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 analyze the VP1-VP4 genetic region of enterovirus 71 ( EV71 ) strains isolated from children with severe or mild hand, foot and mouth disease ( HFMD) in Shenzhen in 2012. Methods EV71 strains were isolated from five children with mild HFMD and five children with severe HFMD in Shenzhen in 2012.Reverse transcription-polymerase chain reaction ( RT-PCR) method was used to amplify the sequence of VP1-VP4 genes of EV71 strains.The sequences of the amplified products were analyzed by comparing with those of the EV71 reference strains ( A, B and C genotypes) published in Gen-Bank using nucleotide alignment, amino acid alignment and phylogenetic tree analysis.Results The homo-geneity between the EV71 strains isolated from severe and mild cases was 95.1%-98.2% in nucleotides and 99.2%-100% in amino acids.The VP1-VP4 nucleotide sequences of 5 strains isolated from severe cases and 5 strains from mild cases in Shenzhen shared 87.9%-97.8% homologies in nucleotides and 97.3%-99.9% homologies in amino acids with the genotype C EV71 reference strain.The EV71 strains isolated from children in Shenzhen were highly similar with the EV71 strain (FJ439769) isolated in Fuyang in 2008 and the one isolated in Jingdezhen in 2011 (JQ806378, C4a subtype) in nucleotide sequences.Mutations at the residue 31 in the VP1 region ( N→D ) were detected in 3 strains isolated from children with severe HFMD.Conclusion All of the 10 EV71 strains isolated in Shenzhen in 2012 belonged to the sub-genotype C4a.The mutation ( aa31 N→D) in the VP1 region of EV71 might be related to the different clinical mani-festations of HFMD cases in Shenzhen area.

Objective To analyze the complete genome sequence of a Shenzhen coxsackievirus A2 strain CVA2-SHZH13-01 and its evolution.Methods RT-PCR was used to amplify the complete genome of CVA2-SHZH13-01 strain.The PCR products were purified and sequenced to analyze their genetic character-istics.Results The complete genome of CVA2-SHZH13-01 strain was 7400 bp in length, encoding 2191 amino acids.CVA2-SHZH13-01 strain was highly similar with the novel recombinant CVA2-HK (431306) strain isolated from Hong Kong sharing the nucleotide homology of 98.3%, 98.8%, 99.0%, 99.2%, 98.8%and 98.9%in 5′UTR, P1 ( VP1 to VP4) , P2, P3, 3′UTR regions and complete genome, respec-tively.CVA2-SHZH13-01 strain was highly identical to the international standard strain CVA2-Fleetwood showing the homology of 81.6% in nucleotide sequences in P1 region, but closely associated with EV71-SHZH03 and EV71-GD2009 strains (82.8%-88.7%) in P2 and P3 regions.The phylogenetic analysis in-dicated that CVA2-SHZH13-01 strain belonged to the CVA2-HK (431306) variant.Data from analysis of amino acid in P1 region showed that there were three amino acid mutations in CVA2-SHZH13-01 strain including aa5L→F, aa666S→G and aa671T→I as compared with CVA2-HK (431306) strain.Conclusion CVA2-SHZH13-01 strain belonged to CVA2-HK (431306) variant.

Objective To evaluate the simulation of standardized patients (SP) in objective structured clinical examination (OSCE) for general practice residency training.Methods The simulation levels of 15 SPs were evaluated by 37 examiners with a rating scale of OSCE Examiner Feedback on SP performance from Melbourne University School of Medicine.The evaluation was conducted in history-taking and doctor-patient communication stations of OSCE for general practice residency training.Results The overall scores of SP performance were high and most examiners considered that the performance of SP was realistic and consistent.Among 9 items of rating scale,more than 90％ of the examiners considered that SP performance met or completely met the requirements of OSCE,except the item of preparation for clothing and making up before role playing.Six items of performance in history-taking station and 4 items in doctorpatient communication station reached 100％ satisfaction from the examiners.T test was used to compare the difference of SP performance between the morning and afternoon,and there was no significant difference (P ＞ 0.05).Conclusion The study showed for this group of SPs,the realistic degree and consistency of performance meet the requirements of OSCE,and its stability is not affected by long time continuous performance.

