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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.
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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.
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Objective:To analyze factors related to clinic attendance for contracted residents in a community health service center in Shanghai.Methods:It was a cross-sectional study. Through the 'Cloud Management of the Community' APP and the 'Service Fee of Contracted Residents' APP, the basic information, contracted time, hospital visits, number of visits, and medical insurance expenses of the contracted residents in Shanggang Community Health Service Center in 2021 were collected, the visiting rate to the contracted community health center and the contracted medical combination hospitals were analyzed.Results:In 2021, the contracting rate of all residents in the community was 49.96% (51 478/103 033). The contracting rate of the key population was 84.59% (43 545/51 478),among whom 66.28% (34 118/51 478) were over 60 years, 49.93% (25 702/51 478) had been contracted for more than 3 years, and 37.43% (19 270/51 478) had hypertension and/or diabetes. The number of contracted general practitioners was 4.89 times of contracted TCM doctors (1 345.17/274.81). Among all contracted residents 78.75% (40 540/51 478) had at least one visit annually, and 65.00% (33 463/51 478) had at least one visit to community health service center and the average number of visits was 17.63(5.00, 24.00)annually. The rate of visit to contracted the community health service center was (46.97±38.37) %, and 41.78% (16 937/40 540) had≥60% visit to contracted community center; the average visiting rate to the combination hospitals was (70.59±34.57) %, and 55.75% (22 602/40 540) had consultation rate≥80%. These residents were older in age, had longer contract time, higher proportion of hypertension and diabetes, and higher medical expenses, compared to those with less visits to contracted community health center and combination hospitals ( P<0.01). Meanwhile, 11 736 residents (35.07%) only visited to the contracted community health service center. Conclusion:The contracted residents are mainly the elderly and the sick ones in the community, but the use of contracted service is inadequate. Improving the visiting rate to community health center is a challenge for make a full use of the contracted health facilities.
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With the increasing prevalence of atrial fibrillation (AF), the incidence of its complications, such as ischemic stroke and thromboembolism is also increasing. According to the two-way referral system proposed by health authorities, AF management should be carried out mainly in primary care settings;and studies show that general practitioners play an indispensable role in AF management. At present,however,the inappropriate anticoagulation,AF complications and risk awareness are three major problems in the primary care of AF management in China. This article reviews the status quo and future prospect of AF management in primary care to provide suggestions for better management of AF in primary care level.
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Remote teaching consultation is an online continuing medical education mode which combines medical practice with teaching and superimposes teaching functions on the basis of remote consultation. Based on the pilot experiences of collaboration between Zhongshan Hospital and Xidu Community Health Service Center, this article analyzes the strengths, weaknesses, opportunities and threats (SWOT)of the remote teaching consultation for general practitioners, and discusses strategies to improve the further implementation plan. The analysis showed that as a novel educational method, the remote teaching consultation should take the advantages of online education, make good use of the remote consultation platform, improve its teaching connotation, and form standardized implementation norms to meet the diversified needs of general practitioners for continuing medical education.
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Objective:To survey the teaching ability of general practitioners(GPs) in community health centers of Shanghai, and its influencing factors.Methods:A questionnaire survey on the teaching ability of general practice trainers was conducted from January to February 2017. The participants of the survey were GPs with teaching experiences from community health centers in Shanghai selected by a stratified and proportional cluster sampling method. The questionnaire included two aspects: the general information and teaching ability of the participants. The influencing factors of teaching ability were analyzed by univariate and multivariate regression analysis.Results:A total of 1 138 GPs from 116 selected community health centers participated in the questionnaire survey, among whom 63.6% (724/1 138) worked in community teaching bases and 78.5% (893/1 138) had received training for trainers. The total score of teaching ability was 38.00 (30.00, 40.00). The score of the item"interesting in teaching"was (3.46±0.80), 75%—80% of the other questions answered "yes". The score of"application of multi-teaching methods"was (3.78±0.72). Multivariate analyses showed that working for 5—9 and 10—19 years [ OR=7.14 (2.47—11.81), P=0.003; OR=5.32 (1.30—9.33), P=0.009], working in community teaching bases [ OR=13.23 (9.88—16.57), P<0.001] and receiving training for trainers [ OR=17.76 (13.80—21.71), P<0.001] were influencing factors of teaching ability. Conclusion:The main problems related to teaching ability in community GPs are lack of teaching interest and the poor application of multi-teaching methods, the relevant training is necessary for them in the future.
