Teaching objectives are the soul and pillar of teaching activity and closely related to class teaching effects. Currently, the cognition and formulation of faculty teaching objectives in standardized training for residency practitioners (abbreviated as general practice residency) has been rarely reported at present.
To understand the cognition, formulation basis, construction and writing of teaching objectives among outstanding teachers of general practice in China, so as to discuss the approaches of teachers to better promote teaching through teaching objectives in the general practice residency during the process of developing general practice residency, which is highly specialized, focused on post competency development, and different from institutional education.
The outstanding general practice teachers with the title of associate chief physician and above and related teaching honors on a college level or above, who have been teaching in general practice residency for 5 years or more and are still involved in teaching visits and developing teaching objectives in their teaching activities were selected as research subjects from the general practice departments of national general practice residency base in the hospitals affiliated with well-known medical colleges located in the regions with high development level of general practice. One-to-one semi-structured in-depth interview was conducted by online video conference from February to June 2022. The thematic framework analysis was used to organize and analyze the data and to refine the interview themes through NVivo 12 software.
A total of 8 general practice teachers were enrolled. Through the analysis of the interview data, a total of 3 themes and 4 sub-themes were extracted, including that general practice teachers can better grasp the establishment principles of teaching objectives; there is a lack of institutional guarantees in the construction of teaching objectives, involving 2 sub-themes of the lack of theoretical foundation and normative environment for the construction of teaching objectives; general practice teachers have insufficient cognition of the role of teaching objectives in the development of post competency, involving 2 sub-themes of cognitive deficiencies in teaching objectives, little significance of teaching objectives in guiding teaching activities.
There are still problems in the recognition and formulation of teaching objectives even among the outstanding general practice teachers, which may affect the teaching effects. It is necessary to focus on and ensure the effective formulation of teaching objectives and enhance relevant theoretical training. The teaching objectives should be taken as a starting point to promote the homogeneous development and construction of general practice teachers, so as to train more qualified general practitioners.
Graduate supervisors in general practice are responsible for the important task of training future general practice professionals, so their abilities to communicate with patients are essential for the development of general practice.
To examine the abilities to communicate with patients in supervisors of master's students in general practice during outpatient encounters.
Seventy-five supervisors of master's students in general practice from Capital Medical University were selected by use of cluster sampling to receive a survey using a self-developed demographic questionnaire conducted from April to June 2022. Then their doctor-patient communication skills during outpatient encounters were assessed by relevant professionals who participated in the whole encounter process as accompaniers using the SEGUE Framework. The total score and dimension scores of SEGUE Framework of these supervisors were compared with those of outpatient specialists in tertiary hospitals and general practitioners (GPs) in community health centers (CHCs) in our previous studies, and were compared across these supervisors by sex, employment method and level of medical institutions. Then the total score of SEGUE Framework was compared between the supervisors and US GPs.
The total score of SEGUE Framework attained by the supervisors ranged from 12 to 24 points, and the average score was (17.8±2.6) . The average scores of five dimensions (set the stage, elicit information, give information, understand the patient's perspective, and end the encounter) obtained by them were (3.9±0.9) , (6.5±1.7) , (3.1±1.1) , (2.6±0.9) and (1.7±0.5) , respectively. These supervisors scored higher on dimensions of set the stage and end the encounter than GPs in CHCs and outpatient specialists in tertiary hospitals (P<0.05) . Compared with their counterparts working in primary hospitals, supervisors working in secondary hospitals scored lower on the SEGUE Framework and set the stage dimension (P<0.05) , and those working in tertiary hospitals scored lower on the SEGUE Framework and set the stage and elicit information dimensions (P<0.05) . These supervisor scored lower on the SEGUE Framework than the US GPs (P<0.05) .
There is still considerable room for improvement of the skills for communicating with patients in outpatient encounters in these supervisors. Their level of communication skills was still lower than that of US GPs. In view of this, the teaching management department responsible for general practice department (school) should pay attention to the training of the abilities of master supervisors to communicate with patients, thereby improving the level of medical humanities in practice in master's students in general practice by supervisors' words and deeds.
