The work competence of Shanghai’s GPs: a cross-sectional study based on self-assessment

The work competence of Shanghai’s GPs: a cross-sectional study based on self-assessment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The work competence of Shanghai’s GPs: a cross-sectional study based on self-assessment Tianhao Wang, Xueying Ru, Yuan Zhang, Xiangjie Zhang, Jian Gong, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-289916/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: General practitioners(GPs) have taken new challenges as requested in a new model introduced in China recently. Unlike some countries where general medicine are well developed, there is a lack of a standard in China that can be generalized to assess GPs’ work competence. The aim of the study was to investigate work competence of GPs in Shanghai’s community health services(CHS) in China by self-assessment, providing evidences for effectiveness of GPs’ post-education and training. Methods: A stratified and proportional cluster sampling method was adopted in this cross-sectional study from 116 CHS in Shanghai.(n=2954). We collected data on GPs demographic variables and work competence which was separated as patient care ability, teaching ability, communication skill and coordination ability, using a self-designed questionnaire. Results: The mean score of patient care ability, teaching ability, communication skill and coordination ability were 76.93±12.55, 63.47±28.97, and 76.31±20.25 on a scale of 100, respectively. GPs who were 30-39 years old, worked in urban CHSs, and participated in GP trainer’s training or had teaching experience got higher scores in patient care ability. Those GPs who worked for 5-20 years in CHS, especially in training CHSs which is involved in post-graduate GPs training program, and participated in GP trainer’s training program had higher scores in teaching ability. As for communication skill and coordination ability, GPs who were older than 30-39 years old and with a senior professional title, worked in training CHSs, participated in GP trainer’s training and had teaching experiences in CHS can got higher scores. Conclusions: There is a large space to improve the patient care ability, teaching ability, communication skill and coordination ability for GPs in Shanghai’s CHS ,especially in teaching ability. General Practice general practitioners work competence patient care ability teaching ability communication skill and coordination ability Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction GPs play a crucial role in a new medical model( 1 ) recently introduced in China. With the exception of provision of patient care, GPs have taken new challenges as requested in the model including team organization management, communication and teaching in their daily works( 2 ) In the countries where general practice is well developed, the requirement for GPs’ competence has been well-documented and implemented appropriately in medical practice( 3 ) ( 4 ).There are some well-known standards abroad, such as the WONCA Tree model( 5 ), the 13 competency model put forward by the Membership of the Royal College of General Practitioners(MRCGP) in England( 6 ), and the ACGME Program Requirements for Graduate Medical Education in Family Medicine in the United States( 7 ). The above standards and assessment systems, do not simply emphasize medical care, and they have begun to underline the non-clinical contents such as management, leading power, and referral or cooperation with specialists( 8 ) ( 9 ). Nevertheless, it is generally considered that there is a lack of a standard in China that can be generalized to assess GPs’ work competence. Some scholars designed questionnaires through Dephi expert consultation method and literature review, and carried out empirical studies( 10 – 13 ).The indexes cited in these study have obtained good reliability and validity, however, there are some inherent limitations including small and convenience samples, incomplete contents or less representative objects in the studies. To assess GP’s work competence in Shanghai’s community health services(CHS) in China, a cross-sectional study was conducted by using a self-designed questionnaires. On the basis of previous researches on ability evaluation of GPs( 14 ), the questionnaires were generated and has since been considered informative and pragmatic. Materials