The expansion of responsibilities in general practice niche in China is still in early stages, facing challenges such as insufficient standardized training and a lack of unified assessment and certification mechanisms. There is no consensus within the industry regarding the necessity, pathways, and models for developing sub-specialty capabilities in general practitioners across management, teaching, and clinical practice.

Taking the expanded role in the international general practice niche as a reference, combined with the domestic model of combining general practice and specialization, this study adopted the Delphi expert consultation method and questionnaire survey method to explore the necessity, main paths, and training methods of cultivating sub-specialty capabilities of general practitioners.

Based on the literature analysis and the previous research results on the development of the integrated general and specialized medical capabilities of community health service centers in Shanghai, we had initially proposed the subspecialty capability item pool for the training of general practitioners. From March to July 2024, we adopted the Delphi expert consultation method, with 60 experts as the research subjects for consultation and argumentation. Through two rounds of consultation, we determined the items regarding the role and necessity of cultivating subspecialty capabilities among general practitioners. At the same time, we surveyed the experts' tendencies regarding the training paths and models, designed the questionnaire dimensions, and the contents included: the training methods for the sub-specialization capabilities of general practitioners, the training time stages, the knowledge and skills categories, the preference for professional direction selection, and the assessment and recognition institutions, etc.

The effective response rates for both rounds of expert consultation questionnaires were 100.0%, with expert authority coefficients of 0.92 and 0.94, and expert coordination coefficients of 0.146 and 0.165, respectively (P<0.001). After two rounds of expert consultation, a set of items regarding the role and necessity of subspecialty competencies for general practitioners were finally formed, consisting of 3 first-level items and 15 second-level items. In terms of the role and necessity of cultivating subspecialty abilities among general practitioners: the mean importance scores for the 3 first-level items (the role of developing subspecialty abilities among general practitioners in primary healthcare; the coordination and complementarity between general medical basic work and specialized disease/subspecialty work; the necessity of developing subspecialty competencies for general practitioners) were all between 4.90 and 4.93, with full-score rates ranging from 88.3% to 91.7%, and coefficients of variation ranging from 0.05 to 0.06; the mean importance scores for the 15 second-level items were all between 4.42 and 4.98, with full-score rates ranging from 45.0% to 98.3%, and coefficients of variation ranging from 0.03 to 0.13. In terms of the pathways and modes for developing subspecialty competencies for general practitioners: 96.7% (58/60) of the experts chose specialist training in tertiary medical institutions with training qualifications for general practitioners, 93.3% (56/60) chose apprenticeship training (supervised by experts from tertiary medical institutions with training qualifications); 78.3% (47/60) of the experts chose the stage of attending physician title, and 11.7% (7/60) chose the stage of resident work after standardized training as the timing for entering subspecialty training.

The cultivation of expanded responsibilities in general practice niche is a practical logic that must be promoted for the development of primary healthcare. It is advisable to establish the "attending physician stage" as the starting point for the development of niche, and adopt the current strategy of "advanced training in tertiary hospitals combined with a mentorship system". Prioritize the development of subspecialties in dermatology and rehabilitation, and focus on stimulating and cultivating niche outside of hospital departments.

我国全科医生细分领域拓展职责发展仍处于起步阶段，面临培养规范化不足、缺乏统一考核及认证机制等挑战。在全科医生亚专长能力培养的必要性、路径与模式等方面，业内在管理、教学、临床实践等不同层面尚未形成共识。

以国际全科医学细分领域的拓展职责为参考，结合国内全专结合的工作模式，采用德尔菲专家咨询法及问卷调研法探讨培养全科医生亚专长能力的必要性、主要路径和培养方式。

研究团队结合文献分析和前期开展的上海市社区卫生服务中心全专结合医疗能力发展的调研结果，初步提出全科医生培养亚专长能力培养条目池；于2024年3—7月，采取德尔菲专家咨询法，邀请60名专家作为咨询论证对象，进行两轮咨询，确定全科医生亚专长能力的作用及必要性条目；同时结合调研专家对于培养路径与模式的倾向性意见，设计调查问卷维度，内容包括：全科医生亚专长能力的培养方式、培养时间阶段、知识技能范畴、专业方向选择偏好以及考核认定机构等。

两轮专家咨询问卷有效回收率均为100.0%，专家权威系数分别为0.92和0.94，专家协调系数分别为0.146和0.165（P<0.001）。经两轮专家咨询最终形成由3个一级条目、15个二级条目组成的全科医生培养亚专长能力的作用及必要性条目。全科医生培养亚专长能力的作用及必要性方面：3个一级条目（全科医生发展亚专长能力在基层医疗中的作用；全科医疗基础工作与专病/专科亚专长工作的协同与互补；全科医生培养亚专长能力的必要性）的重要性赋值均数为4.90~4.93分，满分率为88.3%~91.7%，变异系数为0.05~0.06；15个二级条目的重要性赋值均数为4.42~4.98分，满分率为45.0%~98.3%，变异系数为0.03~0.13。在全科医生亚专长能力培养路径与模式方面：96.7%（58/60）专家选择全科医师到具有培养资质的三级医疗机构专科进修、93.3%（56/60）专家选择师带徒方式培养（由具有培养资质的三级医疗机构专家带教）；78.3%（47/60）专家选择主治医师职称阶段，11.7%（7/60）专家选择规范化培训结束后住院医师工作阶段，为进入亚专长培训的时间阶段。

全科医生细分领域拓展职责的培养是基层医疗发展必须推进的实践逻辑。应确立以"主治医师阶段"为细分领域发展的筹划起点，以"三级医院进修结合导师制"为现行策略，优先发展皮肤、康复亚专长，着力激发和培育非医院专科的细分领域。