Basic characteristics
As shown in Table 1, approximately 275 residents of GPs were approached. In total, 263 residents participated (95.64% response rate). The gender distribution was 133 (50.57%) women and 130 (49.43%) men. The average age of the participants was 28 years with a SD of 1.93. Marital status was 114 (43.35%) married and 149 (56.65%) single. Education status was 2 (0.76%) junior college, 240 (91.25%) bachelors and 21 (7.98%) masters. The number of respondents had finished standard training in 2017 and 2018 were 47 (17.87%) and 216 (82.13%) respectively. Among all the 6 training hospitals, 59 (22.43%) were in Gansu Provincial Hospital, 96 (36.50%) were in The First Hospital of Lanzhou University, 57 (21.67%) were in The Second Hospital of Lanzhou University, 41 (15.59%) were in Chinese People’s Liberation Army 940 Hospital, 6 (2.28%) were in The First Hospital of Tianshui and 4 (1.52%) were in The People’s Hospital of Pingliang. 171 (65.02%) were rural medical oriented graduates. 224 (85.17%) were fresh graduates and 39 (14.83%) were former graduates.
Table 1 Demographic characteristic of the respondents
Demographic characteristic
|
Frequency
|
Percent(%)
|
Gender
|
Male
|
130
|
49.43
|
|
Female
|
133
|
50.57
|
Age
|
<=25
|
7
|
2.67
|
|
25-30
|
223
|
84.79
|
|
>30
|
33
|
12.54
|
Marital status
|
Married
|
114
|
43.35
|
|
Unmarried
|
149
|
56.65
|
Education
|
Junior college
|
2
|
0.76
|
|
Bachelor
|
240
|
91.25
|
|
Master
|
21
|
7.98
|
Years of accepting training
|
2014-2017
|
47
|
17.87
|
|
2015-2018
|
216
|
82.13
|
Residents of training hospital
|
Gansu Provincial Hospital
|
59
|
22.43
|
|
The First Hospital of Lanzhou University
|
96
|
36.50
|
|
The Second Hospital of Lanzhou University
|
57
|
21.67
|
|
Chinese People’s Liberation Army 940 Hospital
|
41
|
15.59
|
|
The First Hospital of Tianshui
|
6
|
2.28
|
|
The People’s Hospital of Pingliang
|
4
|
1.52
|
Residents type
|
Rural medical oriented graduates
|
171
|
65.02
|
|
Other graduates
|
92
|
34.98
|
Graduate type
|
Fresh graduates
|
224
|
85.17
|
|
Former graduates
|
39
|
14.83
|
The survey of standardized training situation for residents of GPs
As shown in Table 2, 243 (92.40%) residents passed certification exam. 180 (68.44%) residents thought it was necessary to launch the standardized training for residents of GPs, while 20 (7.60%) thought it was unnecessary. More than half of residents’ monthly income was among 2000 and 3000RMB. 101(38.40%) residents thought it was useful to improve comprehensive ability by standardized training, while 77 (29.80%) thought it useless. The improved abilities of residents of GPs mainly included clinical technology (91.63%) and medical theoretical knowledge (71.48%). Only 84 (31.94%) residents of GPs showed that the income was inclined comparing to other specialties. Of the rural medical oriented graduates, 73 (42.69%) expressed that they wanted to continue to work at the grass-roots level when the rural serve time was finished, which was lower than those who didn’t want (57.31%). Among those who didn’t want to work at the grass-roots level, they would plan to take part in the entrance exam for postgraduate (69.39%) and go to the better hospital or find a better position (74.49%).