Objective To evaluate the clinical capability of young general practitioners (GPs) in communities in Shanghai.Methods A cross-sectional survey on clinical ability of young GPs was adopted from October to December 2014.Total 211 GPs aged (31 ± 2) years (25-35) from 17 districts of Shanghai participated in the study.Written examination and objective structured clinical examination (OSCE) was applied in the evaluation.Results All 211 GPs (63 male and 148 females) completed the assessment.The overall score of the assessment was (602 ± 83) and the pass rate was 62.6％ (132/211).In written examination the average score was (64 ±7) and the pass rate was 72.1％ (152/211).In OSCE,the highest score (80 ± 15) and pass rate (92.9％,196/211) was in CPR skill,followed by communication skill [average score:(76 ± 15) and pass rate:85.8％ (181/211)].The lowest average score was physical examination (47 ± 15) with a pass rate of 26.1％ (55/211),followed by electrocardiogram reading [average score:(84 ±31) and pass rate:39.8％ (84/211)].In basic operation station,the lowest score was using funduscope and gynecologial examination (29.8％ and 45.4％,respectively).Conclusion Young GPs in Shanghai communities basically master clinical skills,but also have some deficiencies,the training in certain skills need to be strengthened.

Objective To investigate the training needs of general practioners (GPs) in Shanghai and to analyze the related factors.Methods A questionnaire survery on the training needs was conducted among 428 GPs who attended a municipal training program of clinical compentance in Shanghai during July 2011 to February 2012.Results Among 428 GPs receiving the survey,23.9％ (102/427) expressed great willingness for training; 40.2％ ( 169/421 ) preferred part-time and 41.3％ ( 174/421 ) preferred on-job training; 31.7％ (377/1188) wished to have case analysis method of teaching.In the aspect of training contents,common clinical skills were ranked the first,accounting for 32.1％ (1376/4280) of the choices,on the other hand,health care for women,children and the elderly in community was ranked the last,accounting for 18.9％ (485/2568) of the choices.Logistic regression showed that the gender (OR =2.194,P=0.010),age (OR=0.435,P=0.011) and education levels of GPs (OR=0.293,P=0.006) were related factors of training needs.Conclusion The survay reveals that training needs of GPs are strong in Shanghai and GPs prefer short-term training in real clinical situations.

To identify the genotype and analyze the molecular characteristics of dengue virus strain SZ0524 isolated from serum samples of patients with early stage of dengue fever in Shenzhen in 2005 so as to explore its possible origin. The C6/36 cell line was cultivated with virus strain SZ0524 and its suspension was harvested. The type of isolated virus strain was determined by RT-semi-nested PCR and fluorescent PCR. E gene of isolated virus strain was amplified by RT-PCR and sequenced. Homology and phylogenetic tree of E gene of this dengue virus with the strains isolated from other areas were constructed. This SZ0524 strain was further identified by fluorescent PCR, and confirmed to be the type 4 virus after obtaining the 392bp band with type 4 specific primers. The homology of nucleotide sequence of E gene of SZ0524 strain with the standard type 4 dengue virus H241 strain were 99.7%, but the homology with the standard dengue virus 1,2,3 in the same fragment were 57.0%, 59.2% and 56.2% respectively. Analysis of the phylogenetic tree indicated that SZ0524 was more close to D4-73NIID and D4-61NIID strain, next to H241 strain, and they lied in the same branch of phylogenetic tree. The isolated dengue virus type 4 belonged to genotype Ⅰand the SZ0524 strain was proved to be dengue virus type 4 in the molecular level. Combined with epidemiology information, it is suggested that this case can be classified as an imported case and the SZ0524 strain may be transferred from the southeast asian region.

