公立医院临床医师职称晋升中基础研究与教学学术考核指标的优化——基于“临床–教育者轨迹”的国际经验与本土化探析

Optimizing the Assessment Indicators of Basic Research and the Scholarship of Teaching in the Professional Title Promotion of Clinical Physicians in Public Hospitals—International Experience of the “Clinician-Educator Track” and a Localized Exploration

摘要: 职称晋升是引导公立医院临床医师行为的关键“指挥棒”。长期以来，以基础医学研究(以下简称“基础研究”)为代表的学术指标在高级职称评审中近乎刚性，临床服务尤其是教学贡献则被系统性“挤出”，形成科研指标刚性化、评价不分层不分轨、教学贡献计量缺位、制度保障不足并诱发诚信风险等多重困境。尽管将人才培养质量纳入职称晋升评价已是明确的政策要求，可操作的成果形态与计量口径却始终付之阙如。本文运用政策文本分析、文献综述与国际比较方法，梳理2017年以来我国卫生专业技术人员职称制度改革政策与美国学术医学中心的教师晋升轨迹制度，依据Boyer“学术观再思考”与Glassick学术评价六项标准，提炼分轨评价、广义学术、代表作导向与保障对等四条可迁移原则，并批判性审视其在中国情境下的适用边界。据此提出“分层–分轨–代表作”三维本土化优化框架：给出临床型、临床研究型、研究型三类医师轨迹的操作性界定；构建“机构层级 × 医师轨迹”差异化考核矩阵；建立涵盖发现性、整合性、应用性与教学性成果的分级代表作清单及其评价维度，使教学改革与课程建设、教材与教学案例库、住院医师规范化培训带教成果等教学学术贡献与基础研究同台可比、等价可替；并配以学术时间预算、教学能力建设与研究支持团队等保障。文章进一步分析实施中的文化、资源、技术与管理障碍，提出分阶段渐进式改革路线图。所提框架尚需借助德尔菲法与层次分析法予以实证检验。

Abstract: Professional title promotion is a key lever shaping the behaviour of clinical physicians in China’s public hospitals. For years, academic indicators represented by basic medical research have functioned as rigid thresholds in senior title review, while clinical service and, still more, teaching contributions have been systematically crowded out. This has produced several dilemmas: rigidified research indicators, one-size-fits-all assessment that differentiates neither by institutional tier nor by physician track, the absence of a workable metric for teaching contributions, and insufficient institutional safeguards that in turn foster research-integrity risks. Although incorporating the quality of talent cultivation into title-promotion review is already an explicit policy requirement in China, the corresponding forms of recognition and metrics remain absent. Drawing on policy-text analysis, a literature review and international comparison, this paper examines China’s reforms of the health professional title system since 2017 alongside the faculty promotion tracks of U.S. academic medical centres, and, guided by Boyer’s “Scholarship Reconsidered” and Glassick’s six standards, distils four transferable principles: track-based assessment, a broadened conception of scholarship, a representative-works orientation, and parity between requirements and support. Their applicability to the Chinese context is critically examined. A three-dimensional localized framework of “tier-track-representative works” is then proposed: operational definitions are given for the clinical, clinical-research and research tracks; a differentiated “institutional tier × physician track” assessment matrix is constructed; and a graded list of representative works covering the scholarship of discovery, integration, application and teaching is established, so that teaching scholarship such as curricular reform, textbook and teaching-case development and residency-training mentorship becomes comparable with, and substitutable for, basic research. Supporting arrangements including an academic-time budget, faculty development and research-support teams are recommended. The paper further analyses the cultural, resource, technical and managerial barriers to implementation and proposes a phased, incremental reform roadmap. The framework awaits empirical validation through the Delphi method and the analytic hierarchy process.