The long-term and stable development of the general practitioner workforce is crucial to the implementation of policies related to contracted family doctor services, the continuous promotion of construction of the hierarchical diagnosis and treatment system, and the realization of national strategic goals for achieving "big health". Whether a general practitioner continues to work in general practice depends primarily on his confidence in the profession. Exploring the perceptions toward general practice as a career among general medical graduates finishing the standardized general residency training program (SGRTP) , can provide a reference for the improvement of training content and relevant policy formulation. However, there are few relevant studies.
To explore the perceptions toward general practice career among non-targeted admission general medical graduates completing the SGRTP, offering insights into how to better retain general practice talents.
In August 2021, stratified cluster random sampling was used to select non-targeted admission general medical graduates who had been admitted to the SGRTP in 10 standardized general residency training bases in Henan Province during 2014 to 2017, and completed the SGRTP as of the survey date. They attended a self-administered survey conducted through an online platform named "Wenjuanxing", using a questionnaire developed by our research group for understanding their general information, standardized training information, current work situation and perceptions toward a career in general practice.
Three hundred and twenty-six cases attended the survey, and 271 (83.1%) of them who handed in responsive questionnaires were finally included, among whom 77 (28.4%) went into the career of general practice after the completion of SGRTP. Compared with their counterparts who did not work in general practice following the completion of training, the trainees who worked in general practice rated the disciplinary position of general medicine and the social position of general practitioners higher (P<0.05) . Moreover, the percentage of them〔80.5% (62/77) 〕 intending to work in general practice in their whole life was higher (P<0.05) . The score for disciplinary position of general medicine rated by the trainees varied by age and whether or not being the only child of the family (P<0.05) . The score for social position of general practitioners rated by the trainees varied by maternal education level (P<0.05) . The score for the career prospect of general practitioners rated by the trainees varied by age (P<0.05) . Age, marital status, education level, maternal occupation, and current work unit were associated with the differences in scores for intending to be a general practitioner in the whole life given by the trainees (P<0.05) . The top three factors limiting the development of general medicine according to the trainees were "inadequate supporting policies" (150 cases, 55.4%) , "low salary for general practitioners" (146 cases, 53.9%) , and "poor equipment in primary care" (137 cases, 50.6%) . The rates of trainees choosing restrictors of the development of general medicine did not vary by whether or not working in general practice following the completion of SGRTP (P>0.05) . The top three advantages of primary care institutions were "better health guidance for residents" (213 cases, 78.6%) , "optimal allocation of medical resources, relieving pressure on major hospitals and avoiding waste of resources" (165 cases, 60.9%) , and "solving the problem of'seeing a doctor is difficult and expensive' among the masses" (162 cases, 59.8%) . The rates of trainees choosing the options of advantages of primary care institutions did not vary by whether or not working in general practice following the completion of SGRTP (P>0.05) . The top three disadvantages of primary care institutions according to the trainees were "low salary for general practitioners" (212 cases, 78.2%) , "poor hardware and equipment" (181 cases, 66.8%) , and "inadequate social security mechanism" (111 cases, 41.0%) . The rate of trainees choosing "inadequate social security mechanism" or "great concern in educational issues for children due to backward development in remote rural areas" varied by whether or not working in general practice following the completion of SGRTP (P<0.05) , but the rate of choosing each of the other options of disadvantages of primary care institutions did not (P>0.05) .
Age, education level, marital status, mother's education level and occupation, whether or not being the only child in the family, and current work unit were associated with the perceptions toward general practice career in non-targeted admission general medical graduates completing the SGRTP. The supporting policies and salary system are main factors affecting the development of general medicine and primary care institutions, and priority should be given to the allocation of hardware and equipment and the education guarantee for children of general practitioners.
The competency in primary performance positions of rural order-oriented medical graduates of standardized general residency training program (abbreviate for oriented general practitioners) has attracted wide attention. Strengthening continuing medical education is an important measure to enhance the competency of oriented general practitioners.
To understand the current situation, problems and needs of continuing medical education for oriented general practitioners in Guizhou Province, and to provide a basis for improving continuing medical education for oriented general practitioners.
