The construction of general practitioner (GP) workforce has tended to be mature over recent years, but the overall insufficient competencies of GPs is still one difficulty to be tackled for the construction of GP workforce. Clinical reasoning plays a central role in connecting various abilities in competency training of GPs in China, which is the key to improving the quality of general medical services. To cultivate the clinical reasoning of GPs, Tongji University offers a compulsory course named Clinical Reasoning in General Practice for general practice master students. The course is framed using the Miller's pyramid framework, includes three parts of core module (containing inquiry ability, physical examination, auxiliary examination and patient-doctor communication) , case module (covering undifferentiated illnesses, chronic disease management, coexistence of multiple diseases, psychosomatic diseases and health management) and practice module (including patient reception practice and medical record writing) , which fully reflect the basic characteristics of GPs' competencies. The course requires 32 credit hours, and is taught in multiple forms, including theory teaching, class discussion, problem-based learning and practical sessions. The effectiveness of course learning is assessed using the objective structured clinical examination, which is divided into four test stations: medical history collection, physical examination, patient-doctor communication and wring SOAP notes. Compared with relevant previous courses with separation between course design and actual community services, this course fully reflects the characteristics of general medicine, and helps students to enhance their competencies via improving the level of clinical reasoning.

近年来全科医生队伍建设趋于完善，但全科医生岗位胜任力不足仍是当前人才队伍的困境。在国内全科医生岗位胜任力培养内容中，临床思维起到"串联"各项能力的"中枢"作用，是全科医疗服务质量提高的关键。为了培养全科医生的临床诊疗思维，同济大学开设了全科方向硕士研究生必修课程《全科临床诊疗思维》，课程以米勒金字塔理论为框架，设计了核心模块、案例模块和实践模块"三大模块"，充分体现全科医生岗位胜任力的基本特征。核心模块包括了问诊能力、体格检查、实验室检查、医患沟通内容；案例模块包括了未分化疾病、慢性病管理、多病共存、心身疾病和健康管理内容；实践模块包括了接诊实践与病历书写等内容。课程共32个学时，授课形式多元化，包含理论课、讨论课、以问题为导向的学习（PBL）和实践课。课程评估则采用客观结构化临床考试（OSCE）形式，分为病史采集、体格检查、医患沟通和SOAP（subjective，objective，assessment，plan）病历书写4个考站。相较于以往课程设计与基层社区实际工作相割裂的情况，本课程充分体现全科特色，有助于授课对象训练全科临床诊疗思维，从而提高岗位胜任力。