Demographic characteristics
Of the 63 study participants, 62 completed surveys and one was excluded for failing to complete the post-training survey. There were 23 GPs, 8 specialist doctors, 21 nurses, and 10 public health personnel (Table 1). Females accounted for 61.3% of the group; 50% of participants were between the ages of 30 and 40; and 59.7% had a bachelor’s-level education. Clinical medicine (43.5%) and nursing (37.1%) were the most frequent academic majors. Most participants had a primary professional title of Junior (82.3%).
Understanding the responsibilities of GPs
Responses in the questionnaires were summarized as six categories: meaning of the term “general”, disease treatment, disease prevention, GP service mode, effect of GPs’ services on residents’ health, and GPs’ role in a team.
For the meaning of the term “general”, before the training five participants understood “general” as “having all types of clinical skill”; two as “proficient in internal and external gynecology and pediatrics”; one as “panacea”; one as “comprehensive”; and the remaining participants did not know. After the training, seven participants responded with “Five ‘Wholes’”—ie, the whole process, whole person, whole family, whole team, and whole community; 20 mentioned the whole person; and eight gave whole family and whole process as answers.
The second category was an understanding of disease treatment—that is, that GPs are doctors whose primary responsibility is to treat diseases. This view was held by 31 participants before and by 25 after the training.
Regarding disease prevention, before the training only five participants mentioned that GPs should do work related to health education and disease prevention. After the training, 19 participants thought GPs should deliver preventive healthcare; six thought they should provide health education; and seven thought they should provide health management and rehabilitation.
Table 1 Demographic characteristics of the study population
|
|
No.
|
%
|
Sex
|
Male
|
24
|
38.7
|
Female
|
38
|
61.3
|
Age, years
|
≤30
|
17
|
27.4
|
30 to ≤40
|
33
|
53.2
|
41 to ≤50
|
12
|
19.4
|
Education
|
Technical secondary school
|
6
|
9.7
|
College
|
17
|
27.4
|
Undergraduate
|
37
|
59.7
|
Graduate
|
2
|
3.2
|
Major
|
Clinical medicine
|
27
|
43.5
|
Clinical Chinese medicine
|
5
|
8.1
|
General medicine
|
1
|
1.6
|
Preventive medicine
|
6
|
9.7
|
Nursing
|
23
|
37.1
|
Title
|
Junior
|
51
|
82.3
|
Mid-level
|
8
|
12.9
|
Senior
|
3
|
4.8
|
Professional
|
General practitioner
|
23
|
37.1
|
Specialist
|
8
|
12.9
|
Nurse
|
21
|
33.9
|
Public health staff
|
10
|
16.1
|
Work years
|
≤5
|
11
|
17.7
|
5 to ≤10
|
21
|
33.9
|
11 to ≤15
|
12
|
19.4
|
>15
|
18
|
29
|
The fourth category was an understanding of the mode of general practice service. Before the training, door-to-door service and contract service were mentioned by one participant each. After the training, six mentioned contract service.
With respect to an understanding of the role of GPs in patients’ health, before the training, one trainee used the term “health gatekeeper” and another mentioned “patient-centered”. After the training, seven people used the term “health gatekeeper”, four mentioned reducing healthcare spending, and two responded with “health-centered.”
For the position of GPs in a team, before training one participant thought GPs played the roles of handymen and archivists, and the others had no opinion on this subject. After the training, two participants thought that GPs should lead the general practice service team, with the remaining participants having no other opinions.
Views on GPs’ career prospects
After the training, 52/62 (84%) of participants reported a positive change in their views on the career prospects of GPs in the next 10 years as compared to before the training, representing a statistically significant increase (P<0.05; Table 2). Of the 25 participants who thought GPs’ career prospects were “Worse than [those of a specialist]” before the training, 13 changed their responses to “Better than [those of a specialist]” and eight to “Similar to [those of a specialist]” after the training. Ten of the 11 participants who thought GPs’ career prospects were “Similar to [those of a specialist]” before the training changed their response to “Better than [those of a specialist]” after the training; and 14/18 people who answered “Do not know” before the training changed their response to “Better than [those of a specialist]” post training.
Table 2 Views on career prospects of GPs
|
|
After training†
|
Total
|
P
|
Worse than
|
Similar to
|
Better than
|
Before training†
|
Worse than
|
4
|
8
|
13
|
25
|
<0.05
|
Similar to
|
0
|
1
|
10
|
11
|
Better than
|
1
|
0
|
7
|
8
|
Do not know
|
1
|
3
|
14
|
18
|
|
Total
|
6
|
12
|
44
|
62
|
†“Worse than”, “Similar to”, and “Better than” those of a specialist.
There were seven reasons for the change in participants’ views of GPs’ career prospects (Table 3). The most common reason was achieving a better understanding of general practice service policies during the training (93.5%), followed by recognition of the need to develop GP services (83.9%). The training base’s leadership, demonstration effect, improvement of personal skills, performance of the training base, and trainers’ enthusiasm were the other reasons.
Table 3 Reasons for the change in participants’ views of GPs’ prospects
|
No.
|
%
|
During the training I better understood the general practice service policies
|
58
|
93.5
|
During the training I recognized the need to develop general practice services
|
52
|
83.9
|
Leadership of training base
|
43
|
69.4
|
During the training I recognized the feasibility of developing general practice services
|
43
|
69.4
|
During the training I improved my skills
|
39
|
62.9
|
I was encouraged by the performance of the training base
|
38
|
61.3
|
I was encouraged by trainers’ enthusiasm
|
37
|
59.7
|
Professional preferences
To investigate their identification with GPs, participants were asked which they would choose to be—a GP or a specialist—if they did not hold their current position. Before the training, 19/62 participants chose GP, 10 chose specialist, and the others chose neither. After the training, 56/62 participants (90.3%) chose GP and 6/62 (9.7%) chose specialist.
Of the 56 participants who chose GPs, 38 gave reasons (9 in total) for their selection (Table 4). The top three were sense of self-worth, future trends in society, and patients’ needs. Of the six participants—all current GPs—who chose specialist, three gave a reason, which was a higher salary. Seven of eight current specialists chose GPs, for which the following reasons were given:
- “A GP can better help and advise the patient because he/she thinks more broadly and has fewer professional constraints.”
- “There is a greater need at the grassroots level for GPs.”
- “When GPs provide primary medical services, they also engage in health management of chronic diseases. This can reduce medical expenses for the patients and promote their health, thereby improving their quality of life. This is very meaningful.”
- “After years of working as a specialist at the grassroots level, I understand the importance of GPs for patients. It will take time to change from a specialist to a GP.”
- “Because a GP has a more holistic view of health than a specialist, a skilled GP can prevent rather simply treat a disease.”
Table 4 Reasons for preferring GP vs specialist
|
% (No.)
|
Reasons for choosing to be a GP
|
|
Sense of self-worth
|
18.4 (7/38)
|
Future trends in society
|
15.8 (5/38)
|
Meet the needs of the population
|
15.8 (6/38)
|
Improve health
|
13.2 (5/38)
|
Learn more skills
|
10.5 (4/38)
|
Have good relationship with patients
|
7.9 (3/38)
|
Save money for patients
|
7.9 (3/38)
|
Offer better service to patients
|
7.9 (3/38)
|
Less pressure
|
2.6 (1/38)
|
Reasons for choosing to be a specialist
|
|
Higher salary than a GP
|
− (3/4)
|