With the development of primary care in China, nearly 400 000 general practitioners will be trained in China in the next 10 years. The training of competent general practitioners is of vital importance, which requires general practice (GP) educators to explore a large number of evidence-based GP education concepts, methods, and contents that are applicable to China. At present in China, the quality of GP educational intervention studies is poor, and most faculty and researchers in GP lack training in educational intervention studies. The purpose of this paper was to introduce the process of educational intervention research in GP from design to publication, which consists of four stages with 13 steps: constructing research questions (generating research inspiration, literature review, incorporating a theoretical/conceptual framework, refining research questions), research design (trial design, intervention, outcome evaluation), research implementation (establishing a research team, obtaining research resources, applying for ethical approval, program execution), and publication and evaluation (article writing, reflection and evaluation). This paper provides research methods and ideas for educational researchers and practitioners in GP to conduct educational intervention studies, which will contribute to the generation of high-quality educational research "evidence", further improvement of the quality of GP education training, and the training of competent general practitioners.
The clinical reasoning of general practitioners is the key to providing quality medical services to patients, but it is not suitable for traditional methods to evaluate this ability because it is an abstract ability that cannot be directly observed.
This paper aims to improve the efficiency of general practitioners' clinical reasoning training and enrich the evaluation of medical education by optimizing the evaluation method of curriculum teaching.
From September to December 2022, 38 master's degree students of the Medical School of Tongji University were divided into the in-service group (16) and residential training group (22). The course consists of three modules, namely core, case and result, and adopts blended teaching method to carry out teaching. The content of quantitative evaluation is different kinds of rating scale, while the content of subjective evaluation comes from multi-source feedback.
The final course scores for the core and case modules were statistically significant for both groups (P<0.05), but the first course scores were not (P>0.05). The quantitative evaluation scores of the whole class and the two groups of students in the first and last courses of the above two modules were compared, and there was statistical significance (P<0.001). Subjective evaluation can be divided into positive evaluation and improvement evaluation. The positive evaluation of the courses on consultation skills, physical examination, auxiliary examination, health management, and chronic disease management is relatively low, while the improvement evaluation is relatively high; the positive evaluation of the courses on doctor-patient communication, SOAP, multiple diseases coexirelatively high, while the improvement evaluation is relatively low.
Programmatic assessment can enrich the evaluation system of general clinical reasoning, promote students' construction of general clinical reasoning in order, and also found that "flipped classroom" is a form of procedural evaluation.
The outline of the "Healthy China 2030" Plan puts forward the idea of "sharing, co-construction and health for all". As the gatekeeper of residents' health, the training of general practitioners is crucial. Undergraduate education is the foundation of clinical education in medical colleges and the core of future medical talent reserves. Its teaching quality and effectiveness have a significant impact on the development and scale of clinical medicine in China. This article compares the situation of general practice education in undergraduate medical education at home and abroad, and finds that although Chinese universities currently offer general practice courses, the curriculum and content system are still not sound. Building a group of general medicine courses, strengthening medical humanities and ideological and political education in courses, innovating teaching methods, and improving teaching evaluation may be beneficial for promoting general medicine education in China and helping to promote the cause of national health.
Standardized residency training in emergency medicine is crucial for a high-quality clinical physician workforce. As a frontline dedicated to the treatment of ill patients, the emergency medicine serves as a critical training ground for exemplary resident. Medical skills training is an integral component of residency education, and emergency medicine core skills training numerous modules. However, in the of specific training modules between the teachers and students can impact the training's efficacy and quality.
To investigate and analyze the cognitive differences between teachers and residents of emergency professional skills training in standardized resident training in Hebei Province.
On 18 October 2021, a total of 103 teachers and residents from 15 emergency bases in Hebei Province who were prepared to participate in the standardized training skills competition for residents were selected, including 37 teachers and 66 residents. According to the "Clinical Skill Operation Refinement Process and Scoring Criteria", an electronic questionnaire was developed for 13 emergency core skill training projects according to the operation steps of the refinement process, and the scores were divided into "difficulty degree" and "omission during operation".
