The community rotation is an important stage of standardized residency training for general practitioners (GPs).However, the community rotation is also considered as a most difficult part of the GP residency training because of the problems in training management and evaluation .Based on our experiences of 7-months community training , we expanded the duration of community training to 1 year, and implemented a new segmentation and multipoint practice plan in Zhongshan hospital .This is a new attempt for GP residency training , which would hopefully meet the international standards of GP residency training .

Objective To investigate the feasibility of 360-degree evaluation in teaching ability assessment of community general practice trainers.Methods The 360-degree evaluation questionnaire was used to assess the teaching ability of 39 general practice trainers in 3 community teaching bases in Xuhui District of Shanghai during January to March 2014.Five dimensions were included in the questionnaire:ability of primary care, ability of common disease management, clinical skills and appropriate community technology, teaching ability and personal overall ability.Each trainer was evaluated by 2 managers, 2 colleagues, 2 nurses, and 2 trainees, beside trainer him(her)self.Results Total 343 questionnaires were rechieved with a response rate of 97.7%.The average overall scores of assessments from trainers themselves, managers, colleagues, nurses, and trainees were 6.66 ±0.85, 6.91 ±1.28, 8.06 ±0.58, 8.36 ±1.68, and 8.12 ±0.81, respectively.The scores from nurses were the highest in all dimensions of the questionnair.The overall scores and scores of each dimention assessed by colleagues, nurses and trainees were significantly higher than those from trainers themselves ( P <0.05 for all ) , while the scores from managers were higher than those from trainers themselves only in teaching ability dimension ( t=4.655,P<0.001).There was no correlation of overall scores assessed by managers, colleagues, nurses and trainees with those assessed by trainers themselves ( P>0.05 for all).The overall cronbach′s alpha was greater than 0.9 in every aspect of assessors.The cronbach′s alpha of all dimension was greater than 0.8, except that of primary care ability assessed by trainers themself ( 0.694 ).Conclusion The 360-degree evaluation combines the assessments of community service ability, clinical ability, comprehensive quality and teaching ability, so it is practicable for teaching ability assessment of general practice trainers in community.

Objective To review the standardized training of General practitioners (GPs) in Zhongshan Hospital since 2010.Methods Sixty seven GP trainees were recruited by Zhongshan Hospital since 2010.A retrospective analysis was carried out about the training methods,training content,assessment methods and training management.Results The pass rate of hospital examination was 100.0％.Sixteen out of nineteen GP residents of grade 2010 passed both the final examination and medical licensing examination,and completed the training plan; the remaining 3 trainees did not pass the licensing examination,among whom 2 extended the training and passed the exam eventually,and 1 dropped off.Sixteen out of seventeen in grade 2011 passed the medical licensing examination and were preparing for 2014 graduation examination.The training mode of human-centered and competency-based assessment system was established.Conclusion Zhongshan Hospital has accumulated rich experience in standardized training of GPs,established a system of training and assessment,and it will be continuously improved in the future.

Objective To apply 360 degree evaluation in competence assessment of community general practice trainers.Methods The 360 degree evaluation questionnaire was designed by authors and the evaluation was applied to assess the personal comprehensive quality,competence in general practice and teaching of 16 general practice trainers in Fenglin Community Health Service Center of Shanghai Xuhui District.Results The scores of personal comprehensive quality,competency in general practice and teaching were 7.73 ± 0.73,6.91 ± 0.91 and 6.44 ± 1.38,respectively.The total scores from different evaluators were 6.93 ± 0.12 for peers,6.68 ± 0.74 for hospital executives,8.17 ± 0.12 for nurses and 6.43 ± 0.89 from self evaluation (F =27.91,P =0.000).Conclusion The variance between different evaluators in 360 degree evaluation can avoid bias of single one.The results of 360 degree evaluation show that the teaching ability of community general practice trainer is relatively low,suggesting the training of teaching ability should be strengthened for these trainers.

