Survey on the recognition of the post competency index system among Chinese rural general practice assistant physicians and analysis of influencing foctors / 中华全科医师杂志

Objective:To investigate the recognition of the post competency index system among rural general practice assistant physicians and its influencing factors.Methods:This study was a cross-sectional survey. A questionnaire survey on the recognition of post competency index system was conducted from October 2020 to September 2021 among rural general practice assistant physicians from 10 provinces/municipalities selected by stratified cluster sampling method. The recognition of rural general practice assistant physicians at all levels of indexs and the factors influencing recognition were analyzed.Results:A total of 1 123 questionnaires were distributed and 1 024 valid ones were collected with a recovery rate of 91.18%. Of the 1 024 respondents, 529 were male(51.7%) and 435 were aged 40-49 years(42.5%), which was the highest proportion by age group. The average overall recognition score of the index system was 4.41, and the scores of the primary indexes were 4.32-4.45. Three primary indexes had the highest recognition scores: professional competence, basic health care services, and interpersonal communication and teamwork. The recognition scores on the second level index were 4.18-4.61, and the proportion of recognition scores greater than 4 was over 80%. There were significant differences in the recognition scores of the index system among assistant physicians with different working years, educational background, professional title and work unit ( F/H=6.41, 14.83, 12.45, 7.53, P<0.01). Educational background(associate degree: B=0.091, P=0.015; bachelor degree and above: B=0.196, P<0.001) and professional title(intermediate professional title and above: B=-0.234, P<0.001) were the independent factors influencing the recognition degree of the index system for rural general practice assistant physicians. Conclusions:The post competency index system is generally recognized by rural general practice assistant physician, and academic qualifications and professional title status may influence its recognition.

Application feasibility of the post competency index system of rural general practice assistant physicians / 中华全科医师杂志

Objective:To evaluate the application feasibility of the post competency index system of rural general practice assistant physicians, and to analyze and compare the post competency of rural general practice assistant physicians with different characteristics through a survey among rural general practice assistant physicians in China.Methods:This study was a cross-sectional study. A questionnaire survey was conducted among rural general practice assistant physicians in 10 provinces/municipalities selected by stratified cluster sampling method from October 2020 to September 2021. The post competency scores were self-evaluated based on the post competency index system of rural general practice assistant physicians. The results of the survey were analyzed and the application feasibility of the index system was evaluated.Results:A total of 1 123 questionnaires were distributed and 1 024 valid questionnaires were returned with a recovery rate of 91.2%. Of the 1 024 respondents, 529 were males (51.7%), 435 were aged 40-49 years (42.5%), 434 had a secondary school education or less (42.4%), and 531 were junior practitioners (51.9%). The Cronbach′s α coefficient of the overall questionnaire was 0.987, and the Cronbach′s α coefficient of the first level index ranged from 0.897 to 0.974. The cumulative variance contribution rate of exploratory factor analysis was 72.012%. The confirmatory factor analysis showed χ2/ df=3.926, RMSEA=0.076, CFI=0.858, IFI=0.859, indicating that the model fit was basically good. The average self-evaluation scores of the first level index ranged from 3.95 to 4.25, and the average self-evaluation scores of the second level index ranged from 3.74 to 4.36. There were significant differences in self-evaluation scores of post competency among rural general practice assistant physicians with different working years, professional titles, working units and economic regions( F=4.67, 10.54, 22.16 and 20.90,all P<0.05). People with low self-evaluation scores of post competency had the following characteristics: working 10-19 years, intermediate or above titles, working in community health service centers, located in the eastern region.People with high self-evaluation scores of post competency had the following characteristics: primary professional title, working in the village clinic. Conclusion:The competency index system of rural general practice assistant physicians has good application feasibility,and it can be used to evaluate post competency for the education and training of rural general practice assistant physicians.

