Research On The Status And Promotion Strategy Of Rural Doctors' Training In Shandong Province Based On Kirkpatrick Model

Objective: Exploring the current situation of rural doctors' training in Shandong province by combining quantitative and qualitative methods.By analyzing the situation of rural doctors' training,evaluating the current situation of rural doctors' training in different counties,discussing the mechanism of training results,furthermore,identifying the key factors that should be solved firstly to improve rural doctors' training status,and putting forward some suggestions on optimizing the training of rural doctors.Methods: Using multistage stratified random sampling method to select the subjects,and carrying out site investigation by using homemade questionnaires.Organizing relevant experts and scholars,health administrators,rural doctors' managers,training teachers and rural doctors to collect qualitative data through panel discussion,Delphi method and personal in-depth interview.On the basis of "Kirkpatrick model" theory,and combining literature analysis and field investigation,the study introduced training preparation to analyse training status of rural doctors from five levels,and then using RSR method to evaluate the training status of rural doctors in different areas of Shandong Province;Exploring the mechanism of training results by using structural Equation Modeling,and on this basis,determining the key issues to be solved in training progression by using Important Quadrant Model,and putting forward suggestions to improve the training situation.Results:(1)Analysis of the status of rural doctors' training: In the aspect of trainingpreparation: The scores of training demand survey and ability assessment of training organization before training were 3.64 and 3.63,the score of rural doctors' understanding of training was 3.78 points,and the expectations of rural doctors for training and the independent choice evaluation scores were 3.85 and 3.80 points;In the aspect of training response,36.4% of the rural doctors considered that the teachers were "general",and 47.3% thought medical staff at municipal hospitals should be the main teachers.The most training content that rural doctors participated in was the establishment of health records,and 61.9% of rural doctors agree that the application of content was "general".44.4% of the doctors didn't get clinical practice courses,and 37.6% showed "general" satisfaction with the training course set.46.3%of doctors accepted the training methods of classroom lectures,but 21.4% tend to the way of superior doctors on-site guidance,and there are significant differences between the actual acceptance and expectations of the training methods.38.9%considered that skill operation assessment was the best way to assess the training.59.5% had no one to substitute their work during the training period.51.4% of the doctors payed training costs themselves,but only 7.4% thought that should be at their own expense.55.3% of the doctors accepted at least two times free training per year,and 63.8% doctors' training time was more than 2 weeks.58.6% of rural doctors' training places were township hospitals,and 52.1% showed "general satisfaction" on overall satisfaction of training.In the aspect of training learning,51.0%,54.0%,55.8% and 54.9% showed "more consistent" on the evaluation of new knowledge,new skills,attitude improvement,and personal quality and ability improvement.There were differences in genders,ages and personnel management form in the training of rural doctors(P<0.05).In the aspect of training behavior,after training the competence score of rural doctors was 8.51,which was different from the one before training.In the evaluation of the diagnostic ability to enhance,the identification of normal signs,rational selection of drugs,emergency first aid ability to improve and operation standard to enhance,public health service capacity to improve,medical risk prevention and the ability to deal with medical disputes to enhance,the proportion of "more compliance" accounted for 57.7%,57.2%,55.4%,57.2%,54.3%and 56.0%.There were significant differences between different genders,ages and technical titles in the training behavior of rural doctors(P<0.05).In the aspect of training results,53.9%,53.4%,53.9%,48.0%,46.5%,43.0%,54.7%,54.6% and53.4% of rural doctors showed "more compliance" to professional satisfactionimproved,effectiveness of medical services improved,public health services' effectiveness enhanced,the number of first diagnosis in the village clinics increased,number increased,the village health room income increased,peers' satisfaction improved,competent departments' satisfaction improved and patients' satisfaction improved.There were differences between ages in the training results of rural doctors.(2)Using RSR method to evaluate the current situation of rural doctors training in 16 counties,and the sub-file for the "lower" for counties B and O,"top" for the A,N,K,and 11 counties are "medium".(3)Analyzing the mechanism of the training results,and construct the hypothesis model of the training results.Verification through structural equation model,finding that,training learning,training response and training behavior have a direct impact on training results.The influence coefficient is 0.295,0.206,0.421;training preparation has an indirect effect on training results through training learning,training response and training behavior,total indirect effect is 0.486;training response has an indirect effect on the training results through training learning,training behavior,total indirect effect is 0.464;training learning has an indirect effect on the training results through training behavior,the indirect effect is 0.264;these factors also have mutual influence on each other.(4)Analyzing the problems that need to be addressed first in the optimization training by Important Quadrant Model show that “classroom atmosphere is conducive to learning”,“obtaining new knowledge and ideas”,“the course materials are helpful to work”,“improving ability of dealing with doctors and patients disputes”,those four factors need to pay enough attention and improving in the training process.Conclusion:(1)The status on rural doctors' training in Shandong Province is generally better,but there are some shortcomings in the training process,which need to be improved in the aspects of training contents,training methods and training organization management.(2)Comprehensive evaluation on 16 counties' training status found out that in the "better" file of the three counties are economic conditions and policies to implement a better county,ranked in the "general" file of the county accounted for the majority.(3)In the analysis of the internal mechanism of the training results,the training behavior has the greatest direct impact on training results.Training response,training study and training behavior act directly on the training results.Training behavior,training response and training learning have an indirect effect on training results through training behavior.(4)Optimizing the training ofrural doctors need to give priority to solve four issues,adjusting the classroom atmosphere to make it conducive to learning,getting new knowledge and ideas through training,improving the course materials to help rural doctors work better,improving the doctors' capacity from dealing with doctors and patients disputes.(5)Suggestions on optimizing rural doctors' training results have been put forward from the training organizers reasonable arrangements for training,rural doctors to improve their own mentality and initiative,managers improve the training of supporting measures to grasp the various aspects of training and other aspects.