The Research On The Status And Countermeasure In Standardized Training Of General Practitioners In Yunnan Province

Objective:To investigate the current status of GP's standardized training in Yunnan Province.Analyzing the process and influencing factors through the two perspectives of organizers and trainees.Then putting forward suggestions to improve the level of GP's standardized training in Yunnan,and hopefully,providing scientific reference for relevant policy.Methods:(?)Literature review.(?)Routine data collection.(?)Questionnaire survey.Three self-administered questionnaires(administers,teachers and trainees)of GP's training were designed except the Servqual scale and study burnout scale to collected data.Pre-survey was used to ensure the feasibility of the whole research.We collected a cluster sampling of 6 general practitioners clinical training bases with a total of 45 administers,304 teachers and 225 trainees.The major contents of the investigation of this research including:current status of administers and teachers,which included their quantities and qualities,current status of trainees,which included their knowledge,skills,learning status,satisfaction and demands.The methods of data analysis were consist of descriptive analysis,univariate analysis,multivariate analysis,multi-criteria preference analysis and structural equation modeling.(IV)Personal interview and group interview.Data was also obtained through the personal in-depth semi-structured interviews with the administers,while group structured interviews with the trainees.The main contents of the interviews were the recommendations and suggestions of the training.Interviews were audio-taped,transcribed and analyzed using interpretative phenomenological analysis.Identification of individual ideas and shared themes enabled exploration of the interviewees experiences.Results:(?)current situation of administers and teachers quantities.Firstly,number.The duration of the administers being engaged in the training management was less than 5 years mostly(83.7%)and the most of the teachers had not worked in the training education more than 5 years yet(84.8%).The proportion of administers and teachers was 1:5 while teachers and trainees was 1:1.Secondly,training.The participation ratio of administers in management knowledge training and general medicine training were 34.20%and 43.80%.The participation ratio of teachers in general medicine training were 34.20%.Moreover,even 24.8%of the faculties had never received any training before they started the career of training.(?)current situation of administers and teachers qualities.Firstly,management quality.In the aspect of teaching arrangement,over half of the teachers(60.30%)who undertook theoretical teaching and clinical skill teaching as a multi-tasked individual.In the aspect of clinical departments rotation,most of the trainees(88.10%)thought the mechanism was exists.In the aspect of formative assessment methods,there was 71.20%of the departments didn't carry out or just a part of it.The performance index were evaluation with attendance rates,theoretical test score and clinical skills test score(42.90%).In the aspect of personnel administration,nearly half of the trainees(43.80%)didn't accept the management which targeted to them specially.In the aspect of great attention by leadership,41.10%of the trainees thought that they were paid great attention by the leader of training base,over half of the leader supported their staffs took part in this training.Secondly,teaching quality.The pass rate of overall teaching quality was 67.10%.According to the result of one-way ANOVA analysis,base classification(t=-2.08,P<0.05)was the influencing factors of overall teaching quality.(?)current situation of trainees' knowledge.The pass rate of overall theoretical knowledge was 51.60%.According to the result of multiple linear regression,there was no differences between theoretical knowledge(P>0.05).(?)current situation of trainees' skills.In the aspect of clinical departments rotation,most of the trainees(76.30%)had rotated 1-3 departments.In the aspect of bed management,41.5%of the trainees managed more than 5 beds.In the aspect of clinical skill operation,48.8%of the trainees didn't take any of it.In the aspect of teaching rounds,over half of the trainees(52.10%)thought the frequency of teaching rounds which took by teachers was very often.In the aspect of case discussion,54.30%of trainees thought they were lack of this part.(?)current situation of trainees' learning status.The pass rate of overall learning burnout was 46.60%.According to the result of multiple linear regression,gender(?=-0.13,t=-1.98,P<0.01)was the influencing factor of overall learning burnout.(?)current situation of trainees' satisfaction.The pass rate of overall satisfaction was 40.60%.According to the result of multiple linear regression,gender(?=-0.17,t=-2.93,P<0.01),theoretical test(?=-0.27,t=-4.63,P<0.01),the management which targeted to trainees specially(?=-0.19,t=-2.97,P<0.01),great attention by base leadership(?=0.35,t=5.73,P<0.01)were the influencing factor of overall satisfaction.(?)current situation of trainees' demands.Firstly,training demand.Only 25 trainees(11.40%)indicated the willingness to keep training,while 47 trainees(21.50%)indicated the unwillingness to get certification of general medicine degree or diploma.The influencing factors of training demands were certification,training experience and ability improvement.Secondly,employment demand.43.3%of trainees indicated the willingness to become a general practitioner,while the major influential factors include salary and benefits(38.8%).(?)trainees' demands were influenced by teaching quality.According to SEM,teaching quality was positively influencing the general medicine demand of trainees(?=0.29,t=2.80,p<0.05).Furthermore,learning burnout and training satisfaction played a mediator effect role between teaching quality and general medicine demand of trainees.Teaching quality was negatively influencing the learning burnout(?=-0.36,t=-3.46,p<0.05),while learning burnout was negatively influencing the general medicine demand of trainees(?=-0.30,t=-3.38,p<0.05),teaching quality was positively influencing training satisfaction(?=0.24,t=2.17,p<0.05),while training satisfaction was positively influencing general medicine demand of trainees(?=0.27,t=3.24,p<0.05).Conclusion:(?)We still need to Replenishment the quantities of administers and teachers.They lack the experience of training or teaching.The duration of the administers being engaged in the training management is less,some teachers even start to teach without any training before.(?)We still need to improve the manage quality of administers.It has been display great qualities in the aspects of clinical departments rotation,formative assessment methods and great attention by leadership,while teaching arrangement and personnel administration display as a bad one.(?)The overall teaching quality is fairly good and its influencing factor is base classification,the teaching quality of resident standardized training bases is better than specialized general practitioner standardized training bases.(?)The overall theoretical knowledge of trainees stay in a low level.(?)The frequency of clinical departments rotation and teaching rounds has been reach the standards while bed management,clinical skill operation and case discussion are not.(?)The overall learning status is fairly good and its influencing factor is gender.The learning burnout of male is higher than female.(?)The overall satisfaction is fairly poor and its influencing factors are gender,theoretical test,the management which targeted to trainees specially and great attention by base leadership.Trainees who receiving great attention by base leadership or having theoretical test appear to be more satisfactory.Trainees who receiving the management which targeted to trainees specially appear to be more satisfactory.Male trainees shows a great satisfactory than female.(?)Trainees have a strong demands of general training if they can obtain the certification and have the training experience.Considering the major influential factors include salary and benefits,it is not the first choice to choose general practitioner as their career.(?)General medicine demands of trainees are interlinked with teaching quality,learning burnout and training satisfaction.Improving teaching quality could facilitate the ease of learning burnout as well as the increase in training satisfaction with training.Thus,general medicine demands could be enhanced.During elevating the training satisfaction level,higher demands of general medicine would be ignited.But if the learning burnout gets severer,the General medicine demands would turn to be more constrained.