General practitioner trainees' career perspectives after COVID-19: a qualitative study in China

Developing a competency model for Chinese general practitioners: a mixed-methods study

BACKGROUND

The Chinese government has formulated a series of policies and strengthened training of general practitioners (GPs) to support their role as "gatekeepers" of residents' health. This study aimed to explore the core competencies of Chinese GPs and develop a competency framework in line with China's actual conditions, which can provide a more scientific basis for the education, training, and evaluation of GPs.

METHODS

Literature analysis and behaviour event interviews were conducted to build the competency dictionary and the initial version of the competency model. Two rounds of Delphi were performed to gain consensus on the final model. The questionnaire survey was carried out in 10 provinces (municipalities, autonomous regions) of China, and GPs were invited to score the importance of each competency item. The total sample was randomly divided into two groups. One group was for exploratory factor analysis (EFA), and the other was for confirmatory factor analysis (CFA) to examine the scale's reliability and validity.

RESULTS

The dictionary of general practitioners' competency including 107 competency items was constructed. After two rounds of Delphi, a consensus was reached on 60 competencies in 6 domains. A total of 1917 valid questionnaires were obtained in the nationwide survey. The average importance score of all second-level indicators is 4.53 ± 0.45. The Cronbach's α coefficient is 0.984. The results of the five factors extracted by EFA showing the 68.16% cumulative explained variance variation is considered to be consistent with the six dimensions obtained by Delphi after thorough discussion. The model fitness indexes obtained by CFA were acceptable (χ2/df = 4.909, CFI = 0.869, NFI = 0.841, RMSEA = 0.065). The values of the composite reliability (CR) of the six dimensions were all greater than 0.7 (0.943, 0.927, 0.937, 0.927, 0.943, 0.950), and the average of variance extracted (AVE) were all greater than 0.5 (0.562, 0.613, 0.649, 0.563, 0.626, 0.635). The results showed that the model has good reliability and validity.

CONCLUSION

A competency model for GPs suited to China has been developed, which may offer guidance for future training and medical licensing examinations of GPs.

Comparative analysis of village doctors' relative deprivation: based on two cross-sectional surveys

BACKGROUND

Village doctors are the main health service providers in China's rural areas. Compared with other rural groups, they will have a sense of relative deprivation, which has an impact on their practice mentality and job stability. This study aims to analyze the changes and causes of relative deprivation among village doctors, so as to improve the stability of them.

METHODS

The data were collected from two surveys conducted in Shandong Province in 2015 and 2021. In 2015, 322 village doctors were surveyed and 307 questionnaires were collected, with a recovery rate of 95.3%. In 2021, 394 village doctors were surveyed and 366 questionnaires were collected, with a recovery rate of 92.9%. Descriptive and univariate analysis were used to compare the changes before and after the survey.

RESULTS

The scores of vertical deprivation of village doctors increased from 2.77 ± 0.81 in 2015 to 3.04 ± 0.83 in 2021, with a statistically significant difference (P < 0.001). The reference group selected by village doctors changed from village teachers to ordinary villagers. Compared to village teachers, the horizontal deprivation score of village doctors increased from 3.47 ± 0.87 to 3.97 ± 0.77, with a statistically significant difference (P < 0.001). Compared to villagers, only the professional reputation deprivation score increased, from 2.38 ± 0.93 to 2.68 ± 0.76, with a statistically significant difference (P < 0.05).

CONCLUSIONS

As time goes by, village doctors fail to reach the expected level in terms of economic income, social status, professional reputation and living standards, resulting in a sense of relative deprivation. This may have a negative impact on village doctors' work motivation and behavior, and will fail to guarantee the sustainability of the team. We should pay attention to this unbalanced mentality of village doctors.

The Effect of the COVID-19 Pandemic on the Factors Influencing Iranian Medical Residents' Specialty Selection: A Qualitative Study

Background

Medical students' specialty selection influences the composition of the physician workforce and the effectiveness of health systems. Therefore, the identification of factors that influence the choice of specialty is critical for an evidence-based health policy. This study aimed to investigate the effect of the Coronavirus Disease 2019 (COVID-19) pandemic on the determinants of specialty choice among Iranian medical residents.

