The training contents, problems and needs of doctors in urban community health service institutions in China

Developing a professional competency framework for general practitioners in tertiary hospitals in China: a modified Delphi study

OBJECTIVE

At present, the competency of general practitioners (GPs) in tertiary hospitals has not been reported, and there is no suitable competency evaluation tool. This study was conducted to develop a professional competency framework for GPs in tertiary hospitals.

DESIGN

A modified Delphi method was adopted in the study.

PARTICIPANTS

Considering the expert authority, a wide range of sources, expert qualification and willingness, 20 eligible experts were invited and 19 experts agreed to participate in this study.

RESULTS

19 experts (the median age of the experts was 51 (49, 57) years and 84.2% were women) participated in both two rounds of Delphi survey. From the literature review, 4 primary indicators, 14 secondary indicators and 48 tertiary indicators were identified. In the first round, all indicators achieved consensus except for the secondary indicator '3.3 Data processing', which did not achieve 70.0% agreement in both of importance (63.2% agreement) and feasibility (63.2% agreement). After the first round of the Delphi survey, the description of 7 secondary indicators and 11 tertiary indicators was modified. Two secondary indicators and two tertiary indicators were merged, respectively. One secondary indicator was deleted due to not achieving consensus level, and seven new tertiary indicators were suggested to be added by more than two experts. After the second round of the Delphi survey, all three levels of indicators achieved consensus in terms of importance and feasibility. Finally, the professional competency framework for GPs in tertiary hospitals in China was constructed including 4 primary indicators, 12 secondary indicators and 54 tertiary indicators.

CONCLUSION

The professional competency framework for GPs in tertiary hospitals in China was successfully constructed in this study with good scientific soundness and rationality. It is expected to be used in medical education, general practice research, quality improvement and more broadly within the healthcare system to reflect the competency of GPs in tertiary hospital.

Sociodemographic characteristics, occupational characteristics, motivational factors, and job satisfaction among primary health service practitioners

BACKGROUND

The Chinese Basic Public Health Service has achieved certain results since its implementation. As direct providers, understanding the job satisfaction and its influencing factors among basic public health service practitioners is crucial for enhancing service quality and efficiency. This study examines levels of motivational factors and their contribution to job satisfaction among community health workers in China.

METHODS

A multistage sampling method was employed to measure socioeconomic and demographic status, motivational factors, and job satisfaction. Logistic regression analysis was used to assess key determinants of job satisfaction.

RESULTS

Regarding overall occupational characteristics, influencing factors of overall and external satisfaction were respondents with different job titles and different working years. Years of service in primary health institutions and different authorized types influence satisfaction across various dimensions, including working arrangement, interpersonal relationship, environment, promotion opportunities, organizational culture, system and policy, professional identity, social identity, and overall, internal, and external satisfaction. Professional title, interpersonal relationship, work arrangement, system and policy, occupational identity, and other dimensions have a positive impact on satisfaction.

CONCLUSION

The overall job satisfaction of essential public health service practitioners is influenced by various factors. Healthcare managers should focus on improving job satisfaction among healthcare workers in low-resource settings. Establishing scientific and reasonable research on the incentive mechanism at grassroots medical institutions can help stabilize the team, enhance staff satisfaction and work performance, and optimize human resource utilization.

Perceived faculty development needs and motivations of Chinese general practice trainers: a narrative review of the literature

BACKGROUND

Like other countries developing standardized general practice training, China faces the challenge of training vast numbers of new general practice faculty. However, little is known about these clinician-teachers' motivations and perceived needs for faculty development. This review intended to explore available published data on Chinese general practice faculty development needs and motivation for ongoing professional development.

METHODS

A systematic search was conducted using combinations of keyword and MeSH term searches in English in PubMed and in Chinese language CNKI and WanFang databases, followed by a qualitative narrative synthesis of relevant articles identified.

INCLUSION CRITERIA

English or Chinese publications between 1990 and 2021; qualitative or quantitative research, systematic reviews, literature reviews, review or opinion articles pertaining to faculty development or professional development needs or motivations of general practice or family medicine teachers. Articles pertaining to fields outside of medicine, those with a heavy subspecialty focus or not relevant to primary care were excluded.

RESULTS

A total of 88 full text articles were included in this review. Available data on Chinese general practice faculty development needs placed emphasis on fundamental general practice knowledge, principles, and clinical training needs more than teaching and assessment skills. Learning through teaching and a sense of responsibility were potential sources of intrinsic motivation for pursuing faculty development. Potential barriers to participation included busy workloads, inadequate organizational support, and limited finances. Mandatory participation, irrelevant content, lack of teaching experience, lack of motivation to teach, and overall job dissatisfaction appeared to negatively influence motivation to pursue faculty development.

