General Practice Residency Training Research Articles

Status of general practice residency training and career choice of trainees in Henan Province

Objective To survey the status general practice residency training and career choice of trainees in Henan Province. Methods From December 2017 to February 2018, 332 trainees from the first general practice residency training program (2014-2017) were enrolled in the study. The self- administered questionnaire included the demographic information and the current career status. The logistic regression model was used to analyze the influencing factors of the career choice when their completed the training. Results Of 332 participants, there were 167 participants designated by the institutions and the others were directly enrolled by the program. The designated participants were from the 56 medical institutions in Henan. The percentage of participants from the tertiary hospitals was 75.5% (126/167), which was much higher than that from the secondary hospitals (24.5%,41/167). There were 24 participants who did not have a work six months after graduation. Of the 308 employed participants, there were only 111 (36.0%, 111/308) working in the department of general practice, and 197 (64.0%, 197/308) working in other departments. The participants designated by the institutions and with the post-graduate degrees preferred to choose other specialties, instead of the general practice. The reasons were that there was no department of general practice in their institutions or the participants had been designated to the other departments (57.9%, 114/197). Conclusion The survey suggests that the general practice residency training program should enroll trainees mainly from the medical graduates in order to improve the effectiveness of general practitioner residency training and the allocation of health resources in Henan Province. Key words: Inservice training; Employment; General practitioner

Infectious disease rotation for general practice residency training

The ability of prevention, treatment and management of infectious diseases is a basic requirement for general practitioners. This article introduces our experience in the infectious disease rotation for general practice residency training, focusing on the rotation management at different stages of training to explore how to improve teaching quality and the ability of trainers in a short period of the rotation. Key words: General practitioner; diseases; Standardized training of resident

Ophthalmology rotation for general practice residency training

Ophthalmology rotation is an integral part of standardized training for general practitioners. The duration of ophthalmology training is only half a month in whole 33-month general practice residency training. The main objective of training for general practice residents is to master the basic clinical skills of ophthalmology, to be able to accurately and timely identify eye diseases, especially those requiring urgent treatment, and to prevent the loss of visual function. This article introduces our teaching experience in ophthalmology training for general practice residents accumulated since 2014. We suggest that the trainees should pre-examine patients independently, play a role of standard patients and receive consultation from teachers. We developed a simple patient assessment form for primary care doctors, the patient who got 10 or more points of the form, should be referred to ophthalmological specialists. Key words: General practitioners; Standard training; Ophthalmology; Assessment form

Survey on standardized general practice residency training program in Shanxi province

A Survey on the current general practice residency training was carried out in January 2018 among 1 114 general practitioners (GPs) who attended the standardized residency training program during 2014-2017. Basic information was obtained from the management department, other information was obtained from questionnaire. Total 1089 valid questionnaires were received with a retrieval rate of 97.8%. The survey showed that the ratios of male trainees, trainees aged 20-30 years and with bachelor degree were increasing during 2014-2017. The participants were more satisfied with the teaching quality in general hospital bases than that in community practice bases. Participants suggested to improve teaching quality, add teaching contents of humanity courses and TCM knowledge. Only14.4%(157/1 089) participants choose GPs as their career because liked this specialty. And 77.7%(846/1 089) GPs understood the main work of GP. There were 81.4%(887/1 089) participants wanted to work in; 77.7%(846/1 089) participants thought that the prospect of general practice would be excellent or good. Increasing income, professional promotion and a sense of social recognition were their wishes. Standardized residency training is crucial for general practitioners to upgrade their quality and competence, to improve training quality and to develop incentive policies are necessary. Key words: General practitioner; Standardized training program; Shanxi Province; Status

Factors Determining Pakistani Medical Students' Career Preference for General Practice Residency Training.

BackgroundFew studies have explored factors affecting preference of medical students towards general practice as a career choice. We conducted a survey in Karachi across various public and private sector medical colleges to examine factors associated with students’ general practice career aspirations in Karachi, Pakistan.MethodsFrom January to March 2018, we distributed a 21-item questionnaire to final year medical students in eight medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item.ResultsA total of 1400 responses were obtained. The top five specialty fields chosen by students with their numbers were: internal medicine, 898 (64.2%); general practice, 337 (24.1%); pediatrics, 449 (32.1%); surgery, 380 (27.2%); and emergency medicine, 243 (17.4%). The “intent to inherit existing practice” and “other academic or professional experiences prior to medical school” had a positive association with choosing general practice while “having a physician parent’’ had a negative association among the medical students demographics after adjusting for other covariates in the multivariable logistic regression. Medical students who ranked “clinical diagnostic reasoning”, “community-oriented practice”, “involvement in preventive medicine”, and “frequent patient communication” as highly important were more likely to choose general practice, whereas, “access to advanced medical fields”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration.ConclusionThe study’s results depicted limited interest of family medicine as a career option in graduating students, and pointed out the factors that likely influence the choice of general practice as a career are clinical diagnostic reasoning, community-oriented practice and preventive medicine.

