Issues and solutions of general practice education for international medical students in China / 中华医学教育探索杂志

Under the background of internationalization of medical education in China, the general medical education for foreign students started relatively late. At present, there are still some problems in it, such as imperfect curriculum system, lack of unified and standardized textbooks, inadequate language skills of community teachers, difficulties in carrying out practical courses, and cultural differences. Based on the current situation of general practice education for international students in China, this article proposes the following solutions: to insist on standardizing quality management and construct scientific training schemes; to understand the present situation of primary medical and health services in their country of origin, promote cultural integration, and actively explore the fit between training and demand; to write bilingual textbooks suitable for practical needs; to overcome language barriers and build a team of community teachers that speak English; to adopt flexible and diversified teaching modes and comprehensively improve the quality of general practice teaching for international students, so as to promote the communication and dissemination of basic medical and health concepts in China.

Research on the core competence evaluation index system of general practice residents based on the outpatient environment / 中华医学教育探索杂志

Objective:To construct the core competence evaluation index system of general practice residents by the Delphi method.Methods:After the literature review of home and abroad and group discussion, the core competence evaluation index system of general practice residents in the outpatient environment was preliminarily developed. On this basis, the index system was determined through two rounds of expert consultation. Excel 2015 and SPSS 26.0 were used for data entry and statistical analysis.Results:The active coefficients of the two rounds of expert consultation were 95.0% (19/20) and 100.0% (19/19) respectively, and the degree of authority of the two rounds of expert consultation was 0.86. An index system consisting of 6 first-level indicators and 28 second-level indicators was determined. The 6 first-level indicators were medical services/patient care, medical knowledge, professionalism, systems-based practice, practice-based learning and improvement, interpersonal communication, and communication skills.Conclusion:This study has constructed a complete and highly reliable core competence evaluation index system of general practice residents based on the outpatient environment, which can provide reference for the cultivation of the outpatient reception ability of general practice residents in the future.

Comprehensive Treatment and Functional Rehabilitation After Pelvic Fracture in the Elderly With Multiple Organ Failure:Report of One Case / 中国医学科学院学报

We reported the comprehensive treatment of an elderly critically ill patient with pelvic fracture.The functions and quality of life of the patient were recovered after collaborative nursing by both family and hospital according to the general practice principle of both mental and physical rehabilitation.We summarized the diagnosis and treatment strategies of this case,aiming to provide reference for the clinical treatment of such cases.

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.

Application of Leicester assessment package in discipline construction of general practice / 中华全科医师杂志

The contents of general practice discipline construction comprise of orientation, team development, personnel training, scientific research, teaching base establishment and management of the discipline, etc. At present, the weakness in above aspects of general practice discipline construction is still the major challenges in most of the primary healthcare institutions. Our experiences in last 10 years shows that the application of Leicester Assessment Package can effectively promote the general practice discipline development for primary care institutions.

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.

Exploration and practice of TEST teaching mode for general practice residency training in the community teaching base / 中华全科医师杂志

From November 2020 to November 2021, the TEST(Task-Experience- Supervise-Thinking) teaching model was adopted for general practice residency training in teaching clinic of Changfeng Health Service Center of Shanghai Putuo district. The satisfaction of mentors, residents and patients was surveyed with self-assessment questionnaire. The satisfaction scores of mentors, residents and patients were (79.89±0.40), (79.96±0.19) and (49.92±0.40). The adaption of model TEST in teaching clinic is more effective in training of clinical competency, communication ability, management ability and narrative ability for general practice residents. It is also beneficial for mentors to upgrade their teaching ability, as well as for patients to improve their experience and satisfaction for seeking medical service. It is worth popularizing in the community practice base of general resident training.

Pain Management and Treatment: Primary Healthcare's Role

Pain is invariably present in most of the primary care medical requests. The general practitioner plays a key role in its adequate diagnosis and managing. Chronic pain is especially common between the elderly, who require a careful pharmacological prescription. Non-pharmacological therapies have few adverse effects and can be used alone or in combination with pharmacological therapies. Since effective pain control is a duty of health professionals and a human right for patients, it is of the utmost importance that we make this institutional investment in order to make this a reality.