Study on competency characteristics of rural general practitioners based on behavioral event interview / 中华全科医师杂志

Objective:To survey the competency characteristics of rural general practitioners using behavioral event interview.Methods:The competency characteristics of rural general practitioners were extracted by literature research method, and the behavior event interviews were conducted with 18 rural general practitioners nationwide from January to April 2019. According to the interview results, the items were modified and refined. On this basis, the benchmark competencies and excellent competencies of rural general practitioners were extracted.Results:A total of 45 885-second audio recordings and 174 523-word transcripts were obtained from the interviews. Eight identification competencies and 10 benchmark competencies were extracted. Identification competencies included "professionalism, altruism and dedication, love and compassion, visiting a patient at home, establishing good relationships, achievement-oriented, having expertise, and mastering community population dynamics and health status actively". Benchmark competencies included "diagnosis and treatment of common diseases, basic medical skills, learning consciousness and ability, solving medical problems with traditional Chinese medicine, health care for focal groups, rational administration of drug, referral services, managing chronic non communicable diseases, understanding health care system and related policies, and emergency treatment ability".Conclusions:This study preliminarily obtains the identification competencies and benchmark competencies of rural general practitioners. Managers can improve the service quality of rural general practitioners according to these elements.

Construction of index system for post competency of rural general practice assistant physicians / 中华全科医师杂志

Objective:To construct a post competency index system for rural general practice assistant physicians.Methods:On the basis of previous literature research and behavioral event interviews, the questionnaire of Delphi consultation was designed. Two rounds of Delphi expert consultation were conducted from October 2019 to January 2020 to develop an index system of post competency for rural general practice assistant physicians, and the analytic hierarchy process methods was used to calculate the weight of each index.Results:A total of 26 experts were included, with an average age of (48.7±8.6) years and an average working seniority of (22.8±8.8) years. After 2 rounds of consultation, the competency index system was developed, including 6 first level items and 60 seconds level items. The positive coefficient of experts in the 2 rounds was 87% and 100%, respectively; the expert authority coefficient was 0.7-1.0; the coordination coefficient was 0.312 and 0.241, respectively ( P<0.001). According to the order of weight, the first level items were basic medical and health services (0.311 1), basic public health services (0.196 0), medical knowledge and lifelong learning (0.196 0), interpersonal communication and team cooperation (0.138 6), professional quality (0.102 8), information utilization and management ability (0.055 5). The top 2 secondary indexes were clinical expertise (0.079 2), learning awareness and ability (0.055 3). The last 2 secondary indexes were achievement orientation (0.001 6) and inductive thinking (0.002 0). Conclusion:A post competency index system for rural general practice assistant physicians has been preliminary constructed in this study, which may provide reference for the selection, training and assessment of relevant medical workers.

Preliminary study on the competence of Chinese assistant general practitioners / 中华全科医师杂志

Objective:To explore the competency for the assistant general practitioners in China to provide theoretical support for the construction of the post competence model of assistant general practitioners and training and evaluation of assistant general practitioners.Methods:During January 22 to June 18, 2019, Using snowball sampling method and behavioral event interviews, 23 general practitioners and assistant general practitioners were interviewed in China, including 14 general practitioners in the superior performance group and 9 assistant general practitioners in the average performance group. The interview contents were coded and analyzed, and the statistical methods of t test and rank sum test of two independent samples were used to screen competency characteristics and construct the competence model of assistant general practitioners.Results:The total classification consistency and the total coding reliability coefficient was respectively 0.79, 0.87. 59 competency characteristics of assistant general practitioners were obtained including 3 differentiated competency characteristics "Understanding the medical and health system and related policies", "Critical thinking skills" and "General practitioner clinical thinking" and 10 baseline competency characteristics. There was no statistically significant difference between the average performance group and the superior performance group in the total frequency of competency [(29.4±12.7) times to (23.4±7.0) times, t=1.27, P=0.22]. Conclusion:The preliminary competency characteristics of assistant general practitioners have good reliability and can provide references for further exploration of the competency model.

