Current Insights in The Barrier of Continuing Education for General Practitioners in China and Construction of A Novel Raining Model

Review Article

J Fam Med. 2023; 10(4): 1337.

Current Insights in The Barrier of Continuing Education for General Practitioners in China and Construction of A Novel Raining Model

Zhiheng Zhou¹; Jinghua He¹; Shenqing Zhou²; Xianhui Chen¹; Yang Zhang¹; Shuangxi Wang¹; Jiangzhong Deng¹; Jiang Wu¹; Tianyuan Feng¹; Jiaji Wang¹

¹Pingshan hospital of Southern Medical University, Shenzhen, China

²Orange county American High School of Shenzhen, Shenzhen, China

*Corresponding author: Zhiheng Zhou, MD, PhD Pingshan Hospital of Southern Medical University No.16 Renmin Road, Pingshan District, Shenzhen, 518118, China. Tel: +8613828493963 Email: [email protected]

Received: September 12, 2023 Accepted: October 10, 2023 Published: October 17, 2023


Since 1997, China has been carrying out general practice education and has promulgated and implemented the “General Practitioner System”, conducting general practice job transfer training and “5+3” standardized training. However, the continuing education of general practitioners in China was the weakest. This study looked insights in the barrier of continuing education for General Practitioners in China: There was no unified mode and standard for continuing education for general practitioners, lacked of management system covering the entire practice cycle of general practitioners, the focus of post graduation training was unclear, the overall level of the teaching staff was not high, and the enthusiasm of general practitioners to participate in continuing education was poor. In response to these issues, the authors constructed and implemented a full cycle general practitioner continuing education model guided by job competence. Based on summarizing the 10 core job competencies of general practitioners, they constructed a general practitioner training faculty, established general practitioner related systems (continuing education system, practice management system, and professional title promotion system), designed training courses, and conducted hierarchical training, We organized multi-path scientific research training and conducted comprehensive quality management for the continuing education of general practitioners, achieving satisfactory results. Our raining model provided a useful reference for the current continuing education of general practitioners in China and is worth promoting and applying.

Keywords: General practitioner; Continuing education; Mode; Job competence

The Current Status of General Practice Education in China

The Evolution of General Practice in China

In 1986, Chinese scholars participated in the academic annual conference organized by the World Organization of National Colleges, Academies and Academic Association of General Practitioners/Family Physicians (WONCA), and invited the President of WONCA to come to China for academic exchange. The concept of general practice gradually emerged in China. In 1993, the General Practice Branch of the Chinese Medical Association was established, marking the formal establishment of General Practice as a secondary clinical discipline in China. In 1995, China was admitted as a full member state by WONCA. 1997, the State Council, the former Ministry of Health, the National Development and Reform Commission, and other central governments or national ministries individually or jointly issued documents such as the “Decision on Health Reform and Development” and the “Plan for the Construction of Grassroots Medical and Health Teams with a Focus on General Practitioners”, calling for strengthening the construction of grassroots medical institutions, accelerating the training of General Practitioners, and promoting the implementation of the graded diagnosis and treatment system. In 2006, the State Council held a national community health work conference and issued the "Guiding Opinions on the Development of Urban Community Health Services", emphasizing the development of community health services as an important measure to deepen the reform of the urban medical and health system, effectively solve the problems of difficult and expensive medical treatment for urban residents, and serve as the foundation for building a new urban health service system. It also requires relevant departments to fulfill their responsibilities effectively, Jointly promoted the development of community health services [3]. In July 2011, the State Council issued the “Guiding Opinions on Establishing a General Practitioner System”. At this point, the development of general practice medicine in China has entered a fast lane, and general practice education has achieved rapid development.

In 2012, there were only 110000 general practitioners in China, of which 73000 obtained general practitioner training certificates, 37000 registered as general practitioners, and 0.81 general practitioners per 10000 populations. In 2020, there were 409000 general practitioners in China, of which 153000 obtained general practitioner training certificates, 256000 registered as general practitioners, and there were 2.9 general practitioners per 10000 populations. In terms of quantity and quality, China's general medical human resources have achieved leapfrog development. In 2020, China has initially established a vibrant and dynamic system of general practitioners, basically forming a unified and standardized training model for general practitioners and a grassroots service model for first diagnosis. General practitioners have basically established a relatively stable service relationship with urban and rural residents, achieving 2-3 qualified general practitioners for every 10000 residents in urban and rural areas. According to the plan of China's "General Practitioner System", by 2030, there will be 5 general practitioners per 10000 residents, which will better provide the public with continuous, coordinated, convenient and accessible basic medical and health services.