Cutaneous melanoma diagnosis delay: socioeconomic and demographic factors influence

SUMMARY OBJECTIVE: Malignant cutaneous melanoma is the most aggressive type of skin cancer, and its early detection and prompt initiation of treatment play an important role in reducing disease-associated morbidity and mortality. Many factors influence the diagnosis of melanoma, and its recognition is essential for the development of strategies for its early detection. This study was carried out to Identify the main variables related to the delay in diagnosis of Malignant Cutaneous Melanoma and correlate them with the time interval for making the definitive diagnosis. METHODS: Retrospective analysis of 103 patient records from January 2015 to December 2020 correlating social, economic, demographic, and cultural factors with the time elapsed between the onset of symptoms and the diagnosis of malignant cutaneous melanoma. RESULTS: The average time to seek medical services from the onset of symptoms was 29.54 months. The mean time for a referral from the primary to the referral service was 1.35 months, and the factors that contributed to a faster diagnosis were lesion Breslow (>1 mm), lesion growth, income range (≤1.5 minimum wages), lower phototypes (I and II), not having gone to the Basic Healthcare Units, profession (household), smoking, and type of housing. CONCLUSIONS: Our findings demonstrate that there is still a great delay in the recognition of signs and symptoms related to the diagnosis of malignant cutaneous melanoma in our country, influenced by several socioeconomic and demographic factors.

Expectativas de inserción laboral en graduados de residencias de Medicina Familiar y General, Buenos Aires / Employment expectations of graduates from family and general medicine residencies, Buenos Aires

La Medicina Familiar y General (MFyG) es una especialidad clave en la estrategia de Atención Primaria de la Salud (APS). Sin embargo, en Latinoamérica se observa una disminución en la cantidad de aspirantes a las residencias de dicha especialidad y con los años abandono de su práctica. Explorar de manera prospectiva las expectativas de inserción laboral de los residentes del último año de MFyG y de los recientemente graduados e identificar el grado de incumbencia en el ámbito de la APS de las primeras experiencias laborales. Se realizó un estudio cualitativo y descriptivo, a través de 20 entrevistas semi-estructuradas y dos grupos focales a médicos de instituciones de gestión privada de la Ciudad Autónoma de Buenos Aires, durante el año 2019. Del análisis del corpus empírico surgieron 4 dimensiones: el perfil del médico de familia/general, la lucha por el reconocimiento de la especialidad, los factores que influyen en las primeras elecciones laborales y las expectativas laborales post residencia. Observamos que los médicos de familia/general se encuentran muy optimistas en la etapa de recién recibidos, con deseos de trabajar en el ámbito de la APS. Sin embargo, se ven obligados a enfrentar un mercado laboral que no aprecia (y hasta no comprende) su preparación. Las expectativas laborales se ven afectadas por una tensión entre ideas profundas sobre "lo correcto" de su trabajo y las oportunidades laborales reales en un sistema de salud que prioriza las especialidades de la fragmentación (AU)

Family and General Medicine is a key specialty in the Primary Health Care (PHC) strategy. However, in Latin America there has been a decrease in the number of physicians who choose and then practice it. To explore the Family and General Medicine residents' expectations on their labor transition after the last training year and identify the degree of concern in the field of PHC of the first work experiences. Qualitative study, through 20 semi-structured interviews and 2 focus groups involving Family and General physicians from privately managed institutions in Ciudad Autónoma de Buenos Aires, in 2019. From the analysis of the empirical corpus, four dimensions emerged: the profile of the family physicians, the fight for the recognition of the specialty, the factors that influence their first work experiences and the post-residency careers expectations. The graduates from Family and General Medicine residency programs interviewed have to face a difficult labour market that does not appreciate their training and does not understand what family physicians provide in terms of comprehensive care to patients. Therefore, tension arises between what is right and acceptable in their profession and the real job opportunities offered by the health system that prioritizes fragmented specialties (AU)

