求 ［6］ 。同时全科医生直接 提升。