CONCLUSIONS

Further research should explore the broader continuous professional development needs of this large population of general practice teachers. Qualitative studies are needed to clarify how individual, organizational, and contextual factors influence teachers' motivation to pursue faculty development.

Nursing Care of Patients Managed With a Defunctioning Tube Ileostomy: An Exploratory Study

PURPOSE

The purpose of this study was to describe nurses' experiences of caring for patients with colorectal cancer who underwent surgery to create a spontaneously closed defunctioning tube ileostomy after low anterior resection.

DESIGN

Exploratory, descriptive study.

SUBJECTS AND SETTINGS

Data were collected from 6 registered nurses specialized in Wound, Ostomy and Continence Care (WOC nurses). The patient cohort comprised 247 hospitalized patients with histologically confirmed colorectal cancer who underwent low anterior resection of the rectum and creation of a closed defunctioning tube ileostomy. The study setting was the First Affiliated Hospital, Zhejiang University School of Medicine.

METHODS

Semi-structured interviews and content analysis were used to collect and analyze data. The Wound, Ostomy and Continence Care nurses visited patient participants 1 week after hospital discharge and 1 to 2 times per week until the cannula was removed and the ostomy wound closed. Data were collected over a 6-month span after the surgery from January 2016 to December 2018.

RESULTS

Content analysis identified 7 management strategies unique to caring for patients with a closed defunctioning tube ileostomy. They are: (1) cannula fixation (securement); (2) maintaining inflation of the cannular balloon to prevent fecal flow into the distal bowel, (3) cannular patency, (4) dietary advice for prevention of cannular blockage, (5) selecting an ostomy pouching system, (6) patient education, and (7) care during and following cannula removal (extubation).

CONCLUSIONS

We identified 7 areas of nursing care unique to the closed defunctioning tube ileostomy that provide a basis for creating clinical guidelines for patients undergoing this procedure.

Optimization path of primary public health service talent team construction: a largescale survey in Huaihai Economic Zone, China

Background

The primary public health service system is indispensable for the implementation of the "Healthy China 2030" strategy, and primary healthcare workers, as the key drivers of this system, play a pivotal role in its development and establishment to ensure population well-being. In developing countries, such as China, primary public health systems are still weak, and in order to address this phenomenon, health system reform is needed, and primary public health personnel are crucial to health system reform. The current situation of primary public health workers in low-income and developing countries is characterized by varying degrees of problems that need improvement.

Objectives

The purpose of this study is to understand the current situation of primary public health service workforce building, analyze the existing problems of the workforce, put forward suggestions for improvement and explore countermeasures, and provide Chinese wisdom and a reference basis for primary public health workforce building in the world, especially in developing countries.

Methods

Combining the Work-Family Conflict Scale, Copenhagen Burnout Inventory, Minnesota Satisfaction Questionnaire, and Turnover Intention Scale, a relevant survey questionnaire was designed to quantitatively investigate the baseline characteristics of primary public health service institutions and their staff in four representative cities in the Huaihai Economic Zone: Xuzhou in Jiangsu Province, Linyi in Shandong Province, Shangqiu in Henan Province, and Huaibei in Anhui Province. The collected data were analyzed and processed using SPSS 25.0 statistical analysis software through univariate analysis and logistic regression analyses. Methods such as one-way ANOVA, Logistic regression analysis, and independent samples t-test were used to analyze the influencing factors of primary public health workforce development.

Results

The current work intensity at the primary public health level is currently high, the salary and benefits cannot meet the needs of most primary public health personnel, and the competition between work and family in terms of time and resources is pronounced, and the majority of primary public health personnel are dissatisfied with the status quo of "doing more work for less reward" and the poor social security. Emotional exhaustion, depersonalization, and a sense of personal accomplishment were positively correlated with the tendency to leave (all p < 0.01), and the burnout and emotional exhaustion of primary public health workers were intense.

Conclusion

Primary public health personnel play an important role in providing primary public health services. However, the current working conditions of junior public health personnel in the Huaihai Economic Zone are influenced by factors such as workload, income level, and employment situation improvement, leading to low job satisfaction, significant work-family conflicts, and high turnover intention. In this context, based on the opinions of grassroots administrative departments and internationally relevant experiences, a series of suggestions have been proposed to improve the professional service level, job satisfaction, and occupational identity of staff members. These suggestions make valuable contributions to both the Huaihai Economic Zone and countries worldwide in safeguarding individual health and promoting national primary healthcare reform.