In terms of "difficulty", teachers and students exhibited differing of for seven gram (53.85%) : electrocardiography, arterial puncture, abdominal puncture, single-chamber cardiopulmonary (CPR), central venous puncture, tracheal intubation, and three-cavity-two-lung tube placemen, the cognitive differences were observed in 25 steps (16.45%), where teachers rated as less mark than students (P<0.05). In terms of "omissions during operation", teachers and students also differed in their cognitive of nine (69.23%) : electrocardiography, abdominal puncture, single-chamber CPR, central venous puncture, tracheal intubation, three-cavity-two-lung tube placement, lumbar puncture, noninvasive ventilation, and thoracic puncture, the cognitive differences were observed in 24 steps (15.79%) cognitive, with teachers generally a lower mark compared to students (P<0.05). There are no differences were observed between teachers and students in terms of "difficulty" and "omissions during operation" for the remaining three: pericardium puncture, cardioversion, and bone marrow puncture (P>0.05) .
This study confirmed that there are differences between teachers and trainees in the "difficulty" and "omissions in operation" of core skills training in emergency department. On the one hand, it can promote the improvement of clinical skills training curriculum, improve training efficiency, and provide methodological basis for training high-level, high-level and application-oriented medical talents. On the other hand, this study suggests that in the future similar studies on standardized training of residents, the possible differences between teachers and trainees should be taken into account in order to reflect and explore the problems related to residential training more objectively.
Under the background of new medical science, the deep integration of information technology and medical education is encouraged to train first-class medical talents to serve the construction of healthy China.Currently, empathy training in doctor-patient communication mainly consists of simulated communication and group discussion, with less reliance on artificial intelligence technology for learning.
To develop a system for teaching and evaluating doctor-patient communication empathy language. This system will be used in course teaching to pave the way for future doctor-patient communication empathy teaching methods. Carry out teaching applications to enhance the communication and empathy language expression skills of medical students and doctors, and gather feedback to optimize and improve the system.
Between September 2021 and February 2022, the research group focus on utilizing iFlytek speech recognition technology and the empathy semantic recognition algorithm. A system called the "Doctor-patient Communication Virtual Simulation Teaching and Evaluation System of empathic language" was developed using 10 typical cases of doctor-patient communication, demonstrations of empathic language, a semantic database of empathic language, empathic language skills, and an overall scoring standard.A total of 950 students from Nanjing Medical University, including 515 undergraduates, 102 medical doctoral students, and 333 clinicians participating in doctor-patient communication courses or training, were selected as the research subjects from March to May 2022. Based on this system, the Doctor-patient Communication Skills Course (2 class hours) teaching experiment was conducted at Nanjing Medical University. A self-designed questionnaire was used to gather information on the subjects' understanding of empathetic language connotations, their improved empathetic language skills, their perception of system ease of use, and their perception of how the system integrates into the rationality of teaching. NVivo software was used to analyze the subjects' feedback, comments, and suggestions.
Following the implementation of the system, there were statistically significant differences in the mastery of empathic language connotation, the degree of enhancement of empathic language ability, the degree of convenience of the system, and the degree of integration of the system into teaching rationality among undergraduate students, clinicians, and medical doctoral students (P<0.05). 76.1% (723/950) of the participants evaluated that they had "fully mastered" or "highly mastered" the connotation of empathic language. 93.8% (891/950) of the study subjects indicated that the system could "significantly enhance" or "somewhat enhance" the empathic language ability, and 89.5% (850/950) of the study subjects rated the convenience of the system as "very convenient" or "relatively convenient". 95.1% (903/950) of the study subjects rated the degree of cognition of the rationality of integrating the system into teaching as "very reasonable" or "relatively reasonable". The top five words mentioned in the feedback and suggestions are communication, pronunciation, teaching, program, and standard.
This system can help improve medical student and doctors'ability to empathize in doctor-patient communication by learning from individual cases and applying those lessons more broadly. Additionally, the use of an autonomous teaching evaluation system frees up the constraints of time and space in teacher-student interactions. The system's standardized teaching method has received positive and rational feedback from participants, indicating its potential for a wide range of applications. However, the system is still in the early stages of exploration and requires further refinement.
The implementation of standardized teaching clinic activities by the faculty of standardized training of general practice residents (hereinafter referred to as residency training) is a key link in the cultivation of qualified general practitioners. And in July 2021, the Chinese Physicians' Association organized experts to revise the Specification for General Practice Teaching Clinic for Standardized Training of Residents in the Specialty of General Practice (for Trial Implementation), which is referenced by all the residency training bases of general practice across the country to carry out the teaching clinic. However, at this stage, the implementation of teaching clinic in each residency training base is still in the exploratory stage, and the degree of attention is insufficient, and the phenomenon of low quality and irregularity in the form of teaching clinic prevails.
