【作者】 梁小雨；

【导师】 赵志军；

【作者基本信息】 河南大学 ， 社会医学与卫生事业管理， 2011， 硕士

【副题名】From Training Requires and Serive Situation

【摘要】 乡村医生队伍是农村初级卫生保健不可或缺的重要一部分,他们是农村卫生三级服务网络最底层的组成部分。其主要职责是向农村居民提供公共卫生服务及一般疾病的诊治,在实现基本公共卫生服务均等化和保障农民健康权益方面发挥着重要作用。可是,从乡村医生产生和发展的历史来看,目前我国乡村医生队伍的整体素质比较低下,因此必须要重视对乡村医生的岗位培训工作。目的:通过对开封市乡村医生参加培训情况的调查,对调查结果进行分析讨论,得到当前培训中尚且存在的问题,并就这些问题提出一些相关的对策建议。方法:本研究在调查过程中将综合采用文献研究与现场调查等方法收集资料,并运用统计学方法、专家咨询法等进行资料分析。对开封市2010年参加乡村医生培训的243人进行问卷调查。结果:1、被调查地区乡村医生的基本情况:(1)男性占79%,女性占21%;年龄最大的出生于1943年,最小的出生于1987年;(2)从医时间最长的为49年,最短的是4年;(3)15.2%是执业医师,21.8%的执业助理医师,63%没有取得执业资格;(4)从医方式中16.5%为完全脱产;(5)74.9%拥有中专学历;(6)72.8%所学专业为西医临床医学。2、乡村医生培训需求情况调查结果:(1)上次培训中存在的主要问题是培训时间太短、重点不突出、过于形式化等;(2)37%选择了培训场地为医学院校;(3)50.6%选择了培训时间在双休日;(4)68.7%选择了理论与实践相结合的培训模式;(5)51.9%选择医学院校相关专家为培训老师;(6)51.9%认为工作中最感棘手问题是常见病、多发病的诊断和治疗;(7)69.1%认为参加培训的主要原因是自我提高;(8)65.4%选择了愿意参加政府出资安排的培训即便会影响所在诊所的正常运转。3、乡村医生服务情况调查结果:(1)62.6%与村民建立了“一对一”的照顾关系;(2)病人知道联系电话的占69.5%;(3)43.2%定期为村民做体检;(4)54.3%为村民做健康教育;(5)85.6%把患有严重疾病的病人转向上级医院;(6)接受过上级医院转向村卫生室病人的占50.2%;(7)51.4%对所在村患慢性病的病人进行慢性病随防与管理;(8)对三级医院或对口上级医院各科专家专业技术了解很少的占59.7%;(9)72.8%除用西药治疗外还建议病人用其他疗法;(10)37.0%认为村卫生室的医疗专业设备不能满足诊疗需要。4、乡村医生服务时间调查结果:(1)93.4%每周服务七天;(2)87.7%每天工作十小时以上;(3)30.9%每周有五小时为病人提供送医上门服务。5、乡村医生岗位满意度调查结果:30.9%填写了65分。6、乡村医生工作报酬情况调查结果:(1)49.2%认为自己的报酬同乡镇卫生院医生(同年资和同学历)的报酬相比很低;(2)47.1%对自己目前的报酬水平很不满意;(3)30.2%认为相对于工作职责而言,自己的报酬水平极不公正。讨论:1、乡村医生队伍年龄结构偏大且学历程度较低;2、培训时间安排不合理;3、培训内容有待合理设置;4、培训模式需更加实用;5、培训次数可适当提高;6、全科医疗理念需要强化;7、村卫生室基础性设备要求培训更加实用;8、乡村医生工作量大,待遇偏低,有碍培训的稳定性。对策建议:1、充分发挥医学院校的作用:(1)设置相关专业,招收服务农村的医学生;(2)配合政府有关部门,开展乡村医生理论培训;2、根据乡村医生的实际情况安排培训时间;3、从农村实际情况出发合理设置培训内容:(1)突出每次培训的重点;(2)培训内容跟农村实际情况相适应;(3)加强中医、中药学等相关知识的培训;(4)根据社会发展及时讲解新政策、新方法;(5)增加医患交流等方面的培训内容;4、采取更加实用、灵活的培训模式;5、适当提高培训次数,积极开展多种形式的培训;6、着重培养乡村医生的全科医疗理念,明确其工作任务;7、采取保障措施,稳定乡村医生队伍。更多还原

