| Objective: The training of general practitioners(GP)is an important talent guarantee for the implementation of a graded diagnosis and treatment system and realization of Healthy China 2030.A GP training system in line with Chinese characteristics had been initially established,of which the standardized general resident physicians(GRP)training program is the most important part.Primary care competence is a core ability for GRP,but there is a lack of research on the evaluation of primary care competence for GRP.The aim of the study was to construct a better suitable primary care competence evaluation index system(EIS)and exam plan for GRP in China by using mixed methods research.Methods: This study included two parts: construction of an EIS and empirical study of exam application.The first part of research on the construction of an EIS included four research steps.(1)Selecting five representative competency frameworks from literature for description,explanation and comparison,extracting evaluation indexes for EIS,and generating an evaluation index pool.(2)Using one-to-one in-depth structured interviews with 12 GPs to add new evaluation indexes and generate a preliminary EIS through coding of the interview content.(3)Optimizing the evaluation index and determining the EIS by Delphi method consultation with 25 GP experts.(4)Obtaining opinions of GRP on the EIS by an online questionnaire survey from 467 GRPs with primary care experience.The second part was the empirical study of exam application.The assessment scheme for primary care competence was designed and applied through three research steps.(1)Through literature search,according to the form of clinical practical skills assessment,comparing the advantages and disadvantages of common clinical ability evaluation methods,and designing the exam stations and assessment methods of primary care competence.(2)Establishing the exam plan of primary care competence for GRP,including exam station assessment items,exam methods,exam duration and item weighting,by Delphi method consultation with 15 GP experts.(3)Using the empirical research method,by a practical skills assessment and feedback questionnaire with 149 GRPs,to demonstrate and evaluate the primary care competence exam for GRP.Results: A primary care competence EIS for GRP had been constructed and applicated by construction of the EIS and exam application.This study completed the construction and application of a primary care competence EIS for GRP through two parts: EIS construction and empirical researchPart 1: The construction of primary care competence EIS for GRP.(1)Establishing the evaluation index pool.Five representative competency frameworks of GP were compared,including the training content and standards of the Chinese GRP program,the competency model of Chinese clinical doctors,the competency model of GPs in Britain,the competency model of FPs in Canada and the milestones model of FPs in America.Sixty-five indexes were selected to establish the evaluation index pool,which included 5 level-1 indexes,21 level-2 indexes and 39 level-3 indexes.(2)Generating a preliminary EIS.In this stage,in-depth interviews with 12 GPs were completed,with a total of 469 minutes and 81,278 words generated from the interviews.Open coding,axial coding and selective coding were used to code the interview content.A preliminary EIS with 120 indexes were generated,including 8 level-1 indexes,25 level-2 indexes and 87 level-3 indexes.The level-1 indexes included theoretical knowledge,physical examination(PE),basic skills operation,auxiliary exam interpretation,clinical reasoning,medical documents writing,communication and health management.(3)Optimizing and determining the EIS.Three rounds of Delphi expert consultation were completed with 25 GP experts,with a 100% response rate and 0.808 authority coefficient.The Kendall’s coefficient of concordance W was 0.663 for level-1 indexes,0.673 for level-2 indexes and 0.605 for level-3 indexes.The indexes were optimized according to the mean,full score frequency and variation coefficient boundary value.Two indexes were added and 14 indexes were deleted,with 108 indexes remaining.The final primary care competence EIS for GRP included 8 level-1 indexes,24 level-2 indexes and 76 level-3 indexes.(4)Obtaining the opinions of GRPs.A total of 325 GRPs participated in the survey,with a 69.59% response rate.Cronbach’s α coefficient was 0.994,and KMO was 0.975.All evaluation indexes were rated as necessary(mean >3.0)by the GRPs.Part 2: Empirical study on the application of the exam of primary care competence EIS for GRP.(1)Designing the exam stations and selecting exam methods.Seven exam stations were designed from primary care competence EIS,including clinical reasoning(S1),medical examination report writing(S2),health education(S3),general consultation(S4),general PE(S5),SOAP case report writing(S6)and basic skills operation(S7).Four exam methods were selected,including written test,simulated practice with virtual patient,standardized patient and model simulation.(2)Establishing the exam plan.Three rounds of Delphi expert consultation with 15 GP experts were completed,with a 100% response rate and 0.797 authority coefficient.The Kendall’s coefficient of concordance W was 0.810.The GP experts gave a high degree of necessity(9.40-9.87)and effectiveness(8.80-9.53)for all the seven stations.The suggested time duration of each station was during 14.40-15.00 min,except for medical examination report writing,which was 11.00 min.The average score weight of each station suggested by experts was 11.53%-15.47%.The final exam plan of primary care competence for GRP determined that the exam stations and methods should remain unchanged,with two kinds of assessment duration(10 min and 20 min)and three kinds of score weighting(10%,15% and 20%).(3)Practical application and evaluation scheme.A total of 149 GRPs finished the primary care competence exam.The satisfaction of each station was 3.27-4.11,reaching the level of satisfied or very satisfied.The overall score rate and difficulty coefficient was 0.74.The overall scores were mostly in 65-85 point range(83.22%).The score rate and difficulty coefficient was 0.70-0.78,and the discrimination was 0.44-0.69 for each station.According to characteristic curve of each station,the discriminations of S1,S2,S3 and S7 were good for different levels;the discriminations of S4,S5 and S6 were mostly good but not for some levels.Conclusion: A primary care competence EIS for GRP was established in this study,which had eight level-1 indexes including theoretical knowledge,physical examination,basic skills operation,auxiliary exam interpretation,clinical reasoning,medical documents writing,communication and health management.These effectively represent the primary care competence needs for GRP.The assessment plan for GP includes seven stations,including clinical reasoning,medical examination report writing,health education,general consultation,general PE,SOAP case report writing and basic skills operation,which can effectively meet the assessment needs of primary care competence evaluation for GRPs.The study has positive significance for exploration,extension and application,and provides basis and reference for further research on the training of general residents. |