General Practice Education Status in China

The training of general practitioners in China began in 1997. Currently, China has formed a system of general practitioner training with Chinese characteristics, including medical college education and academic education at different levels, including specialized, undergraduate, masters, and doctoral levels. The training model was mainly based on the "5+3"(5 years medical school and 3 years standardized training for residents) model and supplemented by the "3+2" model, and the rural targeted free training policy, and a combination of post graduation education and continuing medical education, including job training/job transfer training. Research has found that the "5+3" training model can only meet the entry-level requirements of general practitioners, and the current training model was still missing in the continuing education dimension of general practitioners [8]. The continuing education refers to the targeted non academic education provided by general practitioners in response to their professional skills needs after completing academic education and training. At present, the way for general practitioners in China to participate in continuing education was single, mainly through attending specialized continuing education courses. In addition, a training system for continuing education has not yet been established. These issues to some extent limit the professional development and improvement of personal qualities of general practitioners [10,11].

The Barrier of Continuing Education for General Practitioners in China

Lack of Unified Continuing Education Models and Standards

China has developed a general practitioner training model based on foreign experience, with a focus on "5+3". However, there was still no unified model and standard for how to carry out continuing education for general practitioners after completing "5+3" in China. The curriculum of continuing education for most general practitioners was not standardized. Many courses were disconnected from the requirements of job abilities. Most general practitioners lacked planned and systematic continuing education in their work positions, and their continuing education become a personal selection, and just to cope with tasks. This has resulted in a slow improvement in the diagnosis and treatment level and health service level of on-the-job general practitioners in China, with significant differences in the diagnosis and treatment levels among different general practitioners [12,13].

Lack Of Management System Covering The Whole Practice Cycle Of General Practitioners

After the registration of general practitioners in China, the management of their continuing education and ability evaluation cannot keep up, resulting in a lack of attention and weak incentives and constraints. At the same time, there was currently lack of continuing education and professional technical ability evaluation systems that met the characteristics of general practitioners. The fact that on duty general practitioners participated in continuing education was a personal behavior, lacking systematic guidance and assessment requirements.

Unclear Focus on Training Content

Continuing education in general medicine in China, did not like “5+3” training in general medicine, did not have clear training outlines and content requirements. Each region only selected certain content for training general practitioners based on the needs of community health services. Therefore, there was no systematic planning and comprehensive evaluation standards, the training focus was unclear, which led it difficult to ensure the quality of training and cultivate a high-level team of specialized general practitioners [14,15].

The Overall Level of the Teaching Staff Was Not High

High quality general practitioners were the fundamental guarantee for cultivating excellent general practitioners. However, there was currently a serious shortage of general practitioners in China. The teaching staff of general practitioners were generally general practitioners and community teachers in general hospitals. Most of the teachers in comprehensive hospitals were transformed from specialized doctors, lacking full-time general practitioners who had undergone systematic theoretical training, deeply understood the connotation of general medicine services, and fully understood the progress of general medicine disciplines both domestically and internationally. The clinical base rotation of general practitioners tends to converge with that of specialized practitioners, who receive a "disease centered" knowledge system from specialized medical teachers. It was difficult to cultivate their comprehensive and systematic general practitioner diagnosis and treatment thinking. Although the teaching staff in grassroots practice bases had rich experience in general practice diagnosis and treatment, due to their overall low education level, most of the teachers had not received standardized training in general practice medicine, and over 80% of the managers in general practice training bases had not systematically learned corresponding medical knowledge and lacked good teaching ability. At the same time, there were also non-standard teaching management and students often use the form of "herding sheep" in continuing education, So the effectiveness of continuing education and training was not high [18].

Poor Enthusiasm of General Practitioners to Participate in Continuing Education

At present, the implementation of continuing education in general medicine in most regions of China lacked organization, and the reward mechanism was not perfect. In addition, due to the relatively insufficient human resources of grassroots health in China and the large workload of community general practitioners, the contradiction between work and education was obvious, and the overall enthusiasm for them to participate in continuing education separately was not high. In fact, most general practitioners hope to continuously improve their professional abilities and had a need to participate in continuing education. However, due to the fragmented training that was currently the main focus of most general practitioners' continuing education, the lack of systematic training and the low quality of training, it was not easy for students to appreciate and gain much, which was also reason why the low enthusiasm of general practitioners to participate in continuing education [19].

Exploration of Continuing Education Model for General Practitioners

Based on a comprehensive analysis of the relevant policies on general practitioner education and management in China, our team had developed a full cycle general practitioner continuing education model guided by job competency through expert consultation, thematic discussions, student interviews, and questionnaire surveys, in response to the problems in general practitioner continuing education in China (Figure 1).

Citation:Zhou Z, He J, Zhou S, Chen X, Zhang Y, et al. Current Insights in the Barrier of Continuing Education for General Practitioners in China and Construction of a Novel Raining Model. J Fam Med. 2023; 10(4): 1337.