Basic characteristics
Approximately 275 residents of GPs were investigated. Finally, 263 residents were available (95.64%) including 133 (50.57%) women and 130 (49.43%) men with an average age of 28 years with a SD of 1.93 (Table 1). Of these subjects, 114 (43.35%) were married and 149 (56.65%) were single. There were 2 (0.76%) with junior college degree, 240 (91.25%) with bachelor degree and 21 (7.98%) with master degree. The proportion of residents completing the standard training were 17.87% (n=47) in 2017 and 82.13% (n=216) in 2018, respectively. Among all the 6 training hospitals, 59 (22.43%) were trained in Gansu Provincial Hospital, 96 (36.50%) in The First Hospital of Lanzhou University, 57 (21.67%) in The Second Hospital of Lanzhou University, 41 (15.59%) in Chinese People’s Liberation Army 940 Hospital, 6 (2.28%) in The First Hospital of Tianshui and 4 (1.52%) in The People’s Hospital of Pingliang. The study included 171 (65.02%) rural oriented medical graduates. There were 224 (85.17%) fresh graduates and 39 (14.83%) 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 degree
|
2
|
0.76
|
|
Bachelor degree
|
240
|
91.25
|
|
Master degree
|
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 oriented medical graduates
|
171
|
65.02
|
|
Other graduates
|
92
|
34.98
|
Graduate type
|
Fresh graduates
|
224
|
85.17
|
|
Former graduates
|
39
|
14.83
|
General situation of standardized training for residents of GPs
A total of 243 (92.40%) residents passed certification exam (Table 2), of whom, 180 (68.44%) considered it necessary for the standardized training whereas 20 (7.60%) thought it unnecessary. More than half of residents’ monthly income was among 2000 and 3000RMB. Only 101(38.40%) residents expressed improvement in the comprehensive ability by standardized training, while 77 (29.80%) thought the training useless. The residents of GPs were improved mainly in clinical operational skills (91.63%) and medical theoretical knowledge (71.48%). Only 84 (31.94%) residents of GPs deemed that their income were higher than other specialties. Of the rural oriented medical graduates, 73 (42.69%) expressed the willing to continue to work in the primary health care institutions after the rural serve time was finished and more graduates (57.31%) had no willing. Those who didn’t want to work in the primary health care institutions planned to take part in the graduate candidate test (69.39%) or find a better position (74.49%).
Table 2 The situation of standardized training for residents of GPs
Statements
|
Frequency
|
Percent(%)
|
Whether you obtain certification of the standardized training for residents of GPs. (n=263)
|
|
Yes
|
243
|
92.40
|
|
No
|
20
|
7.60
|
Is it 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
|
Is it 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 operational skills
|
241
|
91.63
|
|
Sociability
|
129
|
49.05
|
|
Scientific research ability
|
60
|
22.81
|
The income of GPs is higher than other specialties.(n=263)
|
|
Yes
|
84
|
31.94
|
|
No
|
179
|
68.06
|
As a rural oriented medical graduate, whether you have the willing to continue to work in the primary health care institutions after the rural serve is finished.(n=171)
|
|
Yes
|
73
|
42.69
|
|
No
|
98
|
57.31
|
The reasons for not willing to continue to work in the primary health care institutions.(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 primary health care institutions’ 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 in the primary health care institutions.(n=98)
|
|
Take part in the graduate candidate test
|
68
|
69.39
|
|
Find a better position
|
73
|
74.49
|
|
Practice medicine individually
|
21
|
21.43
|
|
Change profession
|
27
|
27.55
|
The satisfaction of residents of GPs on standardized training
As shown in Table 3, 104 (39.54%) residents were satisfied with monthly income, and other 55 (20.91%) were unsatisfied, of whom, 30 (54.55%) thought the satisfactory monthly income was between 3500 and 4000RMB. Among all the residents, more than half (62.74%) were satisfied with teachers of standardized training, while 28 (10.64%) were unsatisfied, of whom, 25 (89.29%) were unsatisfied with teaching approach and 23 (82.14%) teaching motivation. As for six-month community training, 98 (37.26%) residents were satisfied and 76 (28.90%) were unsatisfied, mainly due to the few patients (69.74%) and the poor teaching motivation of teachers (59.21%).
