| BackgroundAt present,the peacekeeping unit dispatched by the army is undertaking the main peacekeeping missions in China,and the accompanying army doctors are responsible for level1 medical support of the peacekeeping unit.The research shows that the current effect of peacekeeping medical support is not ideal,with many problems.The level of peacekeeping medical support and the ability of peacekeeping military doctors need to be further improved.Currently there is no special training base for peacekeeping military doctors at home and abroad,there is no uniform standard for training institutions,curriculum,training time and certification assessment.Therefore,it is of crucial importance to construct targeted training curriculum system for Chinese Army peacekeeping doctors.ObjectivesBy investigating the training status and needs of army peacekeeping doctors,the competency index system and model are established to form the training course modules of army peacekeeping doctors.Hope to solve the current problems in peacekeeping training and provide reference for the selection and training certification of army peacekeeping doctors.Methods1.Literature study: Related Chinese and English papers were retrieved by searching―peacekeeping‖,―curriculum‖,―training‖,―ability‖,―competence‖,―demand‖,―health‖,―disease‖,―medical‖ in CNKI,VIP,Wanfang data,CBM,EMBASE and Pub Med.2.Interview: 10 peacekeeping military doctors(6 in the level 1 hospital and 4 in the level2 hospital)were selected by purposive sampling method,and 6 experts in peacekeeping/medical service,psychology,field surgery and preventive medicine were selected for semi-structured interview.3.Questionnaire:(1)the cluster sampling method was adopted to include the pre-deployment army peacekeeping doctors in 2019,and the training effect and demand of 35 army peacekeeping doctors who completed the training were investigated.In addition to the essential information,the questionnaire used common subjects,combat casualty care,operation skills of acute trauma care,treatment of common infectious diseases in the mission area,treatment of common non-infectious diseases in the mission area,epidemic prevention and health management,peacekeeping English,social etiquette and military skills as the relevant knowledge points to evaluate the mission demand,personal demand,mastery degree and teaching quality.(2)223 peacekeeping standby army doctors and peacekeepers were included in the study.The self-administered questionnaire was developed to evaluate the competency of army peacekeeping doctors.The first part of the questionnaire includes demographic information,mission overview and training effectiveness,as well as the quality of medical security of level 1 hospital.In the second part,52 competency items scores were collected to understand their importance,appropriate learning stages and ideal learning methods in building up army peacekeeping doctor’s competency.4.Delphi: based on the Army Peacekeeping Doctors Competency Index system,an expert consultation form was designed,and 22 experts in the fields of peacekeeping,combat casualty care,trauma care,and preventive medicine were selected to participate in the expert consultation.After two rounds of back-to-back consultations,the "PEACE" training curriculum system for army peacekeepers doctors was formed.Results1.Literature study: A total of 3259 peacekeeping-related papers were retrieved from1987 to 2020,including 2386 in Chinese and 873 in English.1004 papers were included after deduplication and twice screening,of which 659 were in Chinese and 345 in English.The literature can be summarized into six topics: peacekeeping psychology(214 papers),epidemic prevention(90 papers),treatment of infectious diseases(132 papers),treatment of non-communicable diseases(149 papers),medical service and combat casualty care(137papers),training and management(282 papers).Most of the authors of peacekeeping papers have peacekeeping mission experience,according to the publication time and mission location of the literature,summarize the distribution of the number of documents on each topic,we can know the problems of peacekeeping medical security in this period and region.2.InterviewAfter analyzing the text with framework,this study concluded that the host country where the peacekeeping mission is located has political instability and unstable social environment.When army peacekeepers doctors work outside the barracks,they are usually alone.Army military doctors who go out to perform missions are mostly themselves,and can hardly get the help of superior doctors and medical instruments.Routine clinical treatment,combat casualty and tropical disease care are the contents of medical security in level 1 hospitals.The tracking and follow-up of mental health and health management should be paid attention to after the peacekeeping mission.All the interviewees thought that the ability of combat casualty care should be improved.Junior military doctors believe that it is imperative to improve the level of operation technology.Some Interviewees suggested centralized management of training,physical examination