Selection criteria of community mentors for postgraduates in general practice / 中华全科医师杂志

Objective:To establish selection criteria of community mentors for postgraduates in general medicine.Methods:A subject index system of selection criteria of community tutors for general practice postgraduates was drafted and refined based on literature retrieving and in-depth interviews during January to December 2020. Twenty experts in general practice related fields were invited for two rounds of Delphi consultation. Analytic hierarchy process was used to calculate index weight coefficient and consistency test; and the developed selection criteria were evaluated.Results:Through the in-depth interviews with 11 general practice faculty and 11 general practice postgraduates, the following five first-level thematic frameworks were refined: (1) the professional qualities; (2) the basic qualities; (3) the clinical ability; (4) the teaching ability; (5) the scientific research ability. After two rounds of Delphi expert consultation, the selection criteria of community tutors for postgraduates in general practice were finally constructed, including 5 first-level indicators (professional quality, basic quality, medical practice ability, teaching and guidance ability, academic research ability) and 28 second-level indicators. The positive coefficients of experts were 85% and 100%; the expert authority coefficients were 0.825 and 0.860; and the expert opinion coordination coefficients were 0.486 and 0.515, respectively (all P<0.05). the weight coefficients of the five first-level indicators were 0.345, 0.210, 0.138, 0.210 and 0.097, respectively. Conclusion:The criteria and index system on the selection of community mentors for general practice postgraduates has been successfully developed in the study.

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.

Latest research progress in effects of exercise and nutritional interventions on sarcopenia / 中华老年医学杂志

Sarcopenia etiology is diverse and the pathogenesis is complex.It is closely related to limited activity, malnutrition and a variety of clinical diseases, which seriously affects the quality of life in the elderly and has become a global common health problem.This review focuses on the literature of non-drug interventions for sarcopenia in the past five years, focusing on the relationship of multimodal exercise, intestinal flora, parenteral nutrition and comprehensive intervention with sarcopenia, in order to provide a new basis for formulating scientific and effective non-drug intervention for sarcopenia.

Survey on attitude to sexually transmitted disease testing among physicians in community health service centers of 20 cities in China / 中华全科医师杂志

Objective To survey the attitude to sexually transmitted disease(STD)testing among physicians in community health service centers(CHC)of 20 cities in China.Methods A cross-sectional survey using stratified random sample was conducted in September to December 2015, among 1 734 physicians from 158 CHCs in 20 cities of 6 provinces and 2 municipalities.Results The average age of participants was(39.7 ±10.6)years, the time for present position was(15.8 ±11.5)years, and 47.0%(799/1 700)were general practitioners(GPs).The survey showed that in the last month,8.1%(138/1 699)of the physicians contacted with the specific population of STD(sex worker,MSM,drug user, etc), and 18.3%(313/1 706)of them managed STD patients or provided services to suspected STD patients;62.0%(1 048/1 689)of them received the STD-related training previously;46.5%(784/1 686) thought the lack of training in STD testing as the biggest barrier for carrying out STD testing in CHC.As for the specific populations, 73.4%(1 241/1 692)of physicians thought that it was meaningful, 62.0%(1 043/1 683)of them worried about"have difficulty to deal with their STD clinically", and only 5.8%(97/1 683)of them expressed their"dislike of specific population".Conclusions Most physicians in CHCs believe that STD testing should be included in the routine tests, and it is feasible to carry out STD testing in CHCs.Lack of training is the main barrier for STD testing, so it is necessary to conduct STD testing related trainings in CHCs.

[Effect of body image in adolescent orthodontic treatment].

OBJECTIVE: This study was designed to probe the psychological factors adolescent orthodontic patients, the role of body image and self-esteem in the whole process of orthodontic treatment and the impact on the efficacy and satisfaction of orthodontic. METHODS: Five hundred and twenty-eight patients were selected in this study. The Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) , Rosenberg Self-Esteem Scale (SES), Negative Physical Self-General (NPS-G) and other body analysis scale study after orthodontic lasted 18-24 months were used to investigate the role of body image in adolescent orthodontic treatment. RESULTS: Esthetic evaluation of patients teeth after correction had been significantly improved, patient self-evaluation difference IOTN-AC doctor evaluation, Psychosocial Impact of Dental Aesthetics Questionnaire-tooth confidence, aesthetic concerns, psychological impact and social function were significantly improved. The improvement of the dental aesthetics component (T2 when doctors evaluate IOTN-AC) was positively correlated with the evaluation of the efficacy, and was significantly negatively correlated with the negative emotions of patients at baseline. CONCLUSIONS: Negative body image-dental dissatisfied-cognitive component and the affective component, the overall negative body image and negative emotions can predict patient satisfaction with treatment efficacy. Orthodontic treatment not only improves the self-aesthetic evaluation of adolescent patients, but also has a positive effect on the mental health of adolescent patients.

