There is an issue of mismatch between supply and demand of medical care resources in China. The implementation of contracted family doctor services is an effective measure to address the issue, and to improve the hierarchical diagnosis and treatment system. Therefore, it is urgent to speed up the training and ensure the training quality of general practice workforce.
To develop a comprehensive and systematic general practitioner (GP) competency model after analyzing the concept and structural domains of competencies (including inner competencies) required for GPs to deliver contracted healthcare services, providing insights into the realization of training eligible GPs in terms of quantity and quality, and the improvement of quality and efficiency of contracted services.
From December 2020 to September 2021, we conducted in-depth, semi-structured interviews with 38 GPs from 10 medical institutions in four cities (Zhenjiang, Taizhou and Suzhou in Jiangsu Province, and Foshan in Guangdong Province) , then treated the interview results applying the three-level coding and theoretical saturation used in the grounded theory. After that, we developed a General Practitioner Competency Model.
The model consists of 10 items, which belong to four domains: general care capability, humanistic practice capability, team cooperation capability, learning and development capability. General care capability and learning and development capability belong to external competencies, which represent the external performance and driving force of competencies, and determine the level of competencies of GPs to provide contracted services. Humanistic practice capability and team cooperation capability reflect the internal traits and competencies, which belong to the inner competencies, and determine the potential of GPs to provide contracted services.
The model developed by us is complete and comprehensive, in which the inner competencies of GPs have been fully explored, which may be contributive to the training of GPs delivering contracted services, and to the development of a GP competency assessment system using quantitative empirical methods.
General practitioners (GPs) play a major role in providing essential medical services. Most of the existing research on GPs' competencies emphasizes that efforts should be made to improve the medical knowledge and skills of GPs, ignoring the importance of their inner competencies. And there is no scale for effective measurement of GPs' inner competencies in China. Thus, developing a assessment scale of GPs' inner competencies is of great significance for improving the quality of essential medical services.
To develop an inner competency rating scale for GPs and to assess its psychometric properties, providing certain reference for improving GPs' competencies.
By use of literature review and behavioral event interviews results, the draft of the General Practitioner Inner Competency Rating Scale (GPICRS) was developed. Then in September to December 2021, the draft was tested by a survey with a national random sample of 380 (88.2%) GPs. Its rationality was verified by item purification, exploratory factor analysis, confirmatory factor analysis and reliability and validity tests. The weighted average method was used to evaluate the inner competency of GPs. The total and dimensions scores of the GPICRS were compared by demographics.
Three hundred and thirty-five GPs who returned responsive questionnaires were included for analysis. The formal scale consists of 14 items in 4 dimensions: work motivation, self-efficacy, medical humanities and professional qualities. The value of KMO (0.737) and result of Bartlett's Test of Sphericity (χ2=592.715, P<0.001) derived from the exploratory factor analysis, suggested that the data sample was appropriate for factor analysis. Four common factors with an eigenvalue >1.000 were extracted, and the percent of total variance explained by which was 58.861%. The results of confirmatory factor analysis showed that the fitting indicators of the four-factor model were acceptable (χ2/df=2.834, RMSEA=0.074, GFI=0.922, PGFI=0.623, NFI=0.889, TLI=0.903, CFI=0.924) . When it comes to the formal scale, the Cronbach's α was 0.851. The Cronbach's α for each of its dimensions ranged from 0.757 to 0.809. The standardized regression coefficient of each item was greater than 0.500, and the AVE for each dimension was above 0.500. And the CR value for each dimension was greater than 0.700. The arithmetic square root of AVE was greater than the correlation coefficient between the factors. The average total GPICRS score of the 335 GPs was 4.15, which was at a good level, and GPICRS score varied across GPs by different characteristics (gender, age group, professional title, etc.) .
Our GPICRS could effectively evaluate the inner competency of GPs, which may contribute to the decision-making in primary care and the personal development of GPs. In the future, efforts can be made to improve the comprehensive capability of GPs from the following four aspects: self-cognition and occupational identity, theoretical knowledge and practical application, professional ability and work attitude, organizational support and social recognition.
The competencies of general practitioners (GPs) have become a basis for promoting the implementation of tiered diagnosis and treatment, and effective supply of primary healthcare services against the backdrop of the initiation and implementation of contracted services provided by GPs in primary care in China. The regular competency-based assessment systems with clear objectives and strong operability can positively stimulate GPs to provide contracted services with higher quality and efficiency.
To develop a competency rating scale for GPs, providing a tool applicable to scientific evaluation of GPs' competencies in China.
By use of a GP competency model, and review results of relevant studies and competency scales, the measurement items and the draft of the scale were developed, then were revised according to the results of a questionnaire survey conducted with GPs in primary care in major provincial administrative regions from April to August 2021. Among the 402 responders, the answers of 201 cases (sample A) were used for exploratory factor analysis, and those of the other 210 cases (sample B) were used for confirmatory factor analysis. Based on this, the reliability and validity of the final scale were tested.
The final General Practitioner Competency Rating Scale includes four dimensions (general service competency, humanistic competency during practice, teamwork and cooperation competency, learning and development competency) and 21 items. The Cronbach's α for the scale, and the afore-mentioned four dimensions was 0.929, 0.877, 0.850, 0.812, and 0.811, respectively. The P-value of Bartlett's test of sphericity was less than 0.001 (approximate χ2=2 319.759, P<0.001) , reaching a significant standard, and the KMO value (0.923) was close to 1.0. By exploratory factor analysis, four common factors were extracted, explaining 67.680% of the total variance. The first-order confirmatory factor analysis showed that the correlation coefficients of the four dimensions were between 0.68 and 0.72, and highly correlated. The second-order confirmatory factor analysis results were: χ2/df=1.312, RMSEA=0.039, CFI=0.976, GFI=0.913, NFI=0.907.
Our scale has proven to have good reliability and validity, which may be used for assessing the competencies of GPs delivering contracted services in China.