Application of objective structured clinical examination (OSCE) for completion of general practice residency training

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. Key words: Objective structured clinical examination; General practitioner; Standardized training of residents

Effect of short-term training for OSCE examiners in general practice residency training final examination

Objective To evaluate the effect of short-term training of objective structured clinical examination (OSCE) examiner in general practice residency training final examination. Methods Sixty examiners from Xinjiang Uygur Autonomous Region participated in half-day workshop of OSCE. The participants were interviewed with questionnaire before and after the training program and the effect of training was evaluated. Results The study showed that 78.3%(47/60)examiners knew OSCE and understood the concept and implementation steps before the training; 21.7%(13/60)had used it before; 95.0%(57/60)examiners intended to learn the performance of OSCE. After training most participants completely or basically understood the 6 test stands and implementation methods of OSCE; the participants were highly satisfied with the training duration, contents and methods, and the satisfaction rates were all over 70%. Conclusion The examiners recognize the advantages of OSCE in assessment of clinical skills and have strong intention of application. Short-term training has a certain effect and feasibility. Key words: Training; Objective structured clinical examination; General practitioner

What determines medical students\u2019 career preference for general practice residency training?: a multicenter survey in Japan

BackgroundFew studies have systematically explored factors affecting medical students’ general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students’ general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline.MethodsFrom April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item.ResultsA total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, “plan to inherit other’s practice” positively associated with choosing general practice, whereas “having physician parent” had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: “clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40–1.94)”, “community-oriented practice (aOR: 1.33, 95% CI 1.13–1.57)”, and” involvement in preventive medicine (aOR: 1.18, 95% CI 1.01–1.38)”. On the contrary, “acute care rather than chronic care”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration.ConclusionsOur nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.

Application of GP-IP teaching model in general practice residency training

The unique concept, characteristics and service contents of general practice make its residency training to focus on outpatient teaching. General Practitioner Inquiry-Preceptor (GP-IP) is an outpatient teaching mode developed in the general practice residency training base of our hospital. The GP-IP teaching mode includes four modules: diagnosis and treatment package for medically unexplained physical symptoms, Pendleton and RICE inquiry model, video teaching and problem based learning. Key words: General practitioners; Teaching methods

"Balint group"performed as core skill course of doctor-patient communication in general practice residents standardized training program

Communication between doctors and patients is an important way to establish good doctor-patient relationship. It is crucial to master doctor-patient communication skills and arts for general practitioners who will extensively serve the people in community for life-long time after completion of residency training. To improve the communication skills and to enhance the clinical competency of general practitioners, we applied the Balint special group activities as core of doctor-patient communication course in residency training program. Through 3 years of practice, we found that the application of Balint group enriched the teaching contents and form of general practice residency training; improved doctor-patient communication skills, and enhanced the competency and professionalism of general practice trainees. Key words: Inservice training; Psychoanalytic therapy; General practitioner

Development of soft skills in general practice residency training

General practitioners need not only to have comprehensive knowledge and clinical competency, and also to have the soft skill that are social and personal management skills. In the residency training of general practice, it is necessary to pay attention to the soft skill development. The training institutions should adopt various measures: including soft skills cultivation in training contents, emphasizing soft skills training in the traditional teaching practice, establishing a variety of practice platforms and introducing soft skills in the evaluation and examination system. Key words: Training; General practitioners

Problems and countermeasures in clinical practice of general practice residency training in Hebei province

随着我国全科医师规范化培训的逐渐开展，全科医师培训工作已经初具规模，培训相关问题也逐渐展现。通过分析河北省全科医师规范化培训临床实践阶段的情况、存在的问题，提出完善管理制度、培养合格的师资及加强技能训练等可行措施，以提升全科医师临床实践阶段的培训质量，为我国全科医师规范化培训工作提供可借鉴的经验。

Follow-up of graduates of general practice residency training working in community health service centers in Shanghai