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Objective:To investigate the current situation and needs of pharmaceutical training for general practice faculty.Methods:A self-designed questionnaire survey was conducted in April 2019. The participants were general practice faculty attending the national training course in Zhongshan Hospital and selected by convenience sampling method.Results:A total of 219 general practice teachers participated in the survey, 51.14% (112/219) of the participants thought that the current pharmaceutical knowledge did not meet the needs of pharmaceutical services in daily work, and 67.58% (148/219) attended pharmacy related training every year, and the frequency was mainly 1—2 times per year (56.62%, 124/219). The main reasons for attending the training were working needs (68.24%, 101/148) and willingness (55.41%, 82/148); 63.51% (94/148) of the participants thought that the training was moderate or less effective, mainly because of the weak strength of trainers (40.54%, 60/148), insufficient attention paid by trainers (37.16%, 55/148) and lack of depth (37.16%, 55/148). The survey showed that 76.26% (167/219) of general practice teachers had pharmaceutical training needs; and gender, working years and working experience in secondary and/or tertiary hospitals were influencing factors for pharmaceutical training needs. And female faculty, those working less than 10 years and with working experience in secondary hospitals had higher demand for pharmaceutical training. The expected pharmaceutical training focused primarily on the selection and optimization of medication schemes (72.60%, 159/219), interaction/incompatibility between medicines (62.10%, 136/219) and pharmaceutical care in medical treatment (57.08%, 125/219). The expected training methods were mainly interactive case analysis and discussion (69.41%, 152/219) through the internet or APP (such as WeChat) (54.34%, 119/219); the expected training frequency was no more than once in two months (36.07%, 79/219), better in working time (48.86%, 107/219) and each session was 30—45 minutes (38.36%, 84/219).Conclusion:General practice faculty has a high demand for pharmaceutical training. Targeted, individualized and systematic pharmaceutical training courses should be developed according to the pharmaceutical training needs of participants.
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Objective:To investigate the predictive value of C-reactive protein (CRP), neutrophils-lymphocytes ratio (NLR) and leukocyte-erythrocyte ratio (LER) for aspiration pneumonia (AP) in patients with acute cerebral infarction (ACI).Methods:Retrospective analysis was performed on 989 consecutive hospitalized ACI patients in 2021 who were free of infection within 48 h after ACI onset. General information, past medical history, CRP and complete blood count within 24 h after admission were collected. NLR and LER were calculated based on neutrophil, lymphocyte, leukocyte and erythrocyte count. ACI patients were divided into two groups: non-AP group ( n = 883) and AP group ( n = 106) according to whether they had AP 48 h after admission. Spearman correlations of CRP, NLR and LER with AP were analyzed. The receiver operator characteristic (ROC) curves were plotted to evaluate the predictive values of CRP, NLR and LER for the occurrence of AP in ACI patients, and the sensitivity and specificity at the optimal cut-off value were also calculated. Logistic regression analysis was used for further verification. Results:Compared with the non-AP group, CRP, NLR and LER were significantly higher in the AP group ( P<0.05). Spearman correlation analysis showed that AP was positively correlated with CRP, NLR and LER ( r = 0.42, 0.36 and 0.35, P<0.01). ROC curve analysis showed that CRP, NLR and LER had certain predictive value for AP in ACI patients ( P<0.05), and the area under the curve (AUC) was 0.8917, 0.8349 and 0.8269, respectively. The optimal cutoff values of CRP, NLR and LER were 12.70 mg/L, 4.40 and 1.89 ×10 -3, respectively, with the sensitivity and specificity of 79.25% and 86.41%, 71.70% and 84.94%, and 75.47% and 79.95%, respectively. Multivariate Logistic regression analysis showed that CRP ( OR=6.65, 95% CI: 3.70-11.98, β=1.90, P<0.001), NLR ( OR=2.84,95% CI: 1.60-5.03, β=1.04, P<0.001) and LER ( OR=3.51, 95% CI: 2.00-6.16, β=1.26, P<0.001) were independent risk factors for AP in ACI patients. Conclusions:CRP, NLR and LER at baseline show certain predictive value for the occurrence of AP in ACI patients, and CRP has the strongest predictive power.
