Roles and responsibilities of functional departments of the training base in general practice residency training / 中华全科医师杂志

The standardized residency training of general practice is a complex project, the functional departments of the training base should play an active role for its management. The functional department of education in Zhongshan Hospital constantly explores its position and role, connects relevant departments vertically and horizontally to provides management and service for general practice residency training. That means that it should not only to provide advice for leadership decision-making, but also coordinate with all functional departments of the training base. The department has participated in the teaching management and supervision, educational research and training quality control, and accomplished positive results in general practice residency training for last 35 years.

Study on safety performance and condition-suggestion accuracy of the symptom assessment mobile applications / 中华全科医师杂志

Objective:To compare the breadth of condition coverage, accuracy of suggested conditions and appropriateness of urgency advice of the 8 symptom assessment mobile applications (APPs) available on the Chinese market.Methods:The APPs were assessed using 200 primary care vignettes and were measured against the vignettes′ standard. The primary outcome measures were proportion of conditions covered by an APP, proportion of vignettes with the correct primary diagnosis,and proportion of safe urgency advice.Results:For APPs assessed,condition-coverage was from 29.0%(58/200)to 99.5%(199/200), top-3 suggestion accuracy was from 8.5%(17/200) to 61.5%(123/200), the proportion of safe urgency advice was from 84.8%(167/197) to 99.5% (198/199).Conclusions:The APPs showed a wide range of coverage, safety performance and condition-suggestion accuracy. Symptom assessment APPs with good performance could be used by general practitioners as supporting tools. However, even symptom assessment APPs with excellent performance need to be further assessed in a real clinical environment.

Development of the modified medication regimen complexity index of Chinese version(mMRCI-C)and its validation in elderly diabetic patients / 中华全科医师杂志

Objective:To develop the modified medication regimen complexity index of Chinese version (mMRCI-C)and test its reliability and validity.Method:The Chinese version of MRCI was developed by modification,translation and back translation. The MRCI was interculturally adapted by 2-rounds of expert consultation and pilot study to ensure the semantics, content and conceptual equivalence. The validation of the mMRCI-C scale was tested among 420 community-dwelling elderly patients with type 2 diabetes mellitus(T2DM) in Shanghai Changfeng Community Health Service Center from October to December 2020. SPSS 23.0 was used to analyze the reliability and validity of the scale.Results:The mMRCI-C scale included 3 dimensions, namely drug dosage form (14 entries), medication frequency (5 entries), and additional instructions (6 entries), with a total of 25 entries. Among 420 valid questionnaires collected,the respondents were 212 males (50.4%) and 208 females (49.6%) with a mean age of (71.4±8.1) years. The test-retest reliability was 0.999 and internal consistency reliability was 0.849. The content validity exceeded 0.80,the convergent validity was 0.932; and discriminant validity P<0.001. Conclusion:The preliminary testing results show that the reliability and validity of the mMRCI-C scale are satisfactory.

Survey on enablement level of elderly patients in the community and its related factors / 中华全科医师杂志

