Primary health care provided by general practitioners is an important safeguard for the achievement of universal health coverage. With the continues progress of new medical reform, the number of primary care settings, general practitioners and outpatient visits have increased significantly compared with one decade ago. General practitioners, as the main body of implementation of general practice, coincides with the concept of narrative medicine in terms of patient-centeredness and attention to both psychological and social factors of the patients. Narrative medicine is medicine practiced by clinical workers who have narrative ability, with strong theory and weak practice in our country at present. From the perspective of general practitioners, this paper presents the positive influence of narrative medicine practice in primary care on general practitioners in the form of parallel medical records.

General practice in China has developed rapidly in recent years with remarkable progress, but the gap with developed countries in Europe and the United States is still large, and the training system of general practitioners still remains impefect. In Germany, the construction of the primary health care system and the training system of general practitioners have been well developed. Under the system of universal health insurance coverage and hierarchical diagnosis and treatment, a high level of health and patient satisfaction with primary healthcare services among residents have been achieved in Germany. Therefore, this study compares post-graduate education and continuing education of general practice in China and Germany, analyzes the challenges of general practice education reform in China, drawing on the conceptual framework of general practice education in Germany, and proposes targeted ideas and recommendations for solutions as follows: for the standardized residency training of general practice, increase the rotation flexibility as appropriate to facilitate the optimization of trainees' individualized competencies, incorporate the standardized curriculum of psychosomatic medicine and Balint group training to improve trainees' competence in psychosomatic medicine, establish standardized selection criteria and promote standardized training program for faculty of community hospital, and revisit the duration of general practice (including community) rotation after improving the qualifications of general practice faculty of community hospital; for the continuing education, incorporate the special interest and small specialties into the general practice continuing education system to strengthen the functional medical characteristics of general practice and promote the professional diversification of general practitioners, and establish a national unified platform for continuing education in general practice. More practical research and resources are needed to improve the training system of general practitioners in China in the future.

General practitioners (GPs) are the"gatekeepers"of residents' health. In China, Up to 2021, 84.4% of GPs account for 22.7% of the total primary physicians. The quantity and quality of the GP workforce are related to the level of primary care services. In recent years, the central government and governments at all levels have attached great importance to the construction of the GP workforce and successively introduced many supportive policies. However, the number of GPs in China currently only accounts for 10.1% of practicing (assistant) physicians, and the lack of position attractiveness of GPs has become the main reason restricting the development and growth of the GP workforce. Based on the talent itself, this paper constructs a talent development mechanism-oriented model of "primary general practitioner-position attractiveness" to deeply analyze the dilemmas of GPs in seven aspects of education, recruitment, application, motivation, evaluation, development and support, explore countermeasures to solve the problems, in order to provide a scientific basis for enhancing the position attractiveness of GPs, stabilizing the talent team of GPs, and improving the quality and level of primary care services.

The prevalence rate of type 2 diabetes is increasing in China. General practitioners play an important role in the prevention and treatment of type 2 diabetes and its complications. Chronic kidney disease (CKD) is a common co-existing disease in patients with diabetes. However, at present, there is little research evidence on type 2 diabetes combined with CKD in primary care in China.

To investigate the obstructive factors in the monitoring and management of type 2 diabetes mellitus with CKD from the perspective of general practitioners.

From May to July 2022, a one-to-half structured interview was conducted with snowball sampling among general practitioners in an urban area of Beijing, and the interview outline was formulated based on the theoretical domains framework (TDF). NVivo 11 software was used to encode and classify the interview contents. Subject frame analysis method was used to sort out and analyze the data, and extract the theme.

13 general practitioners were interviewed in this study, and the years of working in general practice ranged from 8 to 22 years. The study identified barriers related to six domains in TDF, namely knowledge/skills, beliefs about outcomes, motivation and goals, medical background, resources and norms of conduct. After refining again, the themes were lack of systematic knowledge and skills related to CKD, imperfect incentive mechanism of primary medical staff, lack of smooth referral process between primary medical institutions and higher hospitals, poor self-management ability of patients and other obstacles.