To understand the current situation and influencing factors on the willingness of general practice residency faculty to conduct teaching clinics, not only to analyze the difficulties and confusions in conducting teaching clinics, but also provide reflections and recommendations.
From October 2021 to November 2023, a survey was conducted among general practitioners who participated in the provincial-level general practice residency training programs for regular and key instructors in Guangdong Province. A self-designed questionnaire was used to collect data from the included instructors, covering their basic information, work situation, and their willingness to teach. The electronic questionnaire was created using the "Questionnaire Star" platform, which also facilitated the online distribution and collection of the survey.
The average age of general practice faculty was (40.7±14.1) years, 724 (72.18%) faculty members' institutions had general practice teaching clinics, 792 (78.96%) had a desire to teach, 710 (70.79%) had no experience in teaching, 904 (90.13%) had self-assessed their competence in teaching as a score of 60-89, and 583 (58.13%) had received no general practice teaching clinic faculty training, 462 (46.06%) expected faculty training to be conducted in the form of a combination of multiple types of training, 417 (41.58%) and 309 (30.81%), respectively, believed that the teaching difficulty of general practice teaching clinics was to instruct general practice residents to independently receive patients in the general practice clinic and to teach in a tiered manner, and 377 (37.59%) believed that the most difficult teaching objective to achieve was to instruct general practice residents in general practice clinical thinking and improve their clinical decision-making skills, 216 (21.54%) believed that the most needed training component for general practice residents was consultation skills, and 456 (45.46%) believed that the reason their institution did not/would not conduct a teaching clinic was lack of time. Also, the results of the multifactorial logistic regression analysis showed that the availability of general practice teaching clinics at the institution where they are located, experience in teaching, self-assessment of teaching competence, and acceptance of faculty training in general practice teaching clinics were the factors influencing the willingness to teach in general practice faculty teaching clinics (P<0.05) .
Most of the general practice resident training faculty are willing to carry out general practice teaching clinics, but there are difficulties such as insufficient experience in teaching, training in teaching, and ability in teaching. So it is recommended to optimize and standardize general practice teaching clinics, strengthen the training of general practice concepts for general practice teaching clinic faculty, strengthen incentives for teaching, and improve the monitoring and feedback mechanism for resident faculty in order to improve the quality of general practice teaching clinics.
The development of excellent general practitioners is essential to preserving people's health. Unfortunately, the general practitioner training model in place today is insufficient, which leaves them unqualified to provide primary medical services. Consequently, enhancing clinical competency should be the main goal of general practitioners' training.
To investigate how general practitioners' clinical practice abilities are affected by MDT-based CBL education.
From July 2020 to July 2023, 26 trainee general practitioners received training at the department of pulmonary and critical care medicine as part of their residency programme. As research subjects, they were divided three groups and trained with different model: traditional model, CBL model and MDT-based CBL model, respectively. Leicester Assessment Package (LAP) was used to assess their clinical practice skills by the end. Self-designed questionnaire was used for satisfaction survey anonymously. The results were analyzed statistically.
The MDT-based CBL teaching group outperformed the traditional teaching group and the CBL teaching group in the theoretical examination (P<0.05). The MDT-based CBL teaching group had a significantly higher total LAP score (P<0.05) in comparison to either the conventional teaching group or CBL teaching group. Further investigation revealed that the MDT-based CBL teaching group performed better (P<0.05) in the part of patient admissions, collecting medical histories, patient management, problem solving, physician behavior, patient relationship, and preventive therapy. The students from the MDT-based CBL model had the best overall satisfaction, with a significant difference comparing the students from the CBL and traditional teaching groups (P<0.05). Additionally, the MDT-based CBL teaching group showed a significant improvement in their capacity to guide healthy lifestyle, deal with commodities, guide patient recovery, and use medications after discharge (P<0.05) .
A novel training approach for general practitioner, the MDT-based CBL teaching mode may enhance the clinical practice abilities and competency of general practitioners.
As an important part of the general practice team, assistant general practitioners undertake a lot of grassroots general practice work, but at present, there is no recognized national level assistant general practitioners post competency model to provide scientific basis for training qualified assistant general practitioners.
The competency of assistant general practitioners for China was constructed to provide support for the design of national assistant physician qualification examination, and provide theoretical basis for the training and evaluation of assistant general practitioners.
Based on the research group's previous literature research and behavioral event interviews, from September 2019 to January 2020, the entry pool was established, and 30 experts engaged in general practice were consulted by Delphi method for 2 rounds. The index and weight coefficient of the Chinese assistant general practitioner post competency model were determined by AHP.
