党的二十大报告指出，要"发展壮大医疗卫生队伍，把工作重点放在农村和社区"，全科医生是居民健康和医疗费用的"守门人"，在基本医疗卫生服务中发挥着重要作用，培养"下得去、留得住、用得好"的应用型、复合型新时代全科医生人才，将是推进健康中国建设的重要一步。本报告在《中国全科医生培养发展报告（2018）》的基础上，将2018年至今我国全科医生的队伍建设、培养教育、使用激励机制改革等情况进行了较系统的梳理，并提出了我国全科医生的未来展望，希望可以为我国全科医学的进一步研究提供资料。

Across healthcare systems, current health policies promote interprofessional teamwork. Compared to single-profession general practitioner care, interprofessional primary healthcare teams are expected to possess added capacity to care for an increasingly complex patient population. This study aims to explore patients' experiences when their usual primary healthcare encounter with general practice shifts from single-profession general practitioner care to interprofessional team-based care.Qualitative and quantitative data were collected through interviews and a survey among Norwegian patients. The interviews included ten patients (five women and five men) aged between 28 and 89, and four next of kin (all women). The qualitative analysis was carried out using thematic analysis and a continuity framework. The survey included 287 respondents, comprising 58 per cent female and 42 per cent male participants, aged 18 years and above. The respondents exhibited multiple diagnoses and often a lengthy history of illness. All participants experienced the transition to interprofessional teamwork at their general practitioner surgery as part of a primary healthcare team pilot.The interviewees described team-based care as more fitting and better coordinated, including more time and more learning than with single-profession general practitioner care. Most survey respondents experienced improvements in understanding and mastering their health problems. Multi-morbid elderly interviewees and interviewees with mental illness shared experiences of improved information continuity. They found that important concerns they had raised with the nurse were known to the general practitioner and vice versa. None of the interviewees expressed dissatisfaction with the inclusion of a nurse in their general practitioner relationship. Several interviewees noted improved access to care. The nurse was seen as a strengthening link to the general practitioner. The survey respondents expressed strong agreement with being followed up by a nurse. The interviewees trusted that it was their general practitioner who controlled what happened to them in the general practitioner surgery.From the patients' perspective, interprofessional teamwork in general practice can strengthen management, informational, and relational continuity. However, a prerequisite seems to be a clear general practitioner presence in the team.© 2023. The Author(s).

背景 国内关于全科医生岗位胜任力评价指标的研究主要来自东部经济发达地区，而我国地区间医疗资源配置不平衡、医疗水平差距较大，现有全科医生岗位胜任力评价指标在农村地区或者欠发达地区的适用性可能不足。 目的 构建可用于评判欠发达地区全科医生岗位胜任力的指标体系，为欠发达地区全科医学人才培养、考核、评价提供参考依据。 方法 通过文献研究法初步构建欠发达地区全科医生岗位胜任力评价指标体系。于2021年1—6月，采用目的抽样法，从在欠发达地区从事全科临床工作者、在州/县/乡镇从事全科临床实践/卫生行政管理工作者，以及参与过东西部对口帮扶且曾在欠发达地区挂职的全科医生中遴选18名咨询专家。分别运用专家咨询法、层次分析法完成欠发达地区全科医生岗位胜任力评价指标筛选工作、各指标权重的确定工作。 结果 两轮专家咨询问卷的有效回收率均为100.0%，专家熟悉、判断、权威系数分别为0.76、0.84、0.80，肯德尔协调系数分别为0.24（χ²=297.543，P<0.001）、0.26（χ²=322.083，P<0.001）。建立了包含4个一级指标、20个二级指标、44个三级指标的欠发达地区全科医生岗位胜任力评价指标体系。一级指标"医疗服务能力""公共卫生服务能力""组织管理和应对能力""职业素养"的权重分别为0.350 9、0.109 1、0.189 1、0.350 9；二级指标中，组合权重位列前4位的指标分别为"业务素质"（0.177 1）、"学习思维能力"（0.126 5）、"基层沟通协调"（0.118 6）、"常见病、多发病诊治"（0.108 9）；三级指标中，组合权重位列前4位的指标分别为"工作中与患者、同事、上级医院医生文明沟通、友好交流"（0.118 6）、"人文关怀"（0.098 9）、"掌握心肺复苏术（CPR）、除颤术、导尿术等临床适宜技术"（0.088 3）、"常见病、多发病诊断和治疗"（0.081 7）。 结论 本研究构建的欠发达地区全科医生岗位胜任力评价指标体系具有实用性和科学性，可为欠发达地区全科医生岗位胜任力评价提供科学依据。

