基于洋葱模型的基层医疗卫生机构家庭医生团队长岗位素质评价指标体系构建和验证OA
Development and validation of an Onion Model-based competency evaluation index system for family doctor team leaders in primary healthcare institutions
目的 构建基于洋葱模型的基层医疗卫生机构家庭医生团队长岗位素质评价指标体系,为选拔、培养和评价家庭医生团队长提供依据.方法 通过文献检索、半结构化访谈、集中研讨等方式生成初步条目池.通过问卷对南京市社区卫生服务中心管理者、家庭医生团队长及成员进行调查,通过Cronbach's α系数、探索性因子分析、验证性因子分析等方式检验指标体系的信效度,并利用结构方程模型验证各因子间关系.结果 构建了包括5个维度、32个条目的初始版体系.共调查了842名研究对象,探索性因子分析(n=300)提取出5个公因子,累积方差贡献率为90.563%,删除4个交叉载荷条目后,形成了包含5个维度、28个条目的基层医疗卫生机构家庭医生团队长岗位素质评价指标体系.其中,个性素质6个条目,价值观素质4个条目,角色与态度素质8个条目,内隐知识技能6个条目,外显知识技能4个条目.验证性因子分析(n=542)结果显示模型拟合良好(χ²/df=3.892,近似误差均方根为0.067,比较拟合指数为0.928,Tucker-Lewis指数为0.914).对问卷调查数据进行信度分析,Cronbach's α系数为0.994,折半系数为0.972,均＞0.9,说明量表条目的信度良好.结构方程模型显示,各维度间路径系数为1.026～1.134(P＜0.001).结论 该指标体系基于洋葱模型进行构建,信效度良好,可作为基层医疗卫生机构家庭医生团队长岗位素质的测评工具.
Objective This study attempts to develop an Onion Model-based competency evaluation index system for family doctor team leaders in primary healthcare institutions based on the onion model,so as to provide a basis for the selection,training,and evaluation of family doctor team leaders.Methods A preliminary item pool was generated through literature review,semi-structured interviews,and focus group discussions.A questionnaire survey was conducted among managers,family doctor team leaders,and team members at community health centers in Nanjing.Cronbach's α,exploratory factor analysis,and confirmatory factor analysis and were used to assess the reliability and validity of the index system.Structural equation modeling(SEM)was applied to validate relationships among competency factors.Results A preliminary item pool comprising 5 dimensions and 32 items was constructed.A total of 842 participants were surveyed.Exploratory factor analysis(n=300)extracted 5 common factors with a cumulative variance contribution rate of 90.563%.After deleting 4 items with cross-loadings,a final index system comprising 5 dimensions and 28 items were established:6 items for personality traits,4 items for values,8 items for role and attitude,6 items for implicit knowledge and skills,and 4 items for explicit knowledge and skills.Confirmatory factor analysis(n=542)showed good model fit(χ²/df=3.892,root mean square error of approximation=0.067,comparative fit index=0.928,Tucker-Lewis index=0.914).Reliability analysis of questionnaire data yielded a Cronbach's α of 0.994 and a split-half coefficient of 0.972,both above 0.9,demonstrating good reliability of scale items.Structural equation modeling revealed path coefficients ranging from 1.026 to 1.134 among all dimensions(P＜0.001).Conclusion The evaluation system,developed based on the Onion Model framework,demonstrates good reliability and validity,and can be used as an assessment tool for evaluating the job competency of family doctor team leaders in primary healthcare institutions.
宋希;章雨帆;赵宁;密一恺;王积慧;赵双烨;申玉英
南京医科大学附属南京医院(南京市第一医院)全科医学科,江苏 南京 210000南京医科大学附属南京医院(南京市第一医院)全科医学科,江苏 南京 210000南京市卫生健康委员会,江苏 南京 210000上海交通大学中国医院发展研究院社区医疗研究所,上海 200120南京医科大学附属南京医院(南京市第一医院)全科医学科,江苏 南京 210000南京医科大学附属南京医院(南京市第一医院)全科医学科,江苏 南京 210000南京医科大学附属南京医院(南京市第一医院)全科医学科,江苏 南京 210000
医药卫生
家庭医生团队长核心素养洋葱模型量表评价指标信度
family doctor team leadercore competenciesOnion Modelscaleevaluation indicatorsreliability
《健康发展与政策研究》 2026 (3)
432-438,470,8
江苏省医院协会2023年度医院管理创新研究课题(JSYGY-3-2023-264)
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