每年有60万医学毕业生，仅10万穿上"白大褂"？医改专家反思 Each year 600000 medical graduates，Only 100000 put on"white"？Medical experts reflection

"广种薄收"的医生培养模式该变变了 "GuangZhongBoShou"Doctor training mode this change

　　“医改推进了多年，核心因素是人，卓越医生改革是在为医改‘加力’。”这是我国医改专家对“卓越医生教育培养计划”的普遍评价。但北京大学国家发展研究院经济学教授、著名医改专家李玲同时提示，我国医生培养体系还需“大改”。

“The cure of the advance for many years，The core factor is the man，Excellence in medical doctor reform is for‘strength’。”This is our country to medical experts“Outstanding doctor education training plan”General evaluation of。But the national development research institute of Beijing university economics professor、Cure of the famous experts who also hints，The doctor training system in China should also“Big change”。

　　“国家每年培养约60万医学生，据我掌握的一个数字，只有约10万人能穿上‘白大褂’。‘广种薄收’式的医生培养模式该变变了。”她和北京大学公共卫生学院教授陈育德都认为，从患者利益出发，医生培养模式有必要转为“量少质优”。

“Countries each year training about 600000 medical students，According to my master of a number，Only about 100000 people can wear‘white’。‘GuangZhongBoShou’Type doctor training mode this change。”She and Beijing university school of public health professor ChenYuDe all think，From a patient's interests，The doctor training mode is necessary to“Quantity is little good quality”。

“广种薄收”影响医生临床技能 “GuangZhongBoShou”The influence of clinical skills

　　在校学习的前5年基本“不临床”，后几年才在医院见习与实习，但还要做研究写论文……这是陈育德眼中，作为顶尖医生培养殿堂之一的北京大学医学部对未来医生的培养模式。“8年应该出个好医生了，但由于‘重理论轻临床’的课程设置，结果连医学博士的看病能力，都不容乐观。”

5 years before the school learning basic“No clinical”，Only a few years after the hospital trainee and the practice，But still need to do research writing the thesis……This is ChenYuDe eyes，As one of the top doctor training hall of Peking University health science doctor training mode for the future。“8 years should be a good doctor，But because‘Heavy light clinical theory’curriculum，The results of the medical doctor even see a doctor ability，Are not optimistic。”

　　我国目前的医学生学制一般分为5年制本科、7年制本硕连读和8年制本硕博连读三种。据卫生部《2011年我国卫生事业发展统计公报》，去年底，我国的执业（助理）医生已达到246.6万人。世界卫生组织数据显示，此数字位居世界第一。印度和美国约为75万，英国仅为16万。

Our country's current medical students are generally classified into 5 years college schooling、7 years even read the following eight years and this joins read three。The health department《In 2011, health service development statistical bulletin》，end，China's practice（assistant）The doctor has up to 2.466 million people。The world health organization figures show，The digital world at first。India and the United States is about 750000，Britain is only 160000。

　　媒体报道显示，我国各级医学院校每年招录的医学生，约有60万人。李玲认为，在当前培养模式下，不仅大量人才被浪费，而且很难保证每个医学生在临床技能上都被“精耕细作”。

Media reports，All levels of China's medical colleges and universities ZhaoLu every year medical students，About 600000 people。Who think，In the current training mode，Not only large talent is wasted，And it was difficult to ensure that each medical students in clinical skills are“Intensive cultivation”。

　　陈育德告诉记者，在美国学医，一般分为“双4年”，后4年完全用于临床医学。但在国内学医，在被一再压缩的临床实习环节，近年来因扩招而频频遭遇临床实习医院严重不足、有责任心的医生“师傅”越来越少等尴尬。

ChenYuDe told reporters，In the United States who，Generally divided into“Double 4 years”，Four years after the completely used for clinical medicine。But in the domestic study medicine，In have been compressed the clinical practice link，In recent years because of enrollment expansion and frequently encountering a serious shortage of hospital clinical practice、Responsible doctor“teacher”Less embarrassing, etc。

