Teaching Family Medicine: Who Should Do it?

全科医学的教学团队

Chris Jenkins, MDFamily Medicine Education

InternationalBeijing 2010

Program Implementation – Overview项目实施—概况 To successfully implement a Curriculum or

Program, the developer must ensure: 为了成功地实施一个课程或项目，领导者必须确保：– Sufficient resources 充足的资源– Political and financial support 政治和财政支

持– Development of effective Administrative

strategies of support 发展支持的有效管理策略

To be successful a program must have good teachers

取得成功的前提是好的师资

Identification of Resources 鉴定资源

Personnel 人力Time 时间Facilities 设备Funding/Cost 经费

Identification/Assess Resources鉴定 / 评估资源Personnel 人力资源 Faculty 教职员

– Adequate numbers 充足的数量 – Teaching and content skill 教学技巧 – Faculty development 教职员得到发展

Secretarial / Other support staff 秘书 / 其它支持人员– Prepare/distribute curricular materials, schedules

evaluation tools, etc. 准备 / 分发课程材料，日程表，评估工具等

– General support of learning activities 对于教学活动总体上的支持

Patients - adequate numbers and variety 病人 - 数量充足病种多样

Identification/Assess Resources Time鉴定 / 评估资源 时间 Faculty 教职员

– Preparation/Teaching time 准备 / 教学时间– Plan/Administer the curriculum 计划 / 管理课程安

排 Learners 学习者

– Scheduled learning activities 计划好的学习活动– Read/Independent Learning 阅读 / 独立的学习– Clinical rotations 临床轮转

Support staff 支持的工作人员

Form Follows Function 形式由功能而定

“Family physicians acquire and maintain a broad and varying array of competencies, depending upon the needs of the populations they serve, the communities in which they practice, and the environments in which both they and their patients work and live.”

全科医生需要并具备的能力范围很宽，会因他们服务的人群、从事医疗的社区、他们及病人工作生活的环境不同而有很大的不同。

Looking Into The Future 展望未来

What will be the needs of China for health care?

中国对于健康照顾的需求是什么？ What does the government perceive your role to be and

what are their expectations?

政府认为你的角色是什么？政府的期望是什么？ How will family practice integrate into the current health

care system?

全科医学如何整合到当今的医疗体系中？ How will the Chinese population react to this

type of specialist?

中国人对这种全科类型的专科医生有什么反应？

Our Role As Family Physicians 全科医生的角色 Being able to fulfill all of these roles requires us

to have clinical training in settings where patients will find themselves when ill or in need of their doctor: 病人生病或需要医生帮助时会去哪些地方，全科医生就需要在那些环境里受过培训以胜任在那个地方工作的角色。– Out patient department 门诊– Hospital 医院– Intensive Care Unit 重症监护病房– Operating Room 手术室– Hospice Unit 临终关怀机构– Delivery Room 分娩室– Nursery 婴儿室

Rural or Urban:Rural or Urban: 农村或城市农村或城市Do FP belong only in rural areas?Do FP belong only in rural areas?家庭医生只属于农村地区吗？家庭医生只属于农村地区吗？

Needed in Rural areas: villages, towns, small Needed in Rural areas: villages, towns, small citiescities 在村、镇、小城市等农村地区需要：在村、镇、小城市等农村地区需要：– Not enough specialists to supply all small townsNot enough specialists to supply all small towns 没有足够的专家可以为所有小镇提供医疗服务没有足够的专家可以为所有小镇提供医疗服务– Not enough demand to support all the other Not enough demand to support all the other

specialties specialties 没有那样多的对所有专科的医疗需求没有那样多的对所有专科的医疗需求– FP/GP needs to be well trained to handle many FP/GP needs to be well trained to handle many

complex problems and procedurescomplex problems and procedures 家庭家庭 // 全科医生需要得到很好的培训以应付很多复全科医生需要得到很好的培训以应付很多复

杂的问题和操作杂的问题和操作99

Rural or Urban:Rural or Urban: 农村或城市农村或城市Do FP belong only in rural areas?Do FP belong only in rural areas?家庭医生只属于农村地区吗？家庭医生只属于农村地区吗？

Needed in Urban/city areasNeeded in Urban/city areas 在城市也需要在城市也需要– Specialization is one of the reasons FM is Specialization is one of the reasons FM is

needed needed

需要家庭医生的一个理由是专科化需要家庭医生的一个理由是专科化– Management of care is even more critical Management of care is even more critical