From November to December 2021, 42 oriented general practitioners from 39 township hospitals in 9 cities in Guizhou Province were selected as the research subjects for semi-structured interviews by the purposive sampling and snowball sampling methods. The interview results were coded and analyzed by the research method of procedural grounded theory to extract and summarize the current situation, problems and needs of their continuing medical education.
After three-level coding, 145 concepts, 23 categories and 5 domains related to the continuing medical education of oriented general practitioners were finally sorted out, and a story line was consequenty formed: the continuing medical education of oriented general practitioners is influenced by several factors, among which actual situation is the obstacle, competency requirement is the extrinsic driver, policy system is important guarantee, self-demand is the intrinsic motivation, and the improvement of the training process management is the key process.
The training intention of oriented general practitioners remains to be strengthened in Guizhou Province. The quality of continuing medical education, integration degree of training content and demand, and attention of primary care institutions need to be improved. The support for continuing medical education and the construction of information platform should be strengthened, and the content and form of continuing medical education suitable for oriented general practitioners should be improved, in order to improve the quality and effect of training in continuing medical education.
Continuing medication education for in-service general practitioners (GPs) is a key measure for strengthening the primary health care system, and the department of general medicine in a tertiary general hospital is an important institution undertaking the trainings for GPs. We introduced the development of a staged continuing medical education model for GPs initiated since 2020 by Deqing County Government with Health Bureau of Deqing County in collaboration with Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine and medical educations in Deqing, with a detailed description of the three stages of development, namely the formation of medical and educational framework of Sir Run Run Shaw Hospital in cooperation with the Deqing County Government and medical institutions in Deqing, the construction of "Sir Run Run Shaw Hospital-Deqing" regional GPs education community, and the implementation of trainings for GPs in primary care by the education community using a strategy of "hierarchical and progressive teaching, and cyclic strengthening". The development of this model will offer a reference for the construction of a regional GP training model using the cooperative framework between county-level government and medical institutions and the department of general practice in a tertiary general hospital.
The design and implementation of county continuing professional development and training model for general practitioners is the core of the collaboration on continuing professional development of general practice between the Department of General Practice of Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine and Deqing County of Zhejiang Province. This article introduces the design and implementation of the "hierarchical progressive" continuing professional development training model in the collaboration framework in detail, shares a information platform by virtue of high-quality resources of general practice department of the general hospital, develops the county-level professional development training model for general practitioners, providing reference for colleagues.
Since October 2020, relying on the teaching resources and experience of Department of General Practice of Sir Run Run Shaw Hospital, a three-stage hierarchical progressive teaching and training of "teacher training-backbone training-continuous training" has been carried out for general practitioners in People's Hospital of Deqing County and 12 subordinate primary care institutions in Deqing County.
To analyze the related efficiency of stratified stepped training for regional general practitioners from October 2020 to November 2021.
The stage competencies of 14 senior faculty members were evaluated prior to participation in training (October 2020), at the end of rotation training of Department of General Practice of Sir Run Run Shaw Hospital (January 2021) and at the end of the 12-month training (October 2021) ; the competency evaluation covers five aspects: general practice occupational competence, general practice clinical competence, general practice skills, general practice teaching competence and general practice professional competence. The stage competencies of 28 core general practitioners were evaluated prior to participation in training (January 2021) and after completing the 12-month training (December 2021), the competency evaluation covers four aspects: general practice occupational competence, general practice clinical competence, general practice skills and general practice professional competence. The stage competencies of 82 junior echelon general practitioners were evaluated prior to participation in training (January 2021) and after completing the 12-month training (December 2021), the competency evaluation covers three aspects: general practice occupational competence, general practice clinical competence and general practice skills.