Six first-level indicators [the basic medical and health services (0.244 8), medical knowledge and life-long learning (0.244 8), and professional quality (0.244 8), interpersonal communication and team work (0.138 9), the basic public health services (0.085 8), the information utilization ability and management capacity (0.041 0) ] and 63 second-level indicators were finalized, and the weight coefficients of each indicator were defined.
This study constructs the post competency of assistant general practitioners for China for the first time, which has a high degree of expert representativeness and authority, and a more comprehensive and reasonable index selection, laying a foundation for the empirical study of the index system.
With the continuous development of the training program of rural order-oriented medical students (referred to as publicly-funded medical students) in China, the talent team of general practice is constantly enriched, and the professional identity status and its influencing factors in rural order-oriented medical students have become the focus of current attention.
To analyze the influencing factors of professional identity in rural order-oriented medical students.
Purposive sampling method was used to interview the 30 rural order-oriented medical students from 2018 to 2022 grade of Traditional Chinese Medicine (five-year system) Beneficiary Class of Shandong University of Traditional Chinese Medicine by semi-structured interviews from December 2022 to March 2023. The interview data were coded and analyzed by using open coding, axial coding, and selective coding, following the Anselm Strauss and Juliet Corbin programmatic grounded theory approach.
A total of 482 initial concepts and 47 basic categories were extracted by open coding, 9 main categories obtained by axial coding. A typical relationship structure was formed by selective coding, and it showed that the influencing factors of professional identity in rural order-oriented medical students were consisted with six dimensions of career cognition, career behavior, career choice, career will, career emotion, and career belief.
The influencing factors of professional identity in rural order-oriented medical students are composed of six dimensions, including career cognition, career behavior, career choice, career will, career emotion, and career belief, of which career cognition, career behavior, and career choice belong to the exogenous factors, while career will, career belief, and career emotion belong to the implicit factors.
In 2010, China began to implement a free training program for rural order-oriented medical students (the "program") , which has played an important role in improving the construction of grass-roots health personnel and upgrading the level of grass-roots medical and health services. As the program has progressed, despite certain successes, there are many problems that remain to be solved, and it is not yet known which are the urgent and important core issues.
Sorting out the problems with the program to provide lessons learned for moving the program forward.
In May 2023, Chinese databases were searched using the literature analysis method to sort out the problems of the project documented in the literature; the problems resulting from the sorting out were analyzed using the social network analysis method, and the results calculated based on the social network analysis method were comprehensively evaluated using the TOPSIS method.
The relevant problems in the literature were organized and counted. The top-ranked problems in order of frequency were low salary and treatment at the grassroots level for oriented medical students (14 times) , limited space for career development at the grassroots level for oriented medical students (10 times) , imperfect relevant supporting policies (10 times) , poor working conditions at the grassroots level (7 times) , and lack of motivation and initiative in learning for oriented medical students (7 times) ; and the results of the social network analysis were synthesized and evaluated by the TOPSIS method. The results of the social network analysis method were comprehensively evaluated by the TOPSIS method, and the top four rankings were imperfect relevant supporting policies (Ci=0.867) , limited space for grassroots career development of oriented medical students (Ci=0.800) , low grassroots salary and treatment of oriented medical students (Ci=0.786) , and poor grassroots working conditions (Ci=0.621) in the order of ranking.
Guangxi's free training program for rural order-oriented medical students still has major problems in the process of promoting the program. It is recommended that the program be optimized in the following ways to ensure its high-quality development: improve relevant supporting policies and strengthen supervision and evaluation; smooth career promotion channels and establish a long-term incentive mechanism; improve the remuneration system and raise the level of treatment; and improve the grass-roots working environment to enhance the quality of grass-roots work and increase efficiency.
China's National Compulsory Service Programme (CSP) is an important measure to alleviate its shortage of primary health care (PHC) workforce and improve quality of care in rural areas. Currently, the work status and turnover intention of the CSP medical graduates (the fully-fledged general practitioners in China) have received considerable attention.
This article will investigate the medical graduates' workplace violence, burnout, and turnover intention, in order to provide policy recommendations to stabilize the general practitioners.