　　“有一年，我们学院的本科医学生一下增加了1000多人。为了安排实习，学校只有想尽办法往现有的实习医院‘塞人’，再降低要求，让周边县市区水平参差不齐的大小医院都成了实习医院。没有学生愿意到没有教学经验、医疗水平也不高的医院实习，但这是没有选择的选择。”一位医学生在自己的博客中这样感叹。

“One year，Our institute of undergraduate medical students the increased more than 1000 people。In order to arrange intern，The school only try to go to the existing practice hospital‘Plug people’，To reduce demand，Let the surrounding the different levels of the hospital wing size has become a practice hospital。No students willing to to has no experience in teaching、Medical level is not high also hospital practice，But this is no choice of choice。”A medical student in his blog in such exclamation。

　　中国青年报记者随机采访了8位地方院校的医学本科生后发现，类似遭遇在6个人身上不同程度地上演。有的实习点因为“人满为患”，只能打扫医生办公室、整理粘贴病人化验单、查房；8人中有3人的有效实习时间不超过半年，对基本术前准备工作、写病例等基本功，也自感“不能规范操作”。

China youth daily reporter random interviewed eight local colleges and universities found after the medical students，Similar experiences in six different degree in on performed。Some ShiXiDian because“overcrowded”，Can clean the doctor's office、Finishing paste patient paper、rounds；Eight people have a valid practice time 3 no more than half a year，On the basic of preoperative preparation work、Basic skills such as writing cases，Also puts“Can't standardized operation”。

　　“医生是实践的学科，如果靠‘大把地进、大把地出’，没有尽职尽责的好医生带领，没有足够的实习基地，甚至解剖也不用尸体，怎么能磨练出一名卓越医生，又怎么能让患者放心地‘以健康相托’？”李玲说。

“The doctor is a practical subject，If, by‘Rightly put into、Rightly put out’，No dedicated good doctor lead，Not enough practice base，Even anatomy also need not bodies，How to build up a great doctor，How can you let patients trust‘XiangTuo with health’？”Who said。

　　记者在采访中发现，由于感觉“学不到真东西”，一部分医学生，已把这一年实习期，当成了复习考研、准备转行的缓冲期。另一部分“坚守者”则在走上医生岗位后，还不得不继续尚未完成的实习。

The reporter found in the interview，As a result of feeling“Learn to be less than true thing”，Part of medical students，Already this year internship，As the review one's deceased father grind、Get out of the cushioning period。The other part of“Stick to the”The doctor in on station，Still have to continue to not yet finished practice。

基层还是留不住人才 Grassroots still can't keep talents

　　《2011年我国卫生事业发展统计公报》显示，截止去年年底，全国的卫生技术人员一共620.3万人，其中，各级医院占了370.6万人，社区卫生站和乡镇卫生院合计却不足200万人。与之形成对比的是，全国医院数量共约2万家，而社区和乡镇卫生院（站）加起来，超过了7万个。

《In 2011, health service development statistical bulletin》shows，By the end of last year，The national health personnel altogether 6.203 million people，Among them，The 3.706 million people at all levels of the hospital，Community WeiShengZhan and rural hospitals but has fewer than 2 million total。In contrast，The number of hospital of about 2，And the community and rural hospitals（stand）Added up to，More than 70000。

　　《公报》还显示，2011年年底，乡村医生和卫生员一共112.6万人，却要服务66万多个村卫生室。

《communique》Also shows that the，By the end of 2011，Rural doctors and the altogether 1.126 million people，But service more than 660000 village clinic。

　　“这说明学医的人多了，基层卫生机构还是难留人才。现在的大学本科基本不为农村培养乡村医生。”李玲说。北京大学医学人文研究院一项对380名医学本科生所做的就业意愿调查显示：八成医学生希望留在大城市，愿意去基层的不足二成。

“This shows that the person who is much，Primary health organization or retention talents。Now the university degree basic training for rural village doctor。”Who said。Beijing university medical humanities research institute of a 380 medical undergraduates do employment intend to survey：Eighty percent medical students want to stay in big cities，Willing to less than twenty percent of the grassroots。

　　陈育德告诉记者，在“毕业包分配”的年代，一些县、乡镇一级卫生院还有大学生，现在，他们大多已经或面临退休，后续力量却跟不上。“医学生中的拔尖人才本来就少，近年又大量流向国外，愿意去西部的、去基层的更少，以后乡亲们找谁去看病？”