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Objective:To investigate the frailty state transition in the community-dwelling elderly undergoing health check-up, and related influencing factors.Methods:From September to October 2016, 3 833 residents aged ≥ 60 years undergoing health check-up in Xidu Community Health Center were enrolled in this prospective cohort study by multistage random sampling. All participants completed a questionnaire survey, health examinations, and frailty assessments as measured with the Fried frailty phenotype. A second assessment of frailty status was conducted from June to July 2020, the frailty state transition was analyzed by comparison between two assessments of frailty states. Logistic regression was used to analyze the influencing factors related to frailty progression.Results:The final cohort consisted of 3 061 participants. At the entering of the study, the median age of participants was 71.0 years, 41.0% were male, 1 563 (51.1%) were prefrail, and 156 (5.1%) were frail. At the follow-up, the frailty status of 1 304 (42.6%) participants was progressed and that of 395 (12.9%) participants was improved from their baseline levels, respectively. Logistic regression showed that age ( OR=1.170,95% CI:1.147-1.194), marital status (married: OR=0.377,95% CI:0.292-0.486), physical exercise (never vs. every day: OR=18.610,95% CI:14.461-23.950; sometimes vs. every day: OR=4.210,95% CI:2.186-8.107), baseline frailty state (robust vs. frail: OR=20.464,95% CI:11.779-35.553;prefrail vs. frail: OR=2.147,95% CI:1.270-3.632), stroke ( OR=2.195,95% CI:1.454-3.313) and diabetes ( OR=1.811,95% CI:1.346-2.437) were identified as independent factors influencing frailty progression (all P<0.05). Conclusions:Frailty state progression is common among older adults, and its related factors include age, unmarried status, physical exercise, baseline frailty state, stroke and diabetes. It is necessary to identify elderly at high risk for frailty progression and implement medical interventions.
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Objective:To explore the effect of family doctor system on the risk stratification of community hypertensive population by application of Markov modelMethods:Retrospective investigation was conducted on hypertensive patients under continuing management from 13 community health service centers in Shanghai Xuhui District from January 2014 to December 2016. Among 98 996 subjects, 50 920 (51.45%) were contracted to family doctors (contracted group) and 48 046 (48.55%) did not contracted to family doctors (non-contracted group). According to the risk stratification of hypertension, the four-state Markov model (low-risk, medium-risk, high-risk, and extremely high-risk) was established. The prediction effect of the model was validated, and the changes in the risk stratification status of hypertension in the study subjects from 2017 to 2020 was predicted by using the Markov model.Results:Among all subjects the number of medium-risk and extremely high-risk accounted for the majority(>80%). Compared with 2014, in 2016 the number of low-risk patients with hypertension was decreased from 9 042 cases (17.76%) to 6 851 cases (13.45%) in contracted group; and from 9 971 cases (20.75%) to 7 906 cases (16.46%) in non-contracted group; the number of people at extremely high risk of hypertension was increased from 15 609 cases (30.65%) to 17 639 cases (34.64%) in the contracted group; from 13 847 cases (28.82%) to 15 641 cases (32.55%) in the non-contracted group. According to the Markov model one year after the risk stratification, the risk status of most subjects remained in the original one. There was not transform from extremely high-risk to low-risk state (0%), but there was transform from low-risk to extremely high-risk state in some extend, and the degree of transform in non-contracted group [2.06%(205/9 971)] was higher than the contracted group [1.85%(167/9 042)]. Predicted by the Markov model, between 2017 and 2020 the number and proportion of the medium-risk>extremely high-risk>low-risk>high-risk in both contracted group and non-contracted group. With the extension of time, low-risk proportion is gradually reduces, and the rate of reduction of the contracted group was lower than that of the non-contracted group, while proportion of medium-risk, high-risk and extremely high-risk is gradually increased.Conclusions:The constructed Markov model is accruable and stable, which can be used in the study of hypertension prognosis. The study indicates that the contracted services of family doctor have positive effects on the management of community hypertensive patients.
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Objective:To investigate the potentially inappropriate medication(PIM)among elderly patients with chronic diseases in Shanghai communities and related influence factors.Method:Six community Health service Centers were choosen using stratified sampling. Total 968 elderly patients with chronic diseases who visited to the outpatient clinic of Shanghai Community Health Service Centers from July to August 2018 were included in the study. The PIM was investigated according to the 2015 Beers criteria. The χ 2 test and multivariate logistic regression model were used to analyze factors related to the PIM. Results:The survey showed that 317 elderly patients had PIM with 412 person-doses. In 134 person-doses, the PIM was unrelated to the disease; in 18 person-doses, PIM was caused by interaction of drug with disease/symptoms; in 259 person-doses PIM was related to the drugs that should be cautiously used for elderly; only in 1 person-dose the PIM was caused by the interaction between drugs. The drugs with the highest proportion of PIM were diuretics, benzodiazepines and aspirin. There were significant differences in age, kinds of diseases, kinds of drugs and times of visiting community health service centers between elderly patients with PIM and those without PIM (χ 2=42.28, 35.51, 46.47, 38.46; all P<0.05). The main PIM-related factors were age, kinds of diseases, kinds of drugs and times of visiting community health service centers. Conclusion:The study shows that the prevalence of PIM among elderly chronic diseases patients in Shanghai communities is relatively high, which is associated with the age, kinds of diseases, kinds of drugs and times of visiting community health service centers.