There are many factors preventing general practitioners from monitoring and managing patients with type 2 diabetes complicated with CKD in the community. It is necessary to strengthen the knowledge and skills training of general practitioners with diabetes mellitus complicated with CKD, improve the ability of general practitioners to monitor and manage CKD, improve the incentive mechanism of primary medical institutions and establish an effective referral process with superior hospitals, strengthen the health education of patients, improve the self-management ability of patients, and enhance the prevention and treatment ability of primary medical institutions with type 2 diabetes complicated with CKD.

The current training content of continuing education in general practice cannot meet the needs of clinical practice, as well as the lacking of thinking and characteristics of general practice in teaching faculty and evaluation methods.

To explore the training of clinical thinking in general practice through continuing education, so as to solve practical problems and improve working competence of general practitioners (GPs) .

The design of the 8th GPs' practice ability training workshop course was optimized based on the literature reading and feedback from the continuing education course of GPs' practice ability workshop in November 2020, and a questionnaire survey was conducted through the "wenjuanxing" platform among 200 GPs who participated in the 8th workshop course to evaluate the overall and various levels of improvement in their clinical thinking ability and working competence.

A total of 200 questionnaires were distributed, and 172 valid questionnaires were collected, with a recovery rate of 86.0%. After the training, 52.3% (90/172) and 21.5% (37/172) of the GPs had improved and greatly improved their overall clinical thinking ability in general practice, respectively, and 56.4% (97/172) and 22.1% (38/172) showed improvement and great improvement in overall working competence. There was a statistically significant difference in the improvement of clinical thinking ability and working competence among GPs with different professional titles and job types after training (P<0.05). There were 134 (77.9%), 134 (77.9%), 133 (77.3%), 127 (73.8%), 114 (66.3%) GPs who believed that "reading images" "clinical thinking ability in general practice" "interpretation of test indicators" "diagnosis and treatment of common dermatological and pentacologic diseases" and "scientific research training" could significantly improve the working competence of GPs. There were significant differences in the improvement of working competence by the course on "reading images" "clinical thingking ability in general practice" "diagnosis and treatment of common dermatological and pentacologic diseases" among GPs with different professional titles and job types (P<0.05). There was significant difference in the improvement of working competence by "scientific research" training course section in GPs of different genders (P<0.05) .

Optimized continuing education of general practice has a significant effect on the clinical thinking and working competence of GPs. In the design of training to improve the clinical thinking and working competence of GPs, it is also necessary to pay attention to the integration of various types of knowledge and skills in the training, and the practice experience base and accumulation of the trainees.

Currently, there are many studies on family doctor contracting services from the perspective of residents, but few scholars have conducted studies on the current situation of family doctor team contracting based on the perspective of general practitioners (GPs) .

To understand the current situation of family doctor contracting services in primary health care institutions in Guangdong Province, and explore the factors affecting the contracted number from the perspective of the supplier.

From July 5—31, 2021, GPs in primary health care institutions in Guangdong Province were selected as the study subjects by using a multi-stage stratified cluster sampling method to conduct the survey with a self-designed questionnaire. The contracted number was compared by different GPs and their family doctor team characteristics. A two-level Logistic regression developed by R 4.2.2 software was used to identify influencing factors of contracted number above 2 000.

