The community teaching bases play an important role in training of general practice talents. To raise the training quality, the development of their own capacity is crucial, but community medical institutions also need close cooperation with the departments of general practice in medical schools and the higher-level general hospitals. This article discusses the integration model of management, teaching and research in general practice talent training based on the cooperation of community teaching bases with relevant governmental departments, professional societies/associations, general hospitals and medical schools.

Objective:To develop the training syllabus of palliative care for general practitioners.Methods:Twenty-nine experts in fields of general practice and hospice care from different teaching hospitals and community health service centers were invited to participate in two rounds of Delphi consultation from April 2022 and August 2022. Based on results of Delphi consultation a preliminary training syllabus was established through data analysis, synthesis and process.Results:Of the 29 experts, 11 (37.9%) were male with age of (52.9±8.9) years and working experience of (17.0±7.2) years. The expert activity coefficient of the two rounds of consultation was 100.0% (29/29) and 96.6% (28/29), authority coefficient was 0.815 and 0.870, and opinion coordination coefficient was 0.359 and 0.515, respectively ( P<0.05). The training syllabus comprised of 4 first-grade indicators, 19 second-grade indicators and 58 third-grade indicators. The weight coefficients of the 4 first-grade indicators, namely objective of training, theory courses and theoretical knowledge, clinical base rotation contents and requirements, community base rotation content and requirements, were 0.251, 0.251, 0.250 and 0.248, respectively. Conclusions:A preliminary training syllabus of palliative care for general practitioner has been developed in this study, which provide a basis for standardized training of community palliative care.

Objective:To investigate the intention to stay on among primary health care workers (PHWs) during the COVID-19 epidemics and its influencing factors.Methods:An online questionnaire survey was conducted among PHWs from 62 primary health institutions in 31 provinces, autonomous regions and municipalities across China selected by multi-stage whole cluster random sampling method between May and October 2022. According to the job position, the PHWs were divided into 5 categories: general practitioners (GPs), nurses, public health doctors, managers and support staff. Intention to stay was measured using the Chinese version of the Intention to Stay Questionnaire. Multiple linear regression model was used to analyze the influencing factors of the intention to stay in PHWs of different occupational categories, including personal factors, work factors, factors related to the COVID-19 and psychological reactions.Results:A total of 3 769 PHWs from 44 community health service centers, 18 township hospitals of 27 provinces/autonomous regions and 4 municipalities participated in this survey. The mean age of participants was (37.4±9.2) years, including 2 971(78.8%) women. The mean score of intention to stay of participants was 21.7±4.1. Compared with GPs, managers had lower intention to stay ( P=0.004). Age, female, in marriage, monthly income, years of primary care service, self-evaluation of unit support function, MSQ-SF score, and PA score were positively correlated with the score of intention to stay (all P<0.05), while PHQ-9 score, EE score, and DP score were negatively correlated with the score of intention to stay (all P<0.05). The MSQ-SF scores of all occupational categories were positively correlated with the scores of intention to stay (all P<0.01). In addition, among GPs, monthly income, years of service in primary care, self-evaluation of unit support function, and PA scores were positively correlated with the score of intention to stay (all P<0.05), while PHQ-9 scores and EE scores were negatively correlated with the score of intention to stay (all P<0.05). Among nurses, age, female gender, monthly income, self-evaluation of unit support function, and PA score were positively correlated with the score of intention to stay (all P<0.05), while EE scores and retention will score were negatively associated with ( P<0.001). Among public health doctors, in marriage was positively correlated with the score of intention to stay ( P=0.018). Among managers, DP score was negatively correlated with the score of intention to stay ( P=0.001). Among support staff, female gender, monthly income, years of primary care service, self-evaluation of unit support function, and PA scores were positively correlated with the score of intention to stay (all P<0.05), while EE score and DP score were negatively correlated with intention to stay (all P<0.05). Conclusions:The intention to stay of PHWs in China during the COVID-19 was at an intermediate level, which was affected by many factors. Among them, job satisfaction was positively correlated with the intention to stay of all occupational categories, and the influencing factors of different occupational categories have some variations.

