First, the background and process of opening wide

1) background

The distribution and structure of health human resources in China are unbalanced, and the existing training mode is not in harmony with the demand, and it is excessively concentrated in big cities and hospitals. Rural community health workers are in short supply, and their overall quality is not high, especially general practitioners. As a result, the medical and health development between urban and rural areas and between regions is unbalanced, the development of rural community health is seriously lagging behind, it is difficult and expensive for people to see a doctor, and the gap in residents' health status is widening.

Therefore, the "Decision on Health Reform and Development" of the Central Committee and the State Council made an important decision to "accelerate the development of general practice and train general practitioners". In order to realize this strategic task, it is an important task for medical colleges to accelerate the development of general practice education, build a high-quality community health service team with general practitioners as the backbone, and ensure the in-depth, healthy and sustainable development of community health services.

According to the urgent needs of this special national condition, our hospital sized up the situation, under the personal instructions, care and support of Minister Zhu Chen of the Ministry of Health, closely combined with China's current national conditions and our actual school-running ability, and in line with the weather, geographical location and human harmony, creatively proposed to train general medical education oriented to the vast urban communities and rural communities, so as to train qualified and practical educational talents for the vast rural and urban communities.

2) After that

(1) set up a general practice research group.

The leadership of our hospital attaches great importance to this work, so a special general practice research group has been set up, with a vice president in charge of this work, and the members of the research group are composed of high-level business backbones with high academic qualifications, professional titles and high levels.

(2) Study and study abroad

The research group went to Zhejiang University Medical College, Capital Medical University, Xuzhou Medical College and other medical colleges with rich experience in general practice education in stages to study and inspect, initially established the training goal and mode of general practice education suitable for China's national conditions and the actual starting point of our hospital, and also conducted a comprehensive and detailed investigation on curriculum setting, syllabus formulation, teacher training and assessment system. In addition, the research group also clarified the division of labor, and some members went deep into many famous tertiary specialized hospitals (such as Beijing Friendship Hospital and Fuxing Hospital) and their community health service centers and sites at all levels to investigate the clinical practice and community practice of general medical students in specialized hospitals and community centers; Other members went deep into local health administrative departments and community service centers (points) to conduct extensive investigations and obtain first-hand information. Taking the local situation as a microcosm, the present situation of health talent resources in urban communities and rural areas in China, the health status of ordinary people and their health needs were initially mastered (see the survey report for details). According to the above investigation, the research group timely wrote the feasibility report of setting up clinical medicine specialty (general practice) in our hospital, which is located in urban communities and vast rural areas. The research work of the research group has been highly praised and strongly supported by the leaders of the Ministry of Health, the Provincial Health Department, relevant experts from well-known medical colleges in China and the health administrative department of our city.

(3) Make teaching plan, syllabus and expert argumentation.

In the shortest possible time, the research group concentrated collective wisdom and strength, carefully arranged, scientifically divided, closely cooperated and extensively investigated, and worked out the first draft of the teaching syllabus in strict accordance with the training objectives and the thinking concept of general practice teaching and practice. Then, the first draft was submitted to well-known medical colleges and relevant general practice experts from the Ministry of Health, and the third draft was completed after listening to their opinions and suggestions comprehensively and extensively.

General practice education, the starting point of junior college, is a brand-new thing in China. Although some preliminary work has been done and highly praised and strongly supported by domestic experts and scholars and higher authorities, it is still in the initial exploration stage. In order to run this innovative major more scientifically and rigorously, on July 3, 2008, our hospital invited professors, experts and scholars from well-known medical colleges in China, as well as relevant leaders from the Ministry of Health, the Provincial Health Department and Shangrao City to our hospital to evaluate and demonstrate our preliminary work, hoping that they would give us guiding opinions and suggestions for our follow-up work.

This demonstration invited Meng Qun, director of the Department of Science and Education of the Ministry of Health; Professor Cui of Capital Medical University; Professor Liu Haibo of China Journal of General Practice; Professor Rong Shi from Shanghai Jiaotong University; Professor Yu Hai from Zhejiang University; Professor Yuan of Nanchang University; Professor Wang Shaolang from People's Military Medical Publishing House; Nie Wei, Director of Provincial Education Department; Li Zhigang, Director of Provincial Health Department.