Table 2 The situation of standardized training for residents of GPs
Statements
|
Frequency
|
Percent(%)
|
I obtain certification of the standardized training for residents of GPs. (n=263)
|
|
Yes
|
243
|
92.40
|
|
No
|
20
|
7.60
|
It is necessary to launch the standardized training for residents of GPs.(n=263)
|
|
Necessary
|
180
|
68.44
|
|
Neutral
|
63
|
23.95
|
|
Non- necessary
|
20
|
7.60
|
Monthly income during the standardized training for residents of GPs (RMB).(n=263)
|
|
<=2000
|
76
|
28.90
|
|
2000-3000
|
167
|
63.50
|
|
3000-4000
|
17
|
6.46
|
|
>4000
|
3
|
1.14
|
It is useful to improve comprehensive ability of residents of GPs by standardized training. (n=263)
|
|
Yes
|
101
|
38.40
|
|
A little
|
85
|
32.32
|
|
No
|
77
|
29.28
|
The abilities of residents of GPs are improved by standardized training.(n=263)
|
|
Medical ethics
|
81
|
30.80
|
|
Medical theoretical knowledge
|
188
|
71.48
|
|
Clinical technology
|
241
|
91.63
|
|
Sociability
|
129
|
49.05
|
|
Scientific research ability
|
60
|
22.81
|
The income of GPs is inclined comparing to other specialties.(n=263)
|
|
Yes
|
84
|
31.94
|
|
No
|
179
|
68.06
|
As a rural medical oriented graduate, I want to continue to work at the grass-roots level when I finish the serve time.(n=171)
|
|
Yes
|
73
|
42.69
|
|
No
|
98
|
57.31
|
The reasons for not continuing to work at the grass-roots level.(n=98)
|
|
The low income and fewer good policy or the policy is not been implemented
|
83
|
84.69
|
|
The limited career development
|
88
|
89.80
|
|
The poor primary medical environment
|
66
|
67.35
|
|
The imperfect general practice service mode
|
78
|
79.59
|
|
The wide range of specialties of general practice
|
31
|
31.63
|
|
The low support of grass-roots level’ leader for GPs
|
32
|
32.65
|
|
The main work is about public health but the clinic knowledge is less used
|
32
|
32.65
|
|
The big difference with schoolmates of other specialties
|
15
|
15.31
|
The plan of not continuing to work at the grass-roots level.(n=98)
|
|
Take part in the entrance exam for postgraduate
|
68
|
69.39
|
|
Go to the better hospital or find a better position
|
73
|
74.49
|
|
Practice medicine individually
|
21
|
21.43
|
|
Change profession
|
27
|
27.55
|
The satisfaction analysis of standardized training for residents of GPs
As shown in Table 3, 104 (39.54%) residents were satisfied for monthly income, while 55 (20.91%) were unsatisfied. 30 (54.55%) of 55 residents thought the satisfied monthly income was between 3500 and 4000RMB. Among all the residents, more than half (62.74%) were satisfied for the teacher of standardized training for residents of GPs, while 28 (10.64%) were unsatisfied. Among 28 residents who were unsatisfied for the teacher, mainly unsatisfied sides were teaching method (89.29%) and teaching consciousness (82.14%). About the community training time duration (6 months) of standardized training, 98 (37.26%) residents were satisfied and 76 (28.90%) were unsatisfied. And the mainly unsatisfied sides for the community training time duration included that the number of community patients was fewer (69.74%) and the community teachers’ teaching consciousness was not enough (59.21%).
Table 3 The satisfaction analysis of standardized training for residents of GPs
Statements
|
Frequency
|
Percent(%)
|
I am satisfied for monthly income during the standardized training for residents of GPs.(n=263)
|
|
Satisfied
|
104
|
39.54
|
|
Neutral
|
104
|
39.54
|
|
Unsatisfied
|
55
|
20.91
|
The satisfied monthly income (RMB) of residents of GPs.(n=55)
|
|
<=3500
|
5
|
9.09
|
|
3500-4000
|
30
|
54.55
|
|
4000-4500
|
14
|
25.45
|
|
>4500
|
6
|
1.81
|
I am satisfied for the teacher of standardized training for residents of GPs.(n=263)
|
|
Satisfied
|
165
|
62.74
|
|
Neutral
|
70
|
26.62
|
|
Unsatisfied
|
28
|
10.64
|
The unsatisfied sides for the teacher of standardized training for residents of GPs.(n=28)
|
|
Medical ethics
|
2
|
7.14
|
|
Technology level
|
20
|
71.43
|
|
Title of teacher
|
18
|
64.29
|
|
Education of teacher
|
15
|
53.57
|
|
Teaching consciousness
|
23
|
82.14
|
|
Teaching method
|
25
|
89.29
|
I am satisfied for the community training time duration (6 months) of standardized training for residents of GPs.(n=263)
|
|
Satisfied
|
98
|
37.26
|
|
Neutral
|
89
|
33.84
|
|
Unsatisfied
|
76
|
28.90
|