Anotações de um Jovem Médico e Outras Narrativas, de Mikhail Bulgákov / A Country Doctor's Notebook / Diario de un joven médico

Apesar de ter sido escrito há quase cem anos, Anotações de um jovem médico, de Mikhail Bulgákov, continua uma reflexão excepcionalmente bem escrita sobre a prática médica em forma de narrativa. Ao misturar as suas próprias experiências como único médico em uma área rural com a sua maestria literária, Bulgákov é capaz de capturar o que há de universal nas experiências de ser um médico inexperiente. Para médicos em países em desenvolvimento ou áreas remotas, ainda mais paralelos podem ser traçados. Temas como síndrome do impostor, vieses, falhas, responsabilidade pessoal e outros são abordados.

Despite being written nearly a hundred years ago, A Country Doctor's Notebook, by Mikhail Bulgakov, remains an exceptionally well-crafted reflection on medical practice in narrative form. By blending Bulgakov's own experience as the only doctor in a rural area and his literary mastery, he is able to bring out the universal experience of being an inexperienced doctor. For practitioners in developing countries or remote areas, such as the author, even more parallels can be drawn. Themes such as impostor syndrome, bias, failures, personal responsibility, and others are addressed.

A pesar de haber sido escrito hace casi cien años, Diario de un joven médico, de Mikhail Bulgakov, sigue siendo un reflejo excepcionalmente bien elaborado de la práctica médica en forma narrativa. Combinando la propia experiencia de Bulgakov como médico en una zona rural y su maestría literaria, él es capaz de sacar a relucir la experiencia universal de ser un médico inexperto. Para los profesionales en países en desarrollo o áreas remotas, se pueden establecer aún más paralelismos. Se abordan temas como el síndrome del impostor, sesgos, fracasos, responsabilidad personal y más.

Diabetes mellitus y su influencia en la sexualidad de pacientes varones / Diabetes mellitus and its influence on the sexuality of male patients

RESUMEN Objetivo Estudiar cómo la diabetes mellitus tipo 2 ha influenciado la sexualidad de 54 varones mellitus que acudieron a consulta a dos hospitales de Taxco, Guerrero. Materiales y Métodos Se aplicó una encuesta a un total de 54 hombres que acudieron a consulta a dos hospitales de Taxco, Guerrero, México. Se consideró a hombres con diabetes mellitus tipo 2, con vida sexual activa, con más de 5 años de evolución de la enfermedad, y que acudieron a consulta periódica. Los casos se eligieron tomando en cuenta los planteamientos sobre muestras por conveniencia. El trabajo fue cuantitativo no probabilístico. El cuestionario de encuesta incluyó 15 variables. Resultados Entre los hallazgos alentadores y positivos se destaca que el 76% de los casos manifestó que nunca ha tenido una disminución en el desempeño sexual, y el 80% de los casos expresó nunca haber presentado dolor o molestia después del coito. Sobre los porcentajes adversos y negativos, el 33% manifestó haber tenido siempre un cambió (de manera nociva o dañina) en el interés ante la sexualidad. Conclusiones Diversos autores destacan cómo la diabetes mellitus es una enfermedad epidémica en México, y que provoca incapacidad, mortalidad prematura, y afecta de manera grave la sexualidad de pacientes. En el presente estudio las respuestas indican, tanto hallazgos positivos, como también, un impacto adverso y negativo en la sexualidad de algunos varones encuestados.