General practice service based on internet platform for health management of patients with multiple chronic conditions: a self-control study / 中华全科医师杂志

Objective:To evaluate the effect of general practice service based on network platform in health management of patients with multiple chronic conditions (MCC).Methods:Based on network platform, the general practitioners provided health management service for 626 MCC patients in a petrochemical company in Panjin city of Liaoning province from June 2015 to June 2016. The individualized health management plan included health counseling, diet and exercise guidance, health information delivery, health file establishment, and rational medication guidance. After intervention the patient activeness, quality of life, clinical variables were evaluated.Results:Ninety participants dropped out of study (14.38%, 90/626), the questionnaire survey was conducted in rest 536 participants. After 1-year intervention, the scores of physical functioning, role-physical, general health, vitality, social functioning, role-emotional, mental health, and total scores in SF-36 were significantly increased ( F=12.350, 13.215, 10.515, 29.114, 42.972, 10.951, 89.783 and 33.311, respectively, all P<0.05); the values of BMI, waist, systolic and diastolic blood pressure, total cholesterol, triglycerides, low density lipoprotein cholesterol, fasting blood glucose were significantly decreased( F= 30.039, 33.849, 7.152, 27.453, 59.938, 214.270, 73.488 and 62.014, respectively, all P<0.05); the values of high density lipoprotein cholesterol were markedly increased ( F=16.491, P<0.01); the overall scores of activation were increased ( F=9.471, P<0.01), the level of activation was changed (χ 2=16.183, P<0.05); but there was no change in body pain ( F=1.486, P=0.227). There was a weak correlation between patient activation and the general health ( r=0.099, P=0.013), vitality ( r=0.101, P=0.011), mental health ( r=0.099, P=0.013). Conclusion:General practice service based on network platform is feasible and effective for patients with multiple chronic conditions, after the implementation, the activation and the health outcomes are improved significantly.

Investigation of satisfaction on practical skills in graduation examination of resident training in Liaoning Province / 中华医学教育探索杂志

Objective To get well-informed of the practical skills examination of residents' standardized training in order to detect problems and improve the quality of training. Methods A total of 4484 clinical medical examinees from 2010, 2013 and 2017 in Liaoning province were investigated by questionnaire, from which 4412 valid questionnaires were collected and the total survey efficiency was 98.39％. The survey included the standardized patient (SP) examination, the small station test, the computer simulated case (CCS) examination and the clinical skill operation test station with parts 20 projects. Excel was used to sort and record the data. SPSS 10.0 software was used for statistical analysis. Results All parts of the practical skill assessment was reasonable. The examinees' satisfaction with the test is showing an upward trend year by year, up to 73.93％in 2017. In the standardized patients examination, the key points of the role play (including the fidelity and simulated authenticity of the physical signs) need be strengthened (14.84％ in 2010). Examinees thought the difficulty of computer simulation case examination is increasing year by year. More than 2/3 examinees evaluated the clinical skill operation test station set was reasonable and the difficulty was moderately. Conclusions We should further deepen the exploration of standardized patients assessment model; strengthen the medical humanities in training; improve the residents' clinical thinking;take examination as the guidance and standardize clinical training.

Analysis on the setting of online elective courses at universities / 中华医学教育探索杂志

With the arrival of education informatization, the online elective courses have become an important means of teaching at universities. Problems, such as insufficient attentions from universities and low learning enthusiasm of students, are quite common. Based on the curriculum setting of online courses at a university, we performed a study to identify root causes of those common problems. Students' gender, major, current academic year and their school-year were collected and analyzed to detect any potential differences in the time spent in studying and course grades. With the results in hands, we propose that universities should promote online elective courses, guide students to scientifically plan study time, stimulate students' initiatives for study, shape out students' self-learning and life-long learning abilities, so as to fulfil the destiny of the online elective courses as a powerful complement to traditional teaching.

An empirical study on the criterion-related validity of the National Medical Licensing Exami-nation / 中华医学教育探索杂志

Objective The empirical validity of the National Medical Licensing Examination (NMLE) has rarely been studied. This is one of the first studies comparing NMLE and annual assess-ment scores. This study provided the criterion-related validity evidence for the NMLE. The NMLE can be used to test the abilities and skills of physicians. Method We evaluated the test 163 residents in 12 medical school-affiliated hospitals who had finished their first year of tralning and had taken the NMLE and an annual skills assessment. We used Pearson correlations to estimate the relationship be-tween NMLE scores and annual assessment scores. Results A total of 163 residents met inclusion requirements. Correlations between NMLE scores and annual assessment scores ranged from 0.300 to 0.843. Conclusions The criterion-related validity of NMLE was high, so it can be use to evaluate the residents clinical competence indeed.

