Is training policy for general practitioners in China charting the right path forward? a mixed methods analysis

Abstract

ObjectivesSince 2010, the Chinese government has gradually increased its investment in the training of general practitioners (GPs) to support their role as ‘gatekeepers’ in the healthcare system. However, this training is still organised from the perspective of specialist care. We aimed to assess the appropriateness of the principal GP admission training programme curricula in China, including Residents Training for GPs (RTGP), Residents Training for Assistant GPs (RTAGP) and Training for Specialists with General Practice interest (TSGP).SettingThe study focussed on GP training programmes in Shanghai, China.ParticipantsData on disease competences developed in three GP clinical training programmes (RTGP, RTAGP and TSGP) were derived from official programme training manuals. Data on the proportion of outpatient visits for each disease were taken from the Shanghai community healthcare centres grassroots outpatient database.Primary and secondary outcome measuresWe first conducted a quantitative analysis by comparing the structure of current training curricula with actual outpatient utilisation patterns across all community healthcare institutions in Shanghai from 2014 to 2018. Qualitative analysis was then conducted to evaluate GP training programmes based on Donabedian’s model.ResultsQuantitative analysis showed that the distribution of diseases for which competences were taught did not match the composition of outpatient visits in community healthcare institutions. Concerns identified through qualitative analysis included teachers who were mostly specialists, lack of equipment for differential diagnosis in community healthcare institutions, insufficient teaching of referral standards and GP training in large hospitals that consistently neglected communication skills.ConclusionsThe establishment and implementation of admission training programmes for GPs in China lacks a focus on general practice training and may be improved by adopting an evidence-based general perspective aligned with the medical needs of the community.

Changes of Multisectoral Collaboration and Service Delivery in Hypertension Prevention and Control before and after the 2009 New Healthcare Reform in China: An Interrupted Time-Series Study

“…e model was widely used in the evaluation of various links of public health service, such as the evaluation of treatment outcomes (outcome), quality of service provision (outcome), and general practitioners training program (process). [29][30][31][32].…”

Familiarity of teaching skills among general practitioners transfer training trainers in China: a cross-sectional survey

“…It is evident that the current GP transfer training in China falls short of adequately preparing trainers. One major issue is the lack of in-depth participation by general practice teaching teams in training programmes [ 14 ]. Although short-term training experience can reach a large number of trainers, it may lead to uneven faculty quality.…”

“…Owing to the limited number of healthcare institutions with general practice in China, the rotation task of general practice can be completed in internal medicine [ 12 , 13 ]. This results in many trainers coming from specialist fields rather than general practice [ 14 ]. Until recently, few studies have been conducted on the competence of teaching skills among GP transfer training trainers in China.…”

Training needs and curriculum of continuing medical education among general practitioners in Tibet, China: A cross-sectional survey

“…The policy documents stated that the CME training process would be divided into different stages based on the actual time schedule and the local practical conditions ( 38 ). The challenges included the time conflict between work and training, deficiencies of qualified GP teaching teams, and a shortage of educational funds ( 11 , 22 , 39 ). In extrapolating our study results to staged training plans, several points should be considered, including the feedback of trainees, faculty resources, training time, and funding for training ( 40 ).…”