ChenYuDe told reporters，in“Graduation bag distributive”Of s，Some county、Township health hospital and university students，now，Most of them have retired or face，Subsequent strength just can't keep up。“Medical students of talent of original little，In recent years, and a large going abroad，Willing to go to the west、Go to the less，For folks who later to go to see the doctor？”

　　更严峻的是农村全科医生的匮乏。李玲告诉中国青年报记者，“全科医生”是指能以门诊形式处理常见病、多发病及一般急症的“多面手”，对乡村患者尤其重要。按照理想比例，中国至少应配备60万名全科医生，但据媒体公开报道，我国目前只有7.8万，且素质不容乐观。

The more serious is the lack of the rural all-around doctor。Who told the China youth daily reporter，“All-around doctor”Is the with outpatient service forms processing common diseases、Frequently-occurring disease and general emergency“versatile”，On rural patients especially important。According to the ideal proportion，China should be at least equipped with 600000 gp，But according to public media reports，Our country at present, only 78000，And the quality is not optimistic。

　　国家“十二五”期间深化医疗卫生体制改革规划指出，到2015年，要培养15万名全科医生，定向免费培养已成为“利器”之一。但在两位专家看来，问题要根本解决，还有三个“拦路虎”值得注意。

national“1025”Deepening the reform of medical system during planning said，By 2015，To develop 150000 gp，Directional free training has become“Edge tool”of。But in two experts opinion，Problems to be solved，There are three“tiger”note。

　　“首先是整体人数不足。这15万人能满足城市社区卫生站的需求就已很不易。”李玲指出，对全科医生的培养周期是8年，短期内要让基层“解渴”不现实，以至于一部分全科医生要靠内科医生“转岗培训”而来。

“First is the total number of insufficient。The 150000 can meet the demand of the urban community WeiShengZhan was not easy。”Who points out that，For general doctor training cycle is 8 years，In the short term to let the grassroots“thirst”Not realistic，That part of the general practitioner must depend on the physician“Job-transfer training”And to。

　　陈育德认为，如今医学生的教育模式，也不利于塑造“能适应基层的”全科医生。“现在，医学院对知识点分割很细、很窄，没有广厚的医学技能沉淀，即使是全科医生知识面也不全，看病非常依赖化验、检查以及仪器设备。在农村，没有这些设备怎么办？医生的看病能力，恐怕大打折扣。”

ChenYuDe think，Now the medical students' education mode，Also was disadvantageous to the shape“Can adapt to the grassroots”All-around doctor。“now，Medical school on knowledge points segmentation is very narrow、Very narrow，No wider thick medical skills of precipitation，Even if is the general practitioner knowledge was not all，A doctor is very dependent on tests、Check and instruments and equipment。In the countryside，Without these equipment？The doctor's ability to see a doctor，I'm afraid to sell at a discount greatly。”

　　更大的“拦路虎”恐怕在于，乡村靠什么留住好医生。在上述医学生就业意愿调查中，记者看到，多数医学生“回避”基层的理由是：练不出好技术，没有好编制，未来缺乏进步资本。

more“tiger”I'm afraid is，Keep good doctors rely on what country。In the medical students' employment intend to investigation，The reporter sees，Most medical students“avoid”The reason is：Never made a good technology，There is no good for，Lack of progress future capital。

　　“这提示改革者，要为基层的医务人员设计一套职业规划：有他们单独的上升通道，持续地培养计划，更优厚的待遇。”李玲认为，“应该把‘为基层培养人才’与一般医学教育区别开。为基层培养人才是定向的，最好是本地人，语言相通、有文化认同感，比较能够在地方上留得住。”

“This suggests that reformers，For the medical staff to design a set of career planning：Have they separate rise channel，Continue to develop a plan，More favorable treatment。”Who think，“Should put‘For the talents training’And general medical education difference between open。For the training talents is the oriented，Best is a native of，Common language、A cultural identity，Better able to local in retain。”

