Article(id=1241522927938622230, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202308109, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1691510400000, receivedDateStr=2023-08-09, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931732401, onlineDateStr=2026-03-19, pubDate=1710000000000, pubDateStr=2024-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931732401, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931732401, creator=13701087609, updateTime=1773931732401, updator=13701087609, issue=Issue{id=1241522919977841545, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931730503, creator=13701087609, updateTime=1773931880386, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523548695622547, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523548695622548, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=955, endPage=960, ext={EN=ArticleExt(id=1241522928370635570, articleId=1241522927938622230, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Thoughts on strengthening the cultivation of disease prevention and control concept and practical ability of clinical medical talents in the new era, columnId=1240375111455404044, journalTitle=Modern Preventive Medicine, columnName=Talent Development, runingTitle=null, highlight=null, articleAbstract=

In order to further improve the ability of medical institutions to deal with mass and epidemic diseases, clinical workers need to have strong awareness of disease early screening and prevention and control, as well as the ability of monitoring, early warning, and emergency management. The underlying issue is the need to constantly strengthen clinical medical students’knowledge reserve and practical ability of preventive medicine. Especially in the process of medical education, how to strengthen clinical medical students’ ability to master the basic knowledge and skills of preventive medicine, to be familiar with the management of mass and major epidemic diseases, and to establish the concept of prevention and treatment of acute and chronic diseases are urgent problems to be solved. This paper discussed in-depth the problems and measures related to the cultivation of disease prevention and control mindset and practical ability of clinical medical talents, so as to provide an important reference for improving the training mode of comprehensive clinical medical talents and the formulation of related policies.

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为进一步提高医疗机构对群体性、流行性疾病的应对能力,临床工作者需要有较强的疾病早筛与防控意识,以及监测预警和应急处置能力,其背后的根本性问题是需要不断强化临床医学生预防医学知识储备和实践能力。尤其是在医学教育过程中,如何加强临床医学生掌握基本预防医学知识和技能,熟悉群体性、重大流行性疾病处置,急慢性疾病防治观念等是亟需解决的问题。本文就临床医学人才疾病防控思维和实践能力培养的有关问题和举措做深入探讨,为完善复合型临床医学人才培养模式和相关政策的制定提供重要借鉴。

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杨蕊,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=Gqhb2unRdZN0c9F+qVpqew==, magXml=JGPuyteZ6pdV9XVn+Qu7Lw==, pdfUrl=null, pdf=zml9AQ+/Rh7nmK2C7ZuWpA==, pdfFileSize=1982251, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=DjuEddz6IqaU64UcZlMQNg==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=a7UK9aJsAlCrh0yoKdqssQ==, mapNumber=null, authorCompany=null, fund=null, authors=

邓凤(1982—),女,博士,主治医师,研究方向:生殖医学、医学教育

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新时期加强临床医学人才疾病防控理念和实践能力培养的思考
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邓凤 1 , 李钦 2 , 杨蕊 1
现代预防医学 | 人才培养 2024,51(5): 955-960
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现代预防医学 | 人才培养 2024, 51(5): 955-960
新时期加强临床医学人才疾病防控理念和实践能力培养的思考
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邓凤1, 李钦2, 杨蕊1
作者信息
  • 1.北京大学第三医院妇产科生殖医学中心,北京 100191
  • 2.北京大学公共卫生学院,北京 100191
  • 邓凤(1982—),女,博士,主治医师,研究方向:生殖医学、医学教育

通讯作者:

杨蕊,E-mail:
Thoughts on strengthening the cultivation of disease prevention and control concept and practical ability of clinical medical talents in the new era
Feng DENG1, Qin LI2, Rui YANG1
Affiliations
  • Center for Obstetrics and Gynecology, the Third Hospital of Peking University, Beijing 100191, China
出版时间: 2024-03-10 doi: 10.20043/j.cnki.MPM.202308109
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为进一步提高医疗机构对群体性、流行性疾病的应对能力,临床工作者需要有较强的疾病早筛与防控意识,以及监测预警和应急处置能力,其背后的根本性问题是需要不断强化临床医学生预防医学知识储备和实践能力。尤其是在医学教育过程中,如何加强临床医学生掌握基本预防医学知识和技能,熟悉群体性、重大流行性疾病处置,急慢性疾病防治观念等是亟需解决的问题。本文就临床医学人才疾病防控思维和实践能力培养的有关问题和举措做深入探讨,为完善复合型临床医学人才培养模式和相关政策的制定提供重要借鉴。

