CAJ | 학술논문

目的：了解西部地区农村医师职业能力现状，为开展农村医师职业能力培训和专科层次临床医学教育提供依据。方法2012年9月—2013年2月采用分层多阶段抽样法抽取西部地区（重庆市、贵州省铜仁市和云南省楚雄市）36个农村基层卫生机构，采用自制问卷调查被抽取机构中的农村医师，调查内容包括一般情况和职业能力适应情况（工作环境适应能力、人际关系沟通协调能力、诊疗技术能力及仪器设备使用操作能力）。共调查580人，应答498人，应答率85.9%。结果10.4%（52/498）的农村医师无任何证书。只有43.9%（208/473）的农村医师选择与患者关系好或很好。79.6%（393/494）的农村医师有转诊经历，主要原因为缺乏诊疗设备，35.9%（141/393）的农村医师因为缺乏诊疗技术转诊。农村医师经常并正确使用的诊疗仪器是血压计、听诊器、体质量身高计和血糖仪，对其他常规仪器设备能经常并正确使用的农村医师所占比例较低。67.3%（335/498）的农村医师经常使用仪器辅助诊断，另外32.7%（163/498）偶尔或从不使用。经综合评价，农村医师工作环境适应能力74.2分，人际关系沟通协调能力74.0分，诊疗技术能力69.6分，仪器设备使用操作能力31.8分。结论西部地区农村医师学历较低，与患者沟通能力差，缺乏诊疗技术，不能正确使用诊疗设备，这严重限制了其提供医疗服务的质量。对现有的农村医师按全科医师标准进行培训或进修势在必行，在专科层次临床医学专业教育中加强对学生沟通能力培养和提高临床诊疗技术水平、基本操作技能至关重要。
목적：료해서부지구농촌의사직업능력현상，위개전농촌의사직업능력배훈화전과층차림상의학교육제공의거。방법2012년9월—2013년2월채용분층다계단추양법추취서부지구（중경시、귀주성동인시화운남성초웅시）36개농촌기층위생궤구，채용자제문권조사피추취궤구중적농촌의사，조사내용포괄일반정황화직업능력괄응정황（공작배경괄응능력、인제관계구통협조능력、진료기술능력급의기설비사용조작능력）。공조사580인，응답498인，응답솔85.9%。결과10.4%（52/498）적농촌의사무임하증서。지유43.9%（208/473）적농촌의사선택여환자관계호혹흔호。79.6%（393/494）적농촌의사유전진경력，주요원인위결핍진료설비，35.9%（141/393）적농촌의사인위결핍진료기술전진。농촌의사경상병정학사용적진료의기시혈압계、은진기、체질량신고계화혈당의，대기타상규의기설비능경상병정학사용적농촌의사소점비례교저。67.3%（335/498）적농촌의사경상사용의기보조진단，령외32.7%（163/498）우이혹종불사용。경종합평개，농촌의사공작배경괄응능력74.2분，인제관계구통협조능력74.0분，진료기술능력69.6분，의기설비사용조작능력31.8분。결론서부지구농촌의사학력교저，여환자구통능력차，결핍진료기술，불능정학사용진료설비，저엄중한제료기제공의료복무적질량。대현유적농촌의사안전과의사표준진행배훈혹진수세재필행，재전과층차림상의학전업교육중가강대학생구통능력배양화제고림상진료기술수평、기본조작기능지관중요。
Objectjve To learn the professional ability of rural doctor in western China,and provide scientific reference for the improvement of professional competence training and junior - college clinical medicine education on rural doctor. Methods 36 rural grassroots health institutions from Chongqing City,Tongren City of Guizhou Province,Chuxiong City of Yunnan Province,were included by multi - stage stratified sampling from September 2012 to February 2013. A self - made questionnaire included general situation and vocational ability adaption ( the ability to adapt to the work environment, interpersonal communication skills,clinical diagnosis - treatment capacity and operational capability of medical equipments), was performed in rural doctors from the 36 rural grassroots health institutions. 580 doctors were investigated,498 of which responded,and the rate of response was 85. 9% . Results 10. 4%(52 / 498)of respondents had no any qualification. Only 43. 9%(208 / 473)of respondents choosed the option 〞 maintaining good or very good relationship with patients〞 . Data showed 79. 6%(393 / 494)of respondents ever transfered patients to higher hospital mainly due to the lack of medical equipments,and 35. 9% (141 / 393)of respondents done referral due to lack of medical technology. Phygmomanometer,stethoscope,body mass meter and blood glucose meter were often and proper used by investigated rural doctors,but few rural doctors could use other conventional medical equipments properly. 67. 3% (335 / 498)of respondents used auxiliary diagnosis instrument frequently, while 32. 7%(163 / 498)occasionally or never used auxiliary diagnosis instrument. After a comprehensive evaluation,the work environment adaptability score of investigated rural doctor was 74. 2,interpersonal communication skills score was 74. 0,clinical diagnosis - treatment capacity score was 69. 6,operational capability of medical equipments score was 31. 8. Conclusjon The educational background of rural doctors is relatively low,the interpersonal communication skills ability is poor,the diagnosis -treatment equipments and technology is lack,many rural doctors can not use medical equipment properly,these are the main reasons which severely limit the quality of medical services provided by rural doctors. Thus,it is imperative that rural doctors receiving train according to the standards of general practitioners,it is important to strengthen clinical diagnosis - treatment technology,basic equipment operational skills and communication ability among clinical medical students in junior college.