From December 2021 to February 2022, an online structural questionnaire survey was conducted in nine out of 22 provinces adopting a stratified random sampling method. The electronic questionnaires were distributed to medical graduates with the assistance of the Science and Education Department of the Provincial Health Commission. The burnout of medical graduates was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) . Workplace violence involved the verbal and physical violence. Turnover intention was measured by "Are you willing to continue serving at the PHC institutions upon the completion of the contract (the compulsory service) ?" Multivariate Logistic regression analysis was used to explore the impact of burnout and workplace violence on turnover intention.
A total of 3 615 questionnaires were effectively collected. 87.77% (3 173/3 615) of medical graduates were unwilling or unsure to continue their employment after finishing the contract. 17.46% (631/3 615) of medical graduates had experienced physical violence, and 60.33% (2 181/3 615) had experienced verbal violence. In addition, the detection rate of burnout was 55.82% (2 018/3615) , of which 60.80% (2 198/3 615) were in moderate or severe emotional exhaustion, while the proportions of depersonalization and personal accomplishment were 67.55% (2 442/3 615) and 83.76% (3 028/3 615) , respectively. Logistic regression analysis showed that after controlling for socio-economic factors such as gender, professional title, and personal monthly income, medical graduates who were experiencing burnout had a 4.92 times[95%CI (3.87-6.25) ] higher risk of leaving, a 1.92[95%CI (1.50-2.46) ]times higher risk of uncertain retention (P<0.05) . Medical graduates who experienced verbal and physical violence were 1.46 times[95%CI (1.12-1.91) ] and 0.38 times[95%CI (0.27-0.52) ] more likely to leave after the contract expires (P<0.05) .
Medical graduates have a high intention to leave, and it is expected that there will be a significant loss of general practitioners after the contract expires. Burnout is a significant and prevalent problem affecting turnover intention. Efforts should be made from multiple perspectives to alleviate medical graduates' negative emotions, and thus stabilize the general practitioners.
In outpatient clinics, physicians serve as the primary providers of medical treatment activities; their positive attitudes and effective patient-physician communication methods are essential for guaranteeing high-quality healthcare services.
To compare the outpatient doctor's emotional state and completion of communication details between outpatient doctor's experiential communication and GLTC communication. To provide a reference for improving a doctor's communication skills and emotional state in the future.
From July 2021 to January 2022, 24 outpatient doctors from 6 departments in 4 tertiary general hospitals in Nanjing, Jiangsu Province were randomly selected as the research objects. Outpatient doctor-patient communication scenes meeting the criteria were selected as observation scenes. All of the included outpatient doctors in the same cohort underwent an individual experiential communication program first (recorded as the experiential group). Next, they received training on the outpatient GLTC doctor-patient communication program. Finally, the doctors conducted outpatient GLTC communication one week later (recorded as the GLTC group). The experiential group and the GLTC group were compared in terms of the Brief Profile of Mood States (BPOMS) score before and after communication as well as the completion rate of communication details.
The fatigue dimension score of BPOMS after communication was higher than that before communication in the experiential group (P<0.05) ; After communication, The fatigue and confusion dimension score of BPOMS in the GLTC group were lower than the experiential group (P<0.05) ; the completion rate of communication details in the GLTC group such as kind gaze (reception), polite language (reception), smile (reception), not easily interrupting patients, timely nodding response, appeasement, informing the necessity, patience (experimental examination), consulting patients' opinions, patience (diagnosis and communication), popular explanation, language comfort, friendly attitude, getting up (ending and explaining), kind gaze (ending and explaining), polite language (ending and explanation), smile (ending and explanation) was higher than the experiential group (P<0.05) .
Compared with experiential communication, GLTC communication is more capable of improving doctors' emotional state and relieving doctors' fatigue. At the same time, the completion rate of the corresponding communication details is improved, but there is still room for improvement in the completion rate of some communication details.
Competency development is the core of residency training in general practice, as well as the key to training qualified general practitioners. Summative assessment can evaluate overall training outcome and the attainment of general practitioner competencies. Summative assessment in general practice is still in developing in China, and its relevance to competencies is relatively weak.
To develop competency based summative assessment indicator framework of residency training in general practice, and to provide reference for improving the summative assessment system in China.
From 2023-04-25 to 30, 32 experts from 10 provinces, including Beijing, Shanghai, Hebei, Jiangsu, Zhejiang, Liaoning, Inner Mongolia Autonomous Region, Hainan, Ningxia Hui Autonomous Region and Sichuan Province were invited to participate in Delphi Expert Survey. The indicator framework of summative assessment was established through literature review and Delphi expert survey. The weight of indicators was determined by multiplicative model.