And Methods Sample A stratified and proportional cluster sampling was used in the cross-sectional study during Jan,2016 through Feb,2016 in CHSs of Shanghai, China. There were 16 districts and 245 CHSs in Shanghai in 2016,seven urban districts with 75 CHSs and nine rural districts with 170 CHSs, Sampling was stratified by location of CHS and CHS type (CHS was classified as training CHS and non-training CHS, training CHS means the one which was qualified to afford the teaching affairs of GP standardized training by Shanghai Health and Family Planning Commission. Until 2016 ,57 CHS was qualified as training CHS ) .In this study, all of the training CHSs were chosen, and non-training CHSs were selected in a ratio of 1 to 1 with the training ones. Because the number of training CHS in each districts was different, The number of non-training CHS sampled in each district(N) was calculated as follow formula: N = The number of non-training CHS in each district/The number of non-training CHS in Shanghai × The total number of non-training CHS needed. Finally, a total of 116 CHSs was sampled. Among them, 75 CHSs are located in the urban area including 36 training CHSs and 39 non-training CHSs; the remaining 41 CHSs are located in the rural areas including 21 training CHSs and 20 non-training CHSs. All GPs working in the sampled CHS were invited to take part in the investigation. A distribution of the sampled CHS by location and CHS type was shown in Fig. 1. Design Of Questionnaire The questionnaire was designed on the basis of indicator system to evaluate basic capacities of general practitioners trainer constructed by Zhang Yuan. The GP’s work competence was characterized in the questionnaires as follow: patient care ability, teaching ability and communication skill and coordination ability. The questionnaire consisted of the following 4 sectors: ( 1 )demographic variables including age, sex, education background, professional title, whether accepted GP standardized training(Yes/No), working in an urban or rural CHS, whether accepted GP trainer' training(Yes/No) and years of working and teaching experiences. ( 2 )patient care ability containing 16 indexes, measured within the following 3 fields—basic public health service, diagnosis and treatment of community common diseases and community clinical skills. ( 3 )teaching ability mainly examining the teaching knowledge and skills, containing 10 indexes. ( 4 )communication skill and coordination ability, containing 4 indexes. For each question, there were 5 various answers, which represented 5 tiers of level, i.e. worse ,poor, fair, good and excellent in an ability tested. The above tiers were converted into 1,2,3,4 and 5 points respectively. The reliability(Cronbach α) of the questionnaire was 0.826. Data Collection The questionnaire was used to investigate the participants’ demographic data and work competence. Administrator in each CHS was responsible for issuing and collecting questionnaires. Ineligible ones were deleted. All scores were converted into percentage system. Statistical analysis Data were presented by percentage, means, and standard deviation. The chi-square test, Fisher exact test, Mann-Whitney U test and Kolmogorov-Smirnov test were used to compare the work competence in different population. Multiple liner regression was conducted to explore the effect of demographic characteristics on the 3 categories of ability. Data was analyzed using SPSS Statistics software, version25.0(SPSS Inc. Chicago).P values < 0.05 were considered statistically significant. Results General condition A total of 2594 GPs were sent a questionnaire, and 2592 eligible pieces were returned, where the respond rate was 99.9%. The demographic data of the 2592 GPs was presented in Table 1 . Based on the data received, more females(1526, 58.9%) participated in the study than males(746, 28.8%). Mean age of the GP population was 39.41 ± 7.92 years old. Of the 2592 GPs, 1956(75.5%) worked in urban CHS, and 1562(60.3%) received GP trainer' training. In additions, less than half(1138, 43.9%) of the GPs had teaching experiences in CHS. Table 1 Demographic variables of all the 2592 GPs Variables N(%) Num. of CHS 116(100.0) Num. of GPs 2592(100.0) Sex Male Female Missing 746(28.8) 1526(58.9) 320(12.3) Age(y) < 30 30–39 40–49 ≧ 50 Missing 186(7.2) 1276(49.2) 793(30.6) 286(11.0) 51(2.0) Educational level Technical secondary