The evaluation of educational measurement indexes from the Undergraduates Clinical Skills Competition in a medical university / 中华医学教育探索杂志

Objective The purpose of this study was to analyze and evaluate the educational measurement indexes from the undergraduates clinical skills competition in a medical university.The rationality of the competition was discussed in the view of education survey.Methods 84 students' results which selected from the China Medical University 2nd Clinical Skills Competition were the research objects in this study.The indexes of the difficulty,discrimination,reliability and criterion-reated validity of the competition were evaluated based on the Education surveying principle.The difficulty was calculated by subjective topic difficulty computing formula,and other indexes were carried out with SPSS 18.0 except the difficulty index.Results The average difficulty of the questions of this university was 0.61,the average discrimination was 0.77 and the overall reliability was 0.926.The OSCE scores of the participating students were taken as the criterion in this study.The calculated criterion-related validity was 0.416.Conclusion The college students' clinical skills competition has good reliability,discrimination and effective criterion-related validity.For the selective competition,the difficulty can be further improved while considering the scope of the topic.

Establishment and application of information management platform of standardized residents training in Liaoning Province / 中华医学教育探索杂志

The Information and Management Platform of Standardized Training of Residents in Liaoning Province is a comprehensive management platform with information network , containing the whole process of the standardized training for residents. Liaoning, the populous province, has too many management staff in training residents, so it is very necessary to explore the information-based method for the training management. This platform has realized the whole-course network management of resi-dent training, and many common functions such as the application of training base , on-line registra-tion, on-line real-time monitoring of trainees' daily training state, on-line graduation exam arrangement, and inquiry of statistical information of trainees in the province . It saves human and management costs , improves management efficiency , and orderly pushes forward the standardized of residents training.

Study and exploration of stage assessment of standardized resident training / 中华医学教育探索杂志

Objective To explore and establish the effective model of assessment for residen-cy training. Methods Totally 181 residents completed general specialist stage of resident training of Liaoning province in 2010. Assessment process was designed and implemented for general specialist training stage, including theory exam (basic knowledge, professional knowledge and public knowledge) and objective structured clinical examination (OSCE) (standardized patient(SP), computer-based case simulations(CCS) and clinical skills operation). T test and variance analysis were used and P≤0.05 stands for statistically significant difference. Results The total results consisted of two parts, theory examination results (40.00%) and OSCE results (60.00%) and two students failed the examination. The mean score of OSCE was up to standard (66.58±5.50). The mean score of SP and CCS was close to standard. The mean score of clinical skills operation reached a good level. In terms of the OSCE, SP examination and CCS examination, the performance of residents from the two universities had sig-nificant difference (t=3.818, P=0.000; t=5.581, P=0.000; t=5.419, P=0.013) and the performance of residents from the five hospitals also had significant differences. Conclusions The assessment of standardized resident training is improving gradually. Through the widespread application of OSCE in the assessment;it could be helpful to the clinical training of residents.

Exploration and practice of stage assessment of standardized resident training in Liaoning province / 中华医学教育探索杂志

Stage assessment is an important part of standardized resident training.After two years of practice and exploration,Liaoning had established the complete examination and evaluation system including the theory test and skill test and this system was future improved through analyzing two years' results and summing up the experiences making it more suitable for residency training in the future.

Extracurricular activities in general practice teaching for medical students / 中华全科医师杂志

One hundred and forty-four medical students were enrolled in the study, the participants were randomly divided into experimental group and control group with 72 in each. All students attended the theoretical lecture of general medicine. Students in experimental group took part in the extracurricular teaching activities including the nutritional course and practice, the clinical case study and problem based learning ( PBL), students in control group did not have the extracurricular activities. The results showed that although there was no difference in general testing scores between two groups, the problem solving ability and assay-writing ability of experimental group were significantly higher than those of control group.

