The continuous development of the rural-oriented tuition-free medical education program has greatly contributed to the increasingly expanding of team of general practitioners in primary care. And the service status of targeted admission medical graduates has become a focus of current concern.
To explore the barriers faced by targeted admission medical graduates during the contracted period of providing primary care, and to propose corresponding countermeasures and suggestions.
From January to March 2021, 73 targeted admission medical graduates (admitted in 2010 & 2011) who were working in primary hospitals in Guizhou were selected to attend a semi-structured interview with an outline involving brief introduction of the development of their hospitals, job duties, job progression, main problems existing in work, capability areas for improvement, current situation of continuing education, current living conditions, level of targeted admission medical graduates valued by hospitals, future work plan, and so on. The interview results were analyzed in accordance with the procedures of grounded theory.
One hundred and twenty-seven concepts, 21 categories, 7 main categories (work environment, policy guarantee, family factors, future planning, psychology and perception, person-job fit and career development needs) were identified by an analysis, forming four axes: working practice (primary medical conditions, environment, management and other factors restrict the development of targeted admission medical graduates, and they hope to get more organizational support and suitable job arrangements) , family factors (part of targeted admission medical graduates affected by factors such as family distance and economic pressure during the service period, it is difficult to take into account the responsibility of family care) , internal demand (targeted admission medical graduates are prone to psychological and cognitive gaps, think that their personal abilities and development are limited, and hope for better career development prospects) , policy driving (policy factors run through all aspects of primary care for targeted admission medical graduates, and the implementation and promotion of some policies are insufficient and need to be further strengthened) .
The targeted admission medical graduates in Guizhou mainly faced difficulties in career development, ability improvement, caring for families, economic treatment and other aspects during the contracted period of providing primary care. To improve the situation, retain them in primary care as well as promote their career development, it is suggested to establish a mechanism for receiving their feedback, providing long-term trainings and guidance for them, allocate targeted admission medical graduates from other places, speed up the construction of regional medical consortiums, set up special subsidy funds, and clarify the arrangements after the expiration.
The mental health of trainees receiving the three-year standardized general practice residency program (SGPRP) has been valued recently, and psychological problems are considered to be one major type of causes of their failure to complete the full training. So understanding the mental health status and associated factors of psychological problems in these GP trainees are of important significance for the development of residency training policies and programs.
To explore the mental health status and causes of psychological problems in GP trainees of SGPRP, improving the attention of SGPRP managers and the society given to the mental health of GP trainees.
This was a mixed-method sequential explanatory study. In January 2021, by use of convenience sampling, all in-service GP trainees of SGPRP were recruited from Peking University Shenzhen Hospital to attend a self-administered survey to complete the Demographic Questionnaire compiled by our research team and the Symptom Checklist 90 (SCL-90) . The total score and domain scores of the SCL-90 were analyzed overall, then were compared among the trainees by grade. For understanding the main life events triggering emotional or psychological problems and their associations with residency training program or specialty, and GP trainees' preferred assistance as well as suggestions for the development of SGPRP, from February to June 2021, purposive and heterogeneous sampling were used to recruit GP trainees with mental health assessment to attend an in-depth, semi-structured interview using phenomenological research procedure. The interview results were recorded, and transcribed, then coded using NVivo 12, and analyzed using Colaizzi's seven-step analysis and thematic analysis.
All GPs (n=84) responded to the survey, with a 100% response rate. The mean total SCL-90 score and the mean total symptom index for 84 GP trainees were (149.61±50.55) , and (1.66±0.56) , respectively. Of them, 29 (34.5%) had a total score≥160. The prevalence of obsessive-compulsive, depression, interpersonal sensitivity, anxiety, paranoid ideation, anger-hostility, psychoticism, somatization and phobic-anxiety (prevalence of symptoms in each domain was defined as domain score≥2) was 53.6% (45/84) , 39.3% (33/84) , 34.5% (29/84) , 26.2% (22/84) , 22.6% (19/84) , 21.4% (18/84) , 19.0% (16/84) , 14.3% (12/84) , and 14.3% (12/84) , respectively. The depression domain score varied significantly across GP trainees by grade (P<0.05) . The prevalence of depression was 48.4% (15/31) in grade 2 GP trainees. In total, 21 GP trainees attended the interview, 14 (66.7%) of whom had a total SCL-90 score≥160. Four themes emerged from the analysis: impact of personal problems on psychological status; harm and benefits caused by interpersonal interactions at work; psychological stress related to the residency base; lack of confidence related to specialty choice.
The high prevalence of psychological problems in GP trainees may be closely related to personal factors and problems encountered during residency training. In view of this, psychological guidance and crisis intervention should be listed as an important part of residency training management, and efforts should be made to enhance the trainees' sense of existence and belonging as well as self-confidence, thereby helping them to successfully complete the training.
