Objective To survey the training needs for key general practice (GP) trainers.Methods The survey was conducted among participants of the first training course for national key GP trainers hold on March 2014 in Shanghai.The contents of questionnaire used for the survey included training needs of GP relevant knowledge,teaching ability and modes of assessment.The differences in training needs between GP trainers from community teaching bases and hospital teaching bases were analyzed.Results Total 151 key trainers completed the questionnaire (male/female:48/103) with average age of (38 ± 6)years.Among them 67.5％ (102/151) were from community teaching bases and 29.8％ (45/151) from hospital teaching bases;60.9％ (92/151) participated in the General Practitioner Structured Vocational Training Program (GPSVTP).According to the survey,general practice clinical kills (72.2％,106/151) and general practice clinical thinking (70.2 ％,106/151) were most required relevant knowledge;while general practice basic concept was least required (25.8％,39/151).The rate with need of policy system related GP training in hospital trainers was higher than that in community teaching base trainers(66.7％ vs.44.1％,P ＜ 0.05).For teaching ability needs,85.4％ (129/151) selected teaching methods,75.5％ (114/151) chose teaching assessment and evaluation methods.The participants showed more interesting in new-type teaching and evaluation methods,such as PBL,OSCE,mini-CEX and DOPS,and would use them in future teaching work (P ＜ 0.01).Workshop (58.3％,88/151),demonstration(57.0％,86/151) and experience exchange (50.3％,76/151) were three most interested modes in current training;meanwhile theoretic teaching was lease interested (38.4％,58/151).Study tour was most interested training models for the future (71.5％,108/151),followed by short-term courses (49.0％,74/151),overseas study (39.1％,59/151) and distance learning (27.8％,42/151).Conclusion There are different needs for GP trainers from hospital and community teaching bases.To meet the different requirements,the focused training course and training method should be adapted.

Objective To investigate current status of general practice service teams in urban Shanghai to provide practical evidence and lay theoretical basis for sustainable development of general practice service teams in the future. Methods A cross-sectional study was carried out for 40 staff members of eight general practice service teams in eight urban districts of Shanghai, as well as 110 local residents, by observation, interview and questionnaire methods during March to April 2008. Results Among 21 general practitioners, 86 percent of them ( 18/21 ) were graduated from medical colleges or universities with three-year curriculum or at levels above it and 52 percent ( 11/21 ) had intermediate professional titles or above.Among the eight general practice service teams, five had full coverage of supervision and management for tuberculosis therapy, six had full coverage of management for tumor patients, four had full coverage of management for cardiovascular and cerebrovascular diseases and four had full coverage of management for patients with mental disorders. In all staff members of eight general practice service teams, 38 percent of them (15/40) were satisfactory with their working environment, 40 percent (16/40) with their work activities, five percent (2/40) with their incomes, and 28 percent (11/40) with their professional future.In 110 local residents, 77 percent (85/110) were satisfactory with service environment, 85 percent (93/110) with quality of health-care service and 89 percent (98/110) with the attitude of service teams.Conclusions Implementation of management for chronic diseases and two-way referral, as well as satisfaction of staff members in general practice service teams should be improved further.

Objective To survey the current situation of teaching for general practitioners (GPs) in community health centers of Shanghai.Methods A questionnaire survey on the teaching situation was conducted among 742 GP mentors who attended a municipal training workshop during July to October 2012 in Shanghai.The items of the survey included general background,previous teaching experience and self-evaluation on teaching ability.Results Among 742 GP mentors receiving the survey,the average age was (37 ± 6) years old.49.8％ (366/734) of mentors expressed their willingness of teaching,and the main reason was that it may upgrade themselves,while learning from teaching (58.6％,419/715).Heavy work load,lack of teaching time (31.8％,378/1 187) and teaching experience (30.7％,364/1 187) were the main obstacles for teaching.Among 106 GP mentors who had teaching experience in community health center previously,79.2％ (80/101) made teaching plans,but only 8.9％ (9/102) often prepared syllabus.Teaching plans were made mainly according to the work needs in community health care (54.2％,52/96),the situation and demands students (29.1％,28/96) or requirement of syllabus (17.7％,17/96).The problems included lack of teaching experience (50.5 ％,50/99) and time (42.4％,42/99),monotonous instructional modality (24.1％,25/104),and weak operability of the syllabus (21.2％).The self-reported results showed that 14.4％ were not able to develop a teaching program and to execute,18.3％ were not able to use a variety of teaching methods,31.2％ were not able to engage in teaching for 1.5 days per week.Logistic regression analysis showed that mentors with higher education background (OR =2.027,P ＜ 0.05),community teaching experience (OR =3.069,P ＜ 0.05),higher self assessment of general personal quality and communication ability (OR =2.488,P ＜ 0.05),higher teaching ability (OR =2.399,P ＜ 0.05) and strong training wishes (OR =11.382,P ＜ 0.05) were more willing to engage in the teaching work.Conclusions Heavy work load,insufficiency of teaching capacity and experience are main problems for GP mentors in Shanghai community health centers.Educational theory and methods should be focus on teacher training so as to improve teaching abilities.