There were significant differences in general practice occupational competence among 14 senior faculty members (P<0.05) ; among them, the scores of general practice professional competence in the third month and the twelfth month of training were higher than those before training (P<0.05). There were significant differences in the scores of general practice clinical competence and general practice skills among the senior faculty members in different time points (P<0.05) ; the scores of general practice clinical competence and general practice skills in the third month and the twelfth month of training were higher than those before training (P<0.05). The scores of general practice teaching competence of senior faculty members in the twelfth month of training were higher than those in the third month of training (P<0.05). The scores of general practice professional competence, general practice clinical competence, general practice skills of 28 core general practitioners after training were higher than those before training (P<0.05). The scores of general practice professional competence, general practice clinical competence, general practice skills of 82 junior echelon general practitioners after training were higher than those before training (P<0.05) .
This study provides an orderly, robust and sustainable model of continuous training and ability improvement of regional general practitioners after practice with the leading and supporting of general hospitals, which can effectively enhance the competence level and improve job competency of regional general practitioners.
The training of targeted admission medical students (TAMS) is an important measure to alleviate the shortage of primary care physicians and to improve the overall quality and level of primary care workforce in rural China.
To explore the recent hot topics, present and future trends in the research on TAMS in China, so that a solid theoretical foundation can be laid for future studies.
All articles about the training of TAMS published from January 1, 2010 to December 31, 2021 in three databases (i.e., CNKI, WanFang Data and CQVIP) were searched on February 15, 2022. The number of the articles was counted for analysis. CiteSpace was used to conduct a visualization analysis of authors, research institutions and keywords extracted from the identified articles.
A total of 598 articles were finally included. The annual number of publications demonstrated an increasing trend generally during the period, with a peak in 2018 (n=81) . Five major groups of authors were identified. The top three prolific institutions were Gannan Medical University〔113 articles (18.9%) 〕, Guangxi Medical University〔40 articles (6.7%) 〕 and Xinxiang Medical University〔28 articles (4.7%) 〕. The top three high-frequency keywords were "order-oriented" (70 times) , "targeted admission students" (57 times) and "talent cultivation" (44 times) . Eight topic clusters were derived from keyword cluster mapping, namely "#0 learning motivation" "#1 teaching model" "#2 order-oriented cultivation" "#3 influencing factors" "#4 general medicine" "#5 primary care" "#6 medical college" and "#7 medical students". Knowledge map of keywords with the strongest citation bursts showed that the top three were "career identity" "major identity" and "rural primary care". The time-dependent graph indicated that the evolution of research on the training of TAMS could be roughly divided into three stages: education and training for TAMS at school, post-graduation training and education of TAMS, and current work status of TAMS in primary care.
The research on the training of TAMS in China is increasingly flourishing. Relevant policies are the major facilitators for the training of TAMS. The research is also featured by lack of inter-regional and inter-institutional coordination among related research institutions and authors. Moreover, the hotspots are constantly changing with the times, and the major topics about which can be summarized as follows: training models for TAMS, learning motivation of TAMS, and intention to work at primary care and associated factors in TAMS. The future research directions may be the evaluation of current work status and intention to work at primary care in a long-term period in TAMS, effectiveness of the implementation of policies related to the training of TAMS, and the innovative development of training models for TAMS.
The program of targeted medical education program has been carried out since 2010 in China, aiming to train general medical talents working in primary care. Further research is needed to explore the working status and career planning in targeted admission medical graduates (TAMG) , as well as the overall assessment for them by the employing unit.
To comprehensively understand the working status (competencies, satisfaction, intention to improve professional capabilities) , career planning, retention intention and associated factors after fulfilling the preadmission commitments in TAMG working in Hainan's primary care after completing the "5+3" standardized general residency program, providing a basis for the optimization of incentive policies for training and retaining general practitioners (GPs) , and for medical colleges to determine the orientation and development direction of a general practice school (department) .