The convening of the demonstration meeting was very successful, which attracted great attention from the news, media and society, and was highly praised and unanimously recognized by all professors, experts and leaders attending the meeting. Of course, experts and professors have also put forward many pertinent and valuable opinions on our syllabus and teaching plan. Now, according to the opinions and suggestions of experts and professors, the research group is revising and perfecting the third draft.

Second, the guiding ideology and objectives and tasks

(A) the guiding ideology

Adhere to the guidance of Deng Xiaoping Theory, Theory of Three Represents and Scientific Outlook on Development, conscientiously implement the policy of health work in the new period, take the demand of community health service as the guide, focus on improving the level and quality of community health service, follow the principle of combining long-term development with current needs and seeking truth from facts, highlight key points, guide by classification, and gradually improve. With the general practice education after graduation as the core, focusing on teacher training and on-the-job training, we will actively explore and be brave in practice. By 20 1 1, we will gradually establish a relatively perfect general practice education system in line with the actual situation of our city, and cultivate a high-quality and sufficient community health service team with general practitioners as the backbone to provide reliable talent guarantee for the development of community health services in our city.

(2) development goals

Adhere to the people's health as the center, with the goal of providing sustained, comprehensive and convenient basic health services to individuals, families and communities, and establish a general medical education system that meets the needs of the reform and development of health undertakings in our city. Efforts should be made to cultivate and bring up a high-quality community health service team based on the community, which can provide basic health services for residents and provide preventive, medical, health care, rehabilitation, health education and family planning technical services in a bio-psychological-social medical mode.

(3) Specific tasks

1, 2009, building the basic framework of general medical education. Establish the city's general medical education and training center, general medical education and training station, clinical training and community training base in all districts, and strengthen the construction of teachers.

2.20 10, the general medical education system was initially established and improved. Strengthen the construction of general practice education and training centers, clinical and community training bases, explore effective ways and modes to train high-quality general practitioners, and gradually summarize and popularize them.

3. 20 10-20 12. Improve the general medical education system.

1) Formulate the teaching outline and teaching plan of general practice, and prepare handouts, teaching materials and experimental guidance.

Focusing on the overall goal of establishing a general practice teaching and education model for rural communities, members of the project team collectively discussed and formulated a relatively complete general practice teaching course and the compilation of teaching outlines for various courses (including internships) that meet the requirements of community health services; And write lectures and experimental instructions; Further compile general practice teaching materials at the specialist level.

2) Reform of teaching methods of general practice.

Adopt the method of case teaching; Take various forms of discussion methods, such as focus group discussion, thematic group discussion, problem-centered group discussion, etc. Explore the communication and leap between disciplines, between basic and clinical, and between theory and practice; Improve students' ability of "six-in-one" general medical service, and at the same time understand the new problems encountered in the implementation of the program through discussion and solve them in time.

3) Establish general practice and practice teaching bases.

Establish a fixed practice teaching base of general practice, establish an effective practice teaching assessment system and determine the assessment items; Formulate assessment scoring methods and conduct assessment.

4) Expert demonstration of general practice teaching plan and outline.

Invite relevant experts and leaders to conduct general practice demonstration and teacher training.

5) Training and further study of general practitioners.

Contact Capital Medical University and the General Practice Training Center of the Ministry of Health to train teachers in our hospital.

6) Investigate the current situation of primary health human resources and community health services in Shangrao.

7) Visit relevant colleges and communities and write investigation reports, and ask the Ministry of Health for instructions and feasibility reports.

Third, specific measures to develop general medical education

1) reform and training objectives and capacity requirements: the goal is to train rural community practical general practitioners who have the professional ethics of serving people's health and are "able to get down, use, stay and live well". Professional ability requirements: master the basic theory, knowledge and skills of general practice, be familiar with the thinking mode of diagnosis and treatment of general practice, have the ability to prevent and treat common diseases, frequently-occurring diseases, infectious diseases and diseases in the community, and be able to provide health services including medical treatment, prevention, health care, rehabilitation, health education and family planning guidance to individuals, families and communities with the purpose of maintaining and promoting health.

