| BackgroundGeneral practitioners (GP), also known as the family doctor, are the practitioners of general medicine theory and providers of general health service. Doc.Dicon of WONCA said "If any country’s health-care system is not based on the well-trained GP, it doomed to pay a high price." In recent years, our country pays more and more attention on the cultivation of GP. In 2011, the State Council issued the "Guiding Opinions on the Establishment of a General Practitioner System" which pointed out that the establishment of GP system is helpful to improve the health of residents and good to upgrade the primary health care level as well as an important measure to transfer medical and health services modes. It highlights the importance and necessity of GP in the health service. In 2015,13 academicians of Chinese Academy of Sciences and Chinese Academy of Engineering proposed together that we need to develop general medicine, to train GP and to implement grading treatment.In 2014, elderly population of Guangzhou is over 1.41 million and the ageing rate is up to 17%. The resident population of Guangzhou is 13.08 million by the end of 2014 and 85.43% of which are urban population. The large population of urban and the elderly residents bring great pressure to the development of medical and health services system. GP are known as the "gatekeepers" for residents’health in community which play a crucial role in alleviate the pressure. In 2015, Guangzhou has implemented the medical association. It sets up a primary initial diagnosis, two-way referral, acute and chronic triage, upper and lower linkage hierarchical treatment model step by step. It is necessary to strength the construction of primary health care personnel team which means that to speed up the training of GP is of great significance. The "Opinions on the Establishment of GP System" was issued in Guangzhou which proposed to train GP in "5+3" model step by step. Combined with the actual situation of Guangzhou, there are 2 ways of standardized training of GP:which are "clinical medicine graduate education" and "standardized training after graduation".ObjectivesStandardized training of GP is the main way of GP training. To strengthen the construction of GP team is helpful to provide CHS continuously. This paper first made a comparative analysis of GP training modes at home and abroad and made a research about situation of standardized training of GP in Guangzhou by research literature. And then a questionnaire was designed and issued to 300 medical college students in 3 medical schools so as to understand how much do medical students know about general medicine, the situation and opinions of general medical education of these students and their job-hunting intentions and major influential factors. In addition, the study adopted the method of in-depth interviews on present situation and prospect of GP education and 12 GP were interviewed. Last but not least, to analysis and discuss the issues affecting standardized training of GP and then make the corresponding recommendations.MethodsLiterature research. To study the development of general medicine and the background of GP training by sorting out a large number of literatures; to learn and draw lessons from foreign general practitioner training experience; to explore the status of the standardized training of GP and major problems in Guangzhou.Questionnaire. The main trainees of standardized training of GP are mainly graduates. According to the requirements of GP standardized training enrollment target, students of clinical medicine classes, traditional Chinese medicine classes and traditional Chinese and western medicine classes were selected as the respondents. The contents of the questionnaire included 5 aspects, which were the basic situation, the cognition of the contents of GP education, the situation and opinions of general medical education, the cognition and opinion of the standardized training of general practitioners, employment intention and its influencing factors.Semi-structured interviews. The study adopted the method of in-depth interviews on present situation and prospect of GP education and 12 GP were interviewed.Statistical analysis. Excel 2010 office software was used to input data and construct databases; SPSS 20.0 statistical software was used for descriptive statistical analysis. Count data shows in rates or proportions. Level data using nonparametric test for statistical inference, P< 0.05 as the difference was statistically significantResults1. Questionnaire survey:< 1) The awareness on the GP education of medical students was not high. Most of the medical students do not understand general medicine, CHS, GP and general medical deeply. Less than 50% medical students agree that GP can solve most of the health problems.64.29% medical students are not sure or not agree that general medicine is a discipline.(2) General medical education at college is not fully carried out. Less than 50% medical students took part in both the general medical course and practice. The medical colleges should improve the general satisfaction of students who took part in the general medical course or practice. The result also shows that medical students would like to join in the general medical practice. The practice forms they prefer are trainee, internship, cases studies and discussions, visits, etc.(3) The awareness on the content about standardized training of GP of medical students was not high.81.09% students show that they know a little or do not know at all about the content of standardized training of GP or related policies. 40.34% students consider that the standardized training of GP or related policies are macro and not operability.48.74% students think that the policies are confusing and need further improvement.(4) The willingness to participate in GP standardized training and to become GP of medical students was not high.15.13% students show that they are willing to join the GP standardized training.63.03% students say they will join the training if there are no other options.21.85% students expressed their reluctance clearly. The reasons that students want to be GP are "low pressure", "need not on duty at night", "have holidays", and "have good relationship with patients" and so on. The reasons that students do not want to be GP are "poor benefits"、"cannot trust by residents"-、 "job content do not match with expectation、 "no prospects" and so on.(5) Different professions, different understanding levels to general medical and related content as well as different attitudes towards career prospects of medical students have different willingness to participate in standardized training of GP and the difference was statistically significant (P< 0.05).2. Interview:(1) There are many problems in general medical education. General medical education system is not perfect because it lacks of coherence and relevance. In the undergraduate stage, not many universities offer general medical theory and practice courses. Medical students do not understand general medicine and GP well. They have no idea about the prospects of career development of GP. The time of general practice is short, some medical students do not pay attention on the practice. In career guidance class, it is lack of career planning guidance of GP for medical students. At the standardized training of GP stage, the training content is not suitable for trainees. The knowledge and skills Trainees learned at the hospitals cannot be used at the CHS institutions. Continuing education stage, GP do not have methods and time for self-improvement, continuing education of GP do not truly implemented.(2) There are many problems in the process of career development. The performance distribution of GP is unreasonable. GP are paid with low salary. There is no legal to protect occupational safety of GP. There is no path for career advancement of GP. They have too many works to upgrade themselves. The social status of GP is low. Residents do not know CHS well that it is difficult for GP to carry out the work.Conclusion1. The standardized training of GP has implemented for many years. There are more and more teaching sites and general medical teachers. But the enrollment rate is 29.733in 2014 and 20% in 2015.84.87% medical students are not willing to take part in the standardized training of GP or to be GP when they have no other choices. The number and quality of trainees should be improved.2. Developed countries have standardized modes on GP training including three stages:basic general medical education at the medical college, standardized general medical education after graduation and continuing medical education which link up effectively. The general medical education system has not been established in Guangzhou, general medical education at each stage should be improved.3. Not many colleges offer general medical education. Medical students do not know general medicine or related content well. The proportion of willing to become GP among these students is low than the students who know general medicine well.4. There are still many problems in the process of developing career for GP. The proportion of willing to become GP among students who feel confused with the prospect of career of GP is lower than students who feel optimistic.5. Improve training mechanism of GP. To set up the general medical education system which including three stages:basic general medical education at colleges, standardized general medical education after graduation and continuing medical education.(1) The basic education covering three aspects:general medical publicity for juniors, general medical related theory courses and general medical practice for students of different grades, career guidance for seniors.(2) At the standardized training stage, it needs to study foreign advanced experience and do the local research work. And then improve the training program with reasonable training content and training time.(3) The GP continuing education system need to be built. Let GP know the continuing education requirements. Strengthen the assessment of the continuing education of GP. Improve the quality of GP further.6. Perfect the development mechanism of GP, clear the career prospects of GP.(1) Increasing investment in primary health care and improve the performance appraisal system of GP.(2) Establishing GP clinics norms. Avoid medical risks faced by GP.(3) Clearing GP positioning and their work content, accelerate the construction of general services team.(4) Strengthening the propaganda of CHS. Improve the social status of GP.(5) Setting up the GP professional title assessment system and speed up the implementation of multi-practice policy. |
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