Study On The Competency Of Physicians In One Tertiary General Hospital In Shanghai

Hospital is a knowledge-intensive organization. Medical treatment is a special professional content with high technology and multi-professional collaboration. With the development of our social economy, the improvement of people’s living standards, the change of disease spectrum, the problem of the aging, the medical system of our country is constantly reforming. The competition among the medical organizations is increasing. To improve the level of medical technology is the eternal theme of hospital. However, the application and development of advanced medical technology are based on excellent physicians. And the strategy of enhancing hospital with professional talents is regarded as an essential instrument for sustainable development of hospital. China’s resident training program began in 1921. Shanghai has established the system for resident training in advance in early 2010. China is one of the countries that have not yet established the system for resident training. Western medical education, the United States of America for example, has experienced three major reforms. In December 2010, Lancet issued a report about Health Professionals for the New Century. This report generally expounds the shaping of comprehensive physicians with competency as core. The research of competence began in the 1970’s in the United States. But the domesticstudy in this area has started lately. There is no clear definition of core competency for physicians in China by now. Meanwhile, the standards of selection and training are abstract and cannot evaluate the truly competency in all. As a result, hospitals are confused how to select and train physicians with competency. Developed countries in West, the United States of America for example recently have been taking action to increase the quality of residence training program by the development of Competency-based Education and Competency-based Assessment. It aims to establish the index of competency to evaluate the training program and help the policy-makers to perfect the program.The purpose of this exploratory survey was to establish the model about the competency of physicians. We made analysis about the competency of physicians from one tertiary-care general hospital in Shanghai (hereinafter short for’A Hospital’) by the model. The result can help the policy-makers to promote the training program. Meanwhile, this model can be applied to evaluate other tertiary-care general hospitals in Shanghai.The survey included five aspects about establishing the model of the competency of physicians from tertiary-caregeneral hospitals in Shanghai, the training program of A hospital, the performance of physicians from A hospital in clinical, teaching and research areas, the competency of physicians from A hospital, the difference between the competency of physicians who had been selected in the training program or not.The method of the survey contained the literature review, the expert group, the Delphi method, the questionnaire of the competency of physicians. We used the computer statistic software SPSS to analyze data. The questionnaire was divided tothree parts. The first part was the Delphi method (two rounds).32 experts took part in the survey and the response rate was 100%. The second part was the self-assessment. Totally,300 physicians were surveyed and the effective response rate was as high as 92%. The third part was the official-assessment. The effective response rate was 100%.The aim of the survey was to establish the model of the competency of physicians in Shanghai which included 3 first-grade indexes (including cognitive ability, technical ability, attitude and value),10 second-level indexes (including the core knowledge, knowledge acquisition and application, clinical skills, clinical judgment, clinical teaching ability, clinical scientific research ability, interpersonal skills, management ability, habits of mind, affection and morality),54 third-level indexes (clinical knowledge, operation skills, Table 2). Every index was with effective coefficient of authority and Kendall. The result showed the model can be used to evaluate the competence of physician from tertiary-care general hospitals in Shanghai.The survey showed that the total competency of the physicians (4.22) was at high level. The results of the self-assessment and the official-assessment were the same. So the date analysis followed the self-assessment. The indexes of knowledge acquisition and application(4.20), clinical skills (4.28), clinical judgment (4.30) clinical teaching ability(4.22), interpersonal skills(4.41), management ability (4.16), habits of mind (4.34), affection and morality (4.35) listed in front. But their humanities knowledge was at the middle level, such as maternal and child health care knowledge (3.42), EPI knowledge (3.46), health economics (3.47), health policy (3.54), the legal knowledge (3.64) and the social medicine (3.83). Additionally, the index of clinical research ability (3.93) was at themiddle level, especially on the parts of the choices of research topics (3.85), implementation of scientific research (3.95), thesis writing ability (3.90). In analyzing the opportunities of clinical operations, we found 19.6% of the physicians had less chance, especially below 30 years old.The T Test and the ANOVA Test showed that the total competency was not related with sex, clinical department, graduate institutions. But the total competency was different among different ages, opportunities of clinical operations and the training program. The older the physicians were, the higher the competency they had. The more opportunities the physicians had, the higher the competency they had. The physicians with the training program had higher competency than those without the program. The competency of clinical teaching and clinical research was related with educational background. The higher educational background the physicians had, the higher the clinical teaching and clinical research competency they had. The Logistic Regression Analysis showed that the training program was the key point to influence the competency by controlling basic features and opportunities of clinical operations. By the Logistic Regression Analysis, we discovered that the competency had close relationship with the performance. So we could improve the performanceby enhancing the competency.According to the results, the following measures should be taken. First of all, the hospital should pay more attention on teaching the young physicians with making clear of the qualification of supervisors and providing effective incentive system. Secondly, the hospital needs to focus on improving the humanities of supervisors by learning experience from aboard, such as the PBL courses (Problem-Based Learning, PBL). Thirdly, with the main purpose of improving the diagnoses and treatment level and not just for SCI and promotion, the physicians should be inspired to promote their clinical research competency. The hospital needs to make further cooperation between clinical research and basic research by connecting with different clinical departments, constructing clinical specimen database and labors. Lastly, the hospital should offer overall development for clinical ability, teaching ability and clinical research ability. Through various medical teaching activities, the hospital should raise the understanding of the importance of clinical work from all physiciansto increase clinical teaching ability and clinical research ability in the same time.