2) Innovative training mode: According to the training objectives and ability requirements, the previous training mode of school education plus hospital practice was changed to: 80 weeks of school education+4 weeks of practice in hospitals above Grade II+40 weeks of rotation practice in hospitals+6 weeks of epidemic prevention stations (epidemic prevention and health departments)+6 weeks of community practice.

3) Optimize the curriculum: According to the fact that the training of general practitioners in rural communities does not require students to have very extensive basic theoretical knowledge, we set aside 230 hours for professional basic courses and professional courses by deducting public basic courses (physics, chemistry, cell biology, etc.). ) and compress the public basic courses (two courses, English) that are of little significance to grassroots clinical practice. At the same time, according to the functional requirements of "six in one", courses such as prevention, health care and health promotion are added. See attached table. After optimization, the proportions of public basic courses, specialized basic courses and specialized courses in compulsory courses are 16.4%, 32.8% and 50.8% respectively, while the corresponding proportions of undergraduate colleges are 30.7%, 27. 1% and 4 1.5% respectively. Moreover, the number and hours of specialized courses are not much different from those of undergraduate colleges, which ensures the professional ability and quality of students from the hours.

4) Reform the teaching content and enhance the practicability: according to the ability requirements of rural community general practitioners, rewrite the teaching syllabus and teaching materials (handouts). Delete the contents of repeated clinical confirmatory experiments, such as disseminated intravascular coagulation test, which have little practical significance for community health work. And add three clinical practice experiments, such as routine examination, electrocardiograph, rapid peripheral blood glucose determination and X-ray shooting of common diseases; The repeated contents in the current textbooks are described separately in a certain course, such as the imbalance of water, electrolyte and acid-base in the current internal medicine textbooks, so avoid repeating them in the surgical textbooks. The new textbook (handout) emphasizes the diagnosis and prevention of common and frequently-occurring diseases in rural areas; This fine and practical teaching content ensures the quality of students' rural medical and health services.

5) Reform teaching methods: gradually transfer the current team-based teaching form to the general compound teachers to complete the teaching, learn from the experience of domestic brother provinces and cities, make full use of students' community medical background, and explore methods such as example learning, cooperative learning, role-playing, video recording, direct consultation, demonstration teaching, imitation teaching, discussion, etc., with students as the main body, stimulate students' thinking and improve their ability to analyze and solve problems, thus improving the teaching effect.

6) Pay attention to medical practice skills: invite clinicians who have participated in the training of general practitioners or participated in the backbone training of general practitioners to teach and practice in clinical departments, focusing on cultivating students' symptom-oriented diagnosis and treatment mode, diagnosis, differential diagnosis, prevention and treatment principles and referral indications for common diseases, frequently-occurring diseases and infectious diseases; Handling principles of common emergencies and basic knowledge of pre-hospital first aid; Don't unilaterally pursue high-tech and cutting-edge medical technology. This can cultivate students' general medical diagnosis and treatment thinking and avoid taking the old road of training specialists in clinical practice education; At the same time, students can't aim too high and concentrate on learning medical and health service skills that can be developed in rural areas.

7) Strengthen the construction of training bases and establish a general practice training network.

Set up Shangrao General Practice Education and Training Center, which belongs to the Medical Training Center of the Ministry of Health and is responsible for the training of general practice education teachers and managers, general practitioners and community nurses in the city; Responsible for guiding the training work of training stations in various districts; Coordinate the work of general practice clinical and community training bases; Actively carry out academic exchanges and scientific research. The general practice clinical training base is mainly located in the second-class or above hospitals, and the community training base is mainly located in the first-class hospitals or community health service centers and district-level preventive health care institutions. Form a comprehensive and reasonable general practice training network with the municipal general practice education and training center as the leader, the training stations in all districts as the backbone and the clinical and community training bases as the foundation.

8) Strengthen the construction of teaching staff.

Building a team of high-quality teachers is the key to general medical education and the focus of current work. Make a teacher training plan and train general practitioners in a planned and step-by-step manner. Attract a group of experts who love general practice, have grass-roots work experience and have made certain achievements in clinical disciplines, and enrich the teaching staff through necessary general knowledge training; At the same time, through the way of "please come in and send out", well-known experts at home and abroad are invited to give lectures in Shenzhen in a planned way, or personnel are sent to study and inspect in foreign countries or advanced provinces and cities, and teacher training is carried out through various channels and forms, so as to establish a sufficient number of high-quality teachers as soon as possible.

