Comparison of general practice residents' attitudes and perceptions about training in two programmes in China: a mixed methods survey

Analysis of inequality in the distribution of general practitioners in China: evidence from 2012 to 2018

Aim:

This paper aims to analyze the inequalities in general practitioner (GP) distribution in China.

Background:

GPs-based primary health care (PHC) has been implemented from 2011 in China, aiming to improve the accessibility and quality of basic medical and healthcare services. GPs in China, as the gatekeeper of people’s health, mainly undertake integrated health services at the grass-roots level.

Methods:

The number of GPs and inequality in GPs distribution from 2012 to 2018 was analyzed by the Lorenz Curve/Gini coefficient and Theil L index. Data were extracted from China Health Statistical Yearbook 2013–2019.

Findings:

The demographic Gini coefficient of GPs changed from 2012 (0.234) to 2018 (0.167), showing high equality in China. In contrast, the Thiel L index from 2012 (0.372) to 2018 (0.345) showed less equality. The decomposition of Thiel L index implicated the inequalities within the divisions. The number of GPs in China shows a fast growth trend since the general practice system established, and the GPs distribution becomes more demographically equitable. However, the shortage of GPs and inequality in their distribution remains severe. More incentive and supportive policies need to be made to enhance the quantity, quality, and structure of GPs in China.

Satisfaction of Clinical Teachers on Standardized Residency Training Program (SRTP) in China: A Cross-Sectional Survey

BACKGROUND

The Standardized Residency Training Program (SRTP) is a significant initiative to deepen health systems and medical education in developing countries like China. Despite the promotion of the SRTP nationwide and its implementation with various improvements, Chinese continuous medical education is still in its infancy. Compared with the residents, little is known about clinical teachers under the SRTP in China. However, clinical teachers effectively determine the training quality as critical disseminators of knowledge, skills, and values in medical practice. Thus, the study aims to analyze critical factors affecting their cognitive job satisfaction and provide continuous improvements for SRTP.

METHODS

From 1 December 2018 to 31 May 2019, we conducted a self-designed questionnaire with 13 SRTPs (including both training bases and professional bases) in Shaoxing city to evaluate clinical teachers' satisfaction. Altogether, 574 clinical teachers responded to the survey expressing generally high overall satisfaction. We adopted a Chi-square test and Fisher's Exact Test to evaluate the single impact factors affecting the satisfaction of clinical teachers. The multiple factors analysis applied the logistic regression model.

RESULTS

The male clinical teachers had significant differences in satisfaction with the teaching content (OR: 0.675, [95% CI: 0.477~0.953]), conflicts between study and work (OR: 0.542, [95%CI: 0.371~0.791]), the attention of leaders (OR: 0.403, [95%CI: 0.252~0.645]), and the subsidies of teachers (OR: 0.527, [95%CI: 0.347~0.805]). Compared with internal medicine, clinical teachers from surgery (OR: 2.396, [95%CI: 1.365-4.206]) and other departments (OR: 2.409, [95%CI: 1.406-4.129]) were more satisfied when they considered that residents have high motivation to attend training. In addition, compared with the attending physicians, the deputy chief physicians (OR: 0.493, [95%CI: 0.310-0.783]) and the chief physicians (OR: 0.683, [95%CI: 0.471-0.991]) disagreed more regarding the residents' wage being good enough.

CONCLUSION

Clinical teachers widely recognize the SRTP. However, teachers' satisfaction varied due to different genders, working departments, and professional titles. The study also discussed possible reasons and strategy implications behind these findings, which combined unique Chinese society characteristics. Further, we believe the analysis and interpretations remind us of the applications of residency training methods from other Western countries, which should also consider the unique socio-cultural challenges.

General practitioner trainees' career perspectives after COVID-19: a qualitative study in China

Background

The coronavirus disease 2019 (COVID-19) has been a worldwide public health emergency that has put great pressure on medical workers and the medical system. General Practitioners (GPs) played an important role in controlling the epidemic, and GP trainees also took an active part in this approach. This study was to explore Chinese GP trainees’ career perspectives after COVID-19.

Methods

We conducted a qualitative research study which included 12 GP trainees from three teaching hospitals in China. Semi-structured telephone interviews were conducted. Grounded theory and thematic analysis were used to code the data and identify categories and factors.

Results

Eleven participants chose to continue a GP career after COVID-19, and nearly half of the participants strengthened their determination to dedicate themselves to this career. Only one participant decided to change the career choice because of interest in another specialty. Four main themes influencing GP trainees’ perceptions of career development after COVID-19 emerged from the interviews: changes of GPs’ work content in COVID-19, challenges of being a GP, psychological changes of the career, how to provide better primary care. Although some negative psychological changes existed, most of participants were inspired by role models and medical colleagues. They had more in-depth understanding of GPs’ role and responsibility during COVID-19, and exhibited intensions for self-improvement in career development, especially in public health education and self-protection in preventing infectious diseases. In addition, the wide use of telemedicine provided a new work way for GP trainees. However, challenges, such as increased workloads, low income, lack of resources in primary medical institutions, and distrust of GPs are faced by trainees during the outbreak.

Conclusions

Overall, no substantial changes were seen in the career choice of GP trainees after COVID-19 outbreak. However, they were inspired and had an in-depth understanding about the GP’s work and responsibility during an epidemic. Owing to the challenges faced by the GPs, measures are needed to improve the GP education and work environment in the training phase.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-020-01364-x.

Family medicine residency training in Ghana after 20 years: resident attitudes about their education

Objective

In addition to assessing educational needs of family medicine trainees in Ghana, we sought to assess whether those entering the training programme aimed to pursue an academic career.

Design

A case study using an anonymous cross-sectional survey through collaboration between faculty members from the family medicine departments of Ghana and the University of Michigan.

Setting

The family medicine postgraduate trainees and the most recent graduates in the three training sites, Accra, Kumasi and Mampong, as well as modular residents in Ghana served as the targeted participants during data collection between October and November of 2018.

Participants

Second and third year family medicine residents, fellows (known as senior residents in Ghana) and recent graduates were invited to participate in this study. Thirty-five of 77 eligible subjects provided responses (46% response rate), but five records were eliminated due to incomplete data to yield a survey completion rate of 39% (30/77).

Result

Participants were mostly men (n=19), and the average age of respondents was 37 years old. The participants indicated the residency programmes needed more faculty 97% (n=29), supervision during outpatient care 87% (n=26) and lectures 83% (n=25). The main reason provided by respondents for entering residency programme in family medicine, which is currently not required for practising primary care in Ghana, was to obtain more education 93% (n=28). Participants who had completed the residency programme were much more likely to be interested in becoming faculty compared with those still in residency (p <0.001).

Conclusion

The research confirms the need for more faculty and the importance of investing in faculty development resources for ensuring a robust programme. These findings provide constructive feedback that could improve residency curricula of the local and regional family medicine training programmes and supports investing in trainees and new graduates as future faculty candidates.