Training and Assessment for General Practitioners

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??????????? Training and Assessment for General
Practitioners

• ????????????
• ???????????????

?????
Zhu Shanzhu Faculty of General Practice, FuDan
Medicine Institute Department of General
Practice, ZhongShan Hospital affiliated to FuDan
University
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?? Background

• ???,?????????????5???????????,????8090????????
  ?????(????)???????????????
• According to the recent statistics, only 5 of
  the patients who go to hospital need the
  health-care from specialists, and 8090 health
  problems can be solved by GPs-based community
  health-care system

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• ????????????????????,????????????????????????????
  ????????
• ?10??,?????????????????,????????????????????
• The experience gained in developed countries
  reinforces the idea that to develop GPs-based
  health-care in community setting is a crucial
  measure to reduce medical costs and make use of
  the limited resources of Medicare more
  effectively
• In the recent decade, we have devoted ourselves
  to training GPs and developing a workable system
  for GPs training and assessment in the past
  decade

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???? Research Objective

• ??????????????????????,??????-??-?????????????,???
  ????????????????????????????
• To develop a new efficient system for
  standardized GPs training in comprehensive
  teaching hospital, corresponding with
  biological-psychological-social medical pattern
  and reforming the disease-oriented traditional
  system which focuses solely on medical knowledge
  and skills

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???? Research Method

• ??
• ?????????????,?????????????????????
• Objects
• We recruit students graduated from medical
  universities as our trainees, who have obtained
  bachelor degrees in clinical medicine, and
  willing to become GPs

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• ??
• ??????????????,???????????????,???????????????
  ??????????????????????????????????????,???????????
  ????????
• Methods
• We tried to work-out a new set of
  regulations, a curriculum for standardized GPs
  training, the methods of examination and
  assessment, which drew on GPs training methods
  in the developed country and district, as well as
  the long-term residents training experience of
  our hospital .During the process, we tried to
  improve the methods of teaching and the content
  of the training courses and assessment step by
  step through collecting constructive feedback
  from the trainers and the trainees

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???? Training Methods

• ???????????????????
• ??????????????????????,????????????????????????
• The training process involved 3 phases academic
  learning, clinical rotation and community
  practice
• Senior GPs and specialists assumed the teaching
  tasks together in academic curriculum. At the
  same time, we invited sophisticated GPs coming
  from Taiwan, UK, US to hold a course of lectures

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• ????????????????,???????????????(????)????,???????
  ????,???????
• Attending doctors in wards took charge of
  trainees clinical rotation and adjunct professor
  of Department of General Practice, with
  responsibility for training, supervised the whole
  course, who would learn from the feedback from
  trainees in time and coordinate with the
  supervisors of all wards

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???? Training Methods

• ??????,????????????????????????????????????,??????
  ????????????????????????????????????????1?,??????
• During community practice, the senior physicians
  in community would supervise our trainees, who
  received the academic training of General
  Practice in advance and reflected the existing
  problems in trainees practice through frequent
  telephone communication and rap sessions every
  half an year. Trainees came back to our hospital
  every week so as to communicate with us

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• ????,???????,?????????,??????
• When academic year was over, we would hold a
  session for trainees, collecting constructive
  ideas and suggestions, to improve training
  methods

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???????Training Contents and Schedule

• ??????????????
• 1.?????
• 2.???????
• 3.?????????
• 4.????
• 5.????
• 6.??????????????,??4?
• It took 4 years to perform the training based on
  six aspects as follow patient care, medical
  knowledge, practice-based learning and
  improvement, interpersonal communication skills,
  professionalism and health-care system-based
  practice

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??????? Training Contents and Schedule

• ????2??,??????????????????(???????????????????????
  ????????????)?????
• Academic courses took 2 months, including
  Panorama of General Practice, Preventive
  Medicine, comprehensive courses (such as
  management of clinic in community, rational
  prescription in community clinic, Geriatrics,
  skills of physician-patient communication and
  computer application as well) and medical
  specialized English

