我与住院医师规范化培训走过的道路---记我在国家卫生计生委实习的日子

2016-05-25 星光 烧伤超人阿宝

阿宝按:曾经有很多部门邀请我参加过各种座谈会,大概由于我说话往往不给主人留情面的缘故,大部分邀请者请我一次就决不再请第二次了。然而负责规范化培训的卫计委科教司是个例外。在第一次参加的关于规培工作的座谈中,我当着数十家媒体非常激烈的对规培中的问题提出批评后,他们不仅没有生气,反而多次诚恳的邀请我座谈,认真听我反映规培过程中存在的情况,并采取和很多具体措施。我依然认为,规培工作还存在很多问题需要尽

阿宝按:曾经有很多部门邀请我参加过各种座谈会,大概由于我说话往往不给主人留情面的缘故,大部分邀请者请我一次就决不再请第二次了。然而负责规范化培训的卫计委科教司是个例外。在第一次参加的关于规培工作的座谈中,我当着数十家媒体非常激烈的对规培中的问题提出批评后,他们不仅没有生气,反而多次诚恳的邀请我座谈,认真听我反映规培过程中存在的情况,并采取和很多具体措施。我依然认为,规培工作还存在很多问题需要尽快解决。但是,我同时也真诚的相信,负责这个工作的团队在兢兢业业认认真真的努力。这是一篇全程参与了规培设计实施工作的卫计委实习生的文章,我把它推荐给大家。规培工作刚推开不久,问题是难免的也是难以回避的。我希望大家能积极反应问题并尽量提出建设性意见,以利于规培工作改进。让我们共同努力!
 
两点之间直线最短,但河流为什么不走直路?因为两点之间并不是直线最快。河流在前进的过程中,会遇到各种各样的障碍,而有些障碍是难以逾越的,如高山,如沙漠。于是,它只有顺势而为,蜿蜒而行,才能以最快的速度抵达遥远的大海。像河流一样为既定目标不懈努力,坚持理想而又适应现实,无论遇到什么障碍都要坚持定力,这就是我在国家卫生计生委期间实习期间最大的感受。

2013年12月31日,国家卫生计生委等7部门刚刚在出台了《关于建立住院医师规范化培训制度的指导意见》。翌年初,我研二,偶然得到了在住院医师规范化培训管理最高层实习的机会。去之前,我心里充满了忐忑不安。传说中的“官僚”们,他们在做什么呢?会怎样对待我这个小实习生呢?

刚来的第二天,我参加了《住院医师规范化培训管理办法》配套文件的修订会,作为一个小记录员,我稳稳当当在会场坐了10个小时。第一次见到各位专家对文件内容逐字逐句反复推敲,有时在我看来没有多大问题的一句话,但是各方代表却能从他们的角度提出各种疑问与质疑,然后相互争论利弊权衡,有时甚至可能因为某个词的留存问题,上演一场“打嘴仗”的激烈场面。我被惊呆了,原来文件是这样“磨”出来的。现场还听前辈们讲,前几天7部门联合出台的指导意见更是数易其稿,到底改了多少遍已经记不清了,为的就是既准确、还得符合政策、更得现实可行,切实发挥最大的社会效益。而且在7部门文件出台的第二天,也就是2014年元旦,司里就急锣密鼓的召集专家们开了一天会,研讨专业设置的问题。原来这样的工作状态竟然是常态!听到这里,我有点冒冷汗,暗暗做好了打持久战的准备。

我只是一个小研究生,很多政策我还不懂,我只是觉得他们一点不像传说中的“官僚”,太忙了,太累了。他们“白加黑”“5+2”的学习国际先进经验,去很多地方调研,与医生、学生们交流,研究国内方方面面的政策,探讨怎样成功地借鉴国际经验。至于请专家们开研讨会持续到半夜,利用周末、节假日开会那更是经常的事,因为只有这些时间段才更容易聚齐各方面的专家,共同对文件逐步修改完善。慢慢,我终于理会到为什么他们要这样严谨,这样字斟句酌,因为每项政策的出台都会涉及政治、经济、法律等方方面面的内容,每一个字的改动都可能牵一发而动全身,每一句话都不是某个人或者某个部门就能决定的,每一个文件都是集体智慧的产出。改革,就是在现实条件下做出最大程度的突破,每天往前走一小步,就能积硅步以至千里,最终达到社会效益的最大化。