ABSTRACT Objective To study and analyze how type 2 diabetes mellitus has influenced the sexuality of male patients. Material and Methods A survey was applied to a total of 54 men who attended in two hospitals in Taxco, Guerrero, México. Men with type 2 diabetes mellitus, with an active sexual life, with more than 5 years of evolution of the disease, and who attended periodic consultations were considered. The cases were chosen taking into account the approaches on convenience samples. The work was quantitative, not probabilistic. The survey questionnaire included 15 variables. Results Among the findings encouraging and positive, it is highlighted that 76% of the cases reported never having had a decrease in sexual performance. Likewise, and 80% of the cases expressed never having presented pain or discomfort after inter-course. Regarding the adverse and negative percentages, the 33% stated that they had always had a change (in a harmful way) in their interest in sexuality. Conclusions Several authors highlight how diabetes mellitus is an epidemic disease in Mexico, which can cause disability and premature mortality, and seriously affect the sexuality of patients. In the present study the responses indicate both positive findings, as well as an adverse and negative impact on the sexuality of some male respondents.

Needs and requirements for general practice department in general hospitals from the perspective of grassroots: a qualitative study / 中华全科医师杂志

Objective:To survey the needs and requirements of the general practice department in general hospitals from the perspective of grassroots health care personnel.Methods:From July 2020 to February 2022, a qualitative study on needs and requirements for the general practice department in general hospitals was conducted. Twenty eight participants from community health service centers in Beijing, Xi′an and Guangzhou were selected for the in-depth interviews.Results:The participants expressed their opinions and suggestions on the community needs and requirements for general practice department in general hospitals as follows. (1) The necessity of establishing department of general practice in general hospitals: the general hospitals had advantages to meet the medical needs of the community; the teaching and training should be focus on the way of thinking in the general practice, while the training needs for research ability was less required. (2) The cooperation between general hospital and its community teaching base: to implement the joint teaching rounds and joint home visits were effective ways for collaboration, which may ensure the quality of clinical faculty in the community bases. (3)The training needs of the community: rational use of drugs was most required, sub-specialty training was another concern for general practitioners in grassroots level. (4) The requirements for general practice department in the general hospital: in addition to complete organizational structure, daily teaching work needs to be implemented, and horizontal and vertical connection to relevant health institutions also need to be strengthened. Meanwhile, the teaching work should be a considerable part in the department performance assessment, and excellent clinical ability was also required to facilitate the effective referral of patients from the community.Conclusions:The study shows the necessity of establishing department of general practice in general hospitals, and various needs from the community teaching base, which providing reference for improving the construction of general practice department in the future.

Survey on awareness and application of exercise prescription among faculty of general practice in Taiyuan / 中华全科医师杂志

Objective:To investigate the awareness and application of exercise prescription among general practice faculty in Taiyuan City, and to analyze the related factors.Methods:A questionnaire survey on the awareness and application of exercise prescriptions was conducted from July to September 2021 among general practice faculty in Taiyuan City selected by stratified random sampling method. The influencing factors of awareness and application were analyzed with logistic regression.Results:A total of 589 general practice faculty were enrolled in the study, 342 of whom were females (58.06%). The overall awareness rate of exercise prescription was 38.74% (1 369/3 534); the awareness rate of basic knowledge was 56.08% (991/1 767) and the awareness rate of core knowledge was 21.39% (378/1 767). Logistic analysis showed that specialty as general practitioner ( OR=1.66, 95% CI:1.07-2.57, P=0.024), experience of exercise prescriptions ( OR=2.07, 95% CI:1.37-3.12, P=0.001) and willingness of public promotion of exercise benefits ( OR=2.08, 95% CI:1.05-4.15, P=0.037) were factors related to higher awareness of exercise prescription. The survey showed that 231 responders (39.22%) had given patients exercise guidance, among whom 125 (54.11%) gave oral and specific practice guidance, 206 (89.18%) would ask patients to perform health screening before exercise, and 184 (79.65%) performed health fitness evaluation. The knowledge used for guidance was mostly from textbooks or related guidelines (42.42%, n=98), but none of them had prescribed standardized exercise prescriptions. Conclusions:The survey shows that the knowledge and application rate is relatively low among general practice faculty in Taiyuan City. It is necessary to strengthen the training of exercise prescription for them.

