【背景】在新质生产力驱动医学教育高质量发展的政策背景下，从科技创新和资源配置优化出发，聚焦人才技术要素，激发教学医院的医学教育管理新动能，是推动教学医院临床教学工作创新发展的必然要求。基于结果和胜任力导向的医学教育模式掀起了第三代医学教育改革的浪潮。目前已有针对医学生、住院医师、临床师资等不同角色的胜任力评价模型，指导着医学教育实践的开展，但医学教育管理者的胜任力仍较少受到关注。医院教学秘书作为临床教学管理工作的直接执行者，其工作质量和绩效直接影响着临床医学教育的质量与成效。医院教学秘书的胜任力内涵具有特殊性，难以用医学教育领域的其他胜任力模型进行解释和评价，需要针对这一角色开展更加深入的研究。

【目的】了解当前三级教学医院教学秘书的工作现状，包括工作内容、工作体验、管理模式等，进一步明确其工作职责与岗位要求。结合访谈对象的观点和具体教学管理实践案例，构建医院教学秘书胜任力评价模型。综合实证研究结果，对医院教学秘书的管理工作提出切实可行的操作性建议。

【方法】以北京市X医院作为研究样本，采用方便抽样、滚雪球抽样和理论抽样相结合的方式，选取32名访谈对象进行半结构化深度访谈，其中包括16名医院教学秘书、6名教育处行政管理人员、5名临床学员、3名临床教师和2名医院教学主管。对访谈资料进行主题分析，获得关于医院教学秘书工作现状、工作动机的信息，结合描述性现象学，分析医院教学秘书的复杂工作体验。从扎根理论的视角出发，对访谈资料进行开放式编码、主轴编码和选择性编码和内容分析，构建出医院教学秘书胜任力评价模型。

【结果】

1.从实践出发，医院教学秘书的分类有3种模式，包括学系/专科/学系兼专科、全脱产/半脱产/非脱产、按分管学员类型区分。医院教学秘书的共性特点是处在上传下达的“夹心层”，面临繁重的事务性工作压力，有较强的组织协调和服务属性。

2.医院教学秘书的工作职责可以分为8个大类，包括教学安排与课程管理、学生管理与服务、师资管理与服务、招生与录取管理、考试与考核管理、教学研究与改革、教学质量监控与评估、行政后勤事务。

3.医院教学秘书的选拔方式包括竞聘制、推荐制、轮岗制、实践考察制4种方式，选择依据主要是教学经历、教学热情、工作态度和年资高低。

4.临床医生选择担任教学秘书的工作动机分为组织安排与任务分配、外部激励机制、来自他人的影响、职业发展路径、个人能力提升、个体化的现实需求等7个方面，其中最主要的动机是“服从任务安排”和“对教学工作感兴趣”。

5.医院教学秘书的工作体验是多元的，可以总结为“临床—教学—科研”三重身份的拉扯、一份繁琐的“苦差事”，以及“这是一个良心活”。

6.医院教学秘书的胜任力包括6个核心范畴、37个主范畴、84个次范畴。其中，个人特质和综合能力是教学秘书个体所需要具备的核心胜任力，相对较难培养和评价。行政管理能力是完成教学秘书岗位职能所需要具备的基础能力，也是区分于临床医师等其他角色的关键。临床能力、教学能力、教学相关的科研能力属于外层的知识与技能，相对容易培养、测量和评价。

【结论】本研究聚焦三级教学医院教学秘书的工作现状和胜任力，在对教学秘书及相关管理和服务对象进行深度访谈的基础上，系统梳理了医院教学秘书的岗位设置、工作职责、管理模式、工作动机、工作体验等内容，初步构建了医院教学秘书岗位胜任力评价模型。以上研究发现可以为三级教学医院的教学秘书管理实践提供较为广阔的视野和一手现实材料，推进医院教学秘书管理理念由技术主义向人本主义、由经验主导向科学主导的范式转型，助力临床医学教育工作的创新发展。

【Background】Under the policy background of new quality productive forces driving high-quality development in medical education, it is essential to focus on technological innovation and optimized resource allocation, target talent and technological elements, and stimulate new dynamics in medical education management within teaching hospitals to promote innovative development in clinical teaching. The outcome-based and competency-driven medical education model has ushered in the third wave of medical education reform. Competency assessment models have been developed for various medical education roles, including medical students, residents, and clinical faculty, to guide educational practice. However, the competencies of medical education administrators remain largely overlooked. Hospital teaching secretaries serve as frontline implementers of clinical teaching management. Their work quality and performance directly impact the effectiveness and outcomes of clinical medical education. The competency framework for hospital teaching secretaries possesses unique characteristics that cannot be adequately assessed using existing competency models in medical education. Therefore, targeted research is needed to better understand this specific role.

