German family physicians practice independently in clinics, and provide primary health care services. General practitioners are a type of specialists. The basis for the self-management of German doctors is the homogeneous medical education in Germany. The new round of medical education reform emphasizes the theory and practical training throughout the entire process of medical education. All medical students in Germany need to go to the clinic for internship and be familiar with primary health care models. Post-graduation education sets rotation plans and assessment standards according to the characteristics of general practice specialties, emphasizes the clinical practice time in the clinics, and urges doctors to continue medical education through the payment of medical insurance. This article draws on the German general practitioner training model, proposes to strengthen the enlightenment of general practice education during the education of undergraduate medical colleges, and strengthen the clinical practice of general practitioners and the construction of general practice training bases, as well as improve the ability of the community physician faculties, in order to provide a reference for the training of general practitioners in China.

Objective:To survey the training requirements for doctoral candidates in general practice.Methods:A questionnaire survey was conducted to investigate the requirements for general practice doctorate training; the items included the training target, training objectives and training contents. A total of 130 stakeholders of general practice participated in the survey, including administrators in health committees, general practice educators of medical schools, general practitioners in hospital and community health service centers and students in general medicine. The participants were divided into training unit group ( n=42), employer group ( n=42) and doctor and student group ( n=46). Results:Among all training objectives, the training "general medicine scientific research ability" ranked the first (121, 93.1%); while 114 (87.7%) respondents believed that the training target should be the leading talents in general medicine. Regarding the content of clinical competence training, 86 (66.1%) respondents believed that there was a lack of medical care training for whole life-cycle and whole population currently. The training requirement for acute disease management and referral competence in employer group was significantly higher than the training unit group (χ2=25.73, P<0.01) and the doctor and student group (χ2=24.37, P<0.01). Most survey respondents believed that the doctorate candidates in general medicine should focus on scientific research training in community clinical medicine ( n=110, 84.6%), community preventive medicine and epidemiology ( n=114, 87.7%); 117 (90.0%) respondents believed that clinical research design and methodology training should be strengthened, and 125 (96.2%) respondents believed that clinical teaching thinking training should be strengthened; 108 (83.1%) survey respondents believed that it is necessary for their units to recruit personnel with doctoral degree in general medicine. Conclusion:The training of doctorate candidates in general medicine should aim at cultivating leading talents in general medicine, strengthen the training of clinical scientific research capabilities, and focus on cultivating their comprehensive abilities of "being able to research, be good at teaching, and understand management", so that they can truly become the leaders in this discipline.

This study has combed and analyzed the characteristics of medical doctoral supervisors and the enrollment status from 2015 to 2018 in Tongji University School of Medicine. The results show that the distribution of doctoral supervisors' age, gender and professional title is relatively balanced. The enrollment situation shows the clustering trend. There are obvious differences in enrollment among clinical medical disciplines, and the scales of doctoral supervisors and doctoral students are not matched and unevenly distributed. It is essential to give an overall consideration in discipline resources and optimize enrollment allocation, for improving the construction of doctoral supervisors and the quality of doctoral training.

OBJECTIVETo explore effects and potential mechanisms of high insulin environment on high density lipoprotein (HDL) generation-related functional protein ABCA1.

METHODS[(3)H] labeled cholesterol efflux from mature 3T3-L1 adipocytes was detected by liquid scintillation counting. ABCA1 mRNA and protein expression in mature 3T3-L1 adipocytes post stimulation with various concentrations of insulin was detected by real-time fluorescence-based quantitative techniques and Western blot, respectively, in the absence and presence of CHX (cycloheximide, CHX), calpeptin (calpain pathway inhibitor) or MG-132 (proteasome pathway inhibitor).

RESULTSCholesterol efflux rates were reduced post insulin stimulation in a dose-dependent manner ((7.06 ± 0.27)%, (6.59 ± 0.30)%, (6.34 ± 0.24)%, (5.07 ± 0.40)%, and (4.71 ± 0.40)% at 0, 1, 10, 10², and 10³ nmol/L of insulin, P < 0.05). Cholesterol efflux rates decreased in a time-dependent manner post 10³ nmol/L insulin stimulation (6.52 ± 0.30)%, (5.59 ± 0.71)%, (5.44 ± 0.37)%, (4.52 ± 0.32)%, and (4.38 ± 0.33)% at 0, 2, 4, 6, 12 h, respectively). ABCA1mRNA levels were not affected by insulin (P > 0.05). ABCA1 protein level was significantly downregulated in 10³ nmol/L insulin group compared to 0 nmol/L insulin group (P < 0.01). Compared with the 0 h group, ABCA1 protein level was significantly reduced in 6 h group (P < 0.05) and further reduced in 12 h group (P < 0.01). Both calpeptin and MG-132 could partly reduce insulin-induced degradation of ABCA1. Compared with the negative control group, ABCA1 protein levels were significantly upregulated by cotreatment with calpeptin and MG-132, respectively (both P < 0.01).

CONCLUSIONOur data suggest that high insulin level could promote the ABCA1 protein degradation and reduce cholesterol efflux from mature 3T3-L1 adipocytes through calpain and proteasome pathway, thus, produce a circumference not suitable for nascent HDL formation in 3T3-L1 adipocytes.

3T3-L1 Cells ; ATP Binding Cassette Transporter 1 ; Adipocytes ; Animals ; Calpain ; Insulin ; Leupeptins ; Lipoproteins, HDL ; Mice ; Proteasome Endopeptidase Complex ; RNA, Messenger

Objective:To explore the criteria of general practice doctoral supervisors.Methods:The expert consultation questionnaire was formed by literature analysis. Experts in the field of general medicine from universities and tertiary hospitals in Shanghai were invited to participate in two rounds of Delphi consultation. The consultation content included the basic requirements and the importance evaluation of the selection criteria for general practice doctoral supervisors. Descriptive analysis and Analytic Hierarchy Process (AHP) were used to analyze the results of the study.Results:A total of 29 experts participated in the consultation, all with senior professional titles and doctoral degrees. The positive coefficient and expert authority coefficient of the two rounds of expert consultation were 1.0 and 0.925, respectively. The Kendall coordination coefficient of indicator importance evaluation were 0.436 and 0.397, respectively. The ethics, age, professional title, educational background and academic degree and diploma were considered to be included in the basic qualifications. The optimal standards for supervisor selection included teaching ability, scientific research ability, student training and team promotion ability that subdivided into 13 evaluation indexes.Conclusion:The basic qualifications and optimal standards for general practice doctoral supervisors have been preliminarily developed, which provides reference for selection of qualified general practice doctoral supervisors.