我曾经问老师,住院医师规范化培训只是一个培训而已,为什么在中国就会经历上百年的探索呢?为什么从2009年医改提出之后,到2013年底才出台第一个文件呢?老师给我讲了很多,我终于明白,如果住院医师规范化仅仅是一个培训而已,如果国家不是因为想在财政、学位、职称等方面给医学生最系统完善的设计、给予大家在现实条件下最好的对待,也许制度出台就不会那么晚。比如,在政策设计上,我理解对学员最现实的好处就是保证收入,俗话说就是能给多少钱。“求人不如求己”,小时候常听爸妈说没什么也不能没有钱这句话,也许在他们那个年代是穷怕了吧,最怕的是跟别人借钱。我没有经历过生活的苦,却在工作中体会了当年爸妈那句话的无奈。住培在当时还是个新事物,很多部门很多人都不理解。在经费争取上,我所在实习单位的领导们要向方方面面做好政策解读和宣传,晓之以情动之以理,从国际经验讲到国内现实,从国外医生的优厚待遇讲到国内医学教育的困境,费劲唇舌,竭尽全力。我记得第一次旁听与某部门的座谈会,司领导介绍了国际上住院医师规范化培训的成熟经验和资金补助情况,其情也灼灼其言也凿凿,可就在我满腔热情无比崇拜的时候,对方的发言却上到国家财政下到民生百态像一盆冷水泼了下来。国家的钱不是那么好拿的,何况是对一笔巨大的投入,对一项可能永远不能中断的项目的投入,那得更加小心无比谨慎,国家的每一分钱都得花在刀刃上。当时双方各执己见,场面也越发激烈,即使是对我们的领导、院士专家们也毫不客气。这种情景我曾经、也只有在小说、电影中才看到过。好在历经数月,几经波折后终于形成共识,中央财政给予每人每年3万元的财政补助标准。于此,我只想说,如果说一个伟大的人,他的伟大是用无数卑微的付出来换取的,那么住培这项伟大的制度,就是靠无数领导和专家毫不介意个人得失的无私奉献换来的。

总结我实习的日子,如果用一个字来概括,那就是“忙”。我实习半年以后,也就是从2014年8月以后,一系列配套政策逐步出台。当时为推动各地政策的落地落实,全国电视电话会议、分片区管理干部培训、现场经验交流会、调研、骨干师资培训等多种形式的宣传全面展开。每次会议前领导们都会指导我们,根据参会人员类型、层级等实际情况,精心准备PPT和讲稿,字斟句酌,确保培训宣传的有效性,让各层级的管理者带教医师能领悟政策、落实政策。领导要求很高,以身作则,经常和大家一起加班到凌晨。2014年在我的印象里,每周至少两次是半夜11点之后才离开办公室,其他时间平均晚8点以后回家,开会的前一天一般是凌晨3点之后完工。特别是在冬天的时候,几乎看不到大街上的阳光。因为早上去的时候天还没有亮,晚上下班的时候天已经黑了。那会儿的我,特别想问他们一个问题,难道你们的生活里只有工作这一个爱好吗?

经历了这些,但当时并不觉得累,用小伙伴的话说“每天跟打了鸡血一样”,因为我不是一个人在战斗,我们是站在巨人的肩膀上和他们一起努力。加班无论到几点,领导们都陪着我们,他们一直都在向我展现一种可贵的人生态度,平淡,隽永,认真,踏实,一丝不苟。这就是我们真实的住院医师规范化培训的管理者们。

我只是一个实习生而已,即使我参与了住培制度在设计和实施的过程,也更多的是扮演的一个旁观者的角色。我旁观了这个制度的形成,也旁观了制度推行初期的各种吐槽。我曾经也和众多吐槽者一样,只知其一不知其二。可是当我真正接触了这个圈子,经历了这一切,见证了这些医学专家、学者、大师们为了中国医学教育事业所做的不懈努力,见证了他们近乎完美的团队合作和勇于克服困难的勇气,见证了他们不计个人得失、调动各种资源为行业和社会争取最大利益的决心,我的想法改变了。他们不是“官僚”,他们是医生的守护者,也是我们最优秀的管理者。

作为同样年龄段的年轻人,我也想对住培学员们说一句,好好努力吧,不要抱怨。社会在进步,改革中的阵痛没有人愿意发生,但是却不可避免。但抱怨是一种毒药,它摧毁你的意志,降低你的身价,摧残你的身心,削减你的热情。社会是一个整体,或许在你看来,政策制定者可以有很多的方式解决的你目前的问题,但是你却不了解这些方式背后的障碍和困难。我相信,任何制度都是逐步完善的过程,任何理想都不可能一蹴而就,住培制度同样如此。坚持方向不懈努力,哪怕你只是那小小的一滴浪花,你也能感受到集体奋斗的力量。汇聚涓滴终成江河,纵然一时蜿蜒取道,也必将汇入大海,开创一番波澜壮阔。

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target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584910012336, createdName=saikp, createdTime=Fri May 27 00:15:00 CST 2016, time=2016-05-27, status=1, ipAttribution=)]
  3. 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  4. 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target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584910012336, createdName=saikp, createdTime=Fri May 27 00:15:00 CST 2016, time=2016-05-27, status=1, ipAttribution=)]
    2016-08-20 doctorJiangchao

    继续学习

    0

  5. 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target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584910012336, createdName=saikp, createdTime=Fri May 27 00:15:00 CST 2016, time=2016-05-27, status=1, ipAttribution=)]
    2016-08-20 doctorJiangchao

    继续关注

    0

  6. 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  7. 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target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584910012336, createdName=saikp, createdTime=Fri May 27 00:15:00 CST 2016, time=2016-05-27, status=1, ipAttribution=)]
    2016-05-30 lsblb

    唉唉!!!!

    0

  8. 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target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584910012336, createdName=saikp, createdTime=Fri May 27 00:15:00 CST 2016, time=2016-05-27, status=1, ipAttribution=)]
    2016-05-30 lsblb

    唉唉!!!!

    0

  9. 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    2016-05-27 saikp

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