Objective:To survey the enablement level of elderly patients in the community and its influencing factors.Methods:A total of 460 patients aged ≥60 years visiting Changfeng and Fenglin Community Health Service Centers of Shanghai during September 3 to 15, 2018 were invited for a questionnaire survey. A self-made health status questionnaire, Patient Enablement Instrument (PEI), Chinese Health Questionnaire (CHQ-12), the Consultation and Relational Empathy Measure (CARE) were applied for survey.Results:All valid 460 questionnaires were retrieved. The positive rate of patient enablement was 73.91% (340/460). The median score for PEI was 3, Q1 was 0 and Q3 was 6. The univariate analysis showed that patient′s gender( Z=-2.32, P=0.02), age ( H=9.73, P<0.01), reason for visit ( H=42.06, P<0.01), health status in the past year ( H=8.28, P=0.02), consultation time ( H=22.92, P<0.01), sufficiency of communication with the doctor as patient thought ( H=41.83, P<0.01), detailed inquisition ( H=81.11, P<0.01), attending a contracted doctor ( Z=-3.42, P=0.04), the satisfaction of the visit ( H=38.64, P<0.01), total score of CHQ-12 ( Z=-2.01, P=0.04) and the score of CARE were significantly associated with the enablement level of the patient after the visit ( H=288.06, P<0.01). Multivariate linear regression showed that age 60-79( P=0.03), visit for acute disease( P<0.01), good or moderate health status in past year ( P<0.01), communication with the doctor<3 min or 3-<5 min ( P<0.01), sufficient or moderate time for communication with the doctor as patient thought ( P<0.01), detailed or moderate inquisition( P=0.03 or P=0.01), attending a contracted doctor ( P<0.01), CHQ-12 ≥4 ( P<0.01), middle or high CARE score ( P<0.01)were associated with the enablement of elderly patients after visit, with a cumulative contribution rate of 73.40%( F=50.08, P<0.01). Conclusion:The level of enablement of elderly patients after visiting the general outpatient clinic of the community health service center is relatively low. Patient′s age, types of disease, health status and the time of communication with the doctor, the sufficiency of communication time as patient thought, the detailed inquisition, attending a contracted doctor, the mental health status, and the empathy expression of the doctor are associated with the enablement of patients.

Comparison of contracting status for combination medical service between elderly residents in Shanghai urban and suburban communities and its influencing factors / 中华全科医师杂志

Objective:To compare the contracting status for combination medical service( "1+1+1" contract)between elderly residents in Shanghai urban and suburban communities and its influencing factors.Methods:Total 574 outpatients aged over 60 were selected with stratified sampling and convenient sampling method from 3 urban community health service centers and 3 suburban community health service centers in Shanghai. A questionnaire survey was conducted from July to September 2017, the survey included the general information, health status, health concern, purpose of this visit, satisfaction with the center, frequency of visit, choice of first contact, willingness of referral, understanding "1+1+1" contract and preferential policies, contract signing status and reasons.Results:Total 574 questionnaires were distributed and 564 valid questionnaires were retrieved with an effective rate of 98.25%. Of the 292 participants in urban areas, 167 (57.2%) had signed the contract; of the 272 participants in the suburbs, 133 (48.9%) had signed the contract. Univariate analysis showed that self-evaluated health status, visits to the community health service center, satisfaction with the center, concerning health knowledge, long-term medication, the choice of community health center as first contact, the willingness of referral, knowing the "1+1+1" contract policy were associated with the contract-signing in urban residents (χ 2=13.05, 8.51, 13.89, 10.76, 6.26, 12.98, 24.73, 76.77, respectively; all P<0.05); while age, self-evaluated health status, the purpose of this visit, medical examination, type of chronic disease, long-term medication, the choice of community health service center as first contact, the willingness of referral, knowing the "1+1+1" contract policy were associated with the contrct-signing in suburban residents (χ 2=9.56, 14.26, 13.83, 18.30, 18.65, 11.96, 5.99, 5.46 83.44, respectively all P<0.05). Multivariate analysis showed that self-rated health status and awareness of "1+1+1" contract were independent influencing factors for contract-signing in urban residents ( P<0.05); while the awareness of "1+1+1" contract, the purpose of this visit and the frequency of physical examination were influencing factors for contract-signing in suburban residents ( P<0.05). Conclusion:The "1+1+1" signing rate in urban residents is higher than that in suburban residents due to more self health-concerns and higher awareness of the "1+1+1" contracts. It is suggested that the government attach importance to construction of the "1+1+1" contract system for suburb community health service institutions.