Methods

In early 2022, this qualitative study was conducted among Iranian medical residents in seven provinces, including Tehran, Isfahan, Fars, Khorasan Razavi, Kerman, Kermanshah, and Khuzestan. The participants were selected using a purposeful sampling method. Data were collected using 74 semi-structured in-depth face-to-face interviews. Finally, a thematic content analysis (conventional content analysis) method was applied for data synthesis.

Results

The participant's mean age was 28.7±2.5 years, and more than 52% (N=39) were men. Following data synthesis, 10 sub-themes and four main themes were identified, including educational aspects affected by the pandemic, career-related hazards, personal and professional lifestyles affected by the disease, and experiences and beliefs regarding the pandemic.

Conclusion

The COVID-19 pandemic has had a significant impact on medical students' educational, professional, and personal aspects of specialty choices. This study demonstrated how the disease affected the choice of specialty. Therefore, the findings could be used for developing national health policy and planning.

Education and Training Adaptations for Health Workers during the COVID-19 Pandemic: A Scoping Review of Lessons Learned and Innovations

Introduction: The COVID-19 pandemic has considerably impacted the clinical education and training of health workers globally, causing severe disruptions to learning environments in healthcare facilities and limiting the acquisition of new clinical skills. Consequently, urgent adaptation measures, including simulation training and e-learning, have been implemented to mitigate the adverse effects of clinical education. This scoping review aims to assess the impact of COVID-19 on medical education and training, examine the implemented adaptation measures, and evaluate their effectiveness in improving health workers' education and training during the pandemic. Methods: Employing the PRISMA-ScR framework and Arksey and O'Malley's methodological guidance, we conducted a scoping review, systematically searching PubMed, medRxiv, Google, and DuckDuckGo databases to account for the grey literature. The search included studies published between 1 December 2019 and 13 October 2021, yielding 10,323 results. Of these, 88 studies focused on health worker education and training during the pandemic. Results: Our review incorporated 31,268 participants, including physicians, medical trainees, nurses, paramedics, students, and health educators. Most studies (71/88, 81%) were conducted in high-income and lower-middle-income countries. The pandemic's effects on health workers' clinical skills and abilities have necessitated training period extensions in some cases. We identified several positive outcomes from the implementation of simulation training and e-learning as adaptation strategies, such as enhanced technical and clinical performance, increased confidence and comfort, and an expanded global educational outreach. Conclusions: Despite challenges like insufficient practical experience, limited interpersonal interaction opportunities, and internet connectivity issues, simulation training, e-learning, and virtual training have proven effective in improving clinical education and training during the COVID-19 pandemic. Further research is required to bolster preparedness for future pandemics or similar situations.

Perceived occupational stressors among nurses in a level-1 trauma center under normalized COVID-19 epidemic prevention and control in China: A qualitative study

Background

Nurses in trauma centers encounter emergency patients and are exposed to occupational stressors under normalized pandemic control and prevention.

Objective

The objective of this study was to examine the occupational stressors that nurses perceived during the COVID-19 pandemic in a level-1 trauma center in China.

Methods

From December 2020 to May 2021, a qualitative study was conducted, employing conventional content analysis as the research methodology. A total of twelve nurses were purposefully selected from a trauma center at a major hospital in Beijing to participate in semi-structured interviews (40-50 min' duration). The data collected in this study were analyzed using the conventional content analysis approach proposed by Graneheim and Lundman.

Results

After analyzing the data, two themes emerged: 1) Critical conditions under normalized pandemic prevention and control; 2) Concerns about loved ones and colleagues, along with financial problems. Both these themes further revealed four categories: the complexity and uncertainty of epidemic prevention and health hazards in the former, and concerns for and from families and colleagues, and financial stress in the latter.

Conclusions

The results of this study provide valuable insights into the practical implementation of epidemic prevention and control measures in Chinese trauma centers and shed light on the psychological stress faced by nurses. Improving the tripartite support system of hospital, family, and society, and providing emotional support may help reduce stress among nurses, thereby improving their health and care quality.

The psychological impact on frontline nurses in Spain of caring for people with COVID-19

AIM

To understand the perceptions of National Health System nurses who have been working on the frontline of the psychological impact of caring for people with COVID-19 during the first and second waves.