The unsatisfied sides for the community time duration (6 months) of standardized training for residents of GPs. (n=76)
|
|
The community time duration is too long
|
35
|
46.05
|
|
The number of community patients are fewer
|
53
|
69.74
|
|
The community equipment is imperfect
|
43
|
56.58
|
|
The community teachers are insufficient
|
37
|
48.68
|
|
The community teachers’ ability is low
|
41
|
53.95
|
|
The community teachers’ teaching consciousness is not enough
|
45
|
59.21
|
The survey of work situation and intention anlysis of GPs
As shown in Table 4, when the standardized training was finished, 227 (86.31%) residents had jobs and 36 (13.69%) had no job. Among all the medical institutions, 98(43.17%) worked in hospitals and 129 (56.83%) worked in primary medical and health institutions. 112 (59.34%) residents showed that their monthly income was between 3000 and 5000RMB and 95 (41.85%) residents’ monthly income were lower than 3000RMB. Only 95 (41.85%) medical institutions set up the general medical discipline. Among those who had jobs, 9 (3.96%) residents didn’t pass the qualification of practicing medicine. 68 (29.96%) residents were registered as GPs while 150 (66.08%) were not registered. The reasons for not been registered as GPs included that “the medical institutions and sanitary bureau didn’t know the general medicine policy and didn’t agree”, “there was no difference in the detail work contents between GPs and other doctors”, “the diagnosis and treatment mode at the grass-roots level was not suitable to the development of GPs” and “the residents didn’t want to register and liked to engage in specialized medical direction”, and the percentage of above reasons was 53.33%, 32.67%, 28.00% and 19.33% respectively. 107 (71.33%) residents indicated that they wanted to add the practice range of GPs on existing practice medical license.
134 (59.03%) residents were assigned department in the medical institution. Only 19 (14.18%) were assigned in the general practice department. Of all the 19 residents in the general practice department, their detail work contents mainly included “diagnosis and treatment of common diseases and frequently-occurring diseases and the referral of patients” (68.42%), “chronic disease management” (42.11%) and “health management” (42.11%). Among 115 residents who were not assigned in the general practice department, 50 (43.48%) residents showed their detail work contents were the same with GPs and 62 (53.91%) residents showed they wanted to be GPs. Of all the 227 residents, only 43 (18.94%) expressed that their colleges knew the standardized training for residents of GPs.
Table 4 The work situation and intention anlysis of GPs
Statements
|
Frequency
|
Percent(%)
|
I have a job.
|
|
Yes
|
227
|
86.31
|
|
No
|
36
|
13.69
|
The type of medical institutions. (n=227)
|
|
Hospital
|
98
|
43.17
|
|
Primary medical and health institutions
|
129
|
56.83
|
The hospital attributes. (n=98)
|
|
General hospital
|
81
|
82.65
|
|
Specialized hospital
|
8
|
8.16
|
|
Hospital of traditional Chinese and western medicine
|
9
|
9.18
|
The monthly income (RMB). (n=227)
|
|
<=3000
|
95
|
41.85
|
|
3000-5000
|
112
|
59.34
|
|
5000-7000
|
13
|
5.73
|
|
>7000
|
7
|
3.08
|
The general medical discipline is set up in medical institutions. (n=227)
|
|
Yes
|
95
|
41.85
|
|
No
|
132
|
58.15
|
I am registered as a GP. (n=227)
|
|
Yes
|
68
|
29.96
|
|
No
|
150
|
66.08
|
|
Without qualification of practicing medicine
|
9
|
3.96
|
The reasons for not been registered as GPs. (n=150)
|
|
The residents do not want to register and like to engage in specialized medical direction
|
29
|
19.33
|
|
The medical institutions and sanitary bureau do not know the general medicine policy and do not agree
|
80
|
53.33
|
|
The diagnosis and treatment mode at the grass-roots level is not suitable to the development of GPs
|
42
|
28.00
|
|
There is no difference in the detail work contents between GPs and other doctors
|
49
|
32.67
|
I want to add the range of GPs on existing practice medical license. (n=150)
|
|
Yes
|
107
|
71.33
|
|
No
|
43
|
28.67
|
I am assigned department in the medical institution. (n=227)
|
|
Yes
|
134
|
59.03
|
|
No
|
93
|
40.97
|
The type of assigned departments. (n=134)
|
|
General practice department
|
19
|
14.18
|
|
Internal medicine department
|
48
|
35.82
