In standardized residency training for general practice trainees, the rotation time in various clinical specialties is short, and there is a wide range of learning content, requiring enhanced learning autonomy. General practice faculty would be dealing with trainees from a variety of backgrounds, including 5+3, transfer, professional masters, or 3+2 assistant general practitioners, interns, public health trainees. It was necessary to study how to enable different training targets to get what they need and achieve the desired training effect in training needed to be carefully studied.

The objective of this study was to explore a training method that addresses structural problems, enhances trainees' learning initiative, and cultivates their ability for deeper thinking.

At the end of each learning activity, immediate discussions were organized to address the following questions: "1. What have you learned through the study? 2. What other questions do you have? 3. What are the same or similar experiences that you can share with others? 4. What inspirations do you have for future work?" The paper conducted theoretical analyses of the four questions to elucidate the method's internal logic and trainees' thinking process. Corresponding questionnaires were designed for validation studies conducted in the General Practice Backbone Teachers' Training Class and the Grassroots Talent Class.

The training method received strong agreement from the trainees, with the composite score ranging between "strongly agreed" and "agreed". After conducting parameter tests, no statistical differences were found in the answers concerning gender, age, title, position, and working experience. However, statistical differences were observed in academic qualifications, work units, and participated training programs (P<0.05) .

The use of structural problems with progressive meanings and a flexible training format proved effective in stimulating deeper thinking among trainees. The higher level of acceptance observed in the Grassroots Talent Class suggested that the method was particularly applicable to primary general practitioners and can enhance their ability for deeper thinking.

住院医师规范化培训的全科学员在各临床专科轮转时间短暂，学习内容宽泛，需要增强学习自主性。全科师资会面临不同背景学员，如5+3、转岗、专业硕士，或3+2助理全科、实习医生、公共卫生学员等，如何在培训中，使不同培训对象能各取所需，达到应有培训效果，需要认真研究。

探索基于结构性问题的培训方式，提高学员学习主动性，培养其深度思考能力的作用。

选取2020年江苏省全科/助理全科骨干师资培训班（骨干师资班）和基层卫生人才能力提升培训班（基层人才班）的学员作为研究对象。在每次学习活动结束，即刻组织学员讨论，要求依次回答"通过学习1.你学到了什么？2.还有哪些疑问？3.既往有什么相同或者类似的经验与大家分享？4.对今后工作的启发？"根据上述问题思路自行设计调查问卷调查培训学员对结构性问题培训方式的认同度，分为第1部分一般资料，包括性别、学历、职称、工作单位、岗位、工作年限、参与培训的项目等；第2部分是对"问题1、问题2、问题3、问题4和培训形式5"的解释性问题，5个维度共计20个条目，备选项是四等级，赋值为"１=非常同意，２=同意，３=不太同意，4=完全不同意"。

培训对象对所有条目选择同意与非常同意的百分比均大于95%。不同性别、年龄、职称、岗位、工作年限培训学员等对结构性问题培训方法的认同程度比较，差异无统计学意义（P>0.05）；不同学历、工作单位和培训项目培训学员对结构性问题培训方法的认同程度比较，差异有统计学意义（P<0.05）。相较于研究生及以上学历，本科培训对象对问题3、问题4的认同程度更高（P<0.05）。相较于三级医院，城市社区卫生服务中心（乡镇卫生院）和二级医院的培训对象对于问题1~4认同程度更高（P<0.05）。相较于骨干师资班，基层人才班的培训对象对于问题1~4及培训形式5认同程度更高（P<0.05）。

培训实践中总结出的四个开放式问题，内容简单，含义递进，具有内在联系。运用结构性问题培训全科学员，形式灵活，能够激发被培训者的深度思考，该方法在基层卫生人才培训班获得更高的认可程度，表明适用于全科医生的培养。