METHODS

A qualitative study, the design and analysis of which was based on phenomenology. For data collection, a semi-structured interview was administered to a sample of nurses who worked on the frontline in public hospitals in Extremadura and Madrid, Spain. The interviews, which followed a script including various topics, were conducted between May and November 2020 so as to include the experiences of the first and second waves of the pandemic. Sample collection continued until data saturation. The data were analysed following the phenomenological method of Giorgi with the help of the Atlas-Ti software.

RESULTS

Two main themes emerged from the data analysis that explained the nurses' perceptions: (i) the main psychological repercussions of being frontline carers (anxiety, fear, stress, impotence, frustration, and an increase in obsessions and obsessive behaviours) and (ii) psychological coping strategies (collapse in the face of the situation, dissociative amnesia, leaning on colleagues and working as a team, resigning oneself, perceiving the situation as a war, and being aware of psychological repercussions).

DISCUSSION

Caring as the first line causes great psychological repercussions for nurses. It is necessary to implement psychological and emotional support programmes to address the post-traumatic stress that nurses can suffer.

Recruitment of general practitioners in China: a scoping review of strategies and challenges

Background

China is rapidly expanding its general practitioner (GP) workforce as part of recent healthcare reform, with an extra 400,000 GPs by 2030. This scoping review identifies the published strategies for GP recruitment that are being implemented and the challenges encountered.

Methods

We searched six English and three Chinese databases from 2015 to April 2022, following Arksey and O’Malley’s framework and the PRISMA ScR reporting guidelines.

Results

A total of 40 Chinese-language and 5 English-language records were included. We identified multiple policies, pathways and programmes focused on expanding GP recruitment. Twenty-two evaluations of these initiatives show varying degrees of effectiveness. Selecting general practice as a career is affected by many factors, including individual’s background, remuneration and benefits, career prospects, working environment, self-fulfilment, and current national developments and reorganisations of primary care. The challenge most frequently reported was the adequate provision of qualified GP in rural regions. The targeting of students from rural areas and provision of free education in return for an obligatory six-years’ working in their hometown upon graduation appears to be effective. Extracted records mostly studied views of trainees in a defined locality, and we identified a paucity of studies which explored the perspectives of organisations and institutions, similarly there were areas of China not contributing to the literature and there were no records taking a national perspective.

Conclusions

Long-term monitoring is required to assess policy changes and to systematically evaluate the effectiveness of the interventions nationally. The monitoring of the challenges influencing GP recruitment can be used to inform the design of future initiatives.

Development of a minimum agreed standardised set of outcomes used to measure and report evaluations will help assess the relative contributions and cost effectiveness of different approaches being used to boost GP numbers. We provide suggestions for improving the benefits and rewards for GPs and how to promote recruitment to the more rural or less attractive areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01854-0.

GP wellbeing during the COVID-19 pandemic: a systematic review

BACKGROUND

Doctors' organisations in the UK have reported worrying levels of work-related stress and burnout in the GP workforce for some time, and the COVID-19 pandemic has presented clear new challenges.

AIM

To synthesise international evidence exploring the impact of COVID-19 on primary care doctors' mental health and wellbeing, and identify risk factors associated with their psychological wellbeing during this time.

DESIGN AND SETTING

Mixed-methods systematic review.

METHOD

Six bibliographic databases, Google Scholar, and MedRxiv were searched on 19 November 2020 and 3 June 2021 to identify studies of GP psychological wellbeing during the pandemic. Reference checking was also conducted. Two reviewers selected studies, extracted data, and assessed the quality of studies using standardised tools. Heterogeneity in outcomes, setting, and design prohibited statistical pooling; studies were combined using a convergent integrated thematic synthesis.

RESULTS

Thirty-one studies were included. Multiple sources of stress were identified including changed working practices; risk, exposure, and inadequate personal protective equipment (PPE); information overload; pandemic preparedness; and cohesion across sectors. Studies demonstrated an impact on psychological wellbeing, with some GPs experiencing stress, burnout, anxiety, depression, fear of COVID-19, lower job satisfaction, and physical symptoms. Studies reported gender and age differences: women GPs had poorer psychological outcomes across all domains, and older GPs reported greater stress and burnout. Use of outcome measures and reporting practice varied greatly.

CONCLUSION

This review of international evidence demonstrates that the COVID-19 pandemic has adversely affected GPs' wellbeing around the world. Further research could explore gender and age differences, identifying interventions targeted to these groups.