|
|
Surgery department
|
27
|
20.15
|
|
Gynecology and pediatric department
|
24
|
17.91
|
|
Other departments
|
16
|
11.94
|
The detail work contents in the department of general practice. (n=19)
|
|
Prevention and healthcare
|
5
|
26.32
|
|
Diagnosis and treatment of common diseases and frequently-occurring diseases and the referral of patients
|
13
|
68.42
|
|
Patients’ rehabilitation
|
3
|
15.79
|
|
Chronic disease management
|
8
|
42.11
|
|
Health management
|
8
|
42.11
|
|
Other position
|
7
|
36.84
|
The detail work contents of GPs and other doctors are the same. (n=115)
|
|
Yes
|
50
|
43.48
|
|
No
|
65
|
56.52
|
I want to be a GP in the future if I am a specialist physician. (n=115)
|
|
Yes
|
62
|
53.91
|
|
No
|
53
|
46.09
|
The satisfaction of work and attitude for GPs of college and local civilians
As shown in Table 5, 69 (30.40%) residents were satisfied for the work while 71 (31.28%) were unsatisfied. The lower percentage of residents (14.98%) was satisfied with their monthly income. And 58 (56.86%) showed their satisfied monthly income was between 5000 and 6500RMB. 94 (41.41%) expressed that leaders put the construction of general medicine and cultivation of GPs in an important position. Only 15 (6.61%) residents thought that the local civilians knew the standardized training for residents of GPs at the grass-roots level and only 39 (17.18%) residents thought that the local civilians recognized residents of GPs who have finished the standardized training. The main reasons for not recognizing residents of GPs concluded that “the local civilians had no idea to the standardized training for residents of GPs”, “the local civilians were used to see the familiar and experienced doctors”, “the local civilians thought residents of GPs were too young” and “the local civilians didn’t recognize the medical level of the grass-roots level”, and the percentage of above reasons was 90.38%, 78.85%, 69.23% and 15.38% respectively. Moreover, the main measures to increase recognition for residents of GPs who have finished the standardized training were that they thought the cultivation of GPs should be put in an important position (79.73%) and publicity of general medicine and GPs should be increased (78.85%).
Table 5 The satisfaction of work and attitude for GPs of college and local civilians
Statements
|
Frequency
|
Percent(%)
|
I am satisfied for the work. (n=227)
|
|
Satisfied
|
69
|
30.40
|
|
Neutral
|
87
|
38.33
|
|
Unsatisfied
|
71
|
31.28
|
I am satisfied for the monthly income. (n=227)
|
|
Satisfied
|
34
|
14.98
|
|
Neutral
|
91
|
40.09
|
|
Unsatisfied
|
102
|
44.93
|
The satisfied monthly income (RMB). (n=102)
|
|
<=5000
|
15
|
14.71
|
|
5000-6500
|
58
|
56.86
|
|
6500-8000
|
23
|
22.55
|
|
>8000
|
6
|
5.88
|
The leaders put the construction of general medicine and cultivation of GPs in an important position.(n=227)
|
|
Yes
|
94
|
41.41
|
|
No
|
133
|
58.59
|
My colleges know the standardized training for residents of GPs.(n=227)
|
|
Yes
|
43
|
18.94
|
|
Neutral
|
90
|
39.65
|
|
No
|
94
|
41.41
|
Local civilians know the standardized training for residents of GPs at the grass-roots level. (n=227)
|
|
Yes
|
15
|
6.61
|
|
No
|
212
|
93.39
|
Local civilians recognize residents of GPs who have finished the standardized training. (n=227)
|
|
Yes
|
39
|
17.18
|
|
Neutral
|
136
|
59.91
|
|
No
|
52
|
22.91
|
The reasons for not recognizing residents of GPs who have finished the standardized training. (n=52)
|
|
Residents of GPs are too young
|
36
|
69.23
|
|
The local civilians are used to see the familiar and experienced doctors
|
41
|
78.85
|
|
The local civilians have no idea to the standardized training for residents of GPs
|
47
|
90.38
|
|
The local civilians don’t recognize the medical level of the grass-roots level
|
8
|
15.38
|
Measures to increase recognition for residents of GPs who have finished the standardized training. (n=227)
|
|
The cultivation of GPs should be put in an important position
|
181
|
79.73
|
|
The health education lecture and the free diagnosis activities should be carried out
|
133
|
58.59
|
|
To increase contract services for family doctors
|
120
|
52.86
|
|
To increase publicity of general medicine and GPs
|
179
|
78.85
|
|
To increase construction of primary medical units and the quality of grass-roots manager
|
35
|
15.42
|