更为关键的是健康照顾管理更为关键的是健康照顾管理– Cost controlCost control 费用控制费用控制– PreventionPrevention 预防预防

Training of the Rural Family Physician 培训乡村的全科医生 Consider access to medical specialists 考虑到有使用专科医生的权利 Remoteness of Practice 实践地点遥远 Competent, comfortable, and confident in practice 对医疗实践感到能胜任、舒服并且自信 Training to be more independent: Limited access to

medical services 受过训练更加独立：获得医疗服务受限 Will need added training in surgical, procedural,

obstetrical, and emergency skills 需要增加手术、操作、产科和急诊方面的培训。

Preparing Family Physicians for Rural Areas 让全科医生为乡村地区做好预备 Broad Medical Training广泛的医学培训 Procedural training in skills that are not easily

available 操作培训那些不易得到的技能 Overseeing other health-care providers 监督其它医务工作者

– Nurses, Physician assistants, Nurse practitioners, Public Health personnel 护士、医师助理、执业护士、公卫人员

Knowing when to refer知道何时转诊– Knowing your limitations知道你的限制– Comfortable in your chosen scope of practice 在选定的执业范围内感到舒适自信

Preparing Family Physicians for Larger Cities让全科医生为大城市做好预备

Broad Medical Training广泛的医学培训 Understanding of how to use medical

system resources to the best advantage of the patient 理解为了病人的利益如何利用医疗体系资源– Trained to know what the rest of the

medical system has to offer 受过训练知道医疗体系的哪些医疗资源可以利用

Procedural training 操作技能培训

Preparing Family Physicians for Larger Cities让全科医生为大城市做好预备

Overseeing other health-care providers 监督其它医务工作者

– Nurses, Physician assistants, Nurse practitioners, Public Health personnel , etc 护士、医师助理、执业护士、公卫人员等

Management of care given to the patient 管理给予病人的健康照顾 Knowing when to refer知道何时转诊

– Knowing your limitations知道你的限制– Comfortable in your chosen scope of practice 在选定的执业范

围内感到舒适自信– Knows what tests, procedures, treatments, paramedical

resources are available locally知道当地有哪些化验、手术操作、治疗、医疗辅助资源

Who should Teach GP’s?谁教全科医生？ Preparing the Teachers of Family Medicine 准备好全科医学的老师

General practice doctors 全科医生– Specialists in general practice 全科医疗中的专科医师– Need primary care perspective 需要有初级保健的洞察力

– Global outlook 整体的眼光– Practical clinical skills 实用的临床技能

Not easy to find GP specialists when GP is new全科医疗是新的，不容易找到全科的专科医师

Who should Teach GP’s?谁教全科医生？ Preparing the Teachers of Family Medicine 准备好全科医学的老师 Specialists 专科医师

– Needed for training in specialty areas

在专科领域需要他们来参与培训– Need their expertise 需要他们的专门技能– Need their cooperation 需要他们的合作– Specialists need to understand the need

for and role of GP 专科医师需要理解全科医生的需要和角色

General Practice Specialist Teachers 全科的专科老师

Passion for general practice specialty 热爱全科这个专业 Excellent broad knowledge base 良好广泛的知识基础 Excellent clinical skills良好的临床技能 Excellent doctor patient relationship skills 良好的医患关系技巧 Excellent procedural skills良好的手术操作技巧 Excellent teaching ability良好的教学能力

Specialist Teachers 专科老师 Understand and value the role of GP in the

medical system and for patient health 理解并重视全科医生在医疗体系及病人健康中的作用

Recruited for their teaching ability 因他们的教学能力而被纳入进全科的教学团队

Understands the role of the other specialties in preparing new GPs. 理解在准备新的全科医生时，其它专科医生的任务

They should understand what part of their specialty GP’s need to know 理解在他们专科范围内全科医生需要知道哪些部分– They don’t teach everything 他们不需要教所有的– They know the common diseases GPs need to treat他们理解全科医生需要治疗的常见病

Specialist Teachers: Which Ones?专科老师：哪些人？ Specialists from all the organ system areas that GPs

will be responsible for treating 全科医生有责任治疗的、所有器官系统所涉及的专科– Internal medicine内科

• Cardiology 心脏病学• Pulmonology 肺病学• Gastroenterology胃肠病学• Hematology血液学• Infectious disease感染性疾病• Neurology 神经病学• Rheumatology风湿病学• Endocrinology内分泌学• Nephrology神经病学• Ophthalmology眼科• Otorhinolaryngology 耳鼻喉科• Dermatology 皮肤科• Others 其它