医学教育  /  疾病防控  /  实践教育  /  预防医学  /  公共卫生

In order to further improve the ability of medical institutions to deal with mass and epidemic diseases, clinical workers need to have strong awareness of disease early screening and prevention and control, as well as the ability of monitoring, early warning, and emergency management. The underlying issue is the need to constantly strengthen clinical medical students’knowledge reserve and practical ability of preventive medicine. Especially in the process of medical education, how to strengthen clinical medical students’ ability to master the basic knowledge and skills of preventive medicine, to be familiar with the management of mass and major epidemic diseases, and to establish the concept of prevention and treatment of acute and chronic diseases are urgent problems to be solved. This paper discussed in-depth the problems and measures related to the cultivation of disease prevention and control mindset and practical ability of clinical medical talents, so as to provide an important reference for improving the training mode of comprehensive clinical medical talents and the formulation of related policies.

Medical education  /  Disease prevention and control  /  Practical education  /  Preventive medicine  /  Public health
邓凤, 李钦, 杨蕊. 新时期加强临床医学人才疾病防控理念和实践能力培养的思考. 现代预防医学, 2024 , 51 (5) : 955 -960 . DOI: 10.20043/j.cnki.MPM.202308109
Feng DENG, Qin LI, Rui YANG. Thoughts on strengthening the cultivation of disease prevention and control concept and practical ability of clinical medical talents in the new era[J]. Modern Preventive Medicine, 2024 , 51 (5) : 955 -960 . DOI: 10.20043/j.cnki.MPM.202308109
新冠肺炎疫情对于我国医学教育培养模式、供给水平和支撑能力的一次“大考”,暴露出临床医生疾病防控思维不足对于各级医疗机构的应急处置能力的制约问题,一线临床医生对于重大传染病的超前预警作用发挥不明显,应急处置能力和规范化处置流程存在缺失和疏漏,未能全面发挥公共卫生医学教育对于传染病“早发现、早报告、早隔离、早治疗”的指导作用[1],各级医疗机构也更加深刻地感受到加强临床医学人才疾病防控理念的紧迫性和重要性。
除了新冠肺炎疫情这样的重大公共卫生问题,临床工作者的疾病防控意识不足在非传染病领域也慢慢体现出来。非传染病,如心血管疾病、癌症和慢性呼吸道疾病等,是全球范围内的主要健康挑战。这些疾病的防控需要采取综合性的策略,包括宣传教育、早期筛查、健康管理和治疗等方面[2]。然而,一些临床医生可能更加关注疾病的治疗,而忽视了预防和控制的重要性,这对于非传染病防控工作产生了不利影响。首先,在早期预防和筛查方面,临床医生的超前预警能力不足,会导致疾病的延误诊断和治疗,进而影响患者的康复和生存率。其次,在健康管理和宣传教育方面,临床医生的指导作用受限,也导致患者对于疾病的认识和理解不足,影响他们主动采取预防措施和改变不良生活方式。此外,规范化的处置流程和应急处置能力也可能存在缺失和疏漏,影响非传染病的防控效果[3]。因此,加强临床医生的疾病防控意识对于非传染病防控工作同样重要。