Application of Patient Enablement Instrument (PEI) / 中华全科医师杂志

Patient enablement is a consultation outcome measure that reflects the extent of patients understanding their health problems and the ability to dealing with. It not only reflects patient′s feeling after the consultation, but also the doctor′s ability of diagnosis and treatment. The Patient Enablement Instrument (PEI) has been developed and used to assess the enablement of patients after consultation. The PEI has the characteristics of brevity and conciseness, and its reliability and validity are widely accepted. This article reviews the current status of the application of PEI and related factors to provide a reference for the its further use in China.

Application of Patient Enablement Instrument (PEI) / 中华全科医师杂志

Patient enablement is a consultation outcome measure that reflects the extent of patients understanding their health problems and the ability to dealing with. It not only reflects patient′s feeling after the consultation, but also the doctor′s ability of diagnosis and treatment. The Patient Enablement Instrument (PEI) has been developed and used to assess the enablement of patients after consultation. The PEI has the characteristics of brevity and conciseness, and its reliability and validity are widely accepted. This article reviews the current status of the application of PEI and related factors to provide a reference for the its further use in China.

Application of OSTE in teaching competence assessment for general practice preceptors in community training bases / 中华全科医师杂志

Objective To apply objective structured teaching evaluation (OSTE) in teaching competence assessment for general practice preceptors in community training bases.Methods The teaching competency was assessed with OSTE for 28 general practice preceptors in Fengxian District of Shanghai in December 2017.The application of OSTE was evaluated with questionnaire among preceptors,examiners and standardized students(SS).Results Among 28 preceptors there were 23 females (82.1％),with an average age of (37.3±4.2) years.The average teaching duration was (2.8±2.1) years.In the five OSTE station,the highest total score was (88.1 ±2.7) points in the first station self-presentation,while the lowest was (70.8± 14.5) points of the second part physical examination feedback of the third station ambulatory care teaching.The total score in the fifth station (doctor-patient communication teaching) of participants with＜ 15 years of community practice was higher than those ≥15 years of community practice [(80.1±8.5) vs.(71.6± 7.1),t=2.092,P=0.007].Except"being able to adapt to this form of evaluation",the proportions of choosing "very good"were all more than 50％ in other 4 aspects.The overall willingness of "recommending OSTE as the main method to evaluate the teaching competence of GP trainers" was higher in examiners and SS than that inpreceptors (Z=2.836,P=0.005).Conclusion The innovative approach of OSTE has been widely recognized,but the professional capability,the cognition of general practice,the teaching competence and the willingness to use OSTE need to be strengthened for general practice receptors in community bases.

Characteristics of elderly frequent clinic attenders in a Shanghai community health service center / 中华全科医师杂志

Objective To analyze the characteristics of elderly frequent clinic attenders in a Shanghai community health service center.Methods The medical records of patients over 60 year who visited Shanghai Weifang Community Health Center clinic from October 2014 to October 2017 were obtained from the hospital outpatient management system.The persistent frequent attenders were defined as whose visiting times were among the top 10％ of attendance in the three consecutive years.The general condition and disease characteristics of persistent frequent attenders were analyzed and compared with those of non-frequent attenders and transient frequent attenders.Results There were total 19 240 patients paying 1 171 thousand clinic visits in the center for three years,the persistent frequent attenders accounted for 5.3％ (1 029) of total patients and had 21.4％ of total visits (251 thousand);those figures for transient frequent attenders were 10.2％(1 965) and 23.9％ (280 thousand);for non-frequent attenders were 84.5％ (16 246) and 54.7％(640 thousand),respectively.The average annual visits of three groups were (81.4 ± 27.5),(47.5 ± 21.4) and (13.1± 11.1) times,respectively.The reasons for encounter in persistent frequent attenders were:coronary heart disease (11.2％,48 thousand),cerebral insufficiency (3.5％,15 thousand),joint pain (2.5％,11 thousand),osteoporosis (2.9％,13 thousand) and sequelae of stroke (2.1％,9 thousand).Age above 70(OR=2.163,95％CI:1.872-2.498),age above 80 (OR=2.243,95％CI 1.895-2.655),female sex (OR=1.426,95％CI:1.249-1.627) and contracting general practitioners (OR=5.665,95％CI 4.217-7.611) were associated with persistent frequent attendance (P＜0.05).Conclusion Elderly frequent attenders occupy large outpatient resources of community health center,and age,gender and contracting status could affect their attending frequency.