In both the first and second rounds of expert survey, 32 questionnaires were issued and 32 were recovered, which were all valid. The positive coefficient was 100.0%, the authority coefficient was > 0.8, the importance coordination coefficient of indicators at all levels respectively was 0.382, 0.284, 0.265, and the feasibility coordination coefficient was 0.415, 0.359, 0.332. The final summative assessment indicator framework consisted of 6 first-tier indicators, 24 second-tier indicators and 50 third-tier indicators. The first-tier indicators include application of clinical professional knowledge and skills, the ability to take care of the family, the ability to provide basic public health services, the ability to communicate, cooperate and coordinate, humanistic ability and professionalism, clinical teaching and scientific research ability, and the weights were 0.505, 0.061, 0.109, 0.134, 0.125 and 0.066, respectively.
This study preliminarily explored and constructed competency based summative assessment indicator framework of residency training in general practice, which provides reference for further research on the contents of summative assessment and on the improvement of summative assessment system in China. The framework is important for improving the quality of residency training and competencies of general practitioners.
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.
Social environment and psychological factors have a notable impact on professional identity. Currently, there are no available studies on relationships between perception of workplace violence (WPV) by patients, psychological capital (PsyCap) , and professional identity among general practitioners (GPs) in China.
To investigate the relationships between perceived WPV by patients, PsyCap, and professional identity among GPs in China.
A self-administered electronic questionnaire survey was conducted with 4 632 GPs selected by use of stratified multistage random sampling from eastern, central, and western China between March and May 2021. The survey was used for collecting data mainly consisting of GPs' basic demographics, perceived WPV by patients, PsyCap, and professional identity. Spearman's correlation was used to analyze relationships between perceived WPV by patients, PsyCap, and professional identity. Hierarchical multiple regression analysis was used to analyze the effects of perceived WPV by patients and PsyCap on professional identity.
Altogether, 94.47% of the GPs (4 376/4 632) who handed in responsive questionnaires were included for analysis. Six hundred and twenty-four (14.26%) GPs had experienced WPV by patients in the past year. The average total scores of PsyCap and professional identity were (102.89±16.94) and (33.93±8.95) , respectively. The increase in the score of perceived WPV by patients was correlated with a decrease in the scores of PsyCap and its dimensions, and in the score of professional identity (P<0.01) . The increase in the scores of PsyCap and its dimensions was correlated with increased score of professional identity (P<0.01) . Hierarchical multiple regression analysis showed that the frequency of WPV by patients had a negative predictive effect on professional identity (low frequency, b=-0.071; intermediate frequency, b=-0.054; high frequency, b=-0.042; P<0.001) . PsyCap had a positively predicted effect on professional identity (b=0.330, P<0.001) , and it played a partial mediating role between perceived WPV by patients and professional identity.
The GPs' perceived WPV by patients, PsyCap, and professional identity are interrelated, and PsyCap plays a partial mediating role between perceived WPV by patients and professional identity. Great importance should be attached to the professional work environment, occupational status, and mental health among Chinese GPs.
As healthcare gatekeepers, the competency of community general practitioners (GPs) will directly determine the quality of their services. However, the requirements for the competency of community GPs are still unclear and relevant applied research is scarce.
To construct a competency assessment system for community GPs.
An item pool of the first draft of the Onion Model-based Competency Assessment System for Community General Practitioners (OMCASCGP) was created by use of literature review in January 2021, then items in which were screened and improved in accordance with the results of two rounds of email-based expert consultation conducted with a purposive sample of 52 experts in general medicine and general medical management from February to March 2021. The weight of each index was determined by using the Analytic Hierarchy Process.
The response rate, authority coefficient, judgment coefficient and the degree of familiarity with the index for both rounds of consultation were 100.0% (52/52) , 0.91, 0.904, and 0.916, respectively. The formal system is composed of 6 first-level indices, 15 second-level indices and 48 third-level indices. The 6 first-level indices with corresponding weights are basic information (0.085 7) , clinical capability (0.436 1) , public health capability (0.244 5) , humanistic literacy (0.110 4) , career development (0.082 7) , and other aspects (0.040 6) . The Kendall's W measuring inter-expert agreement on the first-, second- and third-level indices was 0.254, 0.302, and 0.341, respectively (P<0.001) .
The OMCASCGP developed by us has been validated to be scientific and reliable, which could be appropriately promoted as a tool for assessing the comprehensive competencies of GPs.