人才全面培养是解决以上问题的核心和根本,《“健康中国2030”规划纲要》的提出和预防为主的新时代卫生与健康工作方针,树立了大卫生、大健康的观念,把以治病为中心转变为以人民健康为中心,对临床工作和医学教育人才培养提出了新的要求[4]。医学教育不仅是联结“健康中国”和“教育强国”两大战略的纽带[5],也决定着医学卫生健康事业的未来,更是实现“面向人民生命健康”战略部署的重要抓手。新时期要通过高质量的医学教育的发展,努力全方位、全周期保障人民健康。如何从源头抓起,培养一线临床医生的疾病防控思维和实践能力是落实健康中国战略和深化医学教育改革的重要命题,值得深入研究。见图1
临床医学人才疾病防控理念和实践能力不强的主要原因可能是观念、课程设置、课程内容和课程比例的问题。疾病的预防和控制意识不足、缺乏针对性的系统性培养、课程设置和课时比例方面的不足是其中存在的根本性问题。
现代医学模式的教育理念仍然强调临床教育需要注重治疗技能的培养,而较少强调预防和公共卫生的重要性,这导致医学生在培养过程中缺乏对疾病防控的全面认知和重视。公共卫生教学强调以人群为主要研究对象,以“环境-人群-健康”为工作模式,以期达到疾病预防、健康促进、生命质量提升的目的,在现代医学教育体系中具有举足轻重的地位[4],见图2。自1950年以来,我国卫生工作方针经过多次修订,“预防为主”始终是卫生工作的基本原则和重点。然而,早期卫生医疗事业由于经济发展水平低、社会资源投入不足、相关人才缺乏等局限,导致“预防为主”的思想未能很好的贯彻和落实。目前我国仍然存在的“重临床、轻预防”的医学人才培养理念以及社会资源投入存在的问题,始终制约着“预防为主、防治结合”发展理念的发展和推广[6]。王学清等[7]研究者通过对所在院校内的临床医学专业学生进行调查后发现,46.42%的学生认为预防医学知识相关的讲座没有必要,同时,仅67.14%的学生认为有必要对患者进行健康宣教。
随着社会经济发展和人民群众日益增长的健康需求,国家提出“以基层为重点,以改革创新为动力,预防为主,中西医并重,将健康融入所有政策,人民共建共享”的中国新时期的健康与卫生工作方针[8-10]。如何有效提高临床医学人才的疾病防控思想观念成为亟需解决的教育问题。
临床医学人才在培养过程中,长期注重分科精细疾病知识的学习及其对应的救治技能训练,非常缺乏对于传染及非传染病防控工作的系统培训和指导[11-12],见图3。《国务院办公厅关于深化医教协同进一步推进医学教育改革与发展的意见》明确提出探索建立复合型医学人才培养机制。我国目前各大医学院校医学教育专业均开设了预防医学相关课程,涵盖了《流行病学》《医学统计学》《营养与食品卫生学》《职业卫生学》《环境卫生学》等[13]。从课程体系看,公共卫生与预防医学大多数未被纳入专业核心课程[14]。预防医学与临床医学等专业之间的学科交叉不够、知识融合不深,在课程共享、师资交流等方面的制度规定还不健全。此外,在教学过程中普遍存在对预防医学课程重视程度不高、课时和学习内容压缩、预防医学实践技能与临床应用脱节、学生对课程兴趣不大等问题[15-16]。在教学实践中,临床医学等非预防专业对于预防医学实践活动的开展以及公共卫生案例分析和社区实践教学内容较少,面对突发紧急公共卫生事件的防控意识不强及应对技能不足,尤其缺乏应对重大传染病及新发传染病的应急流行病学调查、传染源隔离、现场处置等技术储备。此外,非预防专业人才普遍存在轻视健康宣教的现象,针对复杂病种的系统性与周密性医疗防护培训在临床医学人才住院医师规范化培训过程仍欠缺[17]。当前培训通常围绕一般性的职业卫生知识与防护技能教育,缺乏对烈性传染病的防护装备、消毒灭菌等高防护等级流程的操作训练。医学教育专业实习和住院医师规范化培训环节中缺乏疾病预防控制和公共卫生管理实践,即使有对口的公共卫生实践,也存在要求低、时间短、考核标准模糊等突出问题[18]
