| Objective:As the gatekeeper for health,the comprehensive quality and ability of general practitioners have a direct decisive effect on the level of health services in primary medical institutions.Medical education and talent training based on competency is an important feature of medical education reform in the world today.At present,some countries with relatively mature development of general practice,such as the United States,the United Kingdom,and Canada,have put forward systematic competency index systems of general practitioners based on multiple abilities,and the index systems have been used in the training,assessment,and evaluation of general practitioners.Due to the late start of the development of general practice,and the gaps in economic development,the team building of general practice,the level of general practitioners’medical service abilities,and the responsibilities and requirements of the job for general practitioners across China are not the same.The requirements for the ability and quality of general practitioners are not uniform.So far,there is no national-level competency evaluation system for general practitioners that adapts to China’s national conditions.Therefore,it is of great significance to construct a competency index system for Chinese general practitioners to improve the comprehensive quality of general practitioners,establish a competency-oriented training and evaluation model,and promote the development of general practice and the reform of primary health care in China.Materials and Methods:(1)Using the method of literature analysis to collect and study the domestic and foreign training standards,competency index systems of general practitioners,and related literature,and establish the dictionary of competency features for Chinese general practitioners preliminarily.Behavioral event interview was applied and 22general practitioners were interviewed including 11 in the excellent performance group and 11 in the average performance group.According to the competency feature dictionary,the interview texts were coded and analyzed.The dictionary was supplemented according to the interviews.The threshold competency features and the differentiating competency features of general practitioners were extracted by comparing the frequency,average grade scores,and the highest grade scores of the competencies between the excellent performance group and the average performance group.(2)Based on the results of literature analysis and behavioral event interviews,the preliminary competency framework and the Delphi expert consultation questionnaire were developed.A total of 39 experts participated in the consultation.The reliability of consultation results was judged by the indicators,such as the recovery rate of the questionnaire,authority coefficient,arithmetic mean,full score ratio,coefficient of variation,and coordination coefficient.The competency index system of general practitioners was revised and improved,and the weight was determined by the analytic hierarchy process.(3)Considering the geographical and economic situation,10 provinces were selected for the questionnaire survey.General practitioners from different medical institutions were invited to participate in the survey to score the importance of each competency item in the competency index system.Exploratory factor analysis was performed using SPSS 23.0 and confirmatory factor analysis was performed using Amos 24.0 to test the reliability and validity of the model.(4)Descriptive statistical analysis was used for general statistical analysis.T-test and variance analysis were used for univariate analysis.Multivariate linear regression was used for multivariate analysis.SPSS 23.0 was used to analyze the current situation and influencing factors of the importance scores for general practitioners’competency.(5)The six first-level indicators in the competency index system were used as measurement indicators,and the value that is greater than or equal to the average score of the dimension is assigned to 1,otherwise 0.Using the method of latent class analysis(LCA),the potential classes of general practitioners were analyzed according to the importance score by Mplus8.3.Results:(1)The dictionary of general practitioners’competency including 107competency items was constructed.Using the behavioral event interview method,eight threshold competencies of general practitioners were extracted,which were clinical thinking of general practitioners,interrogation and history collection,effective use of information technology for medical communication and patient health education,good cooperation with other teams,awareness of basic services,sincerity,trustworthy,a strong sense of responsibility,professional dedication and self-sacrifice,the physician caring,sympathy and empathy.Two differentiating competencies were teaching ability and critical thinking ability.(2)The response rates for the questionnaire during the two rounds of Delphi were 92.86%and 89.74%,respectively.The authority coefficient of each expert was between 0.8 and 1,and the coordination coefficients of the two rounds of expert consultation were 0.246 and 0.313,respectively(P<0.01),indicating that the experts were concerned and enthusiastic about this study,and the concordant of experts’opinions was good.After two rounds of the Delphi consultation,the competency index system of general practitioners was determined,including 6 first-level indicators and 60 second-level indicators.The names,weights,and the number of secondary indicators of the six first-level indicators were basic medical services(0.312,13),basic public health services(0.061,8),information utilization ability and management ability(0.061,8),medical knowledge and lifelong learning(0.247,10),interpersonal communication and teamwork(0.142,10),and professionalism(0.178,11).