Effect of body image in adolescent orthodontic treatment / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study was designed to probe the psychological factors adolescent orthodontic patients, the role of body image and self-esteem in the whole process of orthodontic treatment and the impact on the efficacy and satisfaction of orthodontic.</p><p><b>METHODS</b>Five hundred and twenty-eight patients were selected in this study. The Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) , Rosenberg Self-Esteem Scale (SES), Negative Physical Self-General (NPS-G) and other body analysis scale study after orthodontic lasted 18-24 months were used to investigate the role of body image in adolescent orthodontic treatment.</p><p><b>RESULTS</b>Esthetic evaluation of patients teeth after correction had been significantly improved, patient self-evaluation difference IOTN-AC doctor evaluation, Psychosocial Impact of Dental Aesthetics Questionnaire-tooth confidence, aesthetic concerns, psychological impact and social function were significantly improved. The improvement of the dental aesthetics component (T2 when doctors evaluate IOTN-AC) was positively correlated with the evaluation of the efficacy, and was significantly negatively correlated with the negative emotions of patients at baseline.</p><p><b>CONCLUSIONS</b>Negative body image-dental dissatisfied-cognitive component and the affective component, the overall negative body image and negative emotions can predict patient satisfaction with treatment efficacy. Orthodontic treatment not only improves the self-aesthetic evaluation of adolescent patients, but also has a positive effect on the mental health of adolescent patients.</p>

Analysis of the profile esthetics of children with skeletal class Ⅲ malocclusion treated with micro-implant / 实用口腔医学杂志

Objective:To evaluate the profile esthetics of children with skeletal class Ⅲ malocclusion treated with micro-implant.Methods:20 patients (12 boys and 8girls) aged 11-13 years were treated by micro-implant and maxillary protraction for 8 to 10 months.The profile esthetic indexes were measured on pre-and post-treatment cephalometric radiography.Results:The esthetic of the patients were remarkably improved after treatment.The factors that influence the esthetic index of children were the anteroposterior relationship of the maxilla,the mandible and the thickness of soft tissue.The results were stable 1 year after treatment.Conclusion:Maxillary protraction by micro-implant can improve the profile esthetic of children with Class Ⅲ malocclusion,correct over-bite and over-jet.

Assessment of community health service ability of general practitioners after standardized training in Shanghai / 中华全科医师杂志

Objective To assess community health service ability of general practitioners (GPs) with the Standardized General Practitioner Training(SGPT) in Shanghai.Methods One hundred and four GPs receiving SGPT and matched 102 GPs without SGPT were enrolled in this retrospective cohort study from September to November in 2014.Community health service ability,including abilities in basic medical service and public health service were assessed and compared between two groups.Written examination was applied in the public health services ability assessment.Objective structured clinical examination (OSCE) was applied for evaluation of basic medical service abilities.Results The scores of written examination in GPs with SGPT were higher than those without SGPT[(66 ±4) vs.(62 ±7),P ＜0.01].The OSCE scores in GP with SGPT were higher than those without SGPT [(494 ± 78) vs.(448 ± 80),P ＜ 0.01].GPs with SGPT also abtained the higher scores in consultation competence and clinical skills assessment [(245 ± 44) vs.(225 ±40),P＜0.01;(252 ±59) vs.(225 ±61),P ＜0.01].In OSCE,GPs with SGPT got higher score than those without SGPT in 5 stations (medical history collection,doctor-patient communication,basic operation,ECG interpretation,and CPR) (all P ＜ 0.01);however,no significant differences were observed in 3 stations (physical examination,case analysis and X-ray interpretation) between two groups (all P ＞ 0.05).Conclusions GPs with SGPT have better basic medical service and public health service ability.But some aspects of basic medical service ability need to be strengthened in the training and practice.