【Objective】The purposes of this article are as follows: 1) To examine the current working condition of teaching secretaries in tertiary teaching hospitals, including their job responsibilities, work experiences and management models, with the aim of clarifying their professional roles and position requirements. 2) To construct a competency evaluation model for hospital teaching secretaries by integrating perspectives from interviewees with practical cases of teaching management. 3) To propose practical operational recommendations for the management of hospital teaching secretaries based on comprehensive empirical research findings.

【Methods】This study selected Beijing X Hospital as the research sample and conducted semi-structured in-depth interviews with 32 participants recruited through a combination of convenience sampling, snowball sampling, and theoretical sampling strategies. The interviewees comprised 16 hospital teaching secretaries, 6 education department administrators, 5 clinical trainees, 3 clinical faculty members, and 2 hospital teaching supervisors. Thematic analysis of interview transcripts yielded insights into teaching secretaries' current working conditions and motivations, while descriptive phenomenology was employed to examine their complex work experiences. Following grounded theory methodology, the research team performed open coding, axial coding, and selective coding of the interview data, supplemented by content analysis, which collectively informed the development of a competency assessment model for hospital teaching secretaries.

【Results】

1. In practice, hospital teaching secretaries can be classified through three models: department-based/specialty-based/dual-role, full-time/part-time/non-released, and by trainee categories managed. Their common characteristics include serving as intermediaries between administrators and faculty while handling heavy administrative workloads, requiring strong organizational coordination and service-oriented competencies.

2. The responsibilities of hospital teaching secretaries encompass eight major categories: teaching schedule and curriculum management, student administration and support, faculty coordination and services, admissions and enrollment management, examination and assessment administration, educational research and innovation, teaching quality monitoring and evaluation, and administrative/logistical affairs. 

3. Selection methods for these positions include four approaches: competitive recruitment, recommendation-based appointment, job rotation, and performance-based assessment. Primary selection criteria emphasize teaching experience, educational commitment, work attitude, and seniority.

4. The motivations for clinical physicians to assume teaching secretary roles can be categorized into seven dimensions: organizational assignment, external incentive mechanisms, peer influence, career development pathways, personal competency enhancement,  individualized practical needs, and other factors. Among these, the primary motivations are "compliance with task assignments" and "intrinsic interest in teaching activities."

5. The work experience of hospital teaching secretaries is multifaceted, characterized by three key dimensions: the tension between their "clinician-educator-researcher" tripartite roles, the demanding nature of this "labor-intensive" position, and the reality that it remains fundamentally "a conscientiousness-driven undertaking."

6. The competency framework for hospital teaching secretaries comprises 6 core domains, 37 primary categories, and 84 secondary categories. Among these: 1) Personal attributes and comprehensive competencies represent the core requirements for individual teaching secretaries, which are relatively difficult to cultivate and assess. 2) Administrative management capabilities constitute the fundamental skills necessary for fulfilling position functions, serving as key differentiators from other roles like clinical physicians. 3) Clinical competencies, teaching abilities, and teaching-related research capabilities belong to the outer layer of knowledge and skills, being relatively easier to develop, measure, and evaluate.

【Conclusion】This study investigates the working condition and competency requirements of teaching secretaries in tertiary teaching hospitals. Through in-depth interviews with teaching secretaries and relevant administrative and service personnel, we systematically analyzed various aspects including position arrangements, job responsibilities, management models, work motivations, and professional experiences, ultimately developing a preliminary competency evaluation model for this role. The findings provide valuable insights and first-hand empirical data for improving the management of teaching secretaries in tertiary hospitals, promoting a paradigm shift from technology-centered to humanistic approaches and from experience-based to evidence-based practices, thereby facilitating innovation in clinical medical education.