Telephone interview was conducted to follow up the 151 graduates of general practice residency training in Zhongshan Hospital who are working in community health service centers in Shanghai up to June 2014; the results were compared with those of 130 graduates in 2011. Based on investigation of 2014, 94 out of 151 graduates worked in downtown and 57 worked in suburbs of Shanghai, while in interview of 2011, 72 out of 130 in downtown and 58 in suburbs. Among 151 participants in 2014 interview 13 had senior professional title, 138(91.39%) had intermediate or primary professional titles, while 4 in 2011 interview had senior professional title, 126(96.92%) had intermediate or primary professional title. Among 151 participants in 2014 interview, 40(26.49%) were heads of GP teams and 45(29.80%) held administrative positions, while in 2011 interview 33(25.83%) were heads of GP teams and 30(23.08%) held administrative positions. 2014 interview showed that 211 first-author papers were published, 59 research projects were obtained with 4.34 million Yuan funds, 303 prizes was awarded in 151graduates, all of which were increased compared to those of 2011 group. The resign rates in 2011 and 2014 groups were 6.43%(9/140)and 10.06%(17/169), respectively; the job-moving rates in 2011 and 2014 groups were 5.00%(7/140)and 11.95%(19/159), respectively. The resign rate of 2011-2014 was 5.03%(8/159) and the job-moving rate of 2011-2014 was 11.95%(19/159). Conclusion The follow-up study shows that the graduates of general practice residency training of Zhongshan Hospital perform well in community health service centers in Shanghai. Key words: Community health services; Interviews; General practitioners

Application of mini-CEX in community rotation of general practice residency training

Objective To evaluate the effectiveness of mini clinical evaluation exercise(mini-CEX) in community rotation of general practice residency training. Methods Forty nine general practice residency trainees, who participated in community rotation during July 2012 to July 2014 in 3 community teaching bases, were randomly divided into two groups: 25 trainees in intervention group received conventional teaching and additional 2 rounds of mini-CEX in one month, and 24 trainees received conventional teaching only. The changes of self-evaluation scores of clinical competence after the community rotation were evaluated. Focus group discussions of 8 trainees and 8 teachers from intervention group were also adopted in January to February 2013 to assess the effectiveness of mini-CEX. Results Three trainees withdrew in the study and the interventional group completed 232 mini-CEXs. The self-evaluation scores of clinical competence were elevated in all items in interventional group after community rotation(from 7.03±0.68 to 7.30±0.77 in medical history, from 7.00±0.83 to 7.18±0.88 in physical examination, from 7.42±1.20 to 7.52±0.76 in humanistic qualities, from 6.79±0.82 to 7.12±0.70 in clinical judgment, from 6.85±1.06 to 7.18±0.81 in counseling skills, from 6.85±1.15 to 7.12±0.96 in organization, from 7.09±0.81 to 7.33±0.69 in overall competence), while in control group, scores of humanistic qualities(from 7.74±0.89 to 7.60±0.97), clinical judgment(from 6.94±0.77 to 6.77±1.10) and organization/efficiency(from 6.94±0.96 to 6.80±0.76) were declined. After adjusting self-evaluation score before rotation, the increased scores in clinical judgment(7.12±0.70 vs. 6.77±1.10, F=4.339, P=0.042)and organization(7.12±0.96 vs. 6.80±0.76, F=4.336, P=0.042)of intervention group were significantly higher than those of control group. In focus group discussions both trainees and teachers recognized that mini-CEX would enhance clinical competence, be more comprehensive in assessing and adaptable in training program than former rotation tests. The major concerns of using mini-CEX were subjective rating process, non-unified rating standards and insufficient teaching ability. Conclusions Application of mini-CEX in community rotation of general practice residency training can enhance clinical competency of trainees. Key words: General practioners; Teaching; Mini clinical evaluation exercise

Evaluation of standardized patients by examiners in Objective Structured Clinical Examination (OSCE)

Objective To evaluate the simulation of standardized patients (SP) in objective structured clinical examination (OSCE) for general practice residency training. Methods The simulation levels of 15 SPs were evaluated by 37 examiners with a rating scale of OSCE Examiner Feedback on SP performance from Melbourne University School of Medicine. The evaluation was conducted in history-taking and doctor-patient communication stations of OSCE for general practice residency training. Results The overall scores of SP performance were high and most examiners considered that the performance of SP was realistic and consistent. Among 9 items of rating scale, more than 90% of the examiners considered that SP performance met or completely met the requirements of OSCE, except the item of preparation for clothing and making up before role playing. Six items of performance in history-taking station and 4 items in doctor-patient communication station reached 100% satisfaction from the examiners. T test was used to compare the difference of SP performance between the morning and afternoon, and there was no significant difference (P>0.05). Conclusion The study showed for this group of SPs, the realistic degree and consistency of performance meet the requirements of OSCE, and its stability is not affected by long time continuous performance. Key words: Educational measurement; Patient simulation; Objective structured clinical examination; General practitioners