Status and influencing factors of signing combination contract for primary care among elder residents in Shanghai communities / 中华全科医师杂志

Objective@#To investigate the signing status of combination contract( "1+1+1" contract) for primary care among elderly residents in Shanghai communities and its influencing factors.@*Methods@#The policy of combination contract for primary care has been implemented in Shanghai since 2015, the residents signed a service contract with general practitioners in community health service center as well as with one of the secondary or tertiary hospitals ( "1+1+1" ). The questionnaire survey on the signing status of "1+1+1" contract was conducted among residents over 60 years in 6 communities in Shanghai which were selected by stratified and convenience sampling method from September 2017 to November 2017. The questionnaire was designed based on the previous research results of the qualitative interviews. The contents of the questionnaire included the basic characteristics, health status, understanding of the "1+1+1" signing policy, the status and reasons for contract signing, and so on. The date were analyzed by descriptive method, chi-square test, and binary logistic regression.@*Results@#Total 574 questionnaires were distributed and 564 valid questionnaires were retrieved with a recovery rate of 98.25%. Among all participants, 300 (53.2%) had signed and 264 (46.8%) had not signed. Univariate analysis showed that age, self-evaluated health status, chronic disease, medication, visits to the community health service center, the purpose of this visit,satisfaction with the community health service center, medical examination, concerning health knowledge, the willingness of community doctor as gatekeeper, the willingness of community referral, whether or not know the "1+1+1" contract policy, influence the rate of signing were associated with the signing of the contract (all P<0.05). Multivariate analysis showed that whether or not know the "1+1+1" contract policy, the willingness of community referral, and self-evaluation health status were independent factors affecting "1+1+1" contract signing (all P<0.05). The reason for signing the contract were convenience to visit doctor (69.00%, 207/300), and having a good relationship with family doctor (29.33%, 88/300). The reasons for not signing the contract were not understanding the policy (65.15%, 172/264), lack of help for signing (25.38%, 67/264), and restricted choice of seeking medical services (7.58%, 20/264).@*Conclusion@#Whether or not know the "1+1+1" contract policy, the willingness of community referral, and self-evaluation health status are the main influencing factors of signing "1+1+1" contract for primary care among elderly residents in Shanghai communities.

Quality of life assessment for elderly residents in Shanghai communities and relevant influence factors / 中华全科医师杂志

Objective To assess quality of life in elderly in Shanghai communities and to analyze relevant influence factors.Methods The quality of life and relevant influence factors of 4 395 residents aged 60 years or older who were registered in the health records of three community healthcare centers in Shanghai were investigated through questionnaire survey.Results Total 4 350 valid questionnaire were retrieved with a response rate of 99.0％.The mean physical component summary scale (PCS) score was (50.1± 10.1) and the mean mental component summary scale (MCS) score was (47.3±7.9).Factors influencing the quality of life in order of importance were depressive symptom(B=-8.41),self-care ability(B=7.45),disease score(B=-1.91),participating in outdoor activities(B=1.89),proportion of medical expenses over income(B=-1.72),social intercourse score(B=-1.48),gender(B=-1.37),education level(B=-1.03) and age(B=-0.93).Conclusion The quality of life in elderly residents of Shanghai is relatively high,but the mental components of quality of life need to be further improved.

