Continuing medical education (CME) plays an important role in improving doctors’ professional knowledge and skills, optimizing medical behavior, and promoting medical safety1–2. Levine has stated that the main purpose of CME is to “maintain and improve clinical performance”.3–4 Other authors believe that “Only when the acquired knowledge actually offers an opportunity for changes in practice, it is meaningful”.5–6 CME is aimed at working doctors and nurses who have a certain amount of clinical experience. Adults have very different learning needs and learning styles from children and adolescents: adults are results oriented, autonomous, self-directed, relevancy oriented, and practical, and their past experience may promote or interfere with the training.7–10 Therefore, effective CME should emphasize practicality and maneuverability, attach importance to self-evaluation, closely integrate with clinical practice, and protect participants from the interference caused by daily work and the cost of food and accommodation during the training.
Serving as the first contact and “gatekeeper” of the public, the primary health care (PHC) system plays an indispensable role in providing preventive and basic medical care to the entire population. It is generally accepted that high-quality primary care should involve continuity, comprehensiveness, coordination, and patient orientation.11 Although China has made remarkable efforts to strengthen the quality of its PHC during the past decade,12–13 two recent reviews published in the Lancet have pointed out that several inadequacies still exist in the PHC system in China,11, 14 for example, the low quality of the diagnostic process and outcomes, the underperformance of PHC with respect to the management of noncommunicable chronic diseases, substantial gaps in the education of doctors in the PHC system, and widespread low job satisfaction and high occupational burnout. These inadequacies act as obstacles to the Healthy China 2030 blueprint, a national public health strategy;15 thus, there is an urgent need for both the government and institutions to address the above shortcomings.
It can be seen from the above that to promote the PHC quality in China, it is very important to design and continuously and extensively promote a CME and training project that is closely integrated with the community, is strongly practical, improves the professional quality and ability of grassroots medical workers, and promotes their cooperation with higher-level hospitals.16–19 By referring to the available data on existing CME projects, we believe that a future training program should have the following characteristics: (1) local financial and special funding support, and a health administrative department that coordinates the work of medical institutions, which can minimize the stress of doctors participating in the program in terms of leave and expenses; 20–21 (2) general medicine courses that are mainly implemented in hospitals affiliated to comprehensive universities with long-term cooperative relationships with grassroots medical institutions, that involve the joint participation of relevant specialties, and that set teaching objectives after taking into account self-evaluations and the needs of the medical system; 22–23 (3) a focus on practicality and maneuverability, assessments that are closely integrated with daily clinical work, and an emphasis on student-teacher interactions during the course of training, with the aim of improving not only the knowledge and skills of the participants but also their mode and concept of medical practice;24 and (4) some type of certification for grassroots health care workers who successfully complete the training that is of positive significance to their career to encourage more general practitioners (GPs) to participate in the training.11
In recent years, many CME programs for grassroots medical workers have been carried out around the world, but there are some deficiencies in the existing research. Most CME projects focus on training for a particular disease or use a single teaching method.25–31 The main weakness of the few integrated training programs is the lack of control subjects and cross-sectional studies, with only examination results serving as an evaluation indicator.32 Therefore, our research group intended to work with a team of general medicine and specialist teachers in a general hospital to design a new type of CME course that covers (1) basic diagnosis and treatment methods and medical techniques based on the needs of the community, (2) the comprehensive management of common chronic noncommunicable diseases in the community, (3) the practice and management of family doctors, and (4) the training of community teachers.
We designed a centralized training program with teaching methods that included small group discussions, standardized patients, workshops, and traditional lectures. The assessment methods included written examinations, consultations, physical examinations of standardized patients, case presentations of common chronic conditions in the community, and subjective, objective, assessment, and plan (SOAP) medical record scores. The post-training test results and self-evaluations were taken as the immediate evaluation indices, and the participants’ practice of the training content and their improvement in medical quality at 1 year after the training were taken as the long-term evaluation indices. The results of this CME program were comparatively analyzed against those of a conventional training program using decentralized methods and conventional teaching modes. We hope that our study will provide a valuable reference for CME and training projects to meet the real needs of the community and improve the quality of grassroots health care.