As one of the most important members in clinical trials, the number of clinical research nurses (CRN) can't keep up with the growth of experimental projects, so it is urgent to build clinical research training and strengthen the background knowledge of nurses.To construct CRN training program based on position competence, accelerate the construction of CRN talent pool, and provide scientific guidance significance for CRN training.Based on the position competence model, combined with literature research and qualitative interview results, the first draft was prepared of the CRN training program. Two rounds of correspondence with 16 experts were conducted using the Delphi method to determine the training program.The effective recovery rate of the expert correspondence questionnaire was 100% and the authority coefficients of the 2 rounds of experts were 0.826 and 0.895. Finally, 4 first-level indicators and determine 15 s-level indicators of training objectives. The training program included 4 first-level indicators, training requirements, content, methods, assessment and evaluation, 15 s-level indicators, and 74 third-level indicators.The CRN training program based on position competence is scientific and extendable, providing a basis for participation in CRN training.©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.

背景 助理全科医生是全科医生队伍的重要组成部分，承担着许多基层全科工作，但目前国内还没有公认的国家层面助理全科医生岗位胜任力模型为培养合格的助理全科医生提供科学的依据。 目的 构建中国助理全科医生岗位胜任力模型指标体系，为国家助理医师执业资格考试设计的完善提供支持，同时为助理全科医生的培养和评价提供理论依据。 方法 基于课题组前期文献研究和行为事件访谈建立条目池，于2019年9月—2020年1月采用德尔菲法对30位从事全科医学领域的专家进行2轮咨询，运用层次分析法确定中国助理全科医生岗位胜任力模型指标及权重系数。 结果 最终拟定中国助理全科医生岗位胜任力一级指标6个[基本医疗卫生服务（0.244 8）、医学知识与终身学习（0.244 8）、职业素养（0.244 8）、人际沟通与团队合作（0.138 9）、基本公共卫生服务（0.085 8）、信息利用能力与管理能力（0.041 0）]，二级指标63个，并明确了各个指标的权重系数。 结论 本研究首次构建了中国助理全科医生岗位胜任力模型，其专家代表性及权威程度较高，指标筛选较为全面、合理，为指标体系的实证研究奠定了基础。

背景　我国全科人才队伍建设相对滞后，合格的全科医生输入严重不足，制约了基层医疗卫生服务水平。目前国内外对全科医生的能力评价主要依据世界家庭医师组织提出的6项核心胜任力，我国对全科医生能力评价研究较晚，研究多侧重从社区卫生服务中心主任、社区卫生服务中心机构、全科医生的临床能力等出发，对全科医生个人综合能力评价的相关研究较为缺乏。目的　建立全科医生综合能力评价体系，评价上海市某区全科医生的综合能力，从而指导全科医生实践，为建立全科人才队伍、培养优秀全科人才起到指导作用。方法　运用层次结构分析法建立全科医生综合能力评价体系，于2018年6月在上海市某区12家社区卫生服务中心中随机选取4名全科医生，共48名作为调查对象，通过问卷自评的形式对上海市某区全科医生综合能力进行评价。结果　研究从临床诊疗能力、公共卫生服务能力、科研能力、人文素养4个方面构建了全科医生综合能力评价体系。并对上海市某区全科医生进行评价，结果显示上海市某区全科医生评价的总平均得分为78.45分，该区全科医生综合能力属于中等偏上水平。人文素养得分最高，科教能力得分最低，临床诊疗能力和公共卫生服务能力位居中间。其中科教能力评分较低，仅为54.49分。结论　全科医生的培养必须多角度进行，在医疗、公共卫生、人文、科研方面，特别针对科研和教学等薄弱点，要提高认识、加大投入力度，提升全科医生综合能力。