Assessing public health service capability of primary healthcare personnel: a large-scale survey in Henan Province, China

BACKGROUND

The public health service capability of primary healthcare personnel directly affects the utilization and delivery of health services, and is influenced by various factors. This study aimed to examine the status, factors, and urban-rural differences of public health service capability among primary healthcare personnel, and provided suggestions for improvement.

METHODS

We used cluster sampling to survey 11,925 primary healthcare personnel in 18 regions of Henan Province from 20th to March 31, 2023. Data encompassing demographics and public health service capabilities, including health lifestyle guidance, chronic disease management, health management of special populations, and vaccination services. Multivariable regression analysis was employed to investigate influencing factors. Propensity Score Matching (PSM) quantified urban-rural differences.

RESULTS

The total score of public health service capability was 80.17 points. Chronic disease management capability scored the lowest, only 19.60. Gender, education level, average monthly salary, professional title, health status, employment form, work unit type, category of practicing (assistant) physician significantly influenced the public health service capability (all P < 0.05). PSM analysis revealed rural primary healthcare personnel had higher public health service capability scores than urban ones.

CONCLUSIONS

The public health service capability of primary healthcare personnel in Henan Province was relatively high, but chronic disease management required improvement. Additionally, implementing effective training methods for different subgroups, and improving the service capability of primary medical and health institutions were positive measures.

Current situation and needs analysis of medical staff first aid ability in China: a cross-sectional study

OBJECTIVES

We aim to understand the current situation of the first aid ability and training needs of Chinese medical personnel to provide a scientific basis for formulating the contents and methods of emergency medical rescue training and thereby improve the first aid level of Chinese medical personnel.

METHODS

A cross-sectional survey was conducted between June 2022 and February 2023 using a two-stage cluster sampling method with a structured questionnaire sent to medical workers in 12 provinces in China. 14,527 questionnaires were included in this study. Data were collected on demographic characteristics, first aid knowledge and skills, and training needs. Variance analysis was used to compare the difference between the first aid ability and training needs of medical staff in different hospitals, and multiple linear regression analysis was carried out to evaluate first aid ability and training needs.

RESULT

The study included 6041 patients (41.6%) in tertiary hospitals, 5838 patients (40.2%) in secondary hospitals, and 2648 patients (18.2%) in primary hospitals. There were significant differences in the first aid ability and training needs of medical staff in hospitals of different levels (p < 0.001). The score of first aid knowledge and skills in tertiary hospitals was the highest (209.7 ± 45.0), and the score of training needs in primary hospitals was the highest (240.6 ± 44.0). There was a significant correlation between first aid ability and training needs score (p < 0.001). Multiple linear regression analysis shows that geographic region, age, work tenure, gender, job title, department, professional title, monthly income, and hospital level are the influencing factors of training demand.

CONCLUSION

Medical staff in primary hospitals generally have low first aid knowledge and skills and a strong willingness to train. Therefore, it is imperative to strengthen the training of first aid ability and research training strategies. The level of the hospital is closely related to the level of first aid, so it is necessary to recognize the commonalities and differences in medical staff's demand for first aid knowledge and skills and carry out targeted education and training.

The Effectiveness of a Community Nurse-Led Support Program for Dementia Caregivers in Chinese Communities: The Chongqing Ageing and Dementia Study

Background

As the primary caregivers for people with dementia in China, family caregivers face a significant care burden that can negatively impact their mental and physical health. It is vital to investigate ways to support these caregivers.

Objective

To assess the effectiveness of a program led by community nurses to support caregivers of individuals with dementia.

Methods

A total of 30 caregivers received nurse-led support in addition to usual care, while 28 caregivers received only usual care. The primary outcome was caregivers' sense of competency in providing dementia care, which was measured using the Short Sense of Competence Questionnaire (SSCQ). Secondary outcomes included caregivers' ability to perform daily activities, behavioral and psychological symptoms of dementia (BPSD) using a neuropsychiatric inventory questionnaire, and quality of life using the short form health survey (SF-36). The trial was registered at the Chinese Clinical Trial Registry (ChiCTR 2300071484).

Results

Compared to the control group, the intervention group had significantly higher SSCQ scores and a lower caregiver distress index over time. Physical and mental health-related quality of life also improved significantly among caregivers in the intervention group. However, there was no significant difference between the two groups in terms of activities of daily living and BPSD.