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Objective:To explore the influencing factors and the weights for medical graduates to choose general practice and work in grassroots posts in China.Methods:On the basis of pre-investigation, the second interviews were conducted among medical students of grade two to established ahierarchical structure model. A survey was conducted with self-made questionnaire among 407 medical students of grade five from eight medical colleges selected by stratified random cluster sampling from January to June 2017. The influencing factors of choosing general practice choice as the future career were analyzed and the weights were calculated by analytic hierarchy process (AHP).Results:Total 395 valid questionnaires were received from 161 males and 234 females students. Under the general goal layer of influencing factors for medical graduates to choose general practice, the weights of the four first-level indicators were: career status and prospects for development (weight: 0.299), salary (weight: 0.294), family contribution (weight: 0.207) and professional interest (weight: 0.200). Among the secondary indicators of career status and prospects for development, job satisfaction had the highest weight (comprehensive weight: 0.073), followed by the work environment (comprehensive weight: 0.064), social status (comprehensive weight: 0.061), patterns of doctor-patient relationship in comprehensive care of general practice (comprehensive weight: 0.052), and work intensity had the lowest weight (comprehensive weight: 0.048). Among the five secondary indicators of professional interest, the weight of clinical practice was the highest(comprehensive weight: 0.066), followed by the guidance of theoretical teachers (comprehensive weight: 0.063). In the level 3 indicators in clinical practice, the attitude of general practice teachers to general practice had the higher weight than those teachers in other departments (the comprehensive weights were 0.037 and 0.030, respectively).Conclusion:Career status and development prospects and salary are the main influencing factors for medical students to choose general practice. Teachers′ guidance in clinical practice and theoretical study is the most critical factor for medical students to be interested in general practice.
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Objective To survey the employment intention of medical students of five-year program in China.Methods A self-administered questionnaire survey on the employment intention was conducted among grade-5 medical students of 5-year program in 8 medical schools from January to June 2017,395 participants (161 males and 234 females) were selected by stratified random cluster sampling method.Results The survey showed that 57.65％ (226/392) respondents would return hometown after graduation as their first choice,20.66％ (81/392) preferred to work in large cities,only 0.76％ (3/292) chose the Western and rural areas;20.05％ (78/389) responders were willing to be a general practitioner working at the community health center,56.55％ (220/389) did not decide,while 23.40％ (91/389) did not want to be general practitioner.Students from rural areas vs.from urban areas (24.30％ vs.15.08％),whose parents with lower educational level vs.higher educational level (30.62％ vs.25.71％),from medical school in Western regions vs.in Eastern regions (28.65％ vs.11.68％) were more willing to choose general practice(P＜0.05).Students who had clerkship or rotation of general medicine vs.who had not more like the specialty of general practice (27.63％ vs.15.66％,P＜0.05),but there was no significant difference in the employment intention to be a general practitioner (19.93％ vs.20.45％,P＞0.05).Students who knew grassroots employment policies were more willing to be general practitioners (25.48％ vs.13.02％,P＜0.05).Conclusion The survey shows that the employment intention to be a general practitioner is stronger than before among medical students.But it is still need to take necessary measures to attract more medical graduates to work as general practitioners in grass-roots communities.
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A "general-special integrated" prevention and treatment model for chronic obstructive pulmonary disease (COPD) patients in the community was preliminarily established with the joint effets of specialists from the terital hospital and general practitioners in the community health service center.During the implementation of the model the general practitioners recieved research training and participanted in the research project of COPD management;and the "general-special integrated" outpatient clinic greatly improved the management for COPD patients.Since the establishment of the model,the number of acute attacks of COPD patients was decreased,and the proportion of standardized medication was increased.The model also improved the research ability and clinical competency of general practitioners.The established model provides experiences for the tiered-management for COPD patients in the community.