(3)Throughout this nationwide survey on the competency of general practitioners,2126 questionnaires were finally recovered and 209 invalid questionnaires were eliminated.1917 valid questionnaires were accepted,and the effective rate of questionnaire recovery was 90.17%.The overall Cronbach’sαcoefficient of the model is 0.984,and Cronbach’sαcoefficient of each core dimension is also greater than0.9.The 1917 valid questionnaires were randomly divided into two groups,979 for exploratory factor analysis and the remaining 938 for confirmatory factor analysis.Five factors were extracted by exploratory factor analysis,and the cumulative explained variance variation was 68.16%.According to the analysis of the expert group,these five factors are consistent with the six dimensions obtained by Delphi.The model fitness index obtained by confirmatory factor analysis is X~2/df=4.909,CFI=0.869,RMSEA=0.065,NFI=0.841.The values of the composite reliability(CR)of the six dimensions are all greater than 0.7(0.943,0.927,0.937,0.927,0.943,0.950),and the average of variance extracted(AVE)are all greater than 0.5(0.562,0.613,0.649,0.563,0.626,0.635).It can be considered that the fitting degree of the model is acceptable.(4)Thel results of questionnaire survey show that the average importance score is 4.53±0.45.The scores of the six core dimensions were basic medical services 4.62±0.44,basic public health services4.48±0.53,information utilization ability and management ability 4.42±0.57,medical knowledge and lifelong learning 4.45±0.54,interpersonal communication and teamwork 4.56±0.49,and professionalism 4.58±0.48.The degrees were considered as‘important’.(5)The results of the univariate analysis show that gender,institution,educational background,and professional title have impacts on the dimension of basic medical services.Gender,age,institution,educational background,professional title and working years of general practice have impacts on the dimensions of basic public health service,interpersonal communication and teamwork,and overall competency.Gender,age,institution,educational background,professional title,working years and economic division have impacts on the information utilization ability and management ability dimension and medical knowledge and lifelong learning dimension.Gender,age,institution,educational background,and working years of general practice have impacts on the professionalism dimension.The results of multiple linear regression analysis show that gender,institution(secondary hospitals,tertiary hospitals),educational background,and professional title(primary,intermediate)were the factors affecting the overall competency.Gender,institution(tertiary hospitals),educational background,and professional title(primary,intermediate)were the factors affecting the importance score of basic medical services.Gender,institution(secondary hospitals,tertiary hospitals),educational background(undergraduate),professional title(primary,intermediate,deputy senior),and working years of general practice(11-19 years)were the factors affecting the importance score of basic public health services.Gender,institution(secondary hospitals,tertiary hospitals),educational background(undergraduate),professional title(primary),working years of general practice(11-19 years),and economic division(central)were the factors affecting the importance score of information utilization ability and management ability.Institution,educational background,and working years of general practice(11-19 years)were the factors affecting the importance score of medical knowledge and lifelong learning.Age(over 50 years old),institution(secondary hospital,tertiary hospital),and educational background(undergraduate)were the factors affecting the importance score of interpersonal communication and teamwork.Gender,institution(secondary hospitals,tertiary hospitals),and education(undergraduate,master)are factors that affect the importance score of professionalism.(6)Based on the importance scores of competency evaluation,1917 general practitioners can be divided into four latent classes,which are the low competency cognition group(34.69%),high professional competency cognition group(5.01%),low comprehensive competency cognition group(15.23%)and high competency cognition group(45.07%).Conclusion:(1)The competency index system for Chinese general practitioners constructed in this study included 6 first-level indicators and 60 second-level indicators,which has good representativeness,authority,and applicability.(2)Based on the method of behavioral event interview,8 threshold competencies and 2 differentiating competencies of general practitioners were extracted.The index system of threshold competency and differentiating competencies has good reliability.(3)According to the importance score of each dimension,general practitioners can be divided into low competency cognition group,high professional competency cognition group,low comprehensive competency cognition group and high competency cognition group.The results of LCA may provide a theoretical foundation and reference for future research. |
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