Object To study the protective effect of Rodobryum roseum (Hedw) Limpr. on acute myocardial ischemia. Methods Rat acute myocardial ischemia models were prepared by ligating their left coronary arteries. Changes of their S-T segment was observed on lead Ⅱ dynamic ECG. Degree of ischemia was assessed by the extent of S-T segment elevation. Lactic dehydrogenase (LDH), creative phosphokinase (CPK), superoxide dismutase (SOD) and malondialdehyde (MDA) were determined at the same time. Results R. roseum can significantly alleviate S-T segment elevation, being most evident at the dose of 2 g/kg (P

Objective To explore the nicotine dependence levels and the influencing factors of dependence among rural-to-urban migrant workers in Shanghai so as to provide scientific rationales for an effective implementation of tobacco control.Methods Multi-stage randomized sampling was used to select a total of 5 856 rural-to-urban migrant workers from 7 districts in Shanghai.Fagerstrom Test for Nicotine Dependence ( FTND) and logistic regression model were used to analyze the association between nicotine dependence and relevant risk factors.Results The current smoking prevalence was 23.7%.The average FTND score for current smokers , high dependence and low dependence were 3.38 ±2.49, 7.00 ±1.07 and 2.23 ±1.71 respectively.The high and low dependence rates were 21.7% and 78.3%.The results of logistic regression showed that education , duration of smoking and length of migration were associated with nicotine dependence.Lower level of education was more prone to high nicotine dependence.Those with a lower education had a higher risk of nicotine dependence ( junior high school: OR=1.742, primary school or lower: OR =1.994 vs.senior high school or higher ).High nicotine dependence increased with the duration of smoking (smoking 6-10 years:OR=3.007, 11-15 years:OR=4.076, 16-20 years:OR=5.451, 20 years or more:OR=5.726 vs.5 years or less).Length of migration over 3 years was less likely to have a high nicotine dependence (3-5 years: OR=0.602, more than 5 years: OR=0.407 vs.<1 year) .Conclusion The rate of high nicotine dependence is high among rural-to-urban migrant workers in Shanghai.Level of education , duration of smoking and length of migration are significant influencing factors of nicotine dependence.

Objective To survey the mental health status of rural-to-urban migrant workers in Shanghai.Methods The survey subjects were selected from migrant workers in Shanghai with a multi-stage stratified cluster sampling method.The Symptom Check List ( SCL-90 ) scores were used for evaluation of metal health status.Results The prevalence of mental health problem of 5 626 rural-to-urban migrant workers in Shanghai was 18.8% ( 1 058/5 626 ).The mean total score of SCL-90 was 114.86 ±31.21.Compulsive-obsessive, interpersonal sensitivity, hostility ranked the top three among 9 factors, with scores of 1.37 ±0.43, 1.31 ±0.43 and 1.30 ±0.41 respectively.The mean total scores and scores of 9 factors of rural-to-urban migrant workers in Shanghai were lower than those of Chinese adults norm the mean total scores(129.96 ±38.76) ( t =-15.34, -3.84 --24.08 respectively, all P <0.01) .There were significant differences in mental health among migrant workers with different age , education , marital status , living conditions and occupation (all P<0.05).Conclusion The prevalence of mental health problems in Shanghai rural-to-urban migrant workers is high, with are related to their age, education, marital status, living conditions and occupation.

Objective To survey the requirement of objective structured teaching evaluation (OSTE) use for general practice (GP) trainers and the station design.Methods A questionnaire survey on the requirement of OSTE use was conducted among 161 hospital trainers and 110 community trainers from a national key GP trainers training workship in April 2016.The survey included basic information,OSTE use requirements,frequency of clinical teaching scenarios,and frequency of teaching methods.Results The survey showed that 86.3％(234/271) of trainers were willing to use OSTE for assessing teaching competence and 92.3％ (250/271) for training teaching competence.The proportion of “having been observed and being given feedback from superior trainers for teaching process” was higher in hospital trainers than that in community trainers [68.3％(110/161)vs.40.9％(45/110),x2=20.060,P＜0.001].In the part of frequency of teaching scenarios,the proportion of “often” plus “always” was higher in “instructing students to write the medical records” [64.6％(175/271)],“teaching doctor-patient communication skills” [60.9％(165/271)] and “observing students' consultation and giving feedback” [57.9％(157/271)];there were no significant differences in above questions between the two types of trainers (all P＞0.01).In the part of frequency of teaching methodS,the proportion of “often”plus “always”was higher in “clinical supervisor's report” [60.9％ (165/271)],“applied knowledge test” [52.4％(142/271)] and “problem-based learning” [38.0％(103/271)];there were no significant differences in above questions between the two types of trainers (all P＞0.01).Conclusion The requirements of assessment and training by using OSTE are strong in GP trainers.The OSTE stations should be designed based on the routine teaching scenarios and methods for both hospital trainers and community trainers without discriminations.

