García-Mangas José Alberto, Viniegra-Velázquez Leonardo, Arellano-López Jorge, García-Moreno Juan
Coordinación de Educación en Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social.
Rev Med Inst Mex Seguro Soc. 2005 Nov-Dec;43(6):465-72.
To evaluate the development through time of the clinical aptitude in physicians of the first level of attention and the influence of categories of first level physicians.
In a cross-section design the clinical aptitude was studied in three categories of physicians of the first level of attention: general practitioners with functions of family medicine, family physicians, and family physicians working as head of a clinical department in Family Medicine Units with 10 or more consulting rooms. To evaluate the clinical aptitude, an instrument with 12 real clinical cases and 412 questions was used with nine indicators; this instrument was validated in a previous study.
499 physicians of the three categories were included, the scores range was between 52 and 245, with an average of 169 (41%). When comparing the categories of physicians, significant differences were found, in favor of the physicians with a specialty. There were no differences among heads of clinical departments and family physicians. In the global analysis among indicators no differences were found. When correlating the clinical aptitude with the years of experience, without considering the category, a correlation of 0.02 was obtained.
Experience seems to have no influence in the development of clinical aptitude; passive continuing education seems to have little influence in the physicians deepening into frequent health-problem solving in their practice.
评估一级医疗机构医生临床能力随时间的发展情况以及一级医生类别对此的影响。
采用横断面设计,对三类一级医疗机构医生的临床能力进行研究:承担家庭医学职能的全科医生、家庭医生以及在拥有10个或更多诊室的家庭医学单位担任临床科室主任的家庭医生。为评估临床能力,使用了一份包含12个实际临床病例和412个问题的工具,该工具设有九个指标;此工具在先前研究中已得到验证。
纳入了这三类的499名医生,得分范围在52至245分之间,平均分为169分(41%)。比较医生类别时,发现存在显著差异,专科医生得分更高。临床科室主任和家庭医生之间无差异。在指标的整体分析中未发现差异。将临床能力与工作年限进行相关性分析时,不考虑医生类别,得到的相关性为0.02。
经验似乎对临床能力的发展没有影响;被动式继续医学教育似乎对医生在实践中深入解决常见健康问题的能力提升影响甚微。