Specialist Teachers: Which Ones?专科老师：哪些人？ Pediatrics 儿科医生

• Cardiology心脏病学• Pulmonology肺病学• Gastroenterology胃肠病学• Dermatology皮肤科• Endocrinology内分泌科• Otorhinolaryngology耳鼻喉科• Neurology神经病学• Rheumatology风湿病学• Ophthalmology眼科• Others 其它

Specialist Teachers: Which Ones?专科老师：哪些人？ Surgical 手术

– Orthopedics骨科– General surgery普外科– Dermatology皮肤科– Obstetrical产科– Gynecological妇科

Specialist Teachers: Which Ones?专科老师：哪些人？ Obstetrician Gynecologists妇产科

– Obstetrics产科• Normal pregnancies and deliveries正常妊娠和分娩• Ability to recognize high risk pregnancies and

consult or transfer care when needed识别高危妊娠，当必要时请求转诊或会诊的能力

– Gynecology妇科• Normal and pathological conditions正常和病理情

况– Infectious感染– Surgical 手术– Menarche初潮– Menopause绝经– Endocrinological内分泌的

Specialist Teachers: Which Ones? 专科老师：哪些人？Behavioral Medicine行为医学

–Psychiatry精神病学

–Psychology心理学

–Counseling心理咨询

Paramedical Teachers: Which Ones? 医辅专业教师：哪些人？ Pharmacists药剂师 Therapists (physical, occupational, speech,

others) 理疗师（身体的，职业的，语言及其它） Dieticians营养师

Social Workers 社会工作者 Nurse specialists if available 护士专家（如果有

的话）

Curriculum of Specialist Teachers专科教师的课程

Common diseases in each specialty每个专科中的常见病

Common procedures when practical and needed 实用、必需的常见操作

Curriculum developed together with primary care faculty and other specialists 课程设计由全科教职员和其它专科医师共同完成– AAFP and ABFM developed most of their curriculum in

cooperation with the other specialties美国家庭医生协会和家庭医学委员会的课程安排都是和其它专科医生共同制定的

– What to recognize and treat 认识和治疗什么– What procedures to do 做哪些操作– What to refer 什么情况下转诊

CV Requirements 心血管专业培训要求

CV Requirements心血管专业培训要求

Training Sites of GP and Specialist Teachers全科医生和专科师资培训地点 Outpatient department 门诊部 Hospital 医院 Intensive Care Units 重症监护病房 Emergency department急诊科 Old people’s care homes养老院 Occupational medicine 职业病学

Wherever the specialist practices the trainee should be included

专科医生无论在哪里工作，受训者都应该被包括进来 Wherever the GP will practice the GP should be

trained; wherever the GP will refer patients the GP should be trained

全科医生将在哪工作就应该在哪里得到培训；全科医生往哪里转诊病人，就应该在哪里得到培训。

Specialist Teachers 专科师资

Treat GP trainees equally with specialty residents平等地对待全科和专科住院医生

Teach GP students with the same positive attitude given to their own specialty trainees用给予本专业住院医生一样的正面态度对待全科学生

They do not withhold information from trainees

他们不会对受培训者保留信息

Specialist Teachers 专科师资

Use modern teaching techniques 使用现代教学技巧– Lecturing not the most effective method讲课不是最有效的方法

– Active learning more effective积极的学习更有效 Allow graduated increase in responsibility and

hands on care of patients including procedural skills允许他们承担的责任逐渐增加，亲自教他们病人照顾的技巧，包括手术操作技巧。

A Few Suggestions 一点建议 Focus on common things in medical training 在医学培训中关注常见的问题 Develop a passion for what you are doing 燃起对你所做的事情的热爱 Seek out and recruit (if possible) those students who really want

to be family physicians (don’t try to fit square pegs into round holes)

招募那些真正愿意做全科医生的学生。（不要试着把方栓塞进圆孔中）

Seek out and recruit specialists faculty who understand and support the specialty of GP.

招募那些理解并支持全科医学专业的专科师资 Learn to work with specialists 学习与专科医生一起工作 Realize how important you are as family physicians 意识到你作为全科医生有多重要 Continue to focus on the end (your desired product) 继续关注结局（你想要的产品）

Thank You!谢谢