Workplace-based assessment: raters’ performance theories and constructs

Weaknesses in the nature of rater judgments are generally considered to compromise the utility of workplace-based assessment (WBA). In order to gain insight into the underpinnings of rater behaviours, we investigated how raters form impressions of and make judgments on trainee performance. Using theoretical frameworks of social cognition and person perception, we explored raters’ implicit performance theories, use of task-specific performance schemas and the formation of person schemas during WBA. We used think-aloud procedures and verbal protocol analysis to investigate schema-based processing by experienced (N = 18) and inexperienced (N = 16) raters (supervisor-raters in general practice residency training). Qualitative data analysis was used to explore schema content and usage. We quantitatively assessed rater idiosyncrasy in the use of performance schemas and we investigated effects of rater expertise on the use of (task-specific) performance schemas. Raters used different schemas in judging trainee performance. We developed a normative performance theory comprising seventeen inter-related performance dimensions. Levels of rater idiosyncrasy were substantial and unrelated to rater expertise. Experienced raters made significantly more use of task-specific performance schemas compared to inexperienced raters, suggesting more differentiated performance schemas in experienced raters. Most raters started to develop person schemas the moment they began to observe trainee performance. The findings further our understanding of processes underpinning judgment and decision making in WBA. Raters make and justify judgments based on personal theories and performance constructs. Raters’ information processing seems to be affected by differences in rater expertise. The results of this study can help to improve rater training, the design of assessment instruments and decision making in WBA.

Teaching practice of general medical resident standardization training students in the composition of problem-based learning cases

Problem-based learning (PBL) was carried out in general practice residency training program.Interview was used to evaluate the teaching performance.A total of 22 teachers and 198 students participated in evaluations.Among the teachers,17 (77％) were quite satisfied and 5 (23％) relatively satisfied.The overall satisfaction rates of teachers,problems and problem solutions were 87％,75％ and 91％ respectively. PBL stimulated the interests of students and was conducive for the combination of theoretical and practical knowledge.And it might improve the thinking ability of students and would be a good teaching method in general medicine residency training. Key words: Problem based learning; General practitioner

Gender Differences in Career and Practice Patterns of PGD‐Trained Dentists

This study compares differences by gender in the practice patterns and professional activities of general dentists, specialists, and dentists with Advanced Education in General Dentistry (AEGD) or General Practice Residency (GPR) training. The UCLA School of Dentistry surveyed a random sample of 6,725 dentists graduating from dental school in 1989, 1993, and 1997 as part of an evaluation of the impact of federal funding on postgraduate general dentist (PGD) programs. The survey asked about current practice, services referred and provided, and professional activities. Of the 2,029 dentists (30 percent) who responded, 49 percent were general dentists with no specialty training; 7 percent had AEGD training; 20 percent had GPR training; and 24 percent had specialty training. General dentists were more likely to be in private practice (p < 0.05). AEGDs, specialists, and females were more likely to report faculty positions as a secondary occupation. General dentists were more likely to be practice owners than AEGD- or GPR-trained dentists. The mean number of patients seen was highest for specialists. Females reported fewer patients than males, and this difference was significant for GPR-trained dentists. With respect to services, GPR-trained dentists reported significantly more biopsy procedures, conscious sedation, periodontal surgery, and implants than general dentists. AEGD-trained dentists reported more conscious sedation than general dentists. GPR dentists were more likely to volunteer time than general dentists without specialty training. PGD training appears to result in different types of employment and specific practice patterns that strengthen primary care dentistry. We further conclude that there are gender differences in the types of practice, patients seen, and services provided. These findings occur in addition to training differences.

General practice residency training and the osteopathic profession: trends and issues for the 1990s.

With the 1989-1990 training year, the length of postinternship residency training in osteopathic general practice will increase from 1 to 2 years. The longer residency is expected to give trainees a more complete and more competitive education and to protect them against discrimination regarding hospital privileges. With this change comes the opportunity to evaluate the current status of residency training in the field and to use the data as the basis for making rational predictions and recommendations for the future of the specialty. The author considers the effect of curriculum changes on the operation of training residents in osteopathic general practice. He examines the structure of the new training program and discusses issues pertaining to osteopathic general practice.

General practice residency training and the osteopathic profession: Trends and issues for the 1990s

General practice residency training and the osteopathic profession: Trends and issues for the 1990s