A valid sample of 3 252 cases in family doctor team with contracted number more than 100 was screened, and the median contracted number was 1 400 (2 499) in 2020. The differences were statistically significant when comparing the contracted number by gender, age, education level, position, employment form, working years, working unit, working area, training acceptance, and annual income, number of team members, population size under jurisdiction, willingness of specialists from medical community to join the team, inpatient bed resources and guidance from superior departments (P<0.05). Zero model fitting showed that contracted number was clustered at the regional level (P<0.05). Two-level Logistic regression model showed that, with master's degree or above as the reference, the contracted number of the team including GPs with college〔OR (95%CI) =2.79 (1.84, 3.74) 〕and secondary/high school〔OR (95%CI) =2.83 (1.80, 3.86) 〕degrees were more likely to be above 2 000; taking no position as reference, the contracted number of the team including unit leaders〔OR (95%CI) =0.66 (0.33, 0.99) 〕was more likely to be above 2 000; taking temporary staff as reference, the contracted number of the team including formal staff〔OR (95%CI) =2.02 (1.53, 2.51) 〕was more likely to be above 2 000; taking the team with size of 3 or less people as reference, the contracted numbers of the teams with size of 4 to 6 people〔OR (95%CI) =1.31 (1.05, 1.57) 〕, 7-10 people〔OR (95%CI) =2.06 (1.75, 2.37) 〕, 11-19 people〔OR (95%CI) =3.67 (3.31, 4.03) 〕and≥20 people〔OR (95%CI) =3.46 (2.74, 4.18) 〕were more likely to be above 2 000; taking population size under jurisdiction at 2 000 or less as reference, the contracted numbers of the team with population size under jurisdiction at 2 001 to 9 999〔OR (95%CI) =2.37 (2.12, 2.62) 〕, 10 000 to 29 999〔OR (95%CI) =2.92 (2.65, 3.19) 〕and more than 30 000〔OR (95%CI) =2.86 (2.55, 3.17) 〕were more likely to be above 2 000; taking condition of having inpatient bed resources as reference, the contracted number of the teams without such resources〔OR (95%CI) =1.38 (1.14, 1.62) 〕was more likely to be above 2 000 (P<0.05) .

The population under jurisdiction and the large number of team members create favorable conditions for contracting; family doctor teams with GPs with positions, inpatient bed resources and high education level have a good understanding of family doctor contracting service policies and control the number of contracted patients better; comparing with temporary staff, GPs team with formal staff may undertake more contracting tasks.

Domestic studies on post competency evaluation indexes of general practitioners mainly focus on economically developed areas in the east. While the applicability of existing evaluation indexes of post competency of general practitioners in rural areas or less-developed areas may be insufficient due to unbalanced allocation of medical resources and large disparities in medical levels among different regions in China.

To construct an evaluation index system for the post competency of general practitioners and to provide reference for the training, assessment and evaluation of general practitioners in less-developed areas.

An evaluation index system for the post competency of general practitioners in less-developed areas was constructed preliminarily through literature research. From January to June of 2021, 18 consultant experts were selected respectively from general practice clinical workers practicing in less-developed areas, general practice/health administration workers in provinces/counties/towns and general practitioners who had participated in the counterpart support in the east-west counterpart support and worked in less developed areas by purposive sampling method. The expert consultation and hierarchical analysis were used to complete the screening of evaluation indexes of post competency of general practitioners and determine the weight of each index in less-developed areas.

The effective recovery rate of two rounds of expert consultation questionnaires were 100.0%; the familiarity, judgment and authority coefficients were 0.76, 0.84 and 0.80; the Kendall coordination coefficients were 0.24 (χ²=297.543, P<0.001) and 0.26 (χ²=322.083, P<0.001). The evaluation index system for the post competency of general practitioners in less-developed areas was constructed consisting of 4 primary indexes, 20 secondary indexes and 44 tertiary indexes. The weights of primary indexes including "medical service capacity" "public health service capacity" "organizational management and coping ability" and "professionalism" were 0.350 9, 0.109 1, 0.189 1 and 0.350 9, respectively. The top 4 combination weighted indexes in secondary indexes were "professional quality" (0.177 1), "learning and thinking ability" (0.126 5), "communication and coordination in primary care" (0.118 6), "diagnosis and treatment of common diseases" (0.108 9). The top 4 combination weighted indexes in tertiary indexes were "civilized communication and friendship exchange with patients, colleagues and physicians at superior hospitals" (0.118 6), "humanistic care" (0.098 9), "mastering clinical appropriate technology such as cardiopulmonary resuscitation (CPR), defibrillation and catheterization" (0.088 3), "diagnosis and treatment of common and frequently-occurring diseases" (0.081 7) .

