Study On Standardized Training Of General Practitioners And Self-evaluation Of Post Competence In Shanxi Province From The Perspective Of Trainees

Objective:The purpose of this study is to compare and analyze the basic situation,clinical practice and cognitive status of the general practitioners(GPs)in the process of participating in the training of the GPs based on the competency requirements of the GPs,and then discover the problems and deficiencies in the training.It provides a theoretical basis for further optimizing the quality of standardized training of GPs and improving the effect of standardized training of GPs.Methods:This study used self-made questionnaire and post competency index system for GPs that built by Wang Jing and others in 2016 to conducte a survey of the trainees of 11 standardized training bases for GPs in Shanxi Province in 2018;Then the retrieved questionnaires were built using Epidata 3.1,and the data were collated and analyzed using SPSS 19.0 and LISREL,including descriptive analysis of clinical practice status and cognitive status,Single factor analysis of post competency scores and the Analysis based on structural equation modeling.Results:1.In the trainees' cognition survey,nearly 10% of the trainees did not know much about the training-related system,5% of the trainees thought that the training was unnecessary,and 4% of the trainees thought that the training was not helpful;the overall satisfaction score of the trainees was 3.62±0.733,at a medium level,especially with the lowest satisfaction rate(3.02±0.994),which was one of the most important factors for trainees' perceived pressure,which may affect their enthusiasm and initiative.2.During the rotation training of the department,only 26.22% of the trainees thought that the rotation plan was reasonable.The survey found that the trainees' recognition of the rationality of the rotation plan was not high,the examination method was not standardized,and some departments gave insufficient teaching grants to the trainees.There were some problems such as the phenomenon of “Emphasis on Use but Less on Cultivation”,which made the quality and effectiveness of training poor.3.In the survey of the trainees' self-assessment scores,the public health service capacity was still the lowest(6.68±1.773),and the trainees' ability acquisition in "general practice,community health service and public health" is poor,which is contrary to the goal and requirement of the standardized training of GPs.The reason may be related to the current rotation plan of GPs' training which still follows the previous specialized training.The rotation training of clinical departments is the main method,which leads to insufficient training on general practice and grass-roots practice.4.The standardized path diagram of the structural equation model for the competency,training and cognitive situation of the trainees shows that the training situation of the trainees has a direct impact on the cognitive situation and the competency of the post,the effect is 0.44 and 0.27 respectively;cognitive that there is a direct impact on the competency of the post,the effect is 0.12;and the training situation of the trainees has an impact on the competency of the post through cognitive situation,the indirect effect is 0.053,and the total effect is 0.323.Conclusion:1.In the training,it is necessary to constantly improve the rationality and scientificity of the department rotation training plan,highlight the nature and characteristics of general practitioners in training,so as to construct a set of standardized training rotation schedule with general practice' characteristics and meet the needs of GPs' competence.2.The training base management department and the clinical department should continuously improve the training and evaluation system,and formulate uniform assessment standards according to the characteristics and capacity requirements of the department,and strictly implement them.At the same time,they should also actively communicate with the trainees and clinical teaching physicians,and constantly revise and adjust the deficiencies in the training plan according to the actual training situation to ensure the rationality and scientificity of the training plan.3.In the training,it is necessary to strengthen publicity and education on the training-related system,deepen trainees' cognition of training system and policies,then improve their understanding of the importance and necessity of standardized training of GPs and the competency requirements of GPs,so that they would have high purpose,enthusiasm and creativity in learning.4.The training base should strengthen the construction of teachers,especially in the context of that GPs' training is still carried out by rotating training in clinical specialist departments.It should focus on strengthening the faculty's ability and awareness of general practice,focusing on improving the concept of general practice.The base should focus on strengthening the faculty's ability and awareness of general education,focusing on the promotion of general practice philosophy,general medical thinking,and the training requirements and training mode for GPs.5.The training base should continuously improve the salary design of the trainees during the training period,strengthen the implementation of the government's special funds for GPs' training,improve the remuneration and living standards of the trainees,and enhance the satisfaction of the trainees in the standardized training of GPs,and thus improve trainees' learning initiative and enthusiasm.