Undergraduate course of general practice in higher medical education / 中华全科医师杂志

Data were analyzed from self-filled questionnaires for the students who took the elective course of general practice in China Medical University. 95.5% of students thought it was necessary to study general practice in the college. 0-10 was used to score the degree of how they want to choose general practice as a career, the median was 0 before they had the class and the median was 5 after the class (Wilcoxon rank test, P<0.01). But there were still some places need to be improved in terms of curriculum design, teaching methods and community practice. The General Practice teaching need to be innovated and the teaching mode should be different from the traditional one.

To investigate the relation of sudden deafness with hearing loss level and auditory threshold / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the relation of sudden deafness with hearing loss level and auditory threshold.@*METHOD@#A retrospective analysis was performed in 92 cases(97 years) of sudden deafness patients.@*RESULT@#In this group,the best hearing loss prognosis was the ascend type and the back type the total effective rate was both 100.0%. The second was the slow descend type. The total effective rate of this type was 70.0% (7/10). the total effective rate of full deaf is 66.7% (14/21), the sudden descend type is poor, the effective rate was 50% (4/8). although the full deaf groups total effective rate was high than sudden descend type, without one ear completely recovering, and only one ear from sudden descend type was completely cured. After treatment, there were 6 ears of fall deaf in full deaf group. There was one case rised 65 dBHL and one case rised 50 dBHL from the 21 cases full deaf sufferer. In this deaf level group, the light level and the middle level was one ear respectively. Although the total effective rate of this group was the highest, all the cases were not completely recovered. After treatment, the hearing rise 17 dBHL and 19 dBHL respectively. After chi2 text (chi2 = 1.459, P > 0.05), the total effective rate of the more heavier, heavy, and the heaviest to full deaf was no significant difference but after chi2 text (chi2 = 10.09, P < 0.01), the full recover rate was significant difference. The more heavier level group's full recover rate was the highest 38.5% (10/26).the second was heavy level group ,the full recover rate is 33.3% (12/36), the worst level to full deaf group was the lowest: 6.0% (2/33).@*CONCLUSION@#It was considered that the deafness level was no obvious relation to the total effective rate, but there was significant difference in fully recover rate. The different auditory threshold figure of the sudden deafness was closely related to the hearings prognosis.

The Synthetical Evaluation of Basic Medical Testing Papers of 13 Northern Medical Universities of China / 中华医学教育探索杂志

To ensure the quality of building basic test bank and to effectively measure the quality of medical exam questions,now,we analyze the problems of the basic test papers from 13 north medical universities in many aspects such as cognitive rank,difficulty,conformity and core content etc.Having found the main problems of the testing papers,we supply the viewpoint for improvement and make better foundation for the construction of test bank.

The application of the OSCE in the evaluation of clinical skills / 中华医学教育探索杂志

OSCE is an examination of objective evaluation of the clinical skills.This article introduced the development of OSCE at home and aboard,and compared the difference of the exam setting in America,England,Canada and China Medical University.The advantages and disadvantages of SP in OSCE were also analyzed.It was discussed that OSCE would be widely applied in China.

Preliminary Construction and Application of Medical Computer-based Case Simulations Examination System / 中华医学教育探索杂志

It is an essential component of medical exams to evaluate the clinical competency of medical students. After introducing Standardized Patients and non-Standardized Patients examinations into the final comprehensive examination, China Medical University continued to undertake the construction of computer-based case simulations examination system, a project of National Medical Examination Center. The article introduced the design and some crucial points in constructing the examination system.

The Research on the Request to the Doctors in New Century in China / 中华医学教育探索杂志

With the development of society, people request the doctors higher and higher, which advances a new project for cultivating the doctors in new century. In order to provide the basis for confirming the medical talent cultivating target of new century, we have finished the research on the request to the doctors in new century, and the purpose is to make our medical colleges cultivate more medical talents to meet the need of the 21st century.