Follow-up survey on general practitioners after residency training in Shanghai / 中华全科医师杂志

Objective To survey the current working status of general practitioners (GPs) who received residency training in Shanghai.Methods The current status of general practitioners,who completed residency training in Shanghai from 2013 to 2014,was surveyed with self-designed questionnaire by e-mail.The survey items included current employers,job specification,clinical practice,teaching,scientific research and so on.Results Three hundred and thirteen out of 377 GPs,who completed residency training from 2007 to 2012,participated in the survey (83.0％),including 85 males and 228 females with a mean age of (31.2 ± 2.6) years.Among all participants,298 (95.2％) worked in community health service centers,12.8％ (40/313) of them were involved in general practice teaching,9.9％ (31/313) undertook management,9.3％ (29/313) did academic research in community,and 7.7％ (24/313) had chance for overseas study.The survey also showed that 134 person/times received various commendations and awards.Conclusion Most GPs who completed residency training are undertaking clinical practice in community health service centers,and they are also well involved in management,teaching,and research.

Survey on training needs for key general practice trainers in Shanghai / 中华全科医师杂志

Objective To survey the training needs for key general practice (GP) trainers.Methods The survey was conducted among participants of the first training course for national key GP trainers hold on March 2014 in Shanghai.The contents of questionnaire used for the survey included training needs of GP relevant knowledge,teaching ability and modes of assessment.The differences in training needs between GP trainers from community teaching bases and hospital teaching bases were analyzed.Results Total 151 key trainers completed the questionnaire (male/female:48/103) with average age of (38 ± 6)years.Among them 67.5％ (102/151) were from community teaching bases and 29.8％ (45/151) from hospital teaching bases;60.9％ (92/151) participated in the General Practitioner Structured Vocational Training Program (GPSVTP).According to the survey,general practice clinical kills (72.2％,106/151) and general practice clinical thinking (70.2 ％,106/151) were most required relevant knowledge;while general practice basic concept was least required (25.8％,39/151).The rate with need of policy system related GP training in hospital trainers was higher than that in community teaching base trainers(66.7％ vs.44.1％,P ＜ 0.05).For teaching ability needs,85.4％ (129/151) selected teaching methods,75.5％ (114/151) chose teaching assessment and evaluation methods.The participants showed more interesting in new-type teaching and evaluation methods,such as PBL,OSCE,mini-CEX and DOPS,and would use them in future teaching work (P ＜ 0.01).Workshop (58.3％,88/151),demonstration(57.0％,86/151) and experience exchange (50.3％,76/151) were three most interested modes in current training;meanwhile theoretic teaching was lease interested (38.4％,58/151).Study tour was most interested training models for the future (71.5％,108/151),followed by short-term courses (49.0％,74/151),overseas study (39.1％,59/151) and distance learning (27.8％,42/151).Conclusion There are different needs for GP trainers from hospital and community teaching bases.To meet the different requirements,the focused training course and training method should be adapted.

Evaluation of clinical capability of young general practitioners in communities of Shanghai / 中华全科医师杂志

Objective To evaluate the clinical capability of young general practitioners (GPs) in communities in Shanghai.Methods A cross-sectional survey on clinical ability of young GPs was adopted from October to December 2014.Total 211 GPs aged (31 ± 2) years (25-35) from 17 districts of Shanghai participated in the study.Written examination and objective structured clinical examination (OSCE) was applied in the evaluation.Results All 211 GPs (63 male and 148 females) completed the assessment.The overall score of the assessment was (602 ± 83) and the pass rate was 62.6％ (132/211).In written examination the average score was (64 ±7) and the pass rate was 72.1％ (152/211).In OSCE,the highest score (80 ± 15) and pass rate (92.9％,196/211) was in CPR skill,followed by communication skill [average score:(76 ± 15) and pass rate:85.8％ (181/211)].The lowest average score was physical examination (47 ± 15) with a pass rate of 26.1％ (55/211),followed by electrocardiogram reading [average score:(84 ±31) and pass rate:39.8％ (84/211)].In basic operation station,the lowest score was using funduscope and gynecologial examination (29.8％ and 45.4％,respectively).Conclusion Young GPs in Shanghai communities basically master clinical skills,but also have some deficiencies,the training in certain skills need to be strengthened.

