“仅仅是一种美好的奢侈？”公共卫生实习能为研究生全科医学培训增添什么？

Wills Jane, Reynolds Joanna, Swanwick Tim

Institute of Primary Care and Public Health, London South Bank University, UK.

Educ Prim Care. 2009 Jul;20(4):278-84. doi: 10.1080/14739879.2009.11493799.

BACKGROUND

Changing trends in the role of general practice and general practitioners (GPs), including a focus on commissioning and practice population health needs, were reflected in the specialty training curriculum published by the Royal College of General Practitioners (RCGP) in 2007. In response to these developments the London Deanery established training attachments to the public health departments of ten primary care trusts (PCTs) across London, incorporated into three-year GP specialty training programmes. These attachments were evaluated in 2008 by London South Bank University.

AIMS

The aims of the evaluation were to assess the attachment's suitability for addressing areas of the RCGP curriculum; and to explore perceptions of its value for GP training and for future practice.

METHODS

Semi-structured interviews were carried out with two cohorts of trainees towards the end of their public health attachment, and with public health trainers and GP training programme directors from participating schemes.

FINDINGS

The training attachments were generally considered to offer good opportunities for trainees to fulfil both public health competences and to address relevant areas of the RCGP curriculum, through a variety of types of work. However, this did not necessarily influence either the level of importance attributed to public health in comparison with other clinical training posts or the perceived impact of the attachment on the trainees' future practice as GPs. The reported learning outcomes and value of the attachment for the public health trainers and programme directors reflected the changing and perceived future demands on GPs, but these views were not generally shared by trainees.

CONCLUSIONS

Public health attachments may offer general practice training programme opportunities for the development of skills and knowledge that are relevant to the changing nature of general practice. Yet, there still appears to be a barrier for trainee GPs in acknowledging their role in non-clinical, population-focused healthcare provision. This raises questions for the way in which public health is presented in medical education and how the future GP workforce conceptualise their role and responsibilities.

背景

2007年皇家全科医师学院（RCGP）发布的专科培训课程反映了全科医疗及全科医师（GP）角色的变化趋势，包括对医疗服务委托和执业人群健康需求的关注。为应对这些发展，伦敦地区医疗培训管理机构在伦敦十个初级保健信托基金（PCT）的公共卫生部门设立了培训实习点，并将其纳入三年制的全科医师专科培训计划。2008年，伦敦南岸大学对这些实习点进行了评估。

目的

评估的目的是评估该实习点对RCGP课程相关领域的适用性；并探讨其对全科医师培训及未来执业价值的看法。

方法

在两个队列的学员完成公共卫生实习接近尾声时，对他们进行了半结构化访谈，并与参与该计划的公共卫生培训师和全科医师培训项目主任进行了访谈。

结果

总体而言，培训实习点被认为为学员提供了良好的机会，通过各种类型的工作，既能实现公共卫生能力要求，又能涉及RCGP课程的相关领域。然而，这不一定会影响与其他临床培训岗位相比，对公共卫生重视程度的高低，也不一定会影响学员对实习点对其未来作为全科医师执业的影响的认知。所报告的实习学习成果以及对公共卫生培训师和项目主任而言实习点的价值反映了对全科医师不断变化的、可预见的未来需求，但学员们普遍不认同这些观点。