The evaluation index system for the post competency of general practitioners in less-developed areas constructed in the study have practicability and scientificity, which can provide scientific basis for the evaluation of post competency of general practitioners in less-developed areas.

General practitioners (GPs) mainly provide basic medical and health services. The construction of GPs human resources is closely related to the development of primary care system.

To investigate the current status of psychological capital (PsyCap) , professional identity, and intention to stay of GPs in China and explore the relationship among the above three.

A total of 4 632 GPs were selected for electronic questionnaire investigation in the eastern, central, and western China from March to May in 2021 by using a multi-stage stratified random sampling. The questionnaire mainly included basic information, PsyCap, professional identity, and intention to stay. Pearson correlation analysis, hierarchical multiple regression analysis and structural equation model were used to explore the relationship among professional identity, PsyCap, and intention to stay.

A total of 4 376 GPs were included with the effective response rate of 94.47%. The total scores of PsyCap, professional identity, and intention to stay were (102.89±16.94) , (33.93±8.95) , and (21.69±4.04) , respectively. Pearson correlation analysis showed that there were significant positive correlations between PsyCap and professional identity, professional identity and intention to stay, PsyCap and intention to stay (r=0.402, 0.459, 0.236, respectively, P<0.001) . The results of hierarchical multiple regression analysis showed positive predictive effects of PsyCap and professional identity on intention to stay (b=0.079 and 0.361, respectively, P<0.001) , and professional identity had a mediating effect between PsyCap and intention to stay. The structural equation model showed that PsyCap and professional identity had a positive predictive effect on intention to stay (b=0.032, P<0.05; b=0.446, P<0.001) , and professional identity had a part mediating effect between PsyCap and intention to stay.

The intention to stay among GPs in China is at a moderate level. There are positive correlations among PsyCap, professional identity, and intention to stay among GPs in China. PsyCap can affect intention to stay through professional identity. Improving the PsyCap and professional identity of GPs is conducive to improving their intention to stay.

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.

In recent years, China has attached great importance to strengthening the development of general practitioner (GP) workforce and primary care service system. To innovate the incentive mechanism for GP training and employment and improve the training system for GPs, the government has also promulgated a series of policies and put forward major reform measures involving many aspects.

To analyze and evaluate the fairness of distribution of general practitioner (GP) resources in China, and to provide theoretical support for scientific and equitable allocation of GP resources.

Data were sourced from five volumes of China Health and Family Planning Statistical Yearbook (2017—2021), China Health Statistical Yearbook (2017—2021), and China Statistical Yearbook (2017—2021) in June 2022, including the number of GPs, the number of people registered as general medicine professionals, the number of people who obtained the General Practitioner Certificate after training, the number of GPs per 10 000 population, and the number of practicing (assistant) physicians in China, in each geographical division (eastern, central or western), and in each regionin, and the annual gross domestic product (GDP), gross regional product (GRP), and the year-end total population data of each region during 2016 and 2020. Additionally, the total land area of each region was extracted from the China ABC column on the website www.gov.cn. The Lorenz curve and the Gini coefficient were used to analyze the fairness in the distribution of GP resources. The Theil index was used to analyze differences in the distribution of GP resources in eastern, central and western China.

The number of GPs in China increased from 209 083 in 2016 to 408 820 in 2020, showing a growth rate 95.53%. In 2020, the proportion of GPs among all practicing (assistant) physicians reached 10.01% (408 820/4 085 689), and the number of GPs per 10 000 population was 2.90. The Gini coefficients measuring demographic, economic, and geographical distribution inequalities of GP resources were 0.235, 0.178, 0.722, respectively for 2016, 0.231, 0.170 and 0.726, respectively for 2017, 0.225, 0.161 and 0.729, respectively for 2018, 0.177, 0.147 and 0.714, respectively for 2019, and 0.157, 0.136, and 0.707, respectively, for 2020. Overall, the Lorenz curve measuring the inequality in the distribution of GP resources by demographics or economy had lower degree of curvature than that by geography. A reduction was found in Theil index measuring unequal demographic, economic or geographical distribution of GP resources in 2020 compared with that in 2016 (from 0.046 to 0.020; from 0.022 to 0.013; from 0.482 to 0.428) .