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Objective To survey the requirement of objective structured teaching evaluation (OSTE) use for general practice (GP) trainers and the station design.Methods A questionnaire survey on the requirement of OSTE use was conducted among 161 hospital trainers and 110 community trainers from a national key GP trainers training workship in April 2016.The survey included basic information,OSTE use requirements,frequency of clinical teaching scenarios,and frequency of teaching methods.Results The survey showed that 86.3％(234/271) of trainers were willing to use OSTE for assessing teaching competence and 92.3％ (250/271) for training teaching competence.The proportion of “having been observed and being given feedback from superior trainers for teaching process” was higher in hospital trainers than that in community trainers [68.3％(110/161)vs.40.9％(45/110),x2=20.060,P＜0.001].In the part of frequency of teaching scenarios,the proportion of “often” plus “always” was higher in “instructing students to write the medical records” [64.6％(175/271)],“teaching doctor-patient communication skills” [60.9％(165/271)] and “observing students' consultation and giving feedback” [57.9％(157/271)];there were no significant differences in above questions between the two types of trainers (all P＞0.01).In the part of frequency of teaching methodS,the proportion of “often”plus “always”was higher in “clinical supervisor's report” [60.9％ (165/271)],“applied knowledge test” [52.4％(142/271)] and “problem-based learning” [38.0％(103/271)];there were no significant differences in above questions between the two types of trainers (all P＞0.01).Conclusion The requirements of assessment and training by using OSTE are strong in GP trainers.The OSTE stations should be designed based on the routine teaching scenarios and methods for both hospital trainers and community trainers without discriminations.
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Objective To assess the needs and demand of continuing medical education(CME)for general practitioners(GPs)after completion of residency training.Methods A series of surveys were carried out from July 2015 to December 2015 using a questionnaire on needs and demands of CME among 152 GPs, who completed residency training in Zhongshan Hospital from September 2000 to July 2013. Results One hundred and fifty two valid questionnaires were received with a retrieval rate of 100%.Among 512 participants,53(34.9%)regarded CME as necessary,129(84.9%)were willing or very willing to receive CME,87(68.9%)stated that they were willing to receive CME even without credits,120 of them (78.9%)stated that the primary purpose of receiving CME was to update professional knowledge;87(57.2%)stated lack of certain knowledge and 52(34.2%)stated lack of certain skills to some extent;8(5.3%)thought that the previous CME they received did not completely meet their needs,105(69.1%) thought that it partially met their needs;136(89.5%)thought that only high level experts were suitable for CME teaching;the teaching methods they preferred were problem-based learning(PBL), followed by case study,clinical demonstration and instruction,and systematic lectures focused on common clinical problems;88(57.9%)preferred short term training with an average length of 5.01 days(91.4%,139/152);111 (75.0%)preferred CME course to be offered on both workdays and off hours.The factors influencing willingness to attend CME included length of time(87.5%,133/152),lack of suitable program(64.5%, 98/152),monotonous way of training, impractical training contents and its inconsistency with actual need (60.3%, 91/52).Conclusion The needs and demands of continuing medical education for GPs completing residency training are high.The results of this study would provide useful information for effective implementation of continuing medical education for GPs.
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Objective To compare the awareness, training and assessment of teaching competence between hospital and community general practice (GP) trainers. Methods A questionnaire survey on teaching competence was conducted among 161 hospital GP trainers and 110 community GP trainers in 2016 April. Results There were 96 male and 175 female participants with an average age of (30.4 ± 8.0) years. On the the awareness of teaching competence,the propotion of"very important"of"creating a quality teaching environment for students","knowing how to teach students","ability to teach students medical knowledge and skills", " feedback ability ", "showing the virtue of being a teacher" in hospital and community trainers were 47.8％(77/161) and 40.0％(44/110), 66.5％(107/161) and 59.1％(65/110), 71.5％(115/161) and 62.8％(69/110), 54.7％(88/161) and 52.7％(58/110), 65.2％(105/161) and 60.9 (67/110), respectively;there were no significant differences of all importance ratings between the two groups (all P>0.05). Hospital trainers had higher proportions of "having received teaching method training" [70.2％(113/161)vs. 50.0％(55/110),χ2=11.302,P=0.001] and"having received teaching training before practice teaching for the first time" [(45.3％(73/161)vs. 21.8％(24/110),χ2=15.735,P<0.001] than those of community trainers. The proportion of "having received teaching comptence evaluation" was higher in hospital trainers than that in community trainers [(60.9％(98/161)vs. 43.6％(48/110),χ2=7.810,P=0.004], but there were no significant difference in teaching comptence evaluation methods between two types of trainers (P>0.01). Conclusion The awareness of teaching competence is similar between hospital and community GP trainers, but the community trainers are lack of teaching competence training, and their teaching competence evaluation methods need to be improved.