and immunization of army peacekeeping doctors.3.Questionnaire(1)Questionnaire survey on training needs of army peacekeepers doctors.35 valid questionnaires were distributed and collected on site.The results of the questionnaire on the army peacekeeping doctors showed that the average score of mission demand(4.24±0.61),personal demand(4.23±0.61),mastery degree(3.87±0.60),and teaching quality(4.28±0.61)were significantly different(F=21.23,P<0.01),with the average score of mastery degree being the lowest.Multiple comparison results showed that the score of mastery degree of combat casualty care(3.93±0.52)was lower than that of mission demand(4.43±0.49),personal demand(4.38±0.46)and teaching quality(4.42±0.46),the difference was statistically significant(F=8.74,P<0.05).The score of skill operation mastery degree(4.09±0.57)was lower than that of personal demand(4.49±0.54),and the difference was statistically significant(F=3.39,P<0.05).The scores of peacekeeping English and social etiquette mastery degree(3.34±0.58)were lower than mission demand(4.11±0.65),personal demand(3.90±0.72)and teaching quality(4.38±0.63),the scores of personal demands were lower than teaching quality(F=16.23,all P<0.05).The score of infectious disease treatment mastery degree(3.96 ± 0.55)was lower than that of mission demand(4.46±0.61),and the difference was statistically significant(χ 2=26.17,P<0.05).(2)Results of questionnaire survey on the competency of army peacekeeping doctors.223 peacekeepers completed the questionnaire,of which 82 are ready to carry out peacekeeping missions and 141 have completed peacekeeping missions.141 peacekeepers came from peacekeeping units,level 1 hospitals and level 2 hospitals in Lebanon,DRC,Mali and South Sudan.According to the evaluation results of medical security level of the first level hospital,the highest score was Disinfection,insecticidal and rodent control in barracks(4.62 ±0.80),the lowest score was foreign language level(4.35 ±0.89).The importance score of competency index shows that the highest score of peacekeeping standby military doctors and average score was C9 Basic Life Support(BLS)[(4.94±0.24)、(4.84±0.42)];The highest score of military doctors who had carried out peacekeeping missions was C30 the diagnosis and treatment of common infectious diseases in mission area(4.76±0.52).The multiple response results showed that 6371(68.5%),2520(27.1%)and 403(4.3%)believed that training should be conducted at the stages of "pre-deployment","in mission" and "after returning home" to enhance and consolidate the capability of peacekeeping military doctors.The learning methods of army peacekeeping doctors for improving competency were 5362(37.7%)theoretical teaching,3356(23.6%)operational training,1886(13.3%)clinical practice,1884(13.3%)case teaching,1103(7.8%)online courses and 618(4.3%)self-study.Among them,7126(50.15%)believed that operation training,clinical practice and case teaching needed centralized training.4.Delphi: The expert authority coefficient is 0.82.The first-round recovery rate was100%;the recommended rate was 72.73%,Kendall coefficient was 0.18,coefficient of variation was 0-0.28,full score ratio was 0.32-1.00,selection rate was 0.68-1.00,average score was 3.86-5.00.The recovery rate of the second round is 100%;the recommended rate is50%.Kendall coefficient was 0.25,coefficient of variation was 0-0.17,full score ratio was0.68-1.00,selection rate was 0.86-1.00,average score was 4.59-5.00.Experts agreed that after two rounds of ―back-to-back‖ consultations,the "PEACE" training curriculum system for army peacekeeping doctors was formed.Conclusions1.The results of this study show that army peacekeepers doctors have diversified training needs,common needs are related to the attributes of peacekeeping missions,and individual needs are related to the training experience of military doctors.2.The competency research of this subject constructs the index system and model of the competency of army peacekeeping doctors,with 4 level 1 indicators,15 level 2 indicators and39 level 3 indicators can cover the peacetime and wartime medical support modes.The competency model includes three stages: pre-deployment,during and after the mission.3.The construction and implementation of the "PEACE" training curriculum system for army peacekeeping doctors can be summarized as "two systems","three stages" and "five modules".The two systems include online training curriculum system and centralized training curriculum system;The three stages are the completion of training curriculum system(Stage 1),the completion of curriculum MOOCS recording(Stage 2)and the completion of case base construction(Stage 3).Among the five modules,the P-module trains the general knowledge of peacekeeping.Two E-Modules mainly expand clinical experience and operation skills,and the A-module focuses on the prevention and treatment of various common diseases in the mission area.Combat casualty care is a weak link that needs to be mastered by army peacekeeping doctors in level 1 hospitals,which should be focused as a core module. |
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