保证每个医学生学成后都能从医 To ensure that every medical students can learn in the medicine

　　李玲和陈育德都表示，应让医学教育“精英化”，做到量少质优地有计划培养，“一个医学生都不浪费”。

Who ChenYuDe and said，Should let medical education“elite”，Do quantity is little to cultivate good quality in a planned way，“A medical students don't waste”。

　　“培养一个医生是非常昂贵的。以美国为例，医学生在博士毕业后，要接受近10年的住院医生培训和专科医生培训，到独立执业时，欠银行数十万美元是常事。”李玲说。据教育部的数据，中央本级财政2008年给医学教育生的人均拨款，先从7100元提高到了1.15万元，2011年又提高到1.4万元，今年，还将进一步大幅提高。

“Cultivate a doctor is very expensive。In the United States, for example，Dr. Medical students in after graduation，To accept nearly 10 years of residency and a specialist training，To independent practice，Hundreds of thousands of dollars is common owe the bank。”Who said。According to the ministry of education figures，The central finance in 2008 at the corresponding level for medical education born per capita appropriations，First increased from $7100 to $11500，2011 years and up to 14000 yuan，This year，Also will further increase。

　　在中国最大的医生网络交流平台之一丁香园论坛上，中国青年报记者却看到，以“不当医生，医学生还能做什么？”为主题的帖子，从2008年起就常演不衰。不少医学生抱怨“毕业即失业”，只有转行当医药代表、研究人员、教师或出国，更有医学生哀叹自己“入错行”。

In the Chinese biggest doctor network communication platform dxy on one of the BBS，China youth daily reporter only to see，to“Undeserved doctor，Medical student or can do??????？”As the theme of the post，Since 2008, is often play time。Many medical students complain“Graduation is unemployed”，Only turned as a medical representative、The researchers、Teachers or go abroad，More medical students' lament“In the wrong line”。

　　“医学教育有其特殊性，其最终产品是治病救人的医生，医德和医术是重中之重。既然用大笔投入和医德说教，来培养水平参差不齐、每年流失约50万名的医学生，为什么不集中力量，培养一批生源好、水平高、乐于奉献的卓越医生呢？”李玲认为，医学教育每年应有计划地甄选医学生，再施以卓越医生培养教育，使医学生回归应有的职业高度。“保证每个医学生，学成后都能从医。每个从医的学生，各项素质都过硬。”

“Medical education has its particularity，The end product of salving is the doctor，Medical ethics and medical skill is the top priority。Since big investment and medical ethics with a lecture，To the level of training is uneven、Each year about 500000 loss of medical students，Why not focus on，Cultivate a group of students、Level is high、The excellence of devotion to the doctor？”Who think，Medical education each year due to medical students plan selection，With outstanding doctor training education again，Make medical students should return to the professional level。“To ensure that every medical students，After learning the medicine can。Each of the students in the medicine，The quality is excellent。”

　　卓越计划也提出，要着力培养一批有国际视野的精英人才，“调控”未来医生的培养规模。该计划提出：“‘十二五’期间，根据需求，原则上不增设医学院校，不增设临床医学专业点。临床医学专业招生规模过大的省市、高校，要坚决缩减招生数量。”

Excellent plan put forward also，We should focus on the training of a group of elite talents with international vision，“regulation”The future of the doctor training scale。The scheme：“‘1025’during，According to the demand，In principle, don't add a medical college，Don't add clinical medical professional point。Clinical medical professional recruitment of students scale big provinces and cities、university，Must firmly reduction of enrollment。”

　　但一个不容忽视的现实是，在就业压力增大、从业环境恶化的背景下，优质的医学生源正在逐年减少。“医生是一个制度的产物，卓越医生教育培养计划的效果有赖于公立医院是否真正地回归公益性，也有赖于整个医患关系的改善。”李玲说，“医生的奉献也扎根于社会土壤，如果基本的信任没有了，医生怎么做都不对。医生失望，优质生源流失，最终受害的还是患者自己。”

But a serious reality is，In the employment pressure increased、From the background of the deterioration of the environment，High quality medical students are reduced year by year。“The doctor is a system of the product，Outstanding doctor education training plan depends on whether the effect of public hospital real return to public welfare，Also depends on the improvement of the doctor-patient relationship。”Who said，“The doctor's dedication also rooted in social soil，If the basic trust no......，What did the doctor do it。The doctor disappointed，Quality loss of，Finally the victims or patients themselves。”