Objective:To develop standards of hospice care specialized clinical training base for general practitioners.Methods:Twenty nine experts in fields of general practice and hospice care were invited to participate in two rounds of Delphi expert consultation from April 2022 to August 2022. Based the results of Delphi consultations the standards of clinical training base for general practitioner hospice care specialized training were developed through data analysis, synthesis and process.Results:The age of 29 consulting experts was (52.9±8.9) years old, and their working years were (17.0±7.2) years, 69.0% (20/29) of them had senior professional titles. In the two rounds of expert consultation, the expert positive coefficient was 100.0% (29/29) and 96.6% (28/29), the expert authority coefficient was 0.791 and 0.830, and the expert opinion coordination coefficient W of the importance of all indicators was 0.177 and 0.296, respectively ( χ2=133.54 , 223.46; P<0.01). Finally, a set of clinical base standards for general practitioner hospice care specialized training was established, which consisted of 4 first-level indicators and 23 second-level indicators. The 4 first-level indicators were basic conditions, teaching conditions, teacher conditions and teaching management, with the weight coefficients of 0.250, 0.250, 0.251 and 0.253, respectively. Conclusions:The clinical training base standards of hospice care specialized training for general practitioners have been established in this study, which will be helpful in selecting appropriate hospitals as the specialized clinical training base for general practitioners.

Objective:To evaluate the application of modular teaching program in the clinical competence training for community general practitioners.Methods:This was a cross-sectional study. A 140 teaching hour-modular training program was designed by the authors on the basis of the previous training experience and conducted in clinical competence training for 20 general practitioners (study group) from all 10 community health service centers in Shanghai Huangpu district between September 2022 and April 2023; and 26 general practitioners who planned to participate in the next batch of training courses were enrolled as the control group. The clinical competence assessment was conducted in May 2023, including knowledge level tests and clinical skill assessment. By comparing the scores of clinical competence assessment and satisfaction survey between two groups, the training effectiveness was evaluated.Results:Among the 46 general practitioners, 33 (71.7%) were female, aged 27 to 47 (37±6), working in general practice for 2 to 25 (9.4±5.5) years, 31 (67.4%) had participated in standardized residency training for general practice and 31 (67.4%) were contracted family doctors. The total score of 46 general practitioners was 69.7±9.6, and 68.9±8.6 for knowledge level and 69.8±10.6 for clinical skills. The total scores and single scores of trained participants were all significantly higher than those of untrained(all P<0.05). The multiple linear regression model showed that after controlling for gender, age, educational background, professional title, years of working in general practice, participation in standardized residency training, and status as a contracted family doctor, the trained participants had significantly higher scores in history collection, pediatric reception, indwelling gastric tube and abdominal puncture (all P<0.05). There was no statistically significant difference in the scores in knowledge level test, nervous system physical examination, SOAP medical record writing, and tutorium between the trained and untrained groups (all P>0.05). Among 20 general practitioners who completed training, the overall satisfaction score of the training program was 4.3±0.7 points, including 4.3±0.6 for the training course, 4.3±0.7 for teachers, and 4.3±0.7 for the organization and arrangement; 85% of the participants considered the training to be very helpful or helpful for improving their competence, and 90% considered the training to be very helpful or helpful for their future work. Conclusion:Modular teaching program is helpful to improve the clinical competence of community general practitioners, especially in clinical skills.

Objective:To develop standards of hospice care community training base for general practitioners.Methods:Twenty-nine experts in general practice and hospice care from different teaching hospitals and community health service centers were invited to participate in two rounds of Delphi consultation from April to August 2022. Based on the consultations a set of standards of hospice care community training base was developed.Results:The age of experts was 38-75 (52.9±8.9) years, and their working years were 5-32 (17.0±7.2)years. In the two rounds of expert consultation, the expert positive coefficient was 100.0% (29/29) and 96.6% (28/29), the expert authority coefficient was 0.791 and 0.830, and the expert opinion coordination coefficient W of the importance of all indicators was 0.137 and 0.289, respectively ( χ2=114.83, 226.94; P<0.05). A set of hospice care community training base standards for general practitioner was established, which consisted of 4 first-level indicators and 27 second-level indicators. The 4 first-level indicators were basic conditions, teaching conditions, teacher conditions and teaching management, with the weight coefficients of 0.247, 0.248, 0.250 and 0.252, respectively. Conclusion:The standards developed in this study may be used for constructing and evaluating hospice care community training base for general practitioners.