Fourth, teacher training.

Teachers are the core and key to the success or failure of teaching. Because this major is the first time in our college, the shortage of teachers is the biggest bottleneck of teaching and the biggest difficulty at present. Teacher training is urgent and imperative! Under the care and recommendation of the director of the Department of Science and Education of the Ministry of Health, the general practice research group of our hospital invited the general practice experts and professors from Zhejiang University, Shanghai Jiaotong University, China Medical University, Nanchang University and other well-known domestic medical colleges headed by Professor Cui, the former academic director of Capital Medical University, and now the deputy director of the training center of the Ministry of Health, to come to our hospital to train general practice teachers, and conducted a strict examination on the students. 765,438+0 teachers in our hospital passed the examination and obtained the training certificate of general practitioners from the Ministry of Health.

Five, professional characteristics and curriculum system reform

The clinical medicine specialty (general practice) in our hospital has the following characteristics:

1. Can go and stay: Standardized medical undergraduates are unwilling to go to rural communities, and specialist general practitioners are willing to go to the grassroots.

2. Short cycle: This scheme only needs three years.

3. Less investment.

4. Applicability: The curriculum reform of prevention and treatment of common diseases, frequently-occurring diseases and chronic diseases in counties and townships and the cultivation of clinical medical skills enable students to have relatively strong practical ability.

5. Master the thinking mode of diagnosis and treatment of general medicine.

1) Curriculum system reform

In such a short time (136 weeks), can we cultivate a general practitioner who can reassure, trust and satisfy the people in rural communities? We have taken the following measures: according to the training of general practitioners in rural communities, students are not required to have very extensive basic theoretical knowledge. We have greatly reduced and compressed professional basic courses (physics, chemistry) and public courses (two courses, English) that have little to do with clinical practice. Delete the experimental contents that have no practical significance in specialized courses, and add experiments that are closely related to clinic, such as three routine examinations of blood, urine and stool, operation of electrocardiograph and rapid blood glucose meter, and X-ray shooting of common diseases.

2) In addition to teaching common clinical skills, it also focuses on strengthening the working ability of community preventive health care, community first aid, community nursing, rural community health management and the cultivation of general practice concepts. Using the thinking concept of general practice, we should focus on cultivating students' thinking habit of general practice diagnosis and treatment, which is symptom-oriented and focuses on physical examination. According to the requirements of general practitioners, master the diagnosis, differential diagnosis, prevention and treatment principles and referral indications of common diseases, frequently-occurring diseases and infectious diseases in rural communities, master the handling principles of common clinical emergencies and the basic knowledge of pre-hospital first aid, and do not unilaterally pursue high, new and sophisticated medical skills.

3) Registration status

Through a series of previous work, in 2008, our hospital was recruited by the provincial recruitment office to recruit clinical medicine (general practice). Up to now, the number of students enrolled in this major has exceeded 230, which greatly exceeds the number of plans issued by the provincial admissions office. A considerable number of students strongly demand to transfer from other majors to this major, which shows that many students and parents are very optimistic about the prospects of this major.

Problems and solutions of intransitive verbs

1) the connection and matching between the enrollment plan and employment model and the current national policies.

This is the most important point, and it is also a problem that the school can't solve as a pure teaching unit. There must be relevant policies issued by the government to ensure the continuity of general education in schools. It is suggested that local governments, under the guidance of national macro-policies and according to the specific needs of local general practitioners, formulate order-based (orientation) plans, entrust schools to train them, and orient them to specific units for employment after graduation. The government must ensure that these graduates are treated reasonably after graduation and that they can "stay". This policy has been fully rolled out in Zhejiang, Shanghai, Beijing, Shenzhen and other developed areas, which should be a desirable experience and trend for the development of primary health care in China in the next few years.

2) General practice theory, clinical practice and community teacher training.

The key and core of the success or failure of general practitioner training at the starting point of junior college lies in teachers, and schools should attach great importance to the training of general practitioner teachers. As this major is offered for the first time in our hospital, the general teachers are blank in theory, clinic and community. Based on the principle of training theoretical teachers first and paying equal attention to clinical and community teachers, our hospital first consolidates theoretical teachers step by step, and then strengthens the training of clinical and community teachers according to professional characteristics, so as to effectively promote the training of general practice teachers in stages, batches and levels, and avoid "grasping the eyebrows and beards" in the training process.