Conclusions

The community nurse-led support program significantly improved caregivers' competency in providing dementia care and quality of life and reduced distress. These findings have important implications for dementia care policies, resources, and workforce development in China, including strengthening community dementia care services through collaboration with specialists in hospitals.

Patient views of the good doctor in primary care: a qualitative study in six provinces in China

BACKGROUND

China has been striving to train primary care doctors capable of delivering high-quality service through general practitioner training programs and family doctor team reforms, but these initiatives have not adequately met patient needs and expectations. In order to guide further reform efforts to better meet patient expectations, this study generates a profile of the good doctor in primary care from the patient perspective.

METHODS

Semi-structured interviews were conducted in six provinces (Shandong, Zhejiang, Henan, Shaanxi, Shanxi, Heilongjiang) in China. A total of 58 interviewees completed the recorded interviews. Tape-based analysis was used to produce narrative summaries. Trained research assistants listened to the recordings of the interviews and summarized them by 30-s segments. Thematic analysis was performed on narrative summaries to identify thematic families.

RESULTS

Five domains and 18 attributes were generated from the analysis of the interview data. The domains of the good doctor in primary care from the patient perspective were: strong Clinical Competency (mentioned by 97% of participants) and Professionalism & Humanism (mentioned by 93% of participants) during service delivery, followed by Service Provision and Information Communication (mentioned by 74% and 62% of participants, respectively). Moreover, Chinese patients expect that primary care doctors have high educational attainment and a good personality (mentioned by 41% of participants).

CONCLUSIONS

This five-domain profile of the good doctor in primary care constitutes a foundation for further primary care workforce capacity building. Further primary care reform efforts should reflect the patient views and expectations, especially in the family physician competency framework and primary care performance assessment system development. Meanwhile, frontline primary care organizations also need to create supportive environments to assist competent doctors practice in primary care, especially through facilitating the learning of primary care doctors and improving their well-being.

Evaluation of the star family doctors training program: an observational cohort study of a novel continuing medical education program for general practitioners within a compact medical consortium: a quantitative analysis

INTRODUCTION

To determine the effectiveness of the Star Family Doctors Training Program, a comprehensive Continuing professional development (CPD) program for general practitioners (GPs) in a compact medical consortium.

PATIENTS AND METHODS

Observational cohort study with a quantitative analyses in primary health care institutions in Sichuan Province. The interventions were as following: (1) The Star Family Doctors Training Program is a full-time, local government allocation program certified by the Health Department of Sichuan Province, emphasizing small group learning and practice, and using standard patients and medical patient simulators; 30 participants were selected by their institutions. (2) The control group underwent a self-financed after-work CPD program using conventional lectures; 50 participants were self-selected. Short-term effectiveness assessed using immediate post-training tests and self-evaluations; long-term (1 year) effectiveness evaluated using self-reported surveys.

RESULTS

The study involved 80 GPs (28.75% men; mean age: 38.2 ± 9.2 years). The average post-training total score was higher in the STAR group than in the control group (72.83 ± 5.73 vs. 68.18 ± 7.64; p = 0.005). Compared to the controls, STAR participants reported seeing more patients (all p < 0.05), and had more patients who signed family-doctor contracts (p = 0.001) as well as increased patient satisfaction (p = 0.03), respectively. STAR-group trainees appraised the program higher and were more willing to recommend it to colleagues (90% vs. 64%, p = 0.011).

CONCLUSION

The Star Family Doctors Training Program achieved good responses and provides a reference for future CPD programs.

Development of a competency model for general practitioners after standardized residency training in China by a modified Delphi method

BACKGROUND

The "5 + 3" residency training is the main stream general practitioner training program in China. However, a competency model is absent for evaluating the clinical competence attained by general practitioners after training. This study was conducted to develop a consensus set of competencies for general practitioners after standardized residency training in China.

METHODS

A modified Delphi process was deployed to develop the competency model, including two stages: (1) generation of an initial set of competencies derived from literature review, behavioral observation of GP-patient consultations, and critical incidents interview of GPs; (2) a 2-round, web-based Delphi survey of experts in general practice, selected using purposive sampling, to prioritize and gain consensus on the essential competencies of GPs.

RESULTS

From literature review, behavioral observation, and critical incidents interview, 46 competencies in 7 domains were identified. After two rounds of Delphi survey of 28 participants (the mean age was 47.9 [9.3] years and 64.3% were women) representing a range of health professionals (GPs, managers, and researchers), a consensus was reached on 50 competencies categorized into 7 domains.

CONCLUSION

A consensus-based competency model for general practitioners in China has been identified which may be used to evaluate the general practitioners' clinical competence after standardized training.