During the five years, the distribution of GP resources in China presented the following features: the number of GPs increased rapidly and became an important part of the workforce of practicing (assistant) physicians, the registration rate of GPs gradually increased, and the total GP resources showed a continuous growth, but the ratio of GPs per 10 000 population was still unsatisfactory, great inter-region differences existed in the distribution of GP resources, and the equity of the distribution of GP resources by geography was more unsatisfactory than by demographics or economy.

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.

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.

General practitioners are medical personnel with high integrated degree, and are the "gatekeepers" of residents' health. Violent incidents affecting health care not only seriously harm the the physical and psychological health of general practitioners, also affect the quality and level of basic medical services, which increases the turnover of general practitioners and the economic burden on the health care system. Previous studies have shown that more than half of general practitioners had experienced workplace violence, with the most common types including verbal violence and threats, followed by physical violence, sexual harassment and assault, patients and their family members were the main perpetrators. The failure of the medical services quality to meet the demands of patients, alcohol abuse, drug abuse and mental disorders of perpetrators, poor physician-patient communication were important factors associated with workplace violence. It is suggested to improve policies and regulations, norms of conduct related to workplace violence of healthcare workers, establish and improve the reporting and punishment mechanisms, enhance the capacity of healthcare workers and health care institutions to provide medical services and prevent workplace violence, give proper play to the role of the public media, promote the establishment of "zero-tolerance" system for violence.

Psychological capital (PsyCap) has a significant impact on individual attitude, behavior, and performance. Currently, studies on the level and associated factors of PsyCap among general practitioners (GPs) are limited.

To investigate the level of PsyCap and its associated factors among community GPs in China, providing evidence for human resource management in primary health care.

To conduct the questionnaire survey, 40 community health service institutions from their list of community health service institutions were randomly chosen, 4 632 GPs (40% of whom were on duty) were randomly selected from each community health service institution's duty roster on the day of the survey, and all five provinces (autonomous, municipalities) regions in the east, central, and west China were chosen by use of multi-stage stratified random sampling between March and May 2021. The questionnaire consisted of 3 sections: general information, workplace violence, and PsyCap, and statistical analysis was performed using general descriptive analysis, rank sum test, and generalized linear regression.

A total of 4 376 community GPs were finally included as eligible respondents. The total median score and average total score of PsyCap were 104 (20) and 4.33 (0.83), higher than the theoretical median (3.50 points). The region〔central China (b=1.355) 〕, age〔40~49 (b=2.609), ≥50 (b=4.035) 〕, marital status〔married (b=1.801) 〕, practice setting〔rural (b=2.088) 〕, holding an administrative post〔no (b=-1.734) 〕, weekly working hours〔>50 (b=2.743) 〕, average number of daily consultations〔20~39 (b=2.177) 〕, workload〔moderate (b=6.900), high (b=8.146) 〕, occupational stress〔moderate (b=-6.936), high (b=-10.309) 〕, occupational development opportunities〔general (b=2.073), more (b=7.747) 〕, and the frequency of workplace violence〔low (b=-3.132), medium (b=-3.990), high (b=-7.033) 〕were factors associated with the level of PsyCap among GPs significantly (P<0.05) .

The PsyCap of community GPs in China is at an upper medium level, and the associated factors are complicated. To improve the level of PsyCap among GPs, attention should be paid to their mental health status, and provide them with interventions targeting PsyCap-related factors to lessen the GPs' stress.

Allergic rhinitis (AR) is a highly prevalent chronic non-communicable disease. The research on the understanding and treatment of AR in China is mainly in otorhinolaryngology specialists, but rarely in general practitioners (GPs) in primary care. And recommendations on the diagnosis and treatment of AR in primary care are also insufficient.