近年来,围绕卫生机构设置、医务人员职能与组织队伍建设、医疗设备投入等方面关注较高、资源投入较大,而针对疾病的上游防控却存在投入不足,“防治分离”的短板日益凸显。临床医学人才培养强调以临床技能为核心,注重临床实践和医学知识的传授。在这个过程中,公共卫生的相关课程常常被忽视。主要原因之一是传统医学教育偏重临床技能和疾病治疗,忽视了预防和公共卫生的重要性。这导致了学生在临床实践中可能缺乏对公共卫生问题的敏感性和解决问题的综合能力[19]。推动临床医学教育与公共卫生教育融合发展,既是时代发展趋势,也是破解“重治轻防、防治分离”顽疾,加快医防融合,推动“四个面向”的必由之路。临床医学人才培养中公共卫生课程设置和课时安排存在不够充分的现象。当前临床医学生培养所用的公共卫生教材仅为《预防医学》一书,其内容量与预防医学专业学生所学习的“五大卫生”相比,不足其五分之一,且课程的次数和学时较少,无法提供足够的知识和实践经验,以培养学生的公共卫生思维和专业素养。此外,课程内容和教材选择也无法引起学生的学习兴趣,缺乏实际应用价值。另外,临床医学人才培养中公共卫生学或预防医学类课程设置不合理的原因还包括教师团队和教学方式的问题。授课老师存在缺乏经验或培训不足的情况,教学方式缺乏案例教学和实践操作环节,学生的问题解决能力和实际操作能力较弱。传统的教学方法可能过于侧重理论知识的灌输,缺乏与实际应用的结合,导致学生对公共卫生实践的理解不足[20]
“防”和“治”机构职责泾渭分明,医院以“治”为主而预防职责缺失,疾控部门主要以“防”为主治疗参与少,而公共卫生执业医师缺少临床处方权,造成“防”“治”医学人才之间不能互通,进一步阻碍了“防”“治”的融合。不难发现,当突发公共卫生事件时,综合医院在传染病监测预警、风险评估、信息共享、应急协同、舆情应对等公共卫生处置能力上的不足以及与政府应急管理部门、疾病预防控制机构、急救中心、传染病医院、专业研究机构沟通协作不顺畅成为公共卫生效能发挥的重要制约因素[20]。在公共卫生管理体制机制方面,公共卫生机构没有行政干预权和应急处置权,而是以公益服务为主,财政全额支出,间接导致公共卫生机构竞争力较弱,降低了临床和公共卫生复合型人才的培养和吸纳能力,人才流失严重[21]
作为直接面对公共卫生事件的一线临床工作者,熟练掌握疾病流行规律、明确疾病诊断和治疗以及及时采取个体和群体预防措施离不开预防医学专业知识和素养的支撑[22-24]
围绕“怎么培养医学生,培养什么样的医学生”的根本问题,通过对“生物-心理-社会”医学模式的透彻理解和掌握,形成“预防为主”的思想理念,进而实现“以疾病为中心”向“以健康为中心”的改革。医学生的预防医学教育,首要的是转变其工作思维,以预防思维来指导医学教育工作,致力于关注人群水平的综合防治服务。以健康中国战略的实施为契机,强化“预防为主,防治结合”的思想,将三级预防的理念贯穿疾病发生发展全过程,实现预防、治疗、康复三位一体,提高医疗资源的利用效率。临床工作者在院进行诊疗工作时,除了必要的治疗手段,还需要将“预防为主”的理念扎根于实践,通过健康教育的方式使患者认识到防患“未病”的合理方式及重要性,同时针对高危群体实施医院-社区联动建档、追踪方案,防止疾病的发生与恶化[25]。其次,随着医学模式转变和演化,医学生不仅需要丰富的专业知识和技能,更需要高水准的责任意识和道德操守。加强医学人文教育,融入思政教育内容,深入挖掘我国传统医学文化和优秀人物先进事迹,提高医学教育人才的职业道德和职业责任感,大力弘扬健康所系、生命相托的职业精神和伟大抗疫精神等新时代正能量,引导医学生将预防疾病、解除病痛和维护群众健康作为自己的首要职责。
在国家层面,需要加强各类教学平台建设,完善人才培养机制,加强问题导向和目标导向的综合型人才培养模式。医学教育改革涉及国家多个卫生、教育、行政主管部门,是一个复杂的系统工程。针对全球化的医学教育发展形势和我国当前医疗卫生发展国情,适时引入国际医学教育标准并借鉴制定国家医学教育专业教育标准,完善医学教育专业预防医学相关课程的教学目标,培养具备医学教育基本理论和预防医学基本技能,在相关临床岗位从事医疗及预防、医学科研等方面工作的医学教育高级人才,开展双学位教育[26]。充分利用基层卫生机构三级服务网络和成人教育、网络教育等继续医学教育平台,把公共卫生相关知识和业务技能进一步向基层医疗机构拓展,为基层医疗机构培养更多的复合型人才提供保障。在教材设计编写方面,教育部门应鼓励多学科与预防医学学科交叉融合,设计推广更符合非预防医学专业需求的公共卫生教材。教材应涵盖从疾病预防、早期诊断到康复和健康管理的全过程,强调这种全局观念,培养学生在临床实践中注重预防和促进健康的意识和能力。在高校教育层面,不同地区医学类院校要根据当地公共卫生特征和问题因地制宜、因校制宜,有针对性地将富有地方特色的预防医学培养体系融入各高校本科教育、专业学位研究生教育、住院医师规范化培训等医学教育环节。以培养公共卫生思维为目标,提高公共卫生素养为核心,注重知识与实践相结合,着重培养人文精神以及批判性思维。摒弃死板的应试教育,采用多角度、多层次考核方式,在课程建设中增强教师与学生的互动,收集学生反馈并及时调整教学方案,致力于培养具有国际化视野和大卫生大健康的观念,适应全球化竞争与合作的优秀医学人才[27]。在医疗机构层面,各医疗机构需要联合高校和卫生防疫部门,加强医学教育各个阶段各类医学教育人才(公共卫生管理人才、临床医护人员、全科医生等)的慢病防治、传染病防治和公共卫生管理能力的培训。