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Objective To survey Introduction to General Practice course taking and knowledge of general practice among medical students in Fudan University.Methods A survey with self-designed questionnaire was conducted in June 2017 among medical students of 5 year program in Fudan University who had taken the course of Introduction to General Practice.Results One hundred and ninety seven questionnaires were distributed and 186 valid ones returned with a recovery rate of 94.42％.The survey showed that 95.16％ of participants (177/186)gained knowledge about the post of general practitioners (GPs) through community practice;97.31％ (181 / 186) thought community practice as necessary;92.47％ (172/186) were very satisfied or fairly satisfied with the community practice course;94.09％ (175/186)gained clear understanding of the duty of GPs through the course study;87.63％ (163/186)completely understood the required capabilities of a GP;74.19％ (138/186)said that the course had opened their mind;64.52％ (120/ 186) said that they had changed their views about general practice;63.44％ (118/186) said that they had acquired new knowledge.The participants also gave some suggestions regarding the content of community practice.Although 96.24％ of the students (179/186)thought that general practitioner had a bright career prospect,only 7 of them (3.76％)were willing to be GPs after graduation;meanwhile 161 of them (86.56％) were willing to be specialists.The main reasons of not willing to be a GP were "wish to be a specialists (82.61％,133/186)","the job was not challenging or difficult for career development (45.34％,73/186)" and "not paid well for GPs (45.34％,73/186)".Conclusion Although many students thought GP would have good career prospect,only few of them are willing to be a GP.How to attract more medical students to chose GP as their career should be paid high attention by education and health authorities.
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Objective To survey the status and related demands of advanced clinical training among community general practitioners (GPs) in Shanghai.Methods A survey on the status and demands of advanced clinical training was conducted with a self-designed questionnaire among GPs in Minhang District and Jiading District of Shanghai from January to May 2016.The questionnaire included basic information , experience of advanced clinical training , satisfaction with training and training demands .Results Total 526 questionnaire were distributed and 478 valid questionnaires were returned with a response rate of 90.9%. Among the participants 202 (42.3%) had experience of advanced clinical study ; the training units were mainly secondary hospitals in Shanghai (69.3%, 140/202); 67.2%(131/195) participants considered that the previous training did not fully meet the needs of the community .There was significant difference in the training demands among participants with different ages , professional titles, and working years ( χ2＝12.754, 7.912, 4.501, all P＜0.01); those with younger age, higher education and shorter working years had higher training demands .Survey showed that 57.3%( 274/478 ) of participants demanded further studies in the future; 58.3%( 239/410) of them chose tertiary hospitals in Shanghai as training unit , 79.0%(321/406) chose internal medicine and geriatrics as training specialties , particularly in outpatient clinic (73.2%, 298/407); the length of study should be 3 months (32.8%, 132/402) or 6 months (27.6%, 111/402), and completed in segments (61.5%, 253/411).The purpose of training was mainly to upgrade clinical competence (94.2%, 258/272); busy working schedule (53.4%, 66/116) was the main reason for not intending the advanced clinical studies .Conclusions The community general practitioners in Shanghai have high demands for advanced clinical training .The training should meet the needs of clinical practice in community and the mode of study should be more flexible .
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Objective To analysis the implementation of the objective structured clinical examination (OSCE) for completion of general practice residency training in Xinjiang Uygur autonomous region.Methods Ninety eight general practice residents took training-completion examination applying OSCE in Xinjiang Uygur Autonomous Region.The examiners (including SP examiners) and examinees were interviewed with questionnaire after the OSCE.Results All 60 examiners and 98 examinees were generally in favor of using OSCE in general practice residency training completion examination;100.0％ (60/60) examiners and 86.7％ (85/98) examinees thought that it was necessary;98.3％ (59/60) examiners and 89.8％ (88/98) examinees thought that the OSCE was able to evaluate the clinical competence of general practice;95.0％ (57/60) examiners and 78.6％ (77/98) examinees thought the OSCE examination stations reasonable;40.8 ％ (40/98) examinees thought that the difficulty degree of the exam was moderate,35.7％ (35/98) and 20.4％ (20/98) examinees thought that it was difficult or very difficult,particularly for history writing and case analysis.Conclusions The examiners and examinees recognize the advantages of OSCE in assessment of clinical competence.This study provides useful information for application of OSCE in general practice residency training completion assessment.