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• ????26??,?????????????????????????????????CDC?
• ????20??
• ????????????1?,????????
• Clinical rotation took 26 months, including
  department of Internal Medicine, Surgery,
  Gynecology Obstetrics, Pediatrics, Emergency,
  ENT, Dermatology, Ophthalmology, Rehabilitation,
  Traditional Medicine, CDC and Psychology etc.
• Community practice took 20 months
• We held a seminar every month to introduce the
  advancement of clinical medicine for trainees

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????? Examination and Assessment

• ????6???????,??????????????,?????????????????????
  ??????????????????????????????????????????????????
  ??????????,?????1?,??????????????
• According to the 6 aspects we mentioned above, we
  worked-out relevant requirements of knowledge,
  skills and attitudes, as well as examination and
  assessment forms respective such as case history
  quality assessment form, clinical ability testing
  form, literature and review assessment form,
  physician-patient communication assessment form,
  patients relative-based communication assessment
  form, co-workers' evaluation form and
  professional morality evaluation form etc. These
  examinations and assessments were performed by
  educational group of our department and relevant
  professionals every half an year

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????? Examination and Assessment

• ????????????,?????????????????,??????????????
• Stage examinations When every phase was over,
  our department would organize examinations of
  corresponding academic knowledge and clinical
  skills, recording the traines scores on the
  manuals

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• ?????????,?????????????????,???????????????,?????
  ??????????????????????
• Comprehensive examinations When the whole
  training was over, trainees were required to hand
  in a paper based on community setting. Those who
  went through the defending smoothly and past
  assessments were eligible will acquire
  qualification certificates for GPs training
  issued by the Healthcare Ministry

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?? Results

• ??????????????
• ??????????????????????????????
• ???????????????????(???)??????(???)???????
  ?(???)?
• Formulated a training pattern for GPs
• Worked out a training curriculum, scheme,
  administration and assessing methods
• Published several textbooks for GPs training

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• ?2000?12??2005?9????6?????????????,???165???????70
  ???????,??????,???????????????
• From Dec.2000 to Sep.2005, standardized GPs
  training courses have been run for 6 times, in
  which 165 students have been enrolled and 70
  students have passed all the examinations and
  acquired the qualification certificates for GPs
  training

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?? Discussion

• ??,?????????????????,?????????????????????????????
  ???????????????,????????????,????????????
• At present, we are still exploring the
  standardized GPs training. Qualified GPs are
  crucial for the sustainable development of
  community health-care system. We devoted
  ourselves in the past decade to training eligible
  GPs so as to enforce the team of GPs and trainers

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• ?????????????????????????????????????,????????????
  ????,???????????,??????????????
• The training for GPs should focus on developing
  students comprehensive ability (including
  offering rational, effective and individual
  health-care as well as managing health problems
  through assessing and adopting best medical
  methods), accommodating to the need of community
  health-care service

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?? Discussion

• ??????????????????,????????????????????
• ????????????????,??????????????????,???????????
  ???????????????????
• GPs training can best be done in comprehensive
  teaching hospitals where there are superior
  educational resources, which will help to enhance
  GPs training programs
• Specialists play an important role in General
  Practice education, whose special medical ideas
  will effect the quality of GPs training unless
  they receive academic education from experienced
  GPs

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• ??????????????????,??????,??????????
• In general, we assess the training quality by
  questionnaire, lack o objective standard, which
  couldnt evaluate the merits and weakness
  objectively of training pattern

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?? Discussion

• ???????????????,??????,????????,?????????????????
  ?
• At present, GPs social status and income arent
  satisfied, on account of which, therere not
  enough trainees for GPs training and the quality
  of trainees couldnt be ensured, furthermore a
  part of trainees will leave school during the
  training

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• ???????????????????????????????????????????????
  ??????????,????????????????????????
• Government should reinforce the General Practice
  education to set up the department of General
  Practice in medical university to ensure the
  implement of GPs training by policy and
  financial subsidization to publicize General
  Practice by media and gain the support of the
  Public so as to enhance the GPs social and
  economic position

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• ??,?????????????,??????????????????????????????
  ,????????????????,????1???????????????????????
• GPs education is becoming more and more
  important with the modernization of Medicare
  system in our country. GPs training done in
  comprehensive teaching hospitals will help to
  enhance GPs training programs and provide a team
  composed of GPs satisfying the basic health-care
  needs of the Public

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Thank You !