Evaluation Of Order-based General Medical Personnels Training Mode In Guangxi Medical Colleges Based On CIPP Model

BackgroundMedical professionals are urgently needed in grassroots of China. Thecountry has been implementing “Rural-oriented Tuition-waived MedicalStudents Training Program” since2010, which aims to cultivate general medicalprofessionals who embark on general medicine at grass-level. Many medicalcolleges have joined order-based general medical education and are exploringgeneral medical professionals training. Based on evaluation, education, othertheories and methods to assess educational quality, and determine whether thetraining mode and the curriculum are adapted to the need of order-basedprofessionals cultivation, and whether professionals cultivation quality meetsthe needs of primary health care services have become essential issues ofmedical education that should be urgently solved. CIPP model is extensivelyused in evaluation, and four steps include context, input, process and product evaluation (short for CIPP).Objective1. To investigate the situation of human resources and the demand ofgrassroots general practitioners for health services in Guangxi based on theCIPP evaluation model; to understand the current work situation of grassrootsgeneral practitioners there and make context evaluation of order-based medicaleducation.2. By studying the current situation of order-based general medicalprofessionals’ cultivation of three medical colleges in Guangxi, we can know thebasic information, training mode, teaching forces, curriculum arrangement andteaching reform of order-based general medical professionals’ cultivation, andcarry out input and process assessment of order-based general medicaleducation.3. Adopt SERVQUAL (service quality) model to construct “Educationalservice quality satisfaction scale” used by students, and evaluate the reliabilityand validity of the Scale. Investigate the order-based students’ satisfactiontoward education service quality, grassroots employment intentions, andteaching effects comparing with5-years medical students to assess the productof order-based general medical education.4. Use SWOT (strengths, weakness, opportunities, threats) strategy toanalyze general medical education in medical colleges and propose suggestions.Methods1. Use document analysis to collect, consult, analyze and sort out therelevant policy documents of order-based general medical education and generalmedical education and the current study situation of all medical colleges, andthen conduct higher education evaluation and education service quality satisfaction evaluation, and make a conclusion about the current study situationand trend at home and abroad.2. Use document analysis and expert consultation to design questionnairesfor all types of objects. Use questionnaires, and select general practitioners,medical colleges, teachers and students from grassroots health services asinterviewees to analyze the background, input, process, and products oforder-based general medical education.3. Use group interviews to interview medical colleges’ administers, and toknow their recommendations about order-based general medical educationdevelopment.4. Use mathematical statistics, means, standard deviation, percentage,proportion, T-test, chi-square test, analysis of variance and Binary Logisticnonlinear regression models to sort out, analyze, calculate explain on thecollected data.5. Use SWOT strategic analysis to put forward proposals for medicalcolleges’ general medical education.Results1. In quantity, general practitioners in Guangxi grassroots health serviceshave a big gap; in quality, general practitioners in Guangxi grassroots healthservices got relatively lower education and job title, and their job contents aremainly basic medical work, and public health service is placed in a secondaryposition; their practical skills are backward, and learning abilities are poor.2. On the input of order-based general medical professional cultivation,three medical colleges in Guangxi attach much importance to order-basedgeneral medical education. They invest a lot of manpower, materials andfinancial resources in enrollment scale, institution establishment, goal-setting of professional cultivation, practice teaching base and teaching force construction,etc. The existing theories teaching forces can meet the basic needs of schools’teaching theory courses, but qualified clinical teachers and community teachersare not enough.3. In the process of order-based general medical professional cultivation, allthe three medical colleges in Guangxi formulate separate schemes fororder-based general medical students in accordance with job requirements forgrassroots doctors, and they also explored and tried with different methods incurriculum arrangement and curriculum reform.4.“Educational service quality satisfaction scale” includes six dimensions,fourteen primary indexes and thirty-two secondary indexes. The Cronbach alphacoefficient is0.97and the cranial Pearson’s coefficient is0.96. The commonfactors of the structure validity could explain63.74%of the total variance. Thusthe scale has good reliability and validity. The average score of all projects inthe "educational service quality satisfaction scale" is between2.82to4.15, andthe average full-scale score of Guangxi Medical University is higher thanYoujiang Medical University for Nationalities. In addition, Guilin MedicalUniversity got the lowest score among the three medical universities. Thedimension of students’ satisfaction degree from the highest to the lowest isbelow: reliability, assurance, effectiveness, tangibility，empathy，and reactivity.There exist differences in the average score of students in different grades.However, the personal information, such as gender, nationality, birthplace,whether they are only-child, party members or student cadres or not and so on,has no significant difference to the students’ average score（p＞0.05）.5. Most of the order-based general medical students are under24years oldand75%of them are from rural areas; close to90%of them are none-only child; near90%of the families’ annual per capita income is less than ten thousand;most of their parents are farmers and primary school or middle school graduates.Families’ suggestion and the pressure of no tuition are the main reasons whythese students choose this major. Seventy-three percent of the students arewilling to take up occupations in grass-roots units. Students in Guangxi MedicalUniversity have higher willingness than the students in Youjiang MedicalUniversity for Nationalities and Guilin Medical University. There are only50%to60%of students who are willing to take up occupations in grass-roots units inthe Youjiang Medical University for Nationalities and Guilin MedicalUniversity. Some students have high satisfaction degree of school educationservice quality and short years of schooling, and they are from the Hannationality and understand national policy. Some students’ fathers have lowculture level. Some students’ reason for enrolling is that they want to service thepeople in their hometowns. Moreover, some students are not forced to work inthe grassroots by the contract before enrollment. All of these students are morewilling to take up occupations in grass-roots（p＜0.05）. Teaching effects ofmoral and professional qualities and medical theoretical knowledge betweenorder-based general medical students and5-years medical students show that theorder-based general medical education also has good effect.6. After the interview which centered on the issues such as the currentcultivation circumstance, training mode, teachers, base construction and so on,total twelve teaching management personnels from three medical universities ofGuangxi offered more than10proposals for school education system andgovernment support, and also give good references for the development of theorder-based general medical education. Order-based general medical studentsput forward285proposals for the medical colleges to develop the order-based general medical education. These proposals are mostly focused on curriculaprovision, training scheme, teaching administration, guides for postgraduateexams, construction of teachers, practical teaching, ideological education,policy propaganda, enrolment of students, and the national policies-making andso on.Conclusions1. The quantity and quality of medical professionals in grassroots are farshort of demand. Order-based general medical education can solve thecontradiction between high demands for grassroots medical professionals andthe low employment rate of students at grass-level by order-based training mode,which is an effective way to ease the current tight supply of grassroots medicalprofessionals.2. The results of the “educational service quality satisfaction scale” meansthat the devotion and the implement process of the order-based general medicaleducation gained the approval of students.3. The order-based general medical education has good teaching effect.Students have willing to work in the grassroots medical organization aftergraduation, which can ease the situation of the shortage of grassroots medicalpersonnel. The goal of improving the quality structure of grassroots medicalpersonnel can be achieved by introducing medical personnel who are welleducated and have the background of systemic medical education.4. From the medical colleges’ level and the governmental departments’level, we should put forward the specific measure and suggestion forstrengthening the education of general practice through SWOT strategic analysisand through combining the demand and situation of general practice medicalpersonnel. The measures and suggestion include the establishment of general practice educational system, change of the educational ideas, strengthening ofgeneral practice talents training in the transitional period, completing the systemguarantee and so on.