Reliability and validity of Chinese version of the Short Form of Quality of Life Enjoyment and Satisfaction Questionnaire for elderly patients / 中华全科医师杂志

Objective@#To evaluate the reliability and validity of the Chinese version of the Short Form of Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) for elderly patients.@*Methods@#The quality of life of 400 elderly outpatients from Kongjiang community health service center were evaluated by using the Chinese version of Q-LES-Q-SF. The reliability of the Chinese version of Q-LES-Q-SF was tested by the internal consistency reliability (Cronbach′s α coefficient) and the half confidence; the validity was tested by structural validity, convergence validity and distinguish validity and calibration validity.@*Results@#The Cronbach′s α coefficient of the internal consistency was 0.956; the Spearman-Brown coefficient of the half confidence was 0.894; the Guttman Split-half coefficient of odd even fold half confidence was 0.894. The exploratory factor analysis showed that there were 2 dimensions: the psychological dimension (Q2-8 items) and the physiological dimension (Q1, Q10-14). The confirmatory factor analysis showed that each psychological dimension factor load of Q2-8 was >0.50; each physiological dimension factor load of Q1, Q10-14 was >0.50. In distinguish validity, there was item with Z> 1.96 (P<0.05), showing that each item had a good distinction between different dimensions. In convergence validity, physiological and psychological dimensions of GFI were all >9.5, RMSEA were all <0.05. In calibration validity, the physiological and psychological dimensions of Q-LES-Q-SF had a good correlation with the corresponding dimensions of the SF-12 (P<0.05), and Pearson correlation value was 0.317 and 0.237, respectively.@*Conclusion@#The Chinese version of Q-LES-Q-SF has a good reliability and validity for elderly patients.

Screening of stroke risks among middle-aged and elderly people in Shanghai community general outpatient clinics / 中华全科医师杂志

Objective To screen stroke risks among middle-aged and elderly people in community outpatient clinics in Shanghai.Methods A stroke risk screening was conducted among people aged 45-75 years selected with convenient sampling method from 10 community health service centers in Putuo district,Yangpu district and Pudong New Area of Shanghai during January to July 2017.The questionnaire and clinical measurement were used for screening.Multivariate logistic regression analysis was used to analyze the risk factors in subjects with high stroke risk.Results In this study,1 094 individuals with high stroke risk were screened out from 1 750 participants (62.5％).The proportion of high risk cases was higher among men (66.7％,473/709) than that among women (59.7％,621/1 041),unmarried,divorced or widowed (75.0％,90/120)than married or cohabitants (61.6％,1 004/1 630),living alone (72.1％,70/97) than living with others (61.9％,1 024/1 653) (x5=8.969,8.571,4.081;P＜0.01).Compared with non-high-risk subjects,the high-risk subjects had higher BMI,systolic blood pressure,diastolic blood pressure,fasting blood glucose,glycated hemoglobin,total cholesterol,triglycerides,serum creatinine and homocysteine,and were more likely to have carotid plaques or stenosis,the difference was statistically significant (P＜0.05).Multiple logistic regression analysis showed that unmarried/divorce/widowed,high BMI,systolic blood pressure,fasting blood glucose,total cholesterol,and carotid plaque or stenosis were positively associated with high stroke risk(OR=2.015,1.173,1.013,1.456,1.139,1.026,2.103;P＜0.05).Conclusions The proportion of high stroke risk individuals among middle-aged and elderly people is higher in community general practice outpatient clinics in Shanghai.Patients with high BMI,systolic blood pressure,fasting blood glucose and total cholesterol,and carotid plaque or stenosis,as well as those unmarried/divorced/widower should be the subjects for stroke intervention.