Health care workers' experiences during the COVID-19 pandemic: a scoping review

BACKGROUND

COVID-19 has challenged health systems worldwide, especially the health workforce, a pillar crucial for health systems resilience. Therefore, strengthening health system resilience can be informed by analyzing health care workers' (HCWs) experiences and needs during pandemics. This review synthesizes qualitative studies published during the first year of the COVID-19 pandemic to identify factors affecting HCWs' experiences and their support needs during the pandemic. This review was conducted using the Joanna Briggs Institute methodology for scoping reviews. A systematic search on PubMed was applied using controlled vocabularies. Only original studies presenting primary qualitative data were included.

RESULTS

161 papers that were published from the beginning of COVID-19 pandemic up until 28th March 2021 were included in the review. Findings were presented using the socio-ecological model as an analytical framework. At the individual level, the impact of the pandemic manifested on HCWs' well-being, daily routine, professional and personal identity. At the interpersonal level, HCWs' personal and professional relationships were identified as crucial. At the institutional level, decision-making processes, organizational aspects and availability of support emerged as important factors affecting HCWs' experiences. At community level, community morale, norms, and public knowledge were of importance. Finally, at policy level, governmental support and response measures shaped HCWs' experiences. The review identified a lack of studies which investigate other HCWs than doctors and nurses, HCWs in non-hospital settings, and HCWs in low- and lower middle income countries.

DISCUSSION

This review shows that the COVID-19 pandemic has challenged HCWs, with multiple contextual factors impacting their experiences and needs. To better understand HCWs' experiences, comparative investigations are needed which analyze differences across as well as within countries, including differences at institutional, community, interpersonal and individual levels. Similarly, interventions aimed at supporting HCWs prior to, during and after pandemics need to consider HCWs' circumstances.

CONCLUSIONS

Following a context-sensitive approach to empowering HCWs that accounts for the multitude of aspects which influence their experiences could contribute to building a sustainable health workforce and strengthening health systems for future pandemics.

The role of European health system characteristics in affecting Covid 19 lethality during the early days of the pandemic

This article examines the main factors affecting COVID-19 lethality across 16 European Countries with a focus on the role of health system characteristics during the first phase of the diffusion of the virus. Specifically, we investigate the leading causes of lethality at 10, 20, 30, 40 days in the first hit of the pandemic. Using a random forest regression (ML), with lethality as outcome variable, we show that the percentage of people older than 65 years (with two or more chronic diseases) is the main predictor variable of lethality by COVID-19, followed by the number of hospital intensive care unit beds, investments in healthcare spending compared to GDP, number of nurses and doctors. Moreover, the variable of general practitioners has little but significant predicting quality. These findings contribute to provide evidence for the prediction of lethality caused by COVID-19 in Europe and open the discussion on health policy and management of health care and ICU beds during a severe epidemic.

Lived experiences of older adults during the first COVID-19 lockdown: A qualitative study

BACKGROUND AND AIM

Public health measures used to mitigate the COVID-19 epidemic may have unintended, detrimental consequences particularly on older adults, whose voices and perspectives are often silent or silenced. The aim of this study was to explore the lived experiences of individuals aged 64 or older during the first COVID-19 lockdown.

METHODS

We conducted a qualitative study in a convenience sample of 19 older adults (aged 64+) living at home in the Italian-speaking region of Switzerland during the first COVID-19 lockdown, between April and May 2020. Participants varied in terms of gender, education, age, nationality, and socio-economic status. We conducted semi-structured phone interviews to elicit emotions, expectations and hopes in relation to the present situation, and the post-pandemic world. We inquired about opinions on the enforced public health measures, including those specifically targeting older adults, and on the societal portrayal of older adults.

FINDINGS

We found that the epidemic and the public health response to it had both generated a variety of resentments and a high degree of ambivalence at the individual, micro-, meso- and macro-social levels. We also found that labelling older adults as an at-risk sub-population inevitably contributed to public and self-stigmatization.

DISCUSSION

We conducted an in-depth qualitative investigation of lived experiences of older adults during the first wave of the COVID-19 pandemic in one of the most gravely hit region in Europe. Our findings on the complexity of unintended, detrimental consequences of outbreak responses on older adults have relevant implications for local adaptions of public health measures, and suggest that public health authorities should engage vulnerable sub-populations and promote bi-directional communication to inform and support communities.