为进一步强化临床医学人才将疾病防控的思维和理念应用到实际,应当从以下几个方面进行改革和提升。
一是认真实施公共卫生与预防医学专业的教育教学改革。积极探索将预防为主的大健康理念贯穿于以岗位胜任力为基础的医学教学模式改革全过程,建立完善“医防协同”育人机制,促进预防医学教学内容与临床医学、护理学等学科的业务能力紧密贴合。
二是优化实践教学内容。以社会问题和疾病特征为切入点,开展典型案例模拟和分析,将现场实习与实验室实习相结合,激发学生兴趣,引导学生走出个体诊断和治疗疾病为主的教学模式,转而以群体疾病监测、危险因素识别和健康评价等实践技能训练为驱动力,提高医学生分析与解决公共卫生问题的基础能力[24]。探索开展以开展预防医学“第二课堂”教学,进一步帮助临床医学生更新观念,强化防治结合的系统性观念,定期开展社会公益宣讲和实践等活动,通过实践培养医学生价值观和行为方式,提升医学学生的责任感和使命感。
三是校内预防医学、医学教育教师与各类实践基地教师要加强教学与学术交流,打造高水平的实践教学教师队伍。
四是摒弃“专科思维”。随着医院发展规模的逐步壮大,各临床学科越分越细,应当探索根据各科室的患者疾病特征,有针对性的开展疾病的“精准预防”实践,积累相关科室预防经验。
建立适应健康全过程、生命全周期理念的多学科交叉、跨专业融合的“大医学”“大卫生”“大健康”培养模式。新时代以来,学科交叉融合成为加速医学技术创新的重要驱动力,这就要求各大医科类院校要打破学科和专业之间的壁垒,探索学科交叉融合的新路径。
首先,我国应借鉴国际经验并充分考虑实际国情,整合基础医学、临床医学和预防医学等主干课程体系,注重通识教育,改革教学方法,通过完善辅修课程、调整学时学分比重等方式,在临床医学专业课程中增强预防医学教育内容,促使医学生在掌握专业技能的同时,不断强化群体预防和健康促进理念,培养面向人群健康的交叉型和复合型人才,促进从“治疗为主”向“生命健康全周期预防、治疗、康复”转变的培养体系改革。
其次,对于医学生和临床医生,应当鼓励其参与公共卫生实践,为其建立相应的疾病预防控制中心、妇幼保健院、职业病防治院、结核病防治院、社区卫生机构为主的实践教学基地。通过短期实习、专项宣传教育日、各类专业志愿服务或调研项目,专业技能培训和应急演练项目培训等多方式的实践活动,提高临床工作者的公共卫生与预防医学专业知识和技能。
最后,应当加强医疗体系和疾控体系的建制性交流,搭建医疗数据共享平台、医学教育人才和公共卫生人才交流互通平台,建立人才从综合性医院向疾控中心、卫生监督机构和职业病医院流动的激励机制,鼓励临床运用先进的医疗病历系统,结合大数据、云计算、人工智能等数字技术,在疾病预防、健康管理等方面更好发挥支撑作用。
总而言之,当前正是临床医学与预防医学学科之间相互融合、相向发展的机遇期,也是促进公共卫生防控体系发展的关键节点。临床医学教育人才的疾病防控思维和能力的培养亟需从打破制度壁垒、加强顶层设计、促进教育改革、优化课程体系等多方面入手。我们相信,在以疾病为中心转移到以健康为重心、为人民群众提供全方位全周期健康服务的大卫生健康观指引下,具有疾病防控思维和能力的临床医学教育人才在学校教育、自我教育和从业再教育过程中可以不断与时俱进加强医防深度融合,一定能为祖国的卫生事业的健康发展做出更大的贡献。
  • 北京大学医学部教育教学研究课题(2023YB40)
  • 北京大学第三医院教育教学研究课题(2020bysyzxkt11)
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2024年第51卷第5期
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doi: 10.20043/j.cnki.MPM.202308109
  • 接收时间:2023-08-09
  • 首发时间:2026-03-19
  • 出版时间:2024-03-10
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  • 收稿日期:2023-08-09
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北京大学医学部教育教学研究课题(2023YB40)
北京大学第三医院教育教学研究课题(2020bysyzxkt11)
作者信息
    1.北京大学第三医院妇产科生殖医学中心,北京 100191
    2.北京大学公共卫生学院,北京 100191

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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