3) Construction of clinical and community practice bases.

In order to cultivate general practitioners who can adapt to the vast rural and urban communities, it is not enough to have theories and teachers, but also to have places for practice. In a sense, rich practice is the only way to use and do well. Therefore, schools must have their own clinical teaching hospitals and community health service centers (stations). Our hospital must establish its own clinical teaching hospital or cooperate with the third-class or higher hospitals, send its own clinical teachers with formal training to teach in our hospital, or invite relevant doctors in our hospital to participate in standardized clinical teacher training. With regard to the establishment of community health service centers (stations), because the investment will not be too large, our hospital plans to start investing necessary manpower, material resources and financial resources in the near future to establish 1 to two relatively perfect and independent community practice bases, which will be mainly used for community probation in the future clinical and community teaching process. Of course, winning government, institutional or private funding is also an unexpected gain.

5) Compilation of teaching materials (handouts)

Teaching materials are the basic support of teaching, and whether there is a set of scientific and practical teaching materials is an important factor to determine the success or failure of teaching. As it is the first time for our hospital to offer general practice education with specialty as the starting point, there are no ready-made teaching materials available, and almost all the general practice teaching materials on the market are undergraduate starting points or teaching AIDS or training materials related to general practice. Therefore, it is an urgent and severe task for us to compile a set of teaching materials and supplementary teaching materials that match the syllabus of general medicine at the starting point of the college. Our college plans to adopt a "three-step" scheme to solve this problem. The first step is to choose a set of relatively scientific, rigorous and informative undergraduate teaching materials as our temporary teaching materials, and constantly absorb and sum up experience in the teaching process. In the second step, teachers are required to prepare teaching handouts for the general practice syllabus suitable for the starting point of the college in the process of using temporary teaching materials, and then gradually transition to teaching with their own handouts. The third step, after 2~3 years, constantly revise and improve the self-compiled handouts. When the conditions are ripe, the teaching department will organize relevant teachers to write a set of general medicine textbooks from the professional starting point.

6) Continuing education and training after graduation.

At present and for a long time to come, the general medical education in China mainly focuses on continuing education and training after graduation, and the general medical education emphasizes lifelong education. Therefore, we should also fully realize this. The academic education we advocate is only a starting point of general medical education, or the enlightenment education of general practitioners. As an education department, schools should naturally cooperate with the state and the government to contribute to the continuing education and training of general practitioners after graduation. Our hospital will work together with Qi Xin, take the initiative to get in close contact with the higher-level government and health administrative departments, and establish its own general practice continuing education and training center as soon as possible. Strive to turn the training center of our hospital into a general practice education and training base or center in East China and even the whole country.

7) Development and perfection of disciplines.

(1) Actively promote scientific research.

Based on the principle of sharing information resources, we should actively go out and introduce science, strive to take general practice as a breakthrough, take the naming of school journals as an opportunity to activate scientific research, and strive to establish an academic Committee for general practice education in five years. Taking this as a lesson, we can fully mobilize the positive atmosphere of advocating scientific research and academics in our college.

(2) Strengthen exchanges with domestic and foreign brother schools and build * * *

Follow the law of school education development, change the concept of thinking, go out and introduce it, and actively strengthen communication with domestic famous schools and foreign universities. Including: academic exchange, talent interaction, scientific research cooperation, joint education, discipline construction, etc.

(30 liters undergraduate major.

After several years of hard work, when the conditions are met, you can consider upgrading to an undergraduate major.

To sum up, the starting point of general medicine specialty in our hospital was set up with the care and support of the leaders of the Ministry of Health, the Provincial Health Department, the municipal government and experts and professors from well-known medical colleges in China. It is a new thing, which needs the support and support of the corresponding policies of the state and the government, the unremitting efforts of all our staff and the enthusiastic attention and support of the whole society. I hope to explore and construct a new general practitioner training mode with China characteristics through our hospital, and provide experience and reference for this kind of education and teaching reform in the whole province and even the whole country.