从我院全科医师规范化培训现状论全科医师规培的重要性

发展社区卫生服务机构能够更好的为国民健康服务,引进和稳定全科医生是其重要内容,而全科住院医师规范化培训是培养高素质全科医师的根本途径。我院自接收全科医师规范化培训以来,培养了一批批合格的全科医师,投入于社区卫生服务。回顾分析我院2009～2018年全科医师规范化培训的历程,通过不断地改进、发展,全科医师规范化培训基地逐步健全,教学逐步趋向稳态。目前已有37名通过招生进入规培程序的毕业生结业,已经很好地投入到社区卫生服务中,为人民健康服务一线贡献力量。全科医师规培是建立全科医学教育体系的核心,是培养全科医师、提高我国社区卫生服务工作水平的主要措施和主要途径。     

上海市郊区全科医师轻度认知障碍相关知识培训需求调查研究

目的 ：对上海市嘉定区全科医师的轻度认知障碍相关知识培训需求开展调查并分析其影响因素。方法 ：于2022年2月1日—2月15日期间选取上海市嘉定区13家社区卫生服务中心所有从事临床一线工作的全科医师作为调查对象，采用《全科医师轻度认知障碍相关知识培训需求调研问卷》对其进行调查。结果 ：399名全科医师中，43.61%参加过轻度认知障碍相关知识培训，90.23%认为有必要开展轻度认知障碍相关知识培训，84.21%对轻度认知障碍相关知识培训的需求较高。多元逐步Logistic回归分析，结果显示，职称、轻度认知障碍相关知识培训经历、对开展轻度认知障碍相关知识培训的态度是对全科医师轻度认知障碍相关知识培训需求具有统计学意义的影响因素（P <0.05）。结论 ：全科医师轻度认知障碍相关知识培训需求较高，应进一步完善全科住院医师规范化培训大纲，建立全专联合的疾病健康管理教育体系，制订符合社区全科医师诊疗服务特点的培训内容。     

血管外科在全科医师规范化培训中的教学要点

全科医师规范化培训内容包括血管外科。本文围绕大纲,结合全科医师在血管外科轮转时间较短的特点,从教学目标和过程阐述了全科医学与血管外科的契合点,包括采用多样化的教学手段,培养学员操作能力,强调兼顾临床技能、人文素质及科研能力的培养。     

上海面向全国招收培养社区全科医生

记者从上海市卫生局获悉，为了在2010年完成构建一支为社区医疗卫生服务的l000名全科医师的人才队伍目标，上海不断加大力度．给出比较优厚的条件，面向全国招生并进行规范化、高质量的培养。近日，2008级上海全科医师规范化培养举行开学典礼，这次招生开班的全科医师学员达154人。上海全科医师培养不断完善，先后制定了《上海市全科医师规范化培养细则》、《临床轮转手册》、《社区实践手册》、《考核管理办法》、《学员人事管理规定》等教学和人事管理文件，并在全市建立了10个全科医师规范化培养临床基地、30个社区基地。     

山西省全科医师规范化培训满意度影响因素分析

<正>随着我国卫生事业的发展,分级诊疗的推进,医疗资源下沉及群众对医疗水平要求的不断提高,我国迫切需要大力发展全科医学事业~([1])。2012年以后国内各省陆续开展了"5+3"的全科医师规培工作~([2]),山西省于2014年开始在全省范围内开展全科医师规范化培训工作,其中太原市内共有五所省级培训基地。本研究旨在通过调查太原市五所省级培训基地2014—2016年规培工作实施情况及学员对规培工作的满意度,通过数据分析寻找对山西省全科医师规范化培训满意度的影响因素,有针对性地提出科学的管理意见和干预措施,为下一步工作改进提供理论依据。     

全科医师的一天

作为全国首届全科医师规范化培训学员（深圳）的一分子，在综合医院轮科三年后，我今天总算可以下社康基地了。     

上海市全科医师规范化培训的进展与挑战

本文回顾了上海自上世纪九十年代开展全科医师培训工作以来经历的三个阶段,总结了上海全科医师培训工作的特色与经验,分析了全科医师培训工作中面临的挑战并提出了政策建议。建立一支"下得去、留得住、用得好"的全科医师队伍,不仅在于培训制度本身,更重要的是要营造吸引、留住和发挥社区全科人才的政策环境。     

