| Objective:Basing on the purpose of talent cultivation, the post competency of General Practitioner(GP) indicator system is built and tested by empirical research. And it can provide references for understanding the post competency of general practitioners, the selection/training/assessment/evaluation of GPs in medical and health institutions as well as the settings of education courses and teaching key points in medical colleges.Methods:Literatures were used to understand the general situation of the post competency of GPs and establish a competency index system. In order to screen, modify and improve the GP competency index system, Delphi was used for two rounds. Through utilizing AHP,the weight assignment of each index entry were calculated. By using GP questionnaire which was based on the index system, the daily work of GPs and the competence of basic situation were understood. Moreover, the reliability, validity and discrimination of the index system were scientifically evaluated.Results:1. The construction of the index system of GPs’ post competency(1) The expert authority coefficient of Delphi was 0.80. Expert positive coefficient of two rounds were 1 and 0.967 respectively and the coordination coefficient were 0.261 and0.208(P < 0.05).(2) The index system of the GPs’ competency was constructed, including 4 first level indicators, 11 second level indicators and 57 third level indicators. The weight score of 4first level indicators were as follows: basic medical service capacity(0.4829), public health service capacity(0.2957), humanities vocational ability(0.1297) and education learning ability(0.0917).2. The examination of the index system of GPs’ post competency The Cronbach’s coefficients of four dimensions in index system of GPs’ post competence were above 0.9 and the correlation coefficients of indicators were all above0.58. In the exploratory factor analysis, the interpretation ratio of cumulative variance about the four common factors which choosed self-defined was 67.03%. In the confirmatory factor analysis, overall model fit indicators including root mean square residual index(RMR), goodness of fit index(GFI), Tucker-lewis index(TLI), comparative fit index(CFI) and the simple goodness of fit index(PGFI), have reached the requirements of appropriate reference standard. There was a statistical significance between the high score group and low score group in each dimension of the index system. The recovery rate of the questionnaire was 100% and the effective rate was 96.67%. Each questionnaire was completed within the specified time and had good feasibility.3. The empirical analysis of the index system3.1 The basic situation of GPs’ work(1)In the survey, about 65% of GPs thought that they had larger workload. Their average working time was about 5.5 days every week and treated about 14 patients every day. The per capita number of residents signed up was 1240.( 2) In terms of basic medical services, treatment for common and frequentlyoccurring disease got the highest score(0.353 ± 0.106) and doctor-patient disputes got the lowest score(0.020 ± 0.007). When it came to capacity of public health services, health education got the highest score(0.333 ± 0.071) and health emergencies related plans got the lowest score which was 0.168 ± 0.037. In terms of general medical skills, mental health services had the highest score(0.097 ± 0.044) while medical economic decision-making ability got the lowest score(0.011 ± 0.005). In the aspects of education/cognition/learning,the item of strengthen the training to improve the competence of cognitive got the highest score(0.359 ± 0.026), but the item of familiar with using the internet for medical information retrieval got the lowest score which was 0.039 ± 0.017.3.2 The evaluation analysis about self-reported satisfaction of GPs’ post competency(1)Univariate analysis showed that age(P=0.020), work experience(P=0.027) and professional title(P=0.029) can affect GP’s competence in the community.(2)In the result of correlation analysis, the self-reported scores of establishment of health records in public health service, the management of chronic disease, health education, the publicity of family planning, immunization and health examination(pregnant/children/elderly) showed a negative relationship with the self-assessment scores of GPs’ post competency and all indicators except those had a positive relationship with the self-assessment scores of GPs’ post competency.(3)There was a certain gap between the score of self-reported satisfaction of GPs’ post competency and the score of importance of the indicators, especially in the indicators of disease treatment based on circulation medicine, new technology of information acquisition, tracking and master and the ability of general medical services.Conclusion:In this study, the index system of GP’s competency is scientific and reliable. It can provide reference for medical and health institutions to select/ training/assess/ evaluate GP as well as for Medical College to set up curriculum about general practice education and its teaching important points. Otherwise, this index system still need to be continuous improvement during application. |
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