From April 25 to May 6, 2021, by use of cluster sampling, 615 GPs (including 309 TAMG trained with the "5+3" standardized general residency program who work as a GP in primary care after graduation, 56 assistant GPs trained with the "3+2" program, and 250 GPs trained with general medicine before shifting to the post) were selected from 19 cities (counties) in Hainan Province to attend a self-administered questionnaire survey for collecting information about their capabilities, satisfaction and intention to improve professional capabilities. At the same time, 1 574 leaders and colleagues of the TAMG were invited to evaluate the capabilities of the TAMG. The factors influencing the retention intention of the TAMG after fulfilling their preadmission commitments in primary care were analyzed by binary Logistic regression. For further understanding the working status, life and thoughts on the job of the TAMG, the offline research team of this study conducted field investigation in three primary hospitals (one in Haikou, one in Qiongzhong, and one in Sanya) , and held a group discussion with directors of health committees of Haikou, Qiongzhong and Sanya, and directors of the three primary hospitals, as well as 38 randomly selected TAMG from May 7 to 8, 2021.
TAMG had lower mean score of self-rated capabilities than assistant GPs trained with the "3+2" program〔 (19.31±2.59) vs (20.46±2.72) 〕, and GPs trained with general medicine before shifting to the post〔 (19.31±2.59) vs (20.77±2.73) 〕 (P<0.05) . TAMG had lower mean score of self-rated job satisfaction than assistant GPs trained with the "3+2" program〔 (39.77±4.66) vs (41.59±4.56) 〕, and GPs trained with general medicine before shifting to the post〔 (39.77±4.66) vs (41.10±5.19) 〕 (P<0.05) . TAMG had lower mean score of self-rated intention to improve professional capabilities than GPs trained with general medicine before shifting to the post〔 (7.80±2.25) vs (9.10±3.17) 〕 (P<0.05) . However, the mean score of capabilities of TAMG rated by TAMG' leaders and colleagues was higher than that rated by themselves〔 (20.29±3.43) vs (19.31±2.59) 〕 (t'=5.735, P<0.001) . One hundred and fourteen of TAMG (36.89%) intended to stay on after the expiration of the contract. The main factors affecting their retention intention were professional title, current income, and wanting to be a GP (P<0.05) . According to the group discussion, TAMG had high level of enthusiasm at their work and a great sense of team spirit. Moreover, more than half of them had a clear career plan. The challenges faced by TAMG in primary care were the following: overall low level of remuneration, unsatisfactory working environment, insufficient understanding and insufficient understanding and undervaluing of GPs and general practice in relevant administrative departments, inadequate implementation of relevant policies, and limited conditions in primary care hindering the acquisition of the latest advances in general medicine and continuing education.
The TAMG had high levels of capabilities and job statistician, but low level of intention to improve professional capabilities and to stay on after the expiration of the contract. Their capabilities were recognized by their leaders and colleagues. The implementation of incentive policies was un-ideal in Hainan, which may be due to satisfactory implementation of the incentive system for health talents in primary care. In view of this, it is suggested that relevant departments in Hainan take multiple measures collaboratively to effectively implement the incentive regimen of training and retaining GPs.
Family doctors play a major role in the construction of the family doctor system, one of the five basic projects in Shanghai launched since April 2011, so understanding their confidence level regarding practice is crucial to the promotion of high-quality development of family doctor system in China.
To investigate the family doctor confidence index (FDCI) in 2020 and its trend from 2014 to 2020 among general practitioners (GPs) in Pudong New Area of Shanghai, and to predict their future 3-year FDCI, providing insights into the promotion of the construction of family doctor system.
Participants were incumbent GPs who provided family care services in 9 community health centers in Pudong New Area of Shanghai, the settings in which the 2014 FDCI survey in Shanghai's Pudong New Area was conducted. They were invited to attend an online survey through the platform of www.wjx.cn in December 2020 using a questionnaire developed by ourselves based on the implementation of family doctor system in Pudong New Area, the contents of E2-E3 pages of the original China Medical Tribune·General Practice Weekly published on June 22, 2017, and the survey contents of FDCI developed by GU Yuan Family Doctor Studio. FDCI was compared by demographic indices. The future 3-year FDCI was estimated overall, and compared across GPs by demographic indices. The trend of FDCI between 2014 and 2020 was analyzed.