Influence of the Integrated Delivery System on the Medical Serviceability of Primary Hospitals

Objective

To explore the change in the medical serviceability of primary hospitals since the establishment of the Huzhou No. 1 People's Hospital medical care group incorporating the integrated delivery system.

Methods

With reference to the “Grade Evaluation Standard of General Hospitals in Zhejiang Province” and the “Guidelines for Service Capacity Evaluation of Township Hospitals (2019 Edition),” we analyzed the influence of the integrated delivery system on the capacity of primary medical services and selected the targeted core indicators. From the four dimensions of diagnosis and treatment breadth, diagnosis and treatment efficiency, surgical ability, and patient satisfaction, an index evaluation system was established to explore the changes in the medical serviceability in primary hospitals.

Results

The measurements were aimed at four specific issues, that is, the low medical technology level of grassroots personnel, the poor information communication among medical institutions, the difficulty in recruiting people, and the imperfect training mechanism in primary hospitals. After establishing a series of measurements related to the problems faced by the primary healthcare sector in China, the score of breadth of diagnosis and treatment, efficiency of diagnosis and treatment ability, surgical ability, and patient satisfaction of the primary hospitals in our medical group have greatly increased.

Conclusion

The integrated delivery system improved the primary hospitals' medical health ability obviously. Our study also provides various useful and operable suggestions for primary healthcare.

Development and preliminary validation of the competency model for rural general practitioner in China

BACKGROUND

There is a shortage of rural general practitioners (GPs) in China. Training programs have been initiated to meet the needs of GP workforce in the rural areas; however, there is an absence of validated tool to assess their competencies.

OBJECTIVE

This study aimed to develop a competency model for rural general practitioner (CMRGP) after training in China and to examine its validity and reliability.

METHODS

A multistage process was adopted to develop the CMRGP comprised literature review, panel discussion and expert consultation, and the initial version of CMRGP was reduced from 10 domains and 77 items to 7 domains and 54 items. A pilot study was conducted among 202 rural GPs for the psychometric evaluation and application of the initial version of CMRGP, in which a questionnaire on the importance of items and self-evaluation was completed by the GPs.

RESULTS

In the pilot study, 132 completed questionnaires (65.3%) were returned. Acceptability and face validity of the CMRGP were supported by high importance scores of the items, in which 52 out of 54 items achieved score higher than 4.00 (possible score from 0 to 5). Factor analysis supported the construct validity. After the modification, the final version of CMRGP contained 6 domains and 47 items. Good reliability was supported by internal consistency reliability (Cronbach's α was 0.98) and split-half reliability (Spearman-Brown coefficient was 0.99).

CONCLUSIONS

The CMRGP demonstrated good reliability and validity. Pilot study showed its potential for application in the rural general practice and training program.

Facilitators and barriers to implement the family doctor contracting services in China: findings from a qualitative study

OBJECTIVE

To identify the facilitators and barriers to implement family doctor contracting services in China by using Consolidated Framework for Implementation Research (CFIR) to shed new light on establishing family doctor systems in developing countries.

DESIGN

A qualitative study conducted from June to August 2017 using semistructured interview guides for focus group discussions (FGDs) and individual interviews. CFIR was used to guide data coding, data analysis and reporting of findings.

SETTING

19 primary health institutions in nine provinces purposively selected from the eastern, middle and western areas of China.

PARTICIPANTS

From the nine sampled provinces in China, 62 policy makers from health related departments at the province, city and county/district levels participated in 9 FGDs; 19 leaders of primary health institutions participated in individual interviews; and 48 family doctor team members participated in 15 FGDs.

RESULTS

Based on CFIR constructs, notable facilitators included national reform involving both top-down and bottom-up policy making (Intervention); support from essential public health funds, fiscal subsidies and health insurance (Outer setting); extra performance-based payments for family doctor teams based on evaluation (Inner setting); and positive engagement of health administrators (Process). Notable barriers included a lack of essential matching mechanisms at national level (Intervention); distrust in the quality of primary care, a lack of government subsidies and health insurance reimbursement and performance ceiling policy (Outer setting); the low competency of family doctors and weak influence of evaluations on performance-based salary (Inner setting); and misunderstandings about family doctor contracting services (Process).

CONCLUSIONS

The national design with essential features including financing, incentive mechanisms and multidepartment cooperation, was vital for implementing family doctor contracting services in China. More attention should be paid to the quality of primary care and competency of family doctors. All stakeholders must be informed, be involved and participate before and during the process.