To explore the understanding of AR and diagnosis and treatment capacities related to AR in GPs in primary care.

By use of simple random sampling, 432 GPs from 21 community health service organizations in Beijing's Chaoyang District were chosen between August and September 2020. The questionnaire was combined with the Guidelines for the Diagnosis and Treatment of Allergic Rhinitis (Tianjin, 2015) (China 2015 AR Guidelines) and Allergic Rhinitis and Its Impact on Asthma (ARIA) Guidelines: 2010 Revision, and its 2016 annual revision, and refinement of the questionnaire after consultation with experts and pre-survey. The information obtained from the questionnaire included basic information about the subjects, understanding level, diagnostic and therapeutic behaviors, training, and support needs regarding AR, et al.

The 383 (88.7%) of the 432 questionnaires were finally returned. Only 0.8% (3/383) of the GPs correctly responded to all of the questions on typical AR symptoms, diagnosis, treatment philosophies, first-line drug classes, and regimens suggested by guidelines. Guidelines for AR, including China 2015 AR Guidelines and ARIA Guidelines, were known to 32.4% (124/383) of the GPs, Web-based continuing education such as www.haoyisheng.com, www.dxy.cn and WeChat and related training. When treating each patient with a respiratory illness, the prevalence of GPs differentiating AR from others, providing recommendations on environmental control, suggesting nasal rinsing, recommending other treatments instead of immunotherapy, and referring the patient to the specialty department without any treatment, was 59.8% (229/383) , 37.1% (142/383) , 17.8% (68/383) , 49.4% (189/383) , and 13.1% (50/383) , respectively. In terms of pharmacological treatment, 17.5% (67/383) of GPs said their hospital offered all four classes of first-line AR medications. As for AR-related training, 75.7% (366/383) of the GPs reported not having taken any AR-related training in 2019; and 91.7% (266/290) needed the training. And 95.6% (290/383) of the GPs said AR should be handled standardizedly in the community. A multivariate stepwise regression Logistic analysis revealed that when encountering patients with respiratory symptoms, GPs with a master's degree or higher〔OR (95%CI) =2.790 (1.057, 7.366) 〕and a good grasp of AR-related health knowledge〔OR (95%CI) =3.537 (2.015, 6.209) 〕were more likely to make a differential diagnosis of AR from other illnesses, GPs with a good grasp of AR-related health knowledge〔OR (95%CI) =4.397 (0.534, 1.576) 〕were more likely to offer patients guidance on environmental control behaviors, GPs who were familiar with nasal irrigation procedures〔OR (95%CI) =6.592 (3.038, 14.306) 〕were more likely to recommend nasal irrigation, and GPs knowing about immunotherapy〔OR (95%CI) =1.881 (1.087, 3.254) 〕, accurately answering questions on the principles of treatment〔OR (95%CI) =128.330 (16.628, 990.402) 〕or their institution providing some/all laboratory testing services〔OR (95%CI) =2.210 (1.299, 3.760) 〕were prone to recommend immunotherapy.

Despite their low awareness levels of AR expertise and guidelines, and unsatisfied practice standardization, GPs in primary care in Chaoyang District demonstrated proactive attitude towards continuing education and carrying out standardized AR treatment in primary care. As high awareness levels of AR-related knowledge and guidelines promote the practice standardization, relevant trainings for GPs in primary care should be strengthened, and AR-related guidelines applicable to primary care should be developed, which can provide support for the standardization of AR treatment at the primary care level.

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.

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.

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.

The prevalence of age-related hearing loss is increasing gradually as population aging advances in China. Untreated hearing loss is strongly associated with many adverse health events. Age-related hearing loss is difficult to be detected due to slow progression of symptoms, and its harmfulness is often underestimated or neglected. General practitioners (GPs) in primary care could play a vital role in early screening, timely referral and health education management regarding age-related hearing loss.

To formulate an GP management of age-related hearing loss system, promoting secondary prevention and management of this illness in primary health care.