A total of 350 cases attended the survey, and 347 of them (99.1%) who returned were responsive questionnaires were included for analysis. The average FDCI of the participants was (51.96±28.42) in 2020, and that predicted for 2023 was (54.03±26.56) , showing no significant difference (P>0.05) . In 2020, GPs working at rural areas had higher FDCI than those working at urban and peri-urban areas (P<0.05) ; Those who became a GP after training prior to the post shift had higher FDCI than those who became a GP after standardized residency training or passing the professional title examination (P<0.05) ; GPs with junior college education or below had higher FDCI than those with a bachelor/master degree or above (P<0.05) ; GPs who held a concurrent administrative post or handled administrative matters in their hospital had higher FDCI than those did not (P<0.05) . Higher FDCI predicted for 2023 was found in those with working at rural areas instead of those working at urban and peri-urban areas, and in those with junior college education or below instead of those with a bachelor /master degree or above (P<0.05) . Those who were male, aged 23-29, worked at urban area, had an experience of≤1 or>5 years of working as a family doctor, had a bachelor degree or intermediate professional title were predicted to have higher FDCI in 2023 than in 2020 (P<0.05) . The overall FDCI in 2020 was higher than that in 2014〔 (51.96±28.42) vs (24.65±22.75) 〕and 2017〔 (51.96±28.42) vs (48.20±23.10) 〕, with statistical significance (P<0.05) .
The overall FDCI of GPs in Shanghai's Pudong New Area in 2020 and that predicted for 2023 was moderate, and the overall FDCI in 2020 was significantly higher than that in 2014 and 2017. The present and future 3-year FDCI varied among GPs by demographic characteristics. GPs were fully confident in the future development of the industry and their own occupation, and needed continuous policy and social supports.
Currently, there is a shortage of general practitioners (GPs) in primary care. Job transfer training is one of the main ways to train GPs and had important contributions to the construction of general practitioners team.
To analyze the job transfer operation of GPs in Xinjiang Uygur Autonomous Region from 2012 to 2020.
During December 2021 to March 2022, this study reviewed China Health Statistical Yearbook from 2013 to 2021 to obtain the data about GPs in Xinjiang from 2012 to 2020, reviewed trainees' lists of GPs job transfer training program from 2010 to 2022 organized by the Health Commission of Xinjiang Uygur Autonomous Region to obtain the real number of GPs transferred to training, and obtained the data about GPs distribution from the Science and Technology Education Department of the Health Commission of Xinjiang Uygur Autonomous Region.
There were 5 980 GPs in Xinjiang in 2020, and 1 765 (29.52%) of them were qualified GPs through the job transfer training. The gender and age distribution of job transfer training GPs in each prefectures of Xinjiang were statistically different (P<0.05) . According to the requirements of 3 qualified GPs per 10 000 residents, 6 696 GPs were needed in Xinjiang, and 7 254 GPs were needed in 2020, however, the fact is that the number of GPs in Xinjiang increased from 1 925 (0.86 per 10 000 residents) in 2012 to 5 980 (2.47 per 10 000 residents) in 2020. The proportion of GPs through job transfer training gradually decreased from 35.84% (690/1 925) in 2012 to 1.07% (64/5 980) in 2020. The largest number of assigned GPs through job transfer training is 293 in 2012, and the smallest number is 11 in 2017. From 2012 to 2020, Kashgar area had the most assigned GPs of 248, Karamay city had the least assigned GPs of 4.
Job transfer training made an important contribution to the training of GPs. With the implementation of various policies, we reached the target of every 10 000 people, but the total number of GPs has not yet reached 7 000. Therefore, there is still a shortage of GPs. We should strengthen the implementation of relevant policies and encourage clinicians to participate in the transfer training of GPs.
District (county) hospitals are leading institutions delivering primary health services, which are responsible for providing local healthcare services, teaching and training medical talents, and carrying out medical research. However, their high-quality development has been restricted by limited scientific and technological innovation capability.
To review the studies published in recent 10 years on the treatment of clinical trial protocol violations, providing evidence for exploring paths to solve such violations during the cultivation of practical sci-tech innovation talents in district (county) hospitals.