Application of Delphi method in constructing the cultivation system of professional postgraduate medical students / 中华医学教育探索杂志

Objective:To construct a training system of the professional postgraduate degree of general practice using the Delphi method.Methods:On the basis of consulting relevant policies and literature, and drawing lessons from foreign general practice training systems, the index system of training professional postgraduate medical students of general practice was preliminarily developed. After two rounds of Delphi expert consultation, using the threshold method to select evaluation indexes, the training system was finally established. Excel 2010 and SPSS 19.0 were used to make data entry and statistical analysis.Results:The active coefficients of experts in the two rounds of Delphi consultation were 75.0% (12/16) and 91.7% (11/12) respectively, both the two rounds of the degree of specialist authority were 0.87, and the final coordination coefficient of the specialists' opinion was 0.452. The index system was composed of 5 first-level indexes including training objectives, theoretical curriculum setting, clinical practice setting, teaching staff and graduation requirements and 31 second-level indexes.Conclusion:The experts have great initiative and authority on research subjects. The opinions of all experts tend to be uniform after two rounds of consultation, and the results are reliable. A relatively complete and credible training index system of professional postgraduate degree of general medicine has been built.

A qualitative study on the working status of outpatient nurses in general practice departments in general hospitals in Beijing / 中华全科医师杂志

Objective:To survey the working status of outpatient nurses in general practice departments of general hospitals.Methods:From March to April 2021, personal in-depth interviews were conducted with outpatient nurses from general practice residency training bases in Beijing. The thematic framework analysis method was used to analyze the interview data and refine the themes.Results:Fourteen nurses working in general practice outpatient clinics were interviewed in this study. Four themes were extracted from the interview data: (1) inadequate staffing of full-time outpatient nurses in general practice departments of comprehensive hospitals; (2) unclear job functions for outpatient nurses in general practice departments; (3) no standardized patient health education in the department; (4) no relevant training received systematically.Conclusion:General practice departments in general hospitals should setup full-time general practice nurse positions, clarify the job responsibilities, strengthen the relevant training and enhance core competency for nurses working in general practice department.

Investigation on mental health of general practice students in a medical school in Jiangsu Province / 中华全科医师杂志

A survey on mental health status was conducted during October 2021 to January 2022 among grade 2017—2021 medical students majored in general practice who received 3+2-year education integrated undergraduate study and residency training for assistant physicians in a medical school in Jiangsu province. The SCL-90 and the self-made scale were used to investigate the mental health status and the results were compared with the national norm, the norm of national physicians, and the norm of medical students in Jiangsu province. A total of 125 valid questionnaires were recovered, and the positive detection rate of SCL-90 scale was 17.6%. Compared with the national norm in 2015, the scores of forcing ( t=-2.47), the interpersonal sensitivity ( t=-2.00), the hostile ( t=-2.65), the paranoid( t=-3.14) and the psychiatric factor( t=-2.45) of the study group were significantly lower than those of the norm ( P<0.05). Compared with the norm of national physicians and the norm of medical students in Jiangsu province, the scores of all the items except the fear factor were lower than those of the norms ( P<0.05). In the study group there were no significant differences in the total score and all factors among students with different genders, different training stages, and different background. The total score of SCL-90 scale was negatively associated with the study performance and clinical skill mastery ( r=-0.18) and the sense of achievement ( r=-0.23, P<0.05). The study shows that the mental health status of this group of students is generally better than that of the several norms.