A survey on anxiety status in patients over 60 years old from one community health service center in Shanghai / 中华全科医师杂志

Objective To investigate the prevalence and related risk factors of anxiety symptoms in elderly patients from one community health service center in Shanghai.Methods Patients aged 60 to 85 years visiting Kongjiang Community Health Service Center from August to December of 2016 were included in the survey.The patients were evaluated with Generalized Anxiety Disorder Scale-7 (GAD-7),Sociodemographic and Health-related Variables Questionnaire,Mental Health Knowledge Scale and Lubben Social Network Scale-6 (LSNS-6).Results Total 2 006 questionnaires were distributed and 1 981 valid questionnaires were returned with a recovery rate of 98.75％.The overall GAD-7 score was 0 (0,2),and 13.5％ (267/1 981) participants had positive anxiety symptoms.Multivariate logistic analysis showed that 6 variables were related to anxiety symptoms,including educational background,exercise frequency,percentage of medical costs over total household expenses,life satisfaction,the amount of chronic somatic disease,mental health knowledge awareness (P ＜ 0.05).Conclusion The prevalence of anxiety symptoms in the study population is relatively high.Anxiety symptoms are associated with multiple factors,to which the attentions should be paid.

A survey on the prevalence of depression symptoms and risk factors among postgraduates in a university in Shanghai / 中华全科医师杂志

Objective To investigate thedepression status and the related risk factors of depression among postgraduates in a university in Shanghai.Methods A cross-sectional study was conducted in 249 postgraduates from a university in Shanghai to investigate the general information,depression status and awareness of graduate students through the Health Questionnaire Depression Scale (PHQ-9) and self-made questionnaires.Results In this survey,the overall prevalence of depression symptoms among postgraduates was 49.8％ (124/249);36.1％ (90/249) had mild depressive symptoms,9.2％ (23/249) had moderate symptoms,2.8％ (7/249) had moderate-to-severe depressive symptoms,and 1.6％ (4/249) had severe depressive symptoms.83.9％ (208/249) of postgraduates believed that the occurrence and development of depression is related to academic pressure;54.2％ (135/249) of them believed that psychosomatic treatment can reduce the occurrence and development of depressive symptoms;when they are aware of depressive symptoms,87.6％ (218/249) of them chose to go to the psychological counseling center.Medical students (OR =0.441,95 ％ CI:0.232-0.837),personality (OR =0.562,95 ％ CI:0.326-0.969) and physical fitness (OR =2.813,95％ CI:1.524-5.190) were associated with depressive symptoms (P ＜ 0.05).Conclusion Non-medical students,feeling introverted and poor physical quality are the risk factors of depressive symptoms in postgraduates and need to be alert to mental health of the students with these factors.

Development of evaluation index system for community general practice teaching base / 中华全科医师杂志

Objective To develop an index system for evaluation index system for community general practice teaching base.Methods A draft of evaluation index system for community general practice teaching base was preliminarily developed on the basis of literature research.Two rounds Delphi consultations with 32 experts of general practice were conducted between July 2014 and May 2015.The results of consultation were analyzed and the evaluation index system for community teaching base was established.Results In two rounds of Delphi consultation,the positive coefficients were both 100％,the authority coefficient of experts were 0.879 and 0.897,respectively,and the coordination coefficient were 0.165 and 0.204 (P ＜0.01).The established evaluation index system consisted of 4 first-class indexes,8 second-class indexes and 27 third-class indexes.Four first-class indexes were basic conditions,teaching conditions,teaching staff and teaching practice.Conclusion The established evaluation index system may be used to accredit community general practice teaching base and to improve the quality of general practitioner training.

Continuing professional development for general practitioners after residency training in Shanghai Weifang community health service center / 中华全科医师杂志

A continuing professional development program was implemented in Shanghai Weifang Community Health Center for general practitioners (GPs) who completed residency training.The program consisted of four aspects: clinical ability, scientific research ability, teaching ability, and management ability.Clinical ability-building included the re-practice of specialty skills, expert mentoring in clinics, continuing education courses and clinic skills competitions.The scientific research ability was built from participating in research projects and talent cultivation programs.GPs were encouraged to be clinical mentors, and teaching ability was developed through attending teacher-training class and teaching practice.For those who were interested in management, the administrative positions related to medical, teaching and research would be provided.The implementation of the program received strong policy support from the health administrations at various levels.