Correlation analysis of the nasolabial angle of Angle's Class II division 1 malocclusion patients with vertical growth pattern after tooth extraction orthodontic treatment / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aims to evaluate the nasolabial angle change and the correlation analysis ot Angle'Is Class II division 1 malocclusion patients with vertical growth pattern after tooth extraction orthodontic treatment and provide experimental results to help in making orthodontic treatment plan and treatments.</p><p><b>METHODS</b>A total of 38 Angle's Class II division 1 malocclusion patients with vertical growth pattern and tooth extraction orthodontic treatment were included in this study. Pre- and post-treatment cephalometric X-rays were performed, and 18 measurement items were measured. The change values of pre- and post-treatment, youngsters, and adults were compared to analyze the correlation of the nasolabial angle change.</p><p><b>RESULTS</b>The nasolabial angle between youngsters and adults was enlarged after treatment, but the nasolabial angle of the adult group changed more significantly. Ul to FH, Ul to NA, U1-NA, Spr-Ptm were reduced after treatment, and the adult group decreased more significantly. The upper lip sulcus and flange thickness, A'-Ptm, upper lip length, and nose prominence were enlarged after the adolescent treatment, but the adult had a certain degree of decrease. The difference had statistical significance. In the correlation of the nasolabial angle change analysis of the two groups, namely, Ul to FH, Ul-NA and U1 to NA had significant negative correlation, significant positive correlation to the upper lip inclination angle, and more significant correlation in the adult group. Upper lip flange thickness and nasolabial angle were negatively correlated, and the upper lip sulcus thickness was positively correlated. However, no significant correlation was observed between these two in the adult group.</p><p><b>CONCLUSION</b>The nasolabial angle change of adolescents with vertical growth pattern in class II division 1 malocclusion after extraction treatment is related to the upper anterior teeth hard tissue and upper lip soft tissue, whereas only adults and upper anterior teeth hard tissue are related.</p>

Establishment of assessment criteria for general practitioner trainers in clinical training base / 中华全科医师杂志

Objective To develop an assessment criteria for general practitioner (GP) trainers in clinical training base.Methods Based on the extensive literature review and expert interview,a preliminary index system was established with 4 first-grade indicators and 45 second-grade indicators for GP trainers in clinical training base.During 2012 to 2013,a two-round Delphi consultation was conducted to establish the assessment criteria.Results Thirty seven experts engaged in clinical practice,training and managers of GP training program from clinical training bases,medical schools,or health bureau in Shanghai were invited for Delphi consultation.Among them 64.8 (24/37) ％ were engaged in GPs training over 5 years,78.4％ (29/37) worked as GP trainers,70.2％ (26/37) with high-level professional title.In two round consultations,the activity coefficient of the experts were 97.3％ and 100.0％,authority coefficient were 0.817 and 0.855,and harmonious coefficient of importance of the evaluation were 0.188 (P ＜ 0.01) and 0.278 (P ＜ 0.01),respectively.The opinions among the experts were consistent from the first round to the second round.The assessment criteria for GP trainers in clinical training bases was established with 4 firstgrade indicators and 27 second-grade indicators.The 4 first-grade indicators were professionalism,clinical practice components,teaching quantity & components,basic conception of general practice,with weight coefficient of 0.253,0.253,0.251 and 0.243,respectively.Conclusion The established assessment criteria for GP trainers is credible and comprehensive,which can be applied in evaluating the comprehensive capacity of trainers in clinical training bases.

Training needs of continuing medical education for gereral practitioners in urban and suburban of Shanghai / 中华全科医师杂志

Objective To assess the continuing medical education (CME) and training needs for gereral practitioners (GPs) in urban and suburb of Shanghai.Methods Gereral practitioners in urban (n =710) and suburb (n =843) of Shanghai attending two municipal training programs were interviewed with self-designed questionnaire during July 2011 to May 2012.Results Urban group included 710 GPs whose mean age were (36.7 ± 6.8) y and 33.0％ were male.Suburban group had 843 GPs whose mean age were (36.6 ± 5.1) y and 33.2％ were male.The survey showed that 84.6％ of urban group and 85.6％ of suburban group had attended CME before.There was no statistical difference in the overall satisfaction of CME between two groups (Z =-0.895,P =0.371).The propotion of satisfied and very satisfied was 45.1％ and 13.8％ in urban groupt,while it was 49.5％ and 9.1％ in suburb group.The overall satisfaction rates of enhancing basic theories (Z =-2.296,P =0.022) and skills (Z =-2.013,P =0.044) and CME textbooks (Z =-2.819,P =0.005) were higher in suburban group than those in urban group.Both of them agreed that the contents of CME were divorced from reality of practice (60.3％ vs.65.2％,x2 =3.213,P =0.082).The percentages of complain of insufficient training time (19.7％ vs.11.0％,x2 =18.045,P ＜ 0.05) and contents (7.5％ vs.4.3％,x2 =5.747,P =0.019),and weak leadership commitment (14.3％ vs.6.5％,x2 =19.95,P ＜ 0.05) were higher in suburban group than those in urban group.On the contrary,the delivery of repeated contents (24.8％ vs.34.8％,x2 =15.327,P ＜0.05) and long training time (16.4％ vs.28.2％,x2 =26.055,P ＜ 0.05) were lower in suburban group than those in urban group.Using case study in the teaching was the common choice of both groups (73.3％ vs.78.0％,x2 =0.635,P =0.426).Compared to urban group,suburban group was more likely to choose lecture of theory (63.6％ vs.50.8％,x2 =6.712,P =0.010) rather than problem based learning (43.1％ vs.51.9％,x2 =4.273,P=0.010).Conclusions Both urban and suburban GPs in Shanghai are generally satisfied with the CME programs.There are some discrepancies in training needs of CME between urban and suburben area in Shanghai,indicating that the CMB programs need to be designed according to the needs of trainees in urban or suburb areas.