In January 2022, studies on clinical trial protocol violations published between January 1, 2010 and December 31, 2021 were searched in databases of CNKI, WanFang Data, CQVIP, Baidu Wenku, PubMed, Medline, the Cochrane Library, Embase, and ClinicalKey using "临床试验" "医学伦理" "违规问题" as search terms in Chinese, and "Clinical Trial" "Ethical Issues" "Clinical Trial" "Ethical Problems" as terms in English. Clinical trial protocol violations were extracted and classified according to the nature of the violations. Systematic clustering algorithm was used to implement cluster analysis of the violations according to inter-cluster connection. Root cause analysis was used to explore the root causes of the violations.
The violations were divided into five classes (covering 27 subclasses) , and the first three were human subject protection (n=42, 33.6%) , clinical trial protocol (n=33, 26.4%) and informed consent (n=31, 24.8%) . Cluster analysis showed that the 125 violations could be grouped into two categories: authenticity (academic fraud) and compliance (violations) . The root causes of academic fraud and violations were as follows: insufficient research capability and low level of ethical knowledge in individuals or institutions; unsatisfactory punishment on individuals or institutions committing academic fraud; inadequate supervision of the sci-tech innovation achievements assessment and the ethical review system.
To solve academic fraud and ethical violations in trials, it is suggested to provide sci-tech innovation talents with practical ideology education on medical ethics that they should abide by in carrying out clinical trials by hospitals and colleges.
Talent team is a key factor that affects the service level and development of township hospitals. The 19th CPC National Congress held in 2017 proposed to strengthen the construction of primary care system and general practitioners team. There are few available studies on primary care physicians' satisfaction with work unit, job and career development in township hospitals.
To examine the relationships among work unit satisfaction, career development satisfaction and job satisfaction in primary care physicians working at township hospitals, providing scientific evidence for the construction of healthcare talent team in township hospitals.
This study was implemented from December 2019 to August 2020. By use of stratified multistage sampling, 1 736 physicians were selected from 193 township hospitals in 9 counties (districts) of Yulin, Baoji and Shangluo, three cities of Shaanxi to attend a questionnaire survey for understanding their basic demographics, work unit satisfaction, career development satisfaction and job satisfaction. SPSS AU and R were used for data analysis. Pearson correlation was used to analyze correlations among work unit satisfaction, job satisfaction and career development satisfaction. Hierarchical regression was used for mediation analysis. The mediating effect of job satisfaction was further tested by bootstrap test for product of coefficients.
Among the 1 736 cases, 1 727 (99.48%) who returned responsive questionnaires were included for final analysis. The average score of work unit satisfaction in the respondents was (2.03±0.52) points, and the average scores for its five dimensions (satisfaction with the overall management, the management system, welfare benefits, and development prospect, as well as the sense of identity obtained from the unit) were (1.94±0.93) , (2.55±1.21) , (2.17±0.73) , (1.91±0.80) , and (1.57±0.72) points, respectively. The average score of job satisfaction was (1.98±0.45) , and that of career development satisfaction was (2.42±0.49) . Pearson correlation analysis showed that career development satisfaction was positively correlated with work unit satisfaction and job satisfaction (P<0.05) . Hierarchical regression analysis revealed that job satisfaction played a mediating role in the relationship of satisfaction with welfare benefits, unit development prospect, and sense of identity obtained from the unit with career development satisfaction (P<0.05) . Further examination of mediation effect of job satisfaction showed that job satisfaction partially mediated in the relationship between satisfaction with welfare benefits and career development satisfaction (with an effect size of 0.020) , satisfaction with unit development prospect and career development satisfaction (with an effect size of 0.022) , or satisfaction with the sense of identity obtained from the unit and career development satisfaction (with an effect size of 0.012) (P<0.05) .
As job satisfaction plays a mediating role between work unit satisfaction and career development satisfaction in primary care physicians in township hospitals, it is suggested to improve their satisfaction with welfare benefits, unit development prospect and sense of identity obtained from the unit, to enhance their job satisfaction, thereby improving their career development satisfaction.
As an important supplement for strengthening the development of general practitioners (GPs) workforce in primary care in China's rural areas, the training for assistant GPs has been carried out in Hebei Province for five consecutive years. Standardizing the construction of the bases for training assistant GPs, and ensuring the quality of the training are key measures to improve the quality of primary care services in Hebei rural areas.