Objective:To compare the breadth of condition coverage, accuracy of suggested conditions and appropriateness of urgency advice of the 8 symptom assessment mobile applications (APPs) available on the Chinese market.Methods:The APPs were assessed using 200 primary care vignettes and were measured against the vignettes′ standard. The primary outcome measures were proportion of conditions covered by an APP, proportion of vignettes with the correct primary diagnosis,and proportion of safe urgency advice.Results:For APPs assessed,condition-coverage was from 29.0%(58/200)to 99.5%(199/200), top-3 suggestion accuracy was from 8.5%(17/200) to 61.5%(123/200), the proportion of safe urgency advice was from 84.8%(167/197) to 99.5% (198/199).Conclusions:The APPs showed a wide range of coverage, safety performance and condition-suggestion accuracy. Symptom assessment APPs with good performance could be used by general practitioners as supporting tools. However, even symptom assessment APPs with excellent performance need to be further assessed in a real clinical environment.

Objective:To construct an evaluation scale for post competence of family doctors based on knowledge-skill-management model.Methods:The evaluation dimensions and indicators for post competency of family doctors were preliminarily developed through literature review, internal group meeting and brainstorming, and in-depth interviews of experts. And 16 experts in the fields of general practice and health management were invited for 2 rounds of Delphi consultation from December 2020 to April 2021. A competency evaluation scale for family doctors based on the dimensions of knowledge, skills and management was finally constructed.Results:The age of the experts was (47.9±7.3) years with a working experience of (24.6±7.8) years. The Cronbach′s α of the questionnaires was 0.891 and the KMO was 0.844. The positive coefficients for 2 rounds of expert consultation were 100%; the familiarity level of experts was 0.86 and authority level was 0.89 in the first round consultation, and those were 0.84 and 0.90 in the second round consultation. After 2 rounds of consultation, the coordination coefficient of expert opinions in the knowledge and skill dimensions was>0.5, and that in the management dimension and overall evaluation system was>0.3. After discussion 2 indicators were deleted in the first round of consultation. The finally constructed family doctor post competency evaluation scale included 3 dimensions, 8 secondary indicators and 61 tertiary indicators. Conclusion:Through the Delphi consultation, we have successfully constructed an evaluation scale for post competence of family doctors based on the three dimensions of knowledge, skills and management.

The standardized residency training of general practice is a complex project, the functional departments of the training base should play an active role for its management. The functional department of education in Zhongshan Hospital constantly explores its position and role, connects relevant departments vertically and horizontally to provides management and service for general practice residency training. That means that it should not only to provide advice for leadership decision-making, but also coordinate with all functional departments of the training base. The department has participated in the teaching management and supervision, educational research and training quality control, and accomplished positive results in general practice residency training for last 35 years.

Objective:To explore the effect of family doctor-specialist dual-contract service model on the management of type 2 diabetic patients in the community.Methods:Two hundred patients with type 2 diabetes mellitus (T2DM)who were treated in Changfeng Community Health Service Center between February 2019 and January 2021 were selected as the study objects by cluster sampling method. Patients were randomly divided into study group and control group with 100 cases in each group. The control group was managed with the conventional family doctor contract service, and the study group was managed with the family doctor-specialist double contract service. After one year of management, the fasting blood glucose, 2 h-postprandial blood glucose, glycosylated hemoglobin, diet control, blood glucose monitoring, medication compliance, exercise and other health behaviors, quality of life and satisfaction of patients were compared between two groups.Results:After intervention, fasting blood glucose, 2 h-postprandial blood glucose and glycosylated hemoglobin in the study group were significantly lower than those in the control group ( t=10.29, 8.49, 7.99, all P<0.05); the health related behaviors such as diet control, exercise behavior, blood glucose monitoring, and medication compliance in the study group were significantly better than those in the control group ( t=9.78, 6.72, 39.81, 7.88, all P<0.05); the quality of life in patients of study group was higher than that of the control group ( P<0.05); the satisfaction rate in study group was higher than that of control group (90.0% vs. 69.0%, χ 2=6.39, P=0.031). Conclusion:Compared with conventional family contract service model, the double contract service improves patient self-management, helps to reduce the blood glucose level and gains high patients′ satisfaction, which is worth promoting and applying in the management of type 2 diabetic patients in the community.