Recruitment of general practitioners in China: a scoping review of strategies and challenges.

BACKGROUND: China is rapidly expanding its general practitioner (GP) workforce as part of recent healthcare reform, with an extra 400,000 GPs by 2030. This scoping review identifies the published strategies for GP recruitment that are being implemented and the challenges encountered. METHODS: We searched six English and three Chinese databases from 2015 to April 2022, following Arksey and O'Malley's framework and the PRISMA ScR reporting guidelines. RESULTS: A total of 40 Chinese-language and 5 English-language records were included. We identified multiple policies, pathways and programmes focused on expanding GP recruitment. Twenty-two evaluations of these initiatives show varying degrees of effectiveness. Selecting general practice as a career is affected by many factors, including individual's background, remuneration and benefits, career prospects, working environment, self-fulfilment, and current national developments and reorganisations of primary care. The challenge most frequently reported was the adequate provision of qualified GP in rural regions. The targeting of students from rural areas and provision of free education in return for an obligatory six-years' working in their hometown upon graduation appears to be effective. Extracted records mostly studied views of trainees in a defined locality, and we identified a paucity of studies which explored the perspectives of organisations and institutions, similarly there were areas of China not contributing to the literature and there were no records taking a national perspective. CONCLUSIONS: Long-term monitoring is required to assess policy changes and to systematically evaluate the effectiveness of the interventions nationally. The monitoring of the challenges influencing GP recruitment can be used to inform the design of future initiatives. Development of a minimum agreed standardised set of outcomes used to measure and report evaluations will help assess the relative contributions and cost effectiveness of different approaches being used to boost GP numbers. We provide suggestions for improving the benefits and rewards for GPs and how to promote recruitment to the more rural or less attractive areas.

Prevalence and Risk Factors of White Matter Lesions in Tibetan Patients Without Acute Stroke.

Background and Purpose- Studies on the prevalence and risk factors of white matter lesions (WMLs) in Tibetans living at high altitudes are scarce. We conducted this study to determine the prevalence and risks of WMLs in Tibetan patients without or with nonacute stroke. Methods- We undertook a retrospective analysis of medical records of patients treated at the People's Hospital of Tibetan Autonomous Region and identified a total of 301 Tibetan patients without acute stroke. WML severity was graded by the Fazekas Scale. We assessed the overall and age-specific prevalence of WMLs and analyzed associations between WMLs and related factors with univariate and multivariate methods. Results- Of the 301 patients, 87 (28.9%) had peripheral vertigo, 83 (27.3%) had primary headache, 52 (17.3%) had a history of stroke, 36 (12.0%) had an anxiety disorder, 29 (9.6%) had epilepsy, 12 (4.0%) had infections of the central nervous system, and 3 (1.0%) had undetermined diseases. WMLs were present in 245 (81.4%) patients, and 54 (17.9%) were younger than 40 years. Univariate analysis showed that age, history of cerebral infarction, hypertension, the thickness of the common carotid artery intima, and plaque within the intracarotid artery were related risks for WMLs. Ordered logistic analysis showed that age, history of cerebral ischemic stroke, hypertension, male sex, and atrial fibrillation were associated with WML severity. Conclusions- Risk factors for WMLs appear similar for Tibetans residing at high altitudes and individuals living in the plains. Further investigations are needed to determine whether Tibetans residing at high altitudes have a higher burden of WMLs than inhabitants of the plains.

First-year medical student attitudes about general practice in China: a comparison between Chinese and international students.

INTRODUCTION: Chinese policy increasingly emphasizes growth of general practice (GP). The purpose of this research was to understand attitudes toward GP among first-year Chinese and international medical students studying in China. METHODS: Based on a cross-sectional survey using a 5-point Likert scale of medical students at Peking University Health Science Center regarding attitudes toward specialty choice, practice setting, care of patient age groups, care types, and GP, we compared responses of Chinese and international medical students. RESULTS: In total, 258 national and 77 international students participated. International students ranked equally or more highly as favorable practice settings associated with GP, eg, outpatient (P=0.05) and home care (P<0), types of care associated with GP, eg, preventive services (P<0) and palliative care (P=0.01), and age-groups of interest, eg, care for babies (P<0), children (P<0), and adult women (P=0.03). Chinese students more strongly endorsed beliefs that GP physicians are needed in rural Chinese areas (P<0), supported by the government (P=0.02), and respected by society (P<0). DISCUSSION: Chinese students' attitudes about the social desirability of GP are consistent with Chinese policy, but international students more strongly endorsed desirable work characteristics of actual GP. These differences accentuate the need for more attention in the medical curriculum to educate Chinese students about why GP can be a personally rewarding career.

Training Pathways to Working as a General Practitioner in China.

BACKGROUND AND OBJECTIVES: To achieve the goal of 300,000 general practitioners by 2020-an increase of 215,200 in a decade-China is utilizing multiple training pathways. To comprehensively illustrate general practitioner training strategies in China, this article introduces and describes these pathways. METHODS: We used descriptive policy analysis. This involved taking an inventory of existing literature and source documents and developing a model to illustrate pathways for training general practice physicians. RESULTS: The rural doctor pathway represents rural clinicians who had only basic training and practiced multiple years prior to training reforms. The 3+2 pathway to assistant general practitioners requires 3 years of junior college and 2 years of clinical training. The transfer pathway for current physicians requires 1-2 years of training. The 5+3 pathway comprises 5 years of bachelor of science degree training in clinical medicine and 3 years of standardized residency training. Despite the development of advanced degree programs, their use remains limited. CONCLUSIONS: These pathways illustrate significant heterogeneity in training of general practitioners. Training ranges from a 2-year technical degree to a doctorate with research. Emphasis on the 5+3 track shows promise for China's goals of improved quality and new goal of 500,000 additional general practitioners by 2030.

Comparison of general practice residents' attitudes and perceptions about training in two programmes in China: a mixed methods survey.

OBJECTIVE: To understand general practice (GP) residents' attitudes about their residency training in China. DESIGN: Mixed methods survey administered cross-sectionally. SETTING: Two GP training programmes similar in most regards according to current GP training policy of 5 years' undergraduate degree in medicine and 3 years of postgraduate GP residency training-but differing as the Beijing programme has adopted educational innovations beyond the nationally prescribed standard curriculum used by the second Shenzhen programme. PARTICIPANTS: 105 (85%) of eligible GP trainees, 35 (90%) in the innovative Beijing programme and 70 (83%) in the standard training Shenzhen programme. RESULTS: Overall, residents felt discrimination because of specialty choice, and that they lacked competency as a general practitioner. Many residents commented faculty had negative teaching attitudes. Beijing residents were more satisfied than Shenzhen residents with their training (p=0.001), and felt teaching faculty had sufficient knowledge (p<0.001), and appropriate attitudes towards teaching (p=0.004). Beijing residents more strongly agreed on five items about good future job prospects (all p<0.05). CONCLUSION: These Chinese GP residents identify areas for improvement in their training as well as strengths. Higher satisfaction with faculty teaching and job optimism in Beijing where GP residents receive training from specifically qualified faculty, and can earn special certification, suggest that the educational innovations enhance training and promote positivity about job prospects. These findings imply that GP residents in China face many training challenges that are similar to other international reports, while also implicating benefits of using an innovative curricular approach.