To understand the assessment of Hebei's assistant GP training bases in 2020, and put forward policy suggestions targeting the existing problems.
We conducted this study during July 27 to 31, 2020. We assessed the 23 assistant GP training bases in Hebei using the Assistant General Practitioner Training Base Assessment System developed by the Chinese Medical Doctor Association, involving general condition, training management, faculty team, process management, quality control and supporting measures. We also conducted a questionnaire survey with trainees randomly selected from these bases (two or three trainees chosen from each base) for understanding their socio-demographics, understanding of the training, satisfaction with the training, attitudes on the career prospect of an assistant GP, and level of intention to work in rural areas.
The rates of qualified, basically qualified and unqualified bases were 65.2% (15/23) , 34.8% (8/23) , and 0, respectively. Thirteen 13 bases (56.5%) had not yet set up an independent general medicine department; 11 bases (47.8%) had qualified teaching rounds assessed in terms of number and implementation standards; 10 bases (43.5%) carried out small lectures and case discussions appropriately assessed in terms of number and implementation standards. The rate of passing the national Assistant Physician Licensing Examination once was≥85% in 2019 for trainees in 8 bases (34.8%) . The rate of passing the completion examination at the end of the training conducted for the first time in all bases in 2019 was≥85% for trainees in 12 bases (52.2%) . A total of 50 trainees attended the questionnaire survey. The prevalence of being satisfied with the design of the rotation of departments, training contents, clinical training base, primary care practice base, and the teaching team was 90.0% (45/50) , 90.0% (45/50) , 92.0% (46/50) , 86.0% (43/50) , and 94.0% (47/50) , respectively. The career prospect of an assistant GP was thought to be good by 39 trainees (78.0%) . Twenty-six trainees (52.0%) were willing to practice in rural areas. The level of satisfaction with policies related to the training for assistant GPs or primary care practice bases differed significantly by age in trainees regardless of whether the bases were qualified or basically qualified (P<0.05) .
In general, Hebei's training bases for assistant GPs were found with a low rate of setting an independent general medicine department, unsatisfactory training quality, and low trainee satisfaction. It is suggested that these training bases should strengthen the establishment of a general medicine department and connotation construction of general practice, improve the construction of primary care practice bases, standardize the process management, thereby improving the training quality.
Community-based clinical teaching is of vital importance in the training of medical undergraduates, but high level of effectiveness of teaching is difficult to be guaranteed at present. So it is essential to establish a scientific and effective system for assessing the effectiveness of community-based clinical teaching for medical undergraduates.
To develop an effectiveness assessment system of community-based clinical teaching for medical undergraduates, providing support for assessing the effectiveness of community-based clinical teaching in these undergraduates.
The item pool for the system used for assessing the effectiveness of community-based clinical teaching in medical undergraduates was developed on the basis of reviewing relevant literature and assessment tools, and was drawn up by group discussions. Then the items were improved according to two rounds of Delphi consultation with a purposive sample of 32 relevant experts from June 2019 to April 2020, and used to develop the Effectiveness Assessment System of Community-based Clinical Teaching for Medical Undergraduates (EASCCTMU) . The Analytic Hierarchy Process was used to calculate the weight of each indicator.
The response rate was 100.0% for both rounds of consultation. The authoritative coefficients for the first and second rounds of consultation were 0.87 and 0.88, respectively. The Kendall's coefficient of concordance for the first and second rounds of consultation were 0.65 and 0.61, respectively (P<0.01) . The final system contains 4 first-level indicators (clinical thinking skills, public health preparedness capability, medical humanistic beliefs, and community-based teaching feelings with corresponding weights of 0.456 1, 0.242 5, 0.283 2 and 0.305 1) and 26 second-level indicators.
The EASCCTMU is highly scientific and operable, which could be used for comprehensively and objectively assessing the effectiveness of community-based clinical teaching in medical undergraduates. However, it still needs to be improved by empirical research.