Survey on training needs of general practioners in Shanghai / 中华全科医师杂志

Objective To investigate the training needs of general practioners (GPs) in Shanghai and to analyze the related factors.Methods A questionnaire survery on the training needs was conducted among 428 GPs who attended a municipal training program of clinical compentance in Shanghai during July 2011 to February 2012.Results Among 428 GPs receiving the survey,23.9％ (102/427) expressed great willingness for training; 40.2％ ( 169/421 ) preferred part-time and 41.3％ ( 174/421 ) preferred on-job training; 31.7％ (377/1188) wished to have case analysis method of teaching.In the aspect of training contents,common clinical skills were ranked the first,accounting for 32.1％ (1376/4280) of the choices,on the other hand,health care for women,children and the elderly in community was ranked the last,accounting for 18.9％ (485/2568) of the choices.Logistic regression showed that the gender (OR =2.194,P=0.010),age (OR=0.435,P=0.011) and education levels of GPs (OR=0.293,P=0.006) were related factors of training needs.Conclusion The survay reveals that training needs of GPs are strong in Shanghai and GPs prefer short-term training in real clinical situations.

Application of standardized patients in intensive training of clinical skills for general practice trainees and its effectiveness / 中华全科医师杂志

Objective To explore application of standardized patients (SPs) in intensive training of clinical competency for general practice trainees. Methods Fifty-three general practice trainees in Shanghai Zhongshan Hospital were enrolled in the study, randomly assigned to intervention and control groups. Control group proceeded in routine clinical rotation, while intervention group accepted intensive training course with SPs as trainers. Three months after intervention, clinical skills of the two groups were compared in a simulated medical environment. Results There was no statistically significant difference in their baseline characteristics between the two groups (P ＞0.05). Competency in history taking, physical examinations,communication with patients, comprehensive consultation, medical record writing as well as case-analysis,improved significantly in intervention group after intervention, as compared to those before it ( P ＜ 0. 01 ),with the highest score of communication skill of 82 ± 10. Although competency of history taking, physical examinations, comprehensive consultation, medical record writing also improved significantly three months later in control group as compared to their baselines (P ＜ 0. 01 ), while no statistically significant difference in their communication skills was found ( P ＞ 0. 05 ). Scores of skills in physician-patient communication,comprehensive consultation as well as medical record analysis were significantly higher in intervention group than those in control one after intervention ( P ＜ 0. 01 ), but no significant difference in physical examinations was found between the two groups ( P ＞ 0. 05 ). Conclusions Application of SP in intensive training course for clinical competency can remarkably improve their competency in interpersonal communication and comprehensive consultation for general practice trainees.

The teaching and assessment of general practice training program in Shanghai: Practice and experiences / 中华全科医师杂志

General practice (GP) training program in Shanghai has been carried out in Zhongshan Hospital of Fudan University,which consists of theoretical study,clinical rotation and community practice.The contents of assessment include clinical competences,theoretical knowledge,and research capability; the methods of assessment include objective structured clinical examination,multiple choice tests,and assay writing.During the program implementation Zhongshan Hospital exert great efforts to set up the teaching management framework,quality control system,and to improve teaching methods in order to upgrade the clinical capability training for the residents.