Objective To survey the status and related demands of advanced clinical training among community general practitioners (GPs) in Shanghai.Methods A survey on the status and demands of advanced clinical training was conducted with a self-designed questionnaire among GPs in Minhang District and Jiading District of Shanghai from January to May 2016.The questionnaire included basic information , experience of advanced clinical training , satisfaction with training and training demands .Results Total 526 questionnaire were distributed and 478 valid questionnaires were returned with a response rate of 90.9%. Among the participants 202 (42.3%) had experience of advanced clinical study ; the training units were mainly secondary hospitals in Shanghai (69.3%, 140/202); 67.2%(131/195) participants considered that the previous training did not fully meet the needs of the community .There was significant difference in the training demands among participants with different ages , professional titles, and working years ( χ2＝12.754, 7.912, 4.501, all P＜0.01); those with younger age, higher education and shorter working years had higher training demands .Survey showed that 57.3%( 274/478 ) of participants demanded further studies in the future; 58.3%( 239/410) of them chose tertiary hospitals in Shanghai as training unit , 79.0%(321/406) chose internal medicine and geriatrics as training specialties , particularly in outpatient clinic (73.2%, 298/407); the length of study should be 3 months (32.8%, 132/402) or 6 months (27.6%, 111/402), and completed in segments (61.5%, 253/411).The purpose of training was mainly to upgrade clinical competence (94.2%, 258/272); busy working schedule (53.4%, 66/116) was the main reason for not intending the advanced clinical studies .Conclusions The community general practitioners in Shanghai have high demands for advanced clinical training .The training should meet the needs of clinical practice in community and the mode of study should be more flexible .

Objective To compare the awareness, training and assessment of teaching competence between hospital and community general practice (GP) trainers. Methods A questionnaire survey on teaching competence was conducted among 161 hospital GP trainers and 110 community GP trainers in 2016 April. Results There were 96 male and 175 female participants with an average age of (30.4 ± 8.0) years. On the the awareness of teaching competence,the propotion of"very important"of"creating a quality teaching environment for students","knowing how to teach students","ability to teach students medical knowledge and skills", " feedback ability ", "showing the virtue of being a teacher" in hospital and community trainers were 47.8％(77/161) and 40.0％(44/110), 66.5％(107/161) and 59.1％(65/110), 71.5％(115/161) and 62.8％(69/110), 54.7％(88/161) and 52.7％(58/110), 65.2％(105/161) and 60.9 (67/110), respectively;there were no significant differences of all importance ratings between the two groups (all P>0.05). Hospital trainers had higher proportions of "having received teaching method training" [70.2％(113/161)vs. 50.0％(55/110),χ2=11.302,P=0.001] and"having received teaching training before practice teaching for the first time" [(45.3％(73/161)vs. 21.8％(24/110),χ2=15.735,P<0.001] than those of community trainers. The proportion of "having received teaching comptence evaluation" was higher in hospital trainers than that in community trainers [(60.9％(98/161)vs. 43.6％(48/110),χ2=7.810,P=0.004], but there were no significant difference in teaching comptence evaluation methods between two types of trainers (P>0.01). Conclusion The awareness of teaching competence is similar between hospital and community GP trainers, but the community trainers are lack of teaching competence training, and their teaching competence evaluation methods need to be improved.