Objective To survey the current working status of general practitioners (GPs) who received residency training in Shanghai.Methods The current status of general practitioners,who completed residency training in Shanghai from 2013 to 2014,was surveyed with self-designed questionnaire by e-mail.The survey items included current employers,job specification,clinical practice,teaching,scientific research and so on.Results Three hundred and thirteen out of 377 GPs,who completed residency training from 2007 to 2012,participated in the survey (83.0％),including 85 males and 228 females with a mean age of (31.2 ± 2.6) years.Among all participants,298 (95.2％) worked in community health service centers,12.8％ (40/313) of them were involved in general practice teaching,9.9％ (31/313) undertook management,9.3％ (29/313) did academic research in community,and 7.7％ (24/313) had chance for overseas study.The survey also showed that 134 person/times received various commendations and awards.Conclusion Most GPs who completed residency training are undertaking clinical practice in community health service centers,and they are also well involved in management,teaching,and research.

Objective To develop an index system for evaluation index system for community general practice teaching base.Methods A draft of evaluation index system for community general practice teaching base was preliminarily developed on the basis of literature research.Two rounds Delphi consultations with 32 experts of general practice were conducted between July 2014 and May 2015.The results of consultation were analyzed and the evaluation index system for community teaching base was established.Results In two rounds of Delphi consultation,the positive coefficients were both 100％,the authority coefficient of experts were 0.879 and 0.897,respectively,and the coordination coefficient were 0.165 and 0.204 (P ＜0.01).The established evaluation index system consisted of 4 first-class indexes,8 second-class indexes and 27 third-class indexes.Four first-class indexes were basic conditions,teaching conditions,teaching staff and teaching practice.Conclusion The established evaluation index system may be used to accredit community general practice teaching base and to improve the quality of general practitioner training.

Objective To assess standardized patients (SP) in resident general practitioners training for their consultation skills to explore its role in clinical competence training. Methods SP are employed in standardized training for 52 resident general practitioners in Shanghai during May to July 2008 to assess trainees' clinical consultation skills, including medical history taking and physical examinations, as well as clinical competencies of trainers including medical history taking, physical examinations, clinical thinking (diagnosis, differential diagnosis and treatment plans), health education, medical record writing,and reception time management. Feedback and appraisal for their consultation skills were provided by SP later. Problems encountered in trainees' consultation were discussed in group manner with their trainers.And two mouths later, assessment with SPs was undergone again for their consultation skills to compare their scores in consultation skills and percentages of them passing the assessment before and after training. Results Trainees were enrolled in the training aged (28±1 ) years in average ( with a ratio of men to women of 19/33 ). Percentage of trainees passing the assessment by SP for consultation skills was significantly higher after training (88.5%) than that before it (46. 2% ) ( P < 0. 01 ). Percentage of trainees with scores passing assessment by trainers was also significantly higher after training than that before it (86.5% vs. 51.9%, P < 0.01 ), with a percentage of those qualified for clinical skills and health education after training of 80. 8% and 88.5%, respectively, as compared to those of 46. 2% and 67. 3%,respectively before it, ( P < 0. 01 ), and with a percentage of trainees qualified for clinical thinking, out-patient medical record writing and reception time management not changed after training (71.2%, 100. 0%,100. 0%, respectively) as compared to those before it (51.9%, 100. 0% and 100. 0%, respectively)(P > 0. 05 ). Conclusions Application of SP can effectively enhance consultation skills of the trainees,especially in their medical history taking and physical examinations. However, there is still rooms to improvein their clinical thinking.