By use of literature review and semi-structured reviews, we developed the first draft of General Practitioner Management of Age-related Hearing Loss System from April to June 2021. For reviewing the draft, we conducted a two-round e-mail-based consultation with a purposive sample of 15 experts (engaging in the field of otolaryngology, general practice, administrative management or public health management) from August to November 2021. Then we calculated the response coefficient, authority coefficient and Kendall's Wfor the two consultations, assessed the weights of indicators using analytic hierarchy process, checked the logical consistency of indicators, and determined the final draftof age-related hearing loss management system.

The first draft of General Practitioner Management of Age-related Hearing Loss System consisted of 6 primary indicators and 15 secondary indicators. The response coefficient was 100.0% for both consultations. The expert authority coefficient was 0.877 for the first round of consultation, and 0.920 for the second round. Kendall's W coefficients were 0.428 (χ²=89.821, P<0.001) , and 0.307 (χ²=87.387, P<0.001) , respectively for the first and second rounds of consultations. The final system consists of 6 primary indicators (theoretical knowledge of age-related hearing loss, screening skills for age-related hearing loss, referral ability of age-related hearing loss, ability to diagnose and treat ear diseases, ability to manage adverse events of age-related hearing loss, doctor-patient communication ability) , and 20 secondary indicators. The mean value of importance for all indicators was above 8.000, the coefficient of variation of all indicators was above 0.250, and the full score ratio of all indicators was above 30.0%. The weights of the above-mentioned six primary indicatorswere 0.082, 0.082, 0.082, 0.077, 0.077, and 0.077, respectively. The consistency ratio of primary and secondary indicators was 0.063 5, 0.043 2, respectively (<0.100 0) .

The response and authority coefficients, and Kendall's W coefficients of the consultations were high, suggesting that the consultation results were scientific, credible and reliable. This system can be used as a guidance system for secondary prevention and management of this illness by GPs in primary care.

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 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.

As the main providers of essential pediatric services, the capabilities of community general practitioners (GPs) in managing pediatric patients may directly reflects the overall status of pediatric care services in primary care settings. In China, there are great regional differences in the supply and demand of pediatric services, and the capabilities of primary care settings are unsatisfactory in providing pediatric services. The current encounters and influencing factors of GPs with pediatric patients in suburban districts are worthy of attention.

To understand the status and associated factors of clinical encounters of GPs with pediatric patients in a suburban district of Beijing, providing a reference for the development of tiered diagnosis and treatment of pediatric diseases.

In June 2021, purposive sampling was used to recruit GPs who participated in a training named "Beijing Miyun District Medical Consortium Construction & General Practitioners' Comprehensive Capability Improvement Project" to attend a semi-structured group interview for understanding the status of clinical encounters of GPs with pediatric patients and related influencing factors. The interview results were recorded, and transcribed, then coded using NVivo 12, and analyzed using thematic analysis.

Nineteen GPs (5 men and 14 women) in the age range of 24-51 years〔average age of (33.2±7.6) years〕, attended the interview, 18 of whom had a bachelor degree; 9 had a title of attending physician; 1 had participated in the standardized general practice residency program; 8 had participated in the "3+2" assistant general practitioners training program; 8 had participated in the standardized training before making a career change into general practice. The average years of them working a GP was 1-18 years〔 (6.3±4.8) years on average〕. Four themes emerged from the analysis: (1) Both the numbers of pediatric patients and illnesses encountered by suburban GPs were less than those encountered by their urban counterparts, and pediatric patients encountered by suburban GPs aged greater than or equal to 3 years. (2) Suburban GPs generally had a low level of self-confidence in treating pediatric patients. (3) The major factors negatively affected suburban GPs encountering pediatric patients include the pediatric patient's parents with a lower level of trust in their GP, inadequate capabilities of GPs in managing pediatric patients, high risk of managing pediatric patients, underperformance of nurses, inadequate available pediatric medicines and equipments for laboratory tests in the community, and lack of a clear referral system. (4) The major facilitators for suburban GPs to encounter pediatric patients include managing pediatric patients in the community by pediatricians, and increasing pediatric medicines and equipments for laboratory tests.