Assessment for consultation competence of resident general practitioners in Shanghai / 中华全科医师杂志

Objective To assess consultation competence of resident general practitioners in Shanghai. Methods Standardized patients (SPs) were employed as an assessment tool in exploring consultation competence of resident general practitioners ( GPs) , including clinical and communication skills. Clinical skills included information collection, clinical thinking, health education, out-patient history taking and recording and reception time management, and patient-physician communication skills included building a good relationship, information collection and feedback, understanding issues from patient's perspective, sharing information and obtaining informed consent and close of consultation. Score rate defined as actual score of each item divided by total score of the domain was employed to assess competence of GPs in varied aspects. Results There were 157 resident GPs, 52 men and 105 women, with an average age of (28 ±2) years. Overall score rate of clinical skills averaged (76 ±10) percent, and score rate of each item ranking from the highest to the lowest was reception time management (91 ±4) percent, out-patient history taking and recording (80 ±14) percent, information collection (76 ±12) percent, clinical thinking (74 ±17) percent, health education (68 ±1) percent. Overall score rate of communication skills averaged (74 ±12) percent, and score rate of each item ranking from the highest to the lowest was building a good patient-physician relationship (86 ±3) percent, information collection and feedback (80 ±5) percent, sharing information and obtaining informed consent (74 ±15 ) percent, close of consultation (62 ±27 ) percent and understanding issues from patient's perspective (43 ±0) percent. Conclusions Resident GPs have improved their consultation competence to certain extent after standardized training, but there still exist some weakness to be improved in them.

Health education in community health-care service in Shanghai / 中华全科医师杂志

Objective To study current status of health education and explore its pattern in community health-care service(CHS)in Shanghai.Methods A total of 200 health-care workers(HCWs)from five CHS centers in Shanghai were investigated by questionnaire of health education knowledge.Results Among 200 HCWs investigated,96.5%(193/200)of them have recognized importance of health education,98.0%(196/200)could undertake health education in their clinical work,only 60.5%(121/200)had receired regular training on it,and 85.5%(171/200)thought they should be further trained regularly.Correct awareness of knowledge was 94.O%.47.0%and 33.6%for health education perception,healthy life-style and health education knowledge for chronic disease.respectively in them.There was very significant difference in correct awareness of knowledge between HCWs with varied ages and districts(χ2=17.663 and 82.376,P=0.001 and 0.000,respectively),but no significant difierence was found between men and women and those with varied professional titles(χ2=0.015 and 2.406,P=0.903 and 0.300.respectively).Short of time(48.5%),lack of relevant knowledge(15.0%)in HCWs and poor compliance of patients(33.0%)were main factors influencing their implementation of health education.Conclusions HCWs in CHS have already recognized importance of health education.but have not known enough its theoretical knowledge and skills.It is necessary to set guidelines of health education intervention for HCWs in CHS,and perfect monitoring and evaluation.as well as mechanism for rewards and penalties to promote development of health education in CHS.

Objective structured clinical examination in assessment for clinical competencies of trainees in standardized training for general practice at its completion in Shanghai / 中华全科医师杂志

Objective To set up methods for objective structured clinial examination(OSCE)for its application in assessment for clinical competencies of trainees in standardized training for general practice at its completion in Shanghai.Methods Trainees in standardized training for general practice in Shanghai were assessed at its completion in July 2009 at Zhongshan Hospital of Fudan University,which was organized and implemented by establishment of OSCE management framework and design of assessment stations,including writing-up medical records for cases,training standardized patients,selecting assessment itemsfrom checklists of clinical skills.as well as working-out a form for assessment scoring.Results Six assessment stations were set up for OSCE,including clinical data collection,medical record writing,case analysis,clinical skills,diagnostic decision-making based on electrocardiograms(ECGs)and x-ray films.Totally,32 trainees took part in OSCE and all passed examination.Score of medical record writing Was higher than that of clinical data collection [86(IQR 74-91)vs.79(IQR 67-85),P＜0.05].There was no significant difference in scores between medical reeord writing and case analysis [86(IQR 74-91)vs.80(IQR 73-86),P＞0.05].Score of X-ray film diagnosis Was higher than that of ECG diagnosis and clinical skills[99(IQR 96-100) vs.95(IQR 91-98),and 99(IQR 96-100)vs.90(IQR 83-94),all P＜0.01].Conclusions Clinical competeneies of trainees of general practice Can be assessed by OSCE in multiple aspects,which provides a new examination method for GP training.