The case design,standardized patients(SPs)training and training communication skills for medical students with SPs were illustrated in this paper.And our experiences of SPs using Were summarized.

Objective To set up methods for objective structured clinial examination(OSCE)for its application in assessment for clinical competencies of trainees in standardized training for general practice at its completion in Shanghai.Methods Trainees in standardized training for general practice in Shanghai were assessed at its completion in July 2009 at Zhongshan Hospital of Fudan University,which was organized and implemented by establishment of OSCE management framework and design of assessment stations,including writing-up medical records for cases,training standardized patients,selecting assessment itemsfrom checklists of clinical skills.as well as working-out a form for assessment scoring.Results Six assessment stations were set up for OSCE,including clinical data collection,medical record writing,case analysis,clinical skills,diagnostic decision-making based on electrocardiograms(ECGs)and x-ray films.Totally,32 trainees took part in OSCE and all passed examination.Score of medical record writing Was higher than that of clinical data collection [86(IQR 74-91)vs.79(IQR 67-85),P＜0.05].There was no significant difference in scores between medical reeord writing and case analysis [86(IQR 74-91)vs.80(IQR 73-86),P＞0.05].Score of X-ray film diagnosis Was higher than that of ECG diagnosis and clinical skills[99(IQR 96-100) vs.95(IQR 91-98),and 99(IQR 96-100)vs.90(IQR 83-94),all P＜0.01].Conclusions Clinical competeneies of trainees of general practice Can be assessed by OSCE in multiple aspects,which provides a new examination method for GP training.

Objectives To investigate and analyze depressive state in patients with diabetes in a community so as to assess adverse impact of depression on diabetes and provide basis for health intervention.Methods A total of 115 patients with type 2 diabetes and healthy control group matched for demographic data and therapeutic compliance were selected from a community.All the subjects were evaluated with Beck Depression Inventory ( BDI),and their baseline data were collected by a short self-administered questionnaire,including diabetic history and medication compliance.Fasting blood glucose ( FBG),two hour post-prandial blood glucose (2hPBG) and HbAlc were measured for the diabetes mellitus (DM) group.Results BDI score was significantly higher in DM group than that in control group (P 0.05 ).There was significant difference in metabolic control,medication compliance and number of patients with complications between depression and non-depression groups in diabetics (P

Objective To investigate the capacity and training needs of the community general practice mentors in different areas of Shanghai.Methods General practice mentors from community health centers,who attended a municipal training program in Shanghai during July 2012 to October 2012,were participated in the survey with a self-designed questionnaire.The general condition,basic ability (clinical skill,teaching ability and professional development),motivation and needs of training were investigated.The factors affecting the willingness of training were analyzed.Results Among 742 mentors receiving the survey,259 were from the urban area,174 from rural-urban continuum and 309 from rural area.The academic degree in urban group was relatively higher:17 out of 257 (6.6％) holding master degree.The ratio of participants who had received standardized training in urban,rural-urban and rural areas was 33.2％,25.3％,37.4％,respectively.The personal quality and communication skills in urban group were significantly higher than those in rural-urban continuum and rural group (18.58 ± 2.49,17.89 ± 2.69,17.85 ±2.34,P ＜0.05).The clinical skill (12.31 ± 1.98,11.95 ±2.02,11.52 ± 1.81),teaching ability (11.99 ± 2.62,11.63 ± 2.86,11.12 ± 2.77) and professional development (6.42 ± 1.61,6.36 ± 1.55,5.61 ± 1.38) in urban group were all significantly poorer than those in other two groups.The main purpose of participation in training was to improve medical knowledge and clinical skills in three groups (70.8％,74.0％,80.4％,respectively),followed by the need for community teaching.The rural group has higher training requirements in improving clinical diagnosis and treatment ability (75.3％,80.1％,85.5％,respectively in three groups),doctor-patient communication ability (38.0％,44.0％,50.7％,respectively) and community preventive care ability (29.4％,30.7％,42.8％,respectively).The urban group had much more requirements in scientific research training (38.8％,34.9％,14.1％,respectively).Logistic regression analysis showed that doctors with supports from the leadership (OR =2.688,P ＜ 0.05) and with less working stress (OR =2.241,P ＜ 0.05) were more willing to participate in mentor training.Conclusion There are discrepancies in basic ability and training needs of community general practice mentors in different areas of Shanghai,so we should develop specific or targeted training program in the future.