全科医生社区实践基地建设的探讨

根据我国目前的社会经济、卫生事业、医学教育事业的实际情况,发展社区卫生服务所需的全科医生,不可能完全由本科医学生毕业后经全科医学教育而来,更多的是基层医院的专科医生经培训转型成为全科医生,因此,全科医生的培训工作任重而道远。从2000年开始浙江省全面开展全科医师培训工程,包括全科住院医师规范化培训、全科医生转岗培训、全科骨干医师培训”。根据《浙江省住院医师规范化培训基地认定办法（试行）》和《浙江省住院医师规范化培训基地管理办法（试行）》的通知精神,培训基地分为临床培训基地和社区实践基地,社区实践基地不设培训学科,与临床培训基地的全科医学学科共同承担住院医师规范化培训的社区实践任务。     

全科医师临床思维训练的探讨

通过对全科医师临床培训的现状分析,总结全科医师临床思维特点,改革全科医师临床思维训练模式,调整全科医师教学内容,优化教学结构。我科急诊医学教学的综合创新模式中,将讨论式教学、情景式教学和迷你临床演练评估引入了全科医师临床思维培训。     

全科医师社区实践基地建设的探索与体会

全科医师经过规范化培训最终将走向社区卫生服务岗位,社区实践基地的建立、健全与全科医生的培养质量密切相关,政府加强社区实践基地的经费投入、培养高质量的师资队伍、丰富和完善考核方式是培养全科医学人才的根本保证。     

医联体模式在提高基层儿科诊疗服务技能中的作用

目的：介绍潍坊社区卫生服务中心通过医联体平台进行中心全科医生儿科带教工作的情况。方法：从2013年起,中心聘请医联体内综合医院专家资源和中心内高年资儿科医生作为师资,对住院医师规范化培训后的11名全科医生开展儿科技能再培训。全科医生每周2个工作日进入儿科门诊工作,采用“1+1”模式即儿科医生与全科医生结对坐诊,时间为3个月。经过中心儿科门诊培训后,跟随专家在中心开展每周半天的儿科门诊教学,时间为3个月。培训期满,学员和带教专科医生分别进行全科医生门诊能力评估。结果：全科医生进入儿科门诊工作后,儿童诊治数量从每月30人次上升到近200人次。全科医生自评和专科医生评估的接诊技能都有了不同程度提升。结论：在医联体模式下开展全科医生专科培训是一种值得推广和借鉴的模式。     

以需求为切入的全科医师临床技能强化训练的效果评价

目的：通过对全科医师技能培训的需求调查,筛选出中心全科医师最迫切希望提升的8项技能,经过培训与考核,让全科医生基本掌握8项技能。方法：对中心30名45周岁以下全科医师进行技能需求问卷调查,筛选出需求前8项的技能,以2个月1项技能的速度进行强化培训。结果：30名参加培训的全科医师培训前、后成绩差异有统计学意义（P＜0.01),技能明显得到提升。结论：基于社区卫生服务中心实际需求的培训能大幅度提高全科医师的操作技能,满足社区卫生服务中心临床需求。     

Complementary medicine and the general practitioner: a survey of general practitioners in the Wellington area

A questionnaire was sent to 226 general practitioners in the Wellington region to determine the relationship between the general practitioner and complementary medicine. A 77% response rate was achieved. Twenty-four % of doctors had received training and 54% wanted further training in a complementary therapy; 27% currently practised at least one therapy. The majority of doctors (94%) knew of complementary practitioners in their locality; 77% indicated they referred to other medical practitioners for complementary therapies and 80% to nonmedical practitioners. Acupuncture, hypnosis and chiropractic were the most popular therapies. The general practitioner's role was perceived as ranging from comprehensive provider of both conventional and complementary medicine to selective practitioner of some options. It is concluded that complementary medicine is of considerable interest to general practitioners; there is demand for more training and information to be made available for doctors and for better referral networks to be developed between the practitioners.     