背景　全科医生能力评价体系在国外发展已趋于成熟。但在国内，仍以医疗机构自行考核为主要方式，由于各个机构标准不一，评价方法不一，其结果的权威性、客观性等无法保证。因此需要构建符合目前全科医学发展的统一标准。目的　通过德尔菲法制定全科医生能力评价分级指标体系，根据指标结果构建“全科医生能力评价分级TSH立方体模型”，推动全科医生能力评价同质化进程，更准确、客观地评价全科医生能力。方法　2019年4—5月，通过文献分析、专题小组讨论，初步确立了全科医生能力评价分级指标体系，包括一级指标3个（全科理论知识、全科临床技能、全科人文素养），二级指标、三级指标各44个。2019-07-01至2019-09-10通过德尔菲法进行两轮专家问询（n=28），将其建议进行归纳整理，最终确定并形成全科医生能力评价分级指标体系。记录专家基本资料、专家积极性、专家修改建议、专家权威程度、专家意见集中程度、专家意见协调程度。结果　第一轮专家咨询的熟悉程度和判断系数为0.900和0.936，第二轮为0.948和0.956；两轮权威系数分别为0.918和0.952，均在0.70以上；第一轮专家咨询重要性、可得性协调系数为0.471、0.409，第二轮为0.363、0.386。最终确定了包含全科理论知识、全科临床技能、全科人文素养3个维度，43条考核指标的全科医生能力评价分级指标体系。根据指标结果及前期所获专利完成“全科医生能力评价分级TSH立方体模型”构建。结论　本研究构建了包括一级指标3个，二级指标、三级指标各43个的全科医生能力评价分级指标体系，经统计分析，专家积极系数、权威程度较高，意见较集中，函询结果科学性、可信度和可靠性高。

The Tibetan area is one of China's minority regions with a shortage of general practice personnel, which requires further training and staffing. This research helps to understand the current condition and demand for general practitioner (GP) training in Tibetan areas and to provide a reference for promoting GP education and training.We conducted a cross-sectional survey using stratified sampling targeting 854 GPs in seven cities within the Tibetan Autonomous Region, utilizing an online questionnaire. Achieving a high response rate of 95.1%, 812 GPs provided invaluable insights. Our meticulously developed self-designed questionnaire, available in both Chinese and Tibetan versions, aimed to capture a wide array of data encompassing basic demographics, clinical skills, and specific training needs of GPs in the Tibetan areas. Prior to deployment, the questionnaire underwent rigorous development and refinement processes, including expert consultation and pilot testing, to ensure its content validity and reliability. In our analysis, we employed descriptive statistics to present the characteristics and current training needs of GPs in the Tibetan areas. Additionally, chi-square tests were utilized to examine discrepancies in training needs across various demographic groups, such as age, job positions, and educational backgrounds of the participating GPs.The study was completed by 812 (812/854, 95.1%) GPs, of whom 62.4% (507/812) were female. The top three training needs were hypertension (81.4%, 661/812), pregnancy management (80.7%, 655/812), and treatment of related patient conditions and events (80.5%, 654/812). Further research shows that the training required by GPs of different ages in "puncturing, catheterization, and indwelling gastric tube use" (64.6% vs. 54.8%, p = 9.5 × 10) varies statistically. GPs in various positions have different training needs in "community-based chronic disease prevention and management" (76.6% vs. 63.9%, p = 0.009). The training needs of GPs with different educational backgrounds in "debridement, suturing, and fracture fixation" (65.6% vs. 73.2%, p = 0.027) were also statistically significant.This study suggests the need for targeted continuing medical education activities and for updating training topics and content. Course developers must consider the needs of GPs, as well as the age, job positions, and educational backgrounds of GPs practicing in the Tibetan Plateau region.Not applicable.© 2024. The Author(s).