Objective To develop criteria for trainers of general practitioners in clinical training bases.Methods A primary version of criteria was established through literature review and expert interview.Thirty-two experts with middle-level professional title or above,who had 10 years of working experience or more in general practice,teaching and administration,were invited for 3 rounds of Delphi consultation during March and October 2013.Results The criteria consisted of 3 first-grade indicators and 12 second-grade indicators were established.The first-grade indicators included professional quality,clinical competence and teaching capability.The weight coefficient of first-grade indicators were 0.332 0,0.336 0 and 0.332 0,respectively.For 3 rounds of consultation the activity coefficient of experts was all 100％ ; the authority coefficients of experts were 0.881,0.897 and 0.883,respectively; and the harmonious coefficient of importance of the evaluation were 0.136,0.127 and 0.204,respectively (P ＜ 0.01).Conclusion The established criteria are credible and important for the selection of trainers of general practitioners in clinical bases,which would improve the quality of standardized training for general practitioners.

Objective To establish a set of accreditation standards for trainers of general practitioner (GP) in community health service centers.Methods A modified Delphi expert consultation was conducted during December 2012 and September 2013.Thirty two experts of general practice from different teaching hospitals and community health service centers were invited for three rounds Delphi questionnaires.A set of accreditation standards for GP trainers in primary care was established through data analysis,synthesis and process.Results Expert activity coefficients were 100.0％ for three rounds consultation,the authority coefficients were 0.894,0.882 and 0.893,respectively.The opinion coordination coefficients of experts were 0.156,0.166 and 0.215,respectively (P =0.000).The developed accreditation standards system comprised of three first-grade indicators and 14 second-grade indicators.The weight coefficients of three first-grade indicators,namely professional profiles,clinical competences in primary care and teaching abilities,were 0.339 8,0.335 6 and 0.324 6,respectively.Conclusions The established accreditation standard system is credible,which would appropriately guide the selection of GP trainers in primary care from three dimensions and enhance the quality of standardized training of general practitioners.

Objective To assess the continuing medical education (CME) and training needs for gereral practitioners (GPs) in urban and suburb of Shanghai.Methods Gereral practitioners in urban (n =710) and suburb (n =843) of Shanghai attending two municipal training programs were interviewed with self-designed questionnaire during July 2011 to May 2012.Results Urban group included 710 GPs whose mean age were (36.7 ± 6.8) y and 33.0％ were male.Suburban group had 843 GPs whose mean age were (36.6 ± 5.1) y and 33.2％ were male.The survey showed that 84.6％ of urban group and 85.6％ of suburban group had attended CME before.There was no statistical difference in the overall satisfaction of CME between two groups (Z =-0.895,P =0.371).The propotion of satisfied and very satisfied was 45.1％ and 13.8％ in urban groupt,while it was 49.5％ and 9.1％ in suburb group.The overall satisfaction rates of enhancing basic theories (Z =-2.296,P =0.022) and skills (Z =-2.013,P =0.044) and CME textbooks (Z =-2.819,P =0.005) were higher in suburban group than those in urban group.Both of them agreed that the contents of CME were divorced from reality of practice (60.3％ vs.65.2％,x2 =3.213,P =0.082).The percentages of complain of insufficient training time (19.7％ vs.11.0％,x2 =18.045,P ＜ 0.05) and contents (7.5％ vs.4.3％,x2 =5.747,P =0.019),and weak leadership commitment (14.3％ vs.6.5％,x2 =19.95,P ＜ 0.05) were higher in suburban group than those in urban group.On the contrary,the delivery of repeated contents (24.8％ vs.34.8％,x2 =15.327,P ＜0.05) and long training time (16.4％ vs.28.2％,x2 =26.055,P ＜ 0.05) were lower in suburban group than those in urban group.Using case study in the teaching was the common choice of both groups (73.3％ vs.78.0％,x2 =0.635,P =0.426).Compared to urban group,suburban group was more likely to choose lecture of theory (63.6％ vs.50.8％,x2 =6.712,P =0.010) rather than problem based learning (43.1％ vs.51.9％,x2 =4.273,P=0.010).Conclusions Both urban and suburban GPs in Shanghai are generally satisfied with the CME programs.There are some discrepancies in training needs of CME between urban and suburben area in Shanghai,indicating that the CMB programs need to be designed according to the needs of trainees in urban or suburb areas.