Table 3 The satisfaction of residents of GPs on standardized training
Statements
|
Frequency
|
Percent(%)
|
The satisfaction of 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
|
The satisfaction of 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
|
|
Clinical operational skill level
|
20
|
71.43
|
|
Title of teacher
|
18
|
64.29
|
|
Education of teacher
|
15
|
53.57
|
|
Teaching motivation
|
23
|
82.14
|
|
Teaching approach
|
25
|
89.29
|
The satisfaction of the six-month community training.(n=263)
|
|
Satisfied
|
98
|
37.26
|
|
Neutral
|
89
|
33.84
|
|
Unsatisfied
|
76
|
28.90
|
The unsatisfied sides for the six-month community training. (n=76)
|
|
The community training time is long
|
35
|
46.05
|
|
The few patients in community
|
53
|
69.74
|
|
The imperfect community equipments
|
43
|
56.58
|
|
The insufficient community teachers
|
37
|
48.68
|
|
The low ability of community teachers
|
41
|
53.95
|
|
The poor teaching motivation of community teachers
|
45
|
59.21
|
Work situation and intention of GPs
As shown in Table 4, 36 (13.69%) had no jobs and 227 (86.31%) residents had jobs after the standardized training, including 98(43.17%) in hospitals and 129 (56.83%) in primary medical and health institutions. Around 112 (59.34%) residents received the monthly income between 3000 and 5000RMB and 95 (41.85%) residents had lower income. Only 95 (41.85%) medical institutions set up the general medical disciplines. 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 and 150 (66.08%) were not registered for the following reasons:. “the medical institutions and sanitary bureau didn’t know the general medicine policy and didn’t agree” (53.33%), “there was no difference in the detail work contents between GPs and other doctors” (32.67%), “the diagnosis and treatment mode in the primary health care institutions was not suitable to the development of GPs” (28.00%) and “the residents didn’t want to register and liked to engage in specialized medical direction” (19.33%) Most residents (107, 71.33%) hoped that the range of practice medical license of GPs was expanded.
Around 134 (59.03%) residents were assigned to the medical institution with only 19 (14.18%) in the GP department for “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%), whereas the remaining 115 working in other departments such as internal, surgery, gynecology and pediatric departments. Of the remaining 115 residents, 50 (43.48%) did the same work as those in GP departments and 62 (53.91%) showed they wanted to be GPs.
Table 4 Work situation and intention of GPs
Statements
|
Frequency
|
Percent(%)
|
Whether you have a job.
|
|
Yes
|
227
|
86.31
|
|
No
|
36
|
13.69
|
The type of medical institutions. (n=227)
|
|
Hospital
|
98
|
43.17
|
|
Primary medical 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 medical institutions set up general medical discipline . (n=227)
|
|
Yes
|
95
|
41.85
|
|
No
|
132
|
58.15
|
Whether you are 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 in the primary health care institutions 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
|
Whether you hope to expand the range of practice medical license of GPs. (n=150)
|
|
Yes
|
107
|
71.33
|
|
No
|
43
|
28.67
|
Whether you are assigned department in the medical institutions. (n=227)
|
|
Yes
|
134
|
59.03
|
|
No
|
93
|
40.97
|
The type of assigned departments. (n=134)
|
|
GP department
|
19
|
14.18
|
|
Internal department
|
48
|
35.82
|
|
Surgery department
|
27
|
20.15
|
|
Gynecology and pediatric department
|
24
|
17.91
|
|
Other departments
|
16
|
11.94
|
The routine work in the GP department. (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 routine work of GPs are the same as other doctors. (n=115)
|
|
Yes
|
50
|
43.48
|
|
No
|
65
|
56.52
|
Whether you want to be GPs. (n=115)
|
|
Yes
|
62
|
53.91
|
|
No
|
53
|
46.09
|
The job satisfaction of GPs and attitude of colleagues and local civilians to GPs
As shown in Table 5, 69 (30.40%) residents were satisfied with their job while 71 (31.28%) were unsatisfied. Only 34 (14.98%) residents were satisfied with their monthly income. Of the 102 residents unsatisfied with the income, 58 (56.86%) showed the satisfactory monthly income was between 5000 and 6500RMB. Around 94 (41.41%) indicated that their leaders put the construction of general medicine and cultivation of GPs in an important position. A low percentage (18.94%) of residents showed their colleagues knew the standardized training for residents of GPs. Only 15 (6.61%) residents thought that the local civilians knew the standardized training for residents of GPs in the primary health care institutions 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 being unfamiliar with residents of GPs included that “the local civilians had no idea to the standardized training for residents of GPs” (90.38%), “the local civilians were used to visiting the familiar and experienced doctors” (78.85%), “the local civilians thought residents of GPs were too young” (69.23%) and “the local civilians didn’t recognize the medical level of the primary health care institutions” (15.38%). In order to increasing the recognition to residents of GPs who have finished the standardized training, 79.73% of residents thought that cultivation of GPs should be put in an important position and 78.85% considered that general medicine and GPs should be more publicized.
Table 5 The job satisfaction of GPs and attitude of colleagues and local civilians to GPs
Statements
|
Frequency
|
Percent(%)
|
The satisfaction of the work. (n=227)
|
|
Satisfied
|
69
|
30.40
|
|
Neutral
|
87
|
38.33
|
|
Unsatisfied
|
71
|
31.28
|
The satisfaction of 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
|
The awareness of colleagues for the standardized training for residents of GPs.(n=227)
|
|
Yes
|
43
|
18.94
|
|
Neutral
|
90
|
39.65
|
|
No
|
94
|
41.41
|
The awareness of local civilians for the standardized training for residents of GPs in the primary health care institutions. (n=227)
|
|
Yes
|
15
|
6.61
|
|
No
|
212
|
93.39
|
The recognition of local civilians to 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 being unfamiliar with 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 visiting 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 primary health care institutions
|
8
|
15.38
|
Measures to increase recognition to 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 manager
|
35
|
15.42
|