Role of the general practitioner in smoking cessation

This paper reflects on the role of general practitioners in smoking cessation and suggests initiatives to enhance general practice as a setting for effective smoking cessation services. This paper is one of a series of reflections on key issues in smoking cessation. In this article we highlight the extent that general practitioners (GPs) have contact with the population, evidence for effectiveness of GP advice, barriers to greater involvement and suggested future directions. General practice has an extensive population reach, with the majority of smokers seeing a GP at least once per year. Although there is level 1 evidence of the effectiveness of smoking cessation advice from general practitioners, there are substantial barriers to this advice being incorporated routinely into primary care consultations. Initiatives to overcome these barriers are education in smoking cessation for GPs and other key practice staff; teaching of medical students about tobacco and cessation techniques, clinical practice guidelines; support for guideline implementation; access to pharmacotherapies; and development of referral models. We believe the way forward for the role of the GPs is to develop the practice as a primary care service for providing smoking cessation advice. This will require education relevant to the needs of a range of health professionals, provision of and support for the implementation of clinical practice guidelines, access for patients to smoking cessation pharmacotherapies and integration with other cessation services such as quitlines. [Zwar NA, Richmond RL. Role of the general practitioner in smoking cessation. Drug Alcohol Rev 2006;25:21-26]     

Early intervention in the general practice setting

There is a growing pressure on general practitioners to become more involved in the detection and management of alcohol related problems. However, there is evidence to suggest that general practitioners are unaware of the alcohol consumption of many of their patients, and even when they are aware that their patients are drinking too much, they are reluctant to manage these problems. This paper discusses some of the reasons why general practitioners avoid dealing with their heavy drinking patients. It is argued that advising patients to modify their alcohol consumption should be viewed as an exercise in health promotion, analogous to advising them to stop smoking or lose weight. The disease model of alcoholism, which is adhered to by many general practitioners, is seen as an impediment to the effective management of heavy drinkers within general practice.     

郊区全科教学门诊模式的建立与实践

为了提高社区全科医师临床诊疗能力及师资带教水平,西渡社区卫生服务中心依托复旦大学附属中山医院于2015年5月成立了中山-西渡全科教学门诊,经过近1年的实践,已初见成效。本文将从开设全科教学门诊的必要性、设置和规范、存在问题和今后发展方向进行分析和总结。     

以全科医师为主体社区健康服务为中心的高血压管理模式探索

目的探索构建以全科医师为主体、社区健康服务为中心无缝融合的高血压等社区慢性病管理模式,以便能够为社区高血压慢性病控制提供决策和实施依据。方法以成都市成华区万年社区卫生服务中心归属的社区内已经确诊为高血压疾病的患者为服务对象,制定血压及相关并发症为指标,实施以全科医师为主体的社区健康服务中心的高血压等慢性病管理模式,并比较管理模式实施前后的相关指标。结果社区内高血压患者经过系统的、规范的、科学的管理后,发生不良行为习惯的人数大大降低,血压情况得到了有效的控制,并且明显的改善了患者的各项指标,管理实施具有积极的意义。结论以全科医师为主体社区健康服务中心的高血压等慢性病管理模式是一种新型的高血压疾病管理模式,提高了高血压患者的生存质量,合理有效的利用了社区医院的医疗资源,降低了患者的治疗费用,非常值得推广。     

The use of antidepressant drugs in general practice

Summary The aim of this study was to examine the antidepressant drug prescribing preferences and habits of a population of general practitioners. The method used was that of a questionnaire survey, including case vignettes. The response rate exceeded 70% Data are presented outlining the attitudes of the respondents to the use of antidepressant drugs in the management of common psychiatric presentations in the primary care setting.The majority of general practitioners (G.P.'s) had received little or no post-graduate education in psychiatry. The antidepressants most frequently prescribed were amitriptyline, clomipramine, trazodone and lofepramine. Despite recognition of the alarming frequency of serious self-poisoning incidents with some of these compounds, 26% of respondents confessed to an inability to make an informed choice of antidepressant drug, with 14% using the same drug with every patient with no attempt to select according to individual patient requirements.The management of depressive neurosis generates considerable clinical confusion with a variety of interventions favoured. The use of a sedating antidepressant is popular. There is greater accord for the management of endogenomorphic depression. The use of the benzodiazepine drugs in the management of anxiety disorders is infrequent, with appropriate recognition of the merits of behavioural approaches. However, the role for antidepressant drugs in the management of anxiety disorders is under-recognized.We conclude that general practitioners are required to undertake a significant body of work for which they may be inadequately trained.