Teaching Family Medicine:
Who Should Do it?
全科医学的教学团队
Chris Jenkins, MD
Family Medicine Education
International
Beijing 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:农村或城市
Do FP belong only in rural areas?
家庭医生只属于农村地区吗？

Needed in Rural areas: villages, towns, small
cities在村、镇、小城市等农村地区需要：
– Not 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
– Not enough demand to support all the other
specialties
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
complex problems and procedures
家庭/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
9
Rural or Urban:农村或城市
Do FP belong only in rural areas?
家庭医生只属于农村地区吗？

Needed in Urban/city areas在城市也需要
– Specialization is one of the reasons FM is
needed
需要家庭医生的一个理由是专科化
– Management of care is even more critical
更为关键的是健康照顾管理
– Cost control费用控制
– Prevention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