Analysis of clinical competence test results of general practitioners in Shanghai Pudong New Area / 中华全科医师杂志

Objective To analyze the clinical competency test results of general practitioners (GPs) in Shanghai Pudong New Area.Methods Total 1 160 GPs from Pudong New Area attended the clinical ability tests,all participated in theory test and 327 GPs attended practice skill tests.The results were reviewed by computer and the scores were automatically generated.Results The average score and pass rate of theory test were (64.24 ± 12.23) points and 64.2％ (745/1 155),respectively.The average scores of GPs with master or above degree were the highest (67.09 ± 13.38 points),however,the pass rate of GPs with undergradnate degree was the highest (69.7％,349/501).GPs with senior professional title got the highest average score and pass rate [68.26 ± 9.92 points and 82.7％ (43/52),respectively].Introduction to General Practice (69.7％),Internal Medicine (68.6％) and Cancer (66.9％) were the top 3 subjects with the highest correct rate.The pass rate of clinical skills was 39.1％ (128/327),GPs with master degree or above (192.87) and those with junior professional titles (171.08) had the highest scores.GPs with master degree or above (50.0％,8/16) and those with intermediate professional title (40.1％,97/242)had the highest pass rate.Conclusions The analysis shows that the average score and pass rate of both theory test and clinic practice skills test are not satisfactory among GPs in Shanghai Pudong New Area.The clinical ability of GPs need to be further improved,and the study of some specific disciplines need to be further strengthened.

Weight establishment of the community teaching base evaluation system for general practitioner in Shanghai / 中华全科医师杂志

Objective To establish the weight of the evaluation index system for community teaching base of general practitioner ( GP ) standardized training .Methods The weight assignment of the evaluation index system for community teaching base of GP training was established by using analytic hierarchy process , based on the literature review and two rounds of Delphi consultation .Results The evaluation index system for community teaching base was composed of four first-class indexes , eight second-class indexes and 27 third-class indexes.Four first-class indexes were basic conditions (weight 0.1953), teaching conditions (weight 0.1381), teaching staff (weight 0.2761) and teaching practice (weight 0.3905).The top three second-class indexes were: teaching management (weight 0.1953), teaching assessment and evaluation (weight 0.1953), and teaching ability (weight 0.1841).All levels of index weights were satisfied with the consistency test , and the weights were acceptable .Conclusion Weight establishment improves the index selection system of community training base for GPs , having better rationality and operability , which may provide a rational assessment tool for community base of GP training in future.

Evaluation of clinical competence training model for general practitioners in Shanghai / 中华全科医师杂志

Objective To evaluate the clinical competence training model for community general practitioners (GPs).Methods Total 759 Gps participated in clinical ability training course (training group) between July 2011 and October 2012.The course included lectures,group discussion,role play,simulation for theoretical teaching;and video demonstration,scene teaching and medical simulator for physical examination and surgical skill training.Other 703 Gps without participating in training course were selected as control group.The examination consisting of theoretical and clinical skill tests were carried out and the results were compared between two groups.Results The participants included 260 males (34.2％) and 499 females (65.8％) were with an average service year of 13.9 ± 7.0 and 72.8％ of them hold bachelor degree.There were no significant differences in gender composition,work seniority and educational level between the two groups (P ＞ 0.05).Before and after training the total scores of the training group were (67.39 8.57) and (73.62 ± 7.19) respectively,(68.67 8.31) and (65.73 ±9.02) respectively for the control group.Before training,the total score and theoretical results of control group were significantly higher than those of training group (all P ＜ 0.01),and there was no significant difference between the two groups in physical examination and operation skill.After training,the total scores and the individual scores (written examination,physical examination and operation skill) of training group were significantly increased,compared with those before training (all P ＜ 0.01),and those of control group (all P ＜ 0.01).Conclusions The clinical competences training model can improve the theoretical knowledge and clinical ability of community general practitioners.