The encounters of suburban GPs with pediatric patients in primary care were unsatisfactory due to many problems and challenges. To improve the situation, it is suggested to improve the capabilities of suburban GPs in managing pediatric patients by trainings, the collaboration between GPs and pediatricians, and the tiered system for the diagnosis and treatment of pediatric diseases.

China is seeing an increasing number of people suffering from dementia as aging advances and life expectancy prolongs. Early diagnosis is extremely important for dementia.

To understand the attitudes and views of community general practitioners (GPs) regarding dementia screening, providing suggestions for the development of dementia screening in the community.

In July 2021, by use of purposive sampling, GPs were recruited from community health centers (stations) in Lanzhou, Gansu, and invited to attend a semi-structured, in-depth, face-to-face individual interview for understanding their attitudes and views toward dementia screening. The interview results were analyzed using phenomenological analysis and thematic analysis.

Ten GPs from five community health centers and five community health stations were finally enrolled, including five males and five females, with an average age of (46.6±6.5) years〔range (35, 57) 〕, an average years of (14.90±8.46) working as a GP〔range (5, 26) 〕; seven with a bachelor degree; four with a title of attending physician. Three themes were extracted: insufficient basic conditions for carrying out community-based dementia screening, difficulties in carrying out community-based dementia screening, and improvement of community GPs' abilities to participate in dementia screening. Nine subthemes were also extracted.

Community GPs supported community-based dementia screening, but had insufficient capacities to carry out the screening. The following may be effective measures for promoting early screening and intervening dementia: improving the ability of community GPs to screen dementia, strengthening the publicity and popularization of dementia-related knowledge to reduce social discrimination against dementia, and deepening the development of contracted family doctor services.

The improvement of the overall health of residents and the sound development of the hierarchical medical system require the support of a large number of qualified general practitioners (GPs) . As of the end of 2020, the GPs-population ratio in Guangdong reached 3.13/10 000, but the job satisfaction of GPs has not received enough attention.

To assess the level and determinants of overall job satisfaction among GPs in Guangdong's primary care settings.

A self-administered questionnaire survey was conducted with 8 710 GPs selected from Guangdong's primary care settings by use of stratified, multistage cluster sampling from July 5th to 31st, 2021. The information collected include GPs' demographics, and services of GPs' teams as well as job satisfaction assessed using Minnesota Satisfaction Questionnaire-Short Form (MSQ-SF) . The determinants of job satisfaction were identified using the multiple linear regression model and analyzed using SPSS Statistics 24.0.

The survey obtained a response rate of 68.96% (6 006/8 710) . The overall satisfaction score of the respondent GPs was (3.70±0.87) points. The three highest-ranked items in terms of score were "The chance to do things for other people"〔 (4.03±0.64) points〕, "The chance to work aloneon the job"〔 (4.02±0.69) points〕, and "The way my co-workers get along with each other"〔 (3.99±0.61) points〕. The items scored relatively lower were "My pay and the amount of work I do"〔 (2.98±1.04) points], "The chances for advancement on this job"〔 (3.19±0.92) points〕, and "The praise I get for doing a good job"〔 (3.39±0.93) points〕. Multiple linear regression analysis found that annual income, administrative position, having a core position in the team, having privileged access to getting an appointment with experts working in secondary or tertiary medical institutions, providing long-term prescribing services for chronic diseases, delivering home sick-bed services, studying occupation-specific knowledge by oneself, and communicating with other teams for exchanging experience were associated with the job satisfaction of GPs (P<0.05) .

In a word, the overall job satisfaction level of GPs in Guangdong's primary care settings was relatively high. High annual income, administrative position, having privileged access to getting an appointment with experts working in secondary or tertiary medical institutions, delivering home sick-bed services and long-term prescribing services for chronic diseases, having a core position in the team, studying occupation-specific knowledge by oneself, communicating with other teams for exchanging experience, were associated with higher level of job satisfaction.