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.
