The Prelimimary Exploration Of The Training Model Of Village Doctor In Minority Border Areas In Yunnan

Objective:To Primary explore the training model of village doctors which was suitable for the minority border areas in Yunnan, and to improve health service capacity of rural doctors, so as to provide practical experience for similar areas in rural health staff training.Methods:Menglian County and Longchuan County were chosen as the study sites. The total of140village doctors from the two counties were recruited and divided into training group and the control group randomly,80doctors in training group and60doctors in the control group. Before training, a questionnaire survey was conducted to village doctors to understand their background, the needs of training and the needs of rural health services. The stakeholders from medical institutions at provincial level, county level and from health administrative officers were invited to participate in the workshop held to discuss the content and form of training, the training curriculum was developed by medical experts. Pre-experiments of training curriculum was undertaken to explore the feasibility of teaching curriculum, and to adjust the training syllabus and training methods based on the pre-experiments. The four steps training design including focused theoretical knowledge learning, skill orientated practice, community-based application and targeted topic learning. The primary training model of village doctors was made up as the fellows:village doctor-centered, job requirement-guided, capacity improvement-prioritized, theory learning and practice combined, multiple teaching approaches applied, four integrated stepwise training design. The doctors in the training group received training following the training model and evaluation before and after each step of training. The evaluations were conducted to know the effect of the training from the reaction level, learning level and behavioral level with Kirkpatrick assessment theory. Knowledge test, skill performance and interview were used to village doctors to evaluate the training results. The stakeholders were in-depth interviewed to assess service changes of village doctors.Results:Of the80village doctors in the training group,57.9%were minority, and the ratio of male to female was1:1.]. The average age was31years old. Doctors with high school or medical school education occupied69.7%. There was only9.2%of village doctors had the certificates of qualification (assistant) doctors. The career of medicine was9years on average.At the end of focused theoretical knowledge learning and skill orientated practice, pass rate of the theoretical knowledge and skills assessment increased significantly from21.1%and30.26%to73.0%and59.7%, respectively. The average scores of theoretical knowledge after training were19higher than those before the training and at the same time higher than that of the control group (P<0.01). he average scores of skill increased3.25higher than those before training. The scores of both theoretical knowledge and skills in Longchuan were15.49and4.00respectively which were significantly higher than those in Menglian (P<0.01)Six months after the training, the scores of theoretical knowledge were12.7lower which was as the same level as the control group. But the skill scores almost kept the similar level as the end of training, the former was7.87分and the latter was7.50(P=0.13) which was1score higher than the control group. Both the scores of theoretical knowledge and skill in Longchuan were higher than those in Menglian.Multiple Logistic Regression models for training indicated that age was negatively correlated to the scores of theory (OR=1.16, P=0.014).and minority were negatively correlated to the scores of skill (OR=0.297, P=0.046) at the end of training. There was39time of failing the test for village doctors with junior high school and lower education compared with village doctors with education higher than junior high school (OR=39.12, P=0.007). Six months after training, minority doctors got lower scores(OR=2.009, P=0.038).The trained doctors responded that their capacity had been improved for the good, active teaching approaches and appreciate curriculum.83.5%village doctors thought the training was necessary. The amount of86.8%village doctors was satisfied in the training. Some expressed that the training improved their serve attitude. They would like to suggest other village doctors to receive this kind of training. The villagers said that they had more confidence to village doctor's services for better capacity of services. Health managers at county level and township level gave feedback that the trained village doctors had improved in capacity of diagnosis and treatment of patients and basic public health service. The model training of village doctors was feasible which was worth extending.Conclusion:The training model of village doctors-village doctor-centered, job requirement-guided, capacity improvement-prioritized, theory learning and practice combined, multiple teaching approaches applied, four integrated stepwise training design is feasible and effective, which is worth extending in rural minority areas. The training result is affected by age and education level. There are more difficulties for minority doctors to study. This study suggests that it is necessary to enroll more young people in rural medical field and take more strengthen training to village doctors, especially to minority doctors.