　　本报北京8月12日电

Our newspaper Beijing on August 12-

相关政策：本科以上学历医学生经医师培训录用后可落户北京 Related policy：Bachelor degree or above medical students employed by the physician training can be settled in Beijing

　　今年起，本科及以上学历的医学生参加住院医师自主培训，合格后被本市医院录用的可按当年毕业生政策办理进京落户手续，这将是北京用人制度上的一大突破。

This year，Bachelor degree or above in medical students to participate in resident independent training，After passing the city hospital can be employed by the graduates in that deal with settle formalities policy performers，This will be the personnel system of Beijing on a big break。

　　据介绍，住院医师培训分为委托培训和自主培训。迄今全市参加规范化培训的住院医师累计达到1.5万多人，平均每年3500人左右。今年培训的人员中80%为医院委托培养，20%为未签订劳动合同或聘用合同自愿参加培训的人员。据悉，除培训基地和特殊批准的单位外，医院也不得使用未经培训的人员独立从事临床工作。

According to introducing，Residency training into entrust training and independent training。So far the standardized training for the resident came to more than 15000 people，Every year on average about 3500 people。This year, 80% of the staff training for hospital entrust training，20% is did not sign labor contract or employ contract voluntarily participate in the training of personnel。It is reported，In addition to training base and special approval of the unit，Hospitals also must not use without training personnel engaged in the clinical work independently。

　　为吸引和选拔优秀人才，在人事管理政策上，培训对象培训期间计算工龄并享有相应的工资待遇和社会保障。非京籍培训人员经培训合格后，可按当年毕业生的政策办理进京落户手续。到本市基层医疗卫生机构就业的可优先办理落户。【详细】

To attract and selected excellent talents，In personnel management policy，The training object during training service and enjoy the corresponding calculation of pay and social security。The Beijing national training by qualified personnel training，But in that the policy for graduates receives Beijing settle formalities。To the basic medical and health institutions of employment prior to deal with settle。【detailed】

广州医学院出档必录 二本共招776人 Guangzhou medical college archives will record the two out of the 776 men were called

　　广州医学院昨日通报，继在一本批次招收临床医学专业全线"丰收"之后，该校在二A批次的招生也顺利完成，共录取考生776人。广医校方表示，对于高分段的考生，学校增加了部分热门专业的招生计划，以最大限度满足考生意愿；对于所有出档到该校、并服从专业调剂且符合录取条件的考生，学校增加招生计划全部予以录取。【详细】

Guangzhou medical college reported yesterday，Following in a batch for clinical medicine all professional"harvest"after，The school in two batches of recruit students also A successfully completed，776 people were admitted to the examinee。GuangYi officials said，For high segmentation of candidates，The school added some of the popular major recruit students to plan，To satisfy the examinee will；For all the file to the school、And to adjust and professional admitted the examinee of conditions，The school increase to recruit students to plan all be admitted。【detailed】

师范、医学院校缺额大 二本高校再抛"橄榄枝" normal、The vacancy of 2 this big medical colleges university to throw"Olive branch"

　　根据高校征集志愿计划表显示，在文史类高校中，缺额计划较大的多集中在师范类和医学院校中。比如，安徽师范大学征集计划为16人；江西师范大学征集计划为11人；山东师范大学征集计划为30人。而和师范类院校"同病相怜"的还有医学类院校，像潍坊医学院缺额计划为494人；泰山医学院缺额计划为394人；黑龙江中医药大学征集计划为5人；济宁医学院缺额计划为133人等。【详细】

According to the university solicitation volunteer schedule shows，In the history of the universities，Space plan larger and more focused on normal universities and medical colleges and universities。For example，Anhui normal university collection plan for 16 people；Jiangxi normal college solicitation plan for 11；Shandong normal university collection plan for 30 people。And and normal universities"Misery loves company"And medical colleges and universities，Like weifang medical school plan for 494 people badly；Mount taishan medical school space plan for 394 people；Heilongjiang university of Chinese medicine solicitation plan for five people；Jining medical school for 133 people badly plan etc。【detailed】