【Abstract】 Rural doctor is an important part of the rural primary health care, they are the component of the bottom in the three-tiered county, township and village health service network in rural areas.That main functions are provided to rural residents the general public health services and the disease treatment for make the realization of the equal access to basic public health service. But from rural doctors on the history of the emergence and development, at present the quality of the doctors are low.That the important reasons why we do the training work of rural doctors.Objectives: through rural doctors to attend training investigation and discusse on the investigation results in Kaifeng, get the current training result and find the existing problems, then put forward some related to these problems policy recommendations.Methods: the study in the investigation process devastates comprehensive adopts literature study and field survey data collection, in methods by using statistical. For expert consultation method and data analysis as the basic way. We take 243 who attend rural doctor’s training of Kaifeng city in 2010.Results: 1,The basic situation of rural doctor in the study area : (1) male, women make up of 79% ,21%; The oldest was born in 1943, the youngest was born in 1987; (2) the longest time 49 years and the shortest is 4 years as a doctor. (3) 15.2% are practicing doctors’, 21.8% are the assistant practicing doctors, 63 percent take no professional qualifications; (4) 16.5 percent are complete medical off-job; (5) 74.9 percent have received technical secondary education; (6) 72.8% major clinical medicine for western medicine.2, Rural doctor’s training demand survey results as: (1) the main problems of the last training are that the training time is short, key important is not outstanding, too formal to ignore the contending, etc.; (2)37 percent choose the training field in the medical colleges and universities; (3)50.6% choose the weekends as training time; (4) 68.7% choose combining theory use in the practice training mode; (5) 51.9% choose relevant experts for training teachers in medical colleges; (6) 51.9% think the most sense thorny issues in work is common disease, frequently-occurring disease diagnosis and treatment; (7) 69.1% think the main reason of attending training is the self-improvement; (8) 65.4% chose that willing to participate in training in government which affords fundion in any conditions. 3, Rural doctor’s service survey results as: (1) 62.6% rural doctors and villagers established "one-on-one" care relations; (2) patients know that the contact telephone number accounted for 69.5%; (3) 43.2% rural doctors check villagers’physical condition regularly; (4)54.3% rural doctors do health education to the villagers; (5) 85.6% rural doctors send the gravely patients to superior hospital ; (6) 50.2 percent rural doctors had received the patients who were sent to village clinic from superior hospital; (7) 51.4% rural doctors towands to chronic disease in village for chronic disease prevention and management; (8)59.7% rural doctors towards to corresponding expert specialized technical of supervisor hospital known few; (9) 72.8% besides using western medicine therapy with other treatments; (10) 37.0% think village clinic medical specialty equipment can’t satisfy needed.4, Rural doctor’s service time survey results as: (1) the rate of seven days a week service in 93.8% (2) explaination work 10 hours a day of above in 87.7%; (3) there are five hours a week for 30.9% provides the patient was hospitalized door-to-door service.5, Rural doctor’s post satisfaction survey results as: 30.9% fill in the 65 points.6, Rural doctor’s work salary situation survey results: (1) 49.2% think that their own reward is lower than the health clinics in towns and townships with seniority; (2) 47.1% is not dissatisfied with their salary; (3) relative to 30.2% job responsibilities that concerned their own reward is unfair.Discuss: 1,The age structure of rural doctor’s age is too old and rural doctor’s degree is in low levels;2, Training time arrangs unreasonable;3, The training content to be setting up reasonable;4, Training mode need more practical;5, Training frequency can be appropriately increased;6, General medical treatment concept needs to be strengthened;7, Village clinic basic equipment request training more practical;8, Rural doctor treated workload is heavy, the stability of low exists in training.Countermeasure: 1,Give full play to the role of medical colleges: (1) setting related professionals, recruit service rural medical students; (2) take in cooperation with relevant government departments, conduct village doctor theory training; 2,According to the actual situation of rural doctors arrange training time;3,From the countryside actual conditions set up the reasonable training content: (1) highlight the key of each training; (2)the training content should adapt to the countryside actual situation; (3) strengthen the training of Chinese medicine, Chinese medicine knowledge; (4) rural doctor are taught in new policies according to the social development; (5)Increase of doctor-patient communication in training content;4,Adopt to the more practical and flexible training mode;5,Increasing training frequency and actively developed various forms in training;6,To cultivate emphatically general medicial concept of the village doctor and figure out the reponsiblity;7,Take supporting measures to pretect the team of rural doctor.更多还原