Evaluation of integrated teaching model based on chronic disease care clinic in general practice department of general hospital / 中华全科医师杂志

Twenty general practice residents who received training in Tongren Hospital from 2018 to 2020 were enrolled. The residents undertook rotation in chronic disease care clinic of the general medicine department, and a multi-disciplinary integrated teaching mode was applied. The theoretical knowledge test, skill assessment and self-evaluation were performed before and after rotation. The 360-degree evaluation was carried out when leaving the department (study group), the results were compared with that of internal medicine (control group) in the same period. The teaching effect was comprehensively evaluated. The scores of theoretical knowledge and skill assessment after rotation were significantly higher than those before rotation ( P<0.01). The self-evaluated ability was significantly higher than that at admission, especially in general practice thinking (7.85±0.88), doctor-patient communication (7.95±0.69), health education (7.80±0.70) and disease management (8.20±0.62) ( P<0.01). The 360-degree evaluation showed that the study group was better than the control group in interpersonal communication skills [(4.75±0.44) vs. (4.41±0.50)], system-based work ability[(4.75±0.44) vs. (4.31±0.47)], practice-based learning and improvement [(4.80±0.41) vs. (4.33±0.48)], patient care [(4.75±0.44) vs. (4.28±0.46)] and training mode satisfaction [(4.85±0.37) vs. (4.38±0.49)] (all P<0.05). The study indicates that the multi-disciplinary integrated teaching mode applied for rotation in the chronic disease care clinic of the general medicine department can improve the teaching effect and raise the teaching quality for general practice residency training.

Application of Lester assessment package in general practice teaching clinic of tertiary hospital / 中华全科医师杂志

From September 2020 to August 2021, 34 general practice trainees in Xuanwu Hospital, Capital Medical University were were randomly divided into the control group and trial group with 17 in each group. The control group adopted the traditional clerkship method for outpatient clinical teaching; the trial group independently received patients with the supervision of clinical instructors, and the Leicester assessment package (LAP) was used for evaluation and training. The performance of two groups were assessed using the Beijing General Practitioner's Graduation Assessment and Admissions Patient Score Sheet. The LAP training was also given to control group at the late stage of the study, and the application of LAP was assessed with a questionnaire survey in two groups of trainees. The results showed that the performance of trial group was better than that of control group in terms of medical history collection [(23.12±1.05) vs. (21.18±0.88), t=-5.82, P<0.01 ], physical examination [(24.88±1.62) vs. (23.12±1.58), t=-3.22, P< 0.01 ], case analysis [(22.94±0.90) vs. (20.82±0.73), t=-7.55, P<0.01 ] and total score [(86.59±2.65) vs. (80.12±2.45) t=-7.40, P<0.01]. For assessment of LAP, all 34 trainees gave 5 points in items of improving patient care, knowledge and skills, communication skills, professional quality, reception skills, clinical thinking, clinical judgment, decision-making skills, and learning interest with the application of LAP in outpatient clinical teaching; the satisfaction of the trainees on the pertinence, teaching effect and LAP training method of the instructing physicians was 100% (34/34). It is suggested that the application of LAP for evaluation and implementation in general practice outpatient teaching will help to improve the teaching quality and the patient receiving ability of general practitioners.

Study on criteria for selection of general practice doctoral supervisors / 中华全科医师杂志

Objective:To explore the criteria of general practice doctoral supervisors.Methods:The expert consultation questionnaire was formed by literature analysis. Experts in the field of general medicine from universities and tertiary hospitals in Shanghai were invited to participate in two rounds of Delphi consultation. The consultation content included the basic requirements and the importance evaluation of the selection criteria for general practice doctoral supervisors. Descriptive analysis and Analytic Hierarchy Process (AHP) were used to analyze the results of the study.Results:A total of 29 experts participated in the consultation, all with senior professional titles and doctoral degrees. The positive coefficient and expert authority coefficient of the two rounds of expert consultation were 1.0 and 0.925, respectively. The Kendall coordination coefficient of indicator importance evaluation were 0.436 and 0.397, respectively. The ethics, age, professional title, educational background and academic degree and diploma were considered to be included in the basic qualifications. The optimal standards for supervisor selection included teaching ability, scientific research ability, student training and team promotion ability that subdivided into 13 evaluation indexes.Conclusion:The basic qualifications and optimal standards for general practice doctoral supervisors have been preliminarily developed, which provides reference for selection of qualified general practice doctoral supervisors.