school college university postgraduate and above Missing 32(1.2) 265(10.2) 2052(79.2) 241(9.3) 2(0.1) Professional title primary intermediate senior Missing 420(16.2) 1848(71.3) 190(7.3) 134(5.2) Years of working(y) < 5 5–9 10–19 ≧ 20 Missing 458(17.7) 605(23.3) 934(36.0) 583(22.5) 12(0.5) Did you receive GP standardized training yes no Missing 1384(53.4) 1204(46.5) 4(0.2) Did you worked in training CHS yes no 1296(50.0) 1296(50.0) CHS location Urban area Rural area Missing 1956(75.5) 628(24.2) 8(0.3) Did you receive general teaching training yes no Missing 1562(60.3) 1018(39.3) 12(0.5) Did you have teaching experience in CHS yes no Missing 1138(43.9) 1417(54.7) 37(1.4) GPs' Patient Care Ability The mean score of patient care ability for GPs were 76.93 ± 12.55, respectively. The index “up on the chronic management approaches”,“knowing the latest guidelines well”and“indwelling gastric tube or urethral catheter” had the lowest score in each of the 3 fields(Basic public health service, Diagnosis and treatment of community common diseases and Community clinical skills), which were 3.82 ± 0.923, 3.94 ± 0.774 and 3.66 ± 1.070, respectively(Table 2 ). Table 2 GPs’ patient care ability Second index \(\stackrel{-}{x}\) ±s Third index \(\stackrel{-}{x}\) ±s Basic public health service 18.91 ± 5.62 Establishment of individual and family healthy record 3.98 ± 0.941 Healthy education 4.09 ± 0.855 Family visit 3.97 ± 0.926 Chronic disease rehabilitation 3.93 ± 0.864 up on the chronic management approaches 3.82 ± 0.923 Diagnosis and treatment of community common diseases 20.06 ± 5.31 Screening of community common diseases 4.21 ± 0.748 Diagnosis of community common diseases 4.31 ± 0.708 Familiar with the latest guidelines 3.94 ± 0.774 Suitable prescribing 4.27 ± 0.726 Familiar with referral indications 4.22 ± 0.748 Community clinical skills 22.07 ± 6.58 EKG skills 3.84 ± 0.854 X-ray judging 3.79 ± 0.841 Debridement and dressing changing 3.84 ± 0.894 Indwelling gastric tube or urethral catheter 3.66 ± 1.070 Explaining laboratory inspection reports 4.14 ± 0.748 CPR 4.07 ± 0.791 Through the multiple liner regression, GPs who were 30 to 39 years old(78.12 ± 18.61; OR = 5.491, P = 0.005), worked in urban CHS(77.21 ± 19.63; OR = 2.451,P = 0.024), participated in GP trainer' training(77.65 ± 20.32; OR = 2.332,P = 0.024) or had teaching experiences(79.00 ± 19.21; OR = 3.628, P < 0.001) got a higher score in the patient care ability. (Fig. 2 ). GPs' Teaching Ability The assessment of GPs' teaching ability was done within those GPs with teaching experiences. Mean score in this sector was 63.47 ± 28.97. Only 75% GPs were willing to spend time in teaching. The index “interesting in teaching” got the lowest score, which was 3.46 ± 0.800. In teaching skills, the index“ applying of various teaching methods” was the lowest, which was 3.78 ± 0.720 points(Table 3 ). Multiple liner regression indicated that GPs who have worked for 5 to 20 years(65.72 ± 27.56; OR = 7.159,P = 0.003 and 65.61 ± 27.28; OR = 5.135,P = 0.013) ,worked in a training CHS(69.24 ± 24.71; OR = 13.379,P < 0.001), or participated in GP trainer's training(67.74 ± 25.81; OR = 18.092,P < 0.001) got a higher score in teaching ability. (Fig. 3 ). Table 3 GPs’ teaching ability Index Mean ± SD/proportion(%) Willing to spend time in teaching 75.1 Willing to accept related training 75.8 Encourage student in teaching 81.0 Giving timely feedback 80.8 Evaluating students every month 78.9 Interests in teaching 3.46 ± 0.800 Familiar with medical service in CHS 4.12 ± 0.687 Integration teaching resources 3.91 ± 0.688 Familiar with GP teaching requirement and contents in CHS 3.85 ± 0.692 Finishing the teaching plans set and carried out suitable for students 3.82 ± 0.674 Adjusting teaching contents and progress according to students’ learning 3.81 ± 0.679 applying of various teaching methods 3.78 ± 0.720 Clinic teaching 3.84 ± 0.678 Teaching ward round 3.75 ± 0.775 Case discussion 3.76 ± 0.775 Lecture 3.75 ± 0.784 GPs' Communication Skill And Coordination Ability Mean score in this sector was 76.31 ± 20.25. The index “organization and management ability” got the lowest score, 3.52 ± 0.774.(Table 4 ) Multiple liner regression indicated that GPs who were older than 30–39 years old(78.91 ± 13.62; OR= -2.224, P = 0.033), in senior professional title(82.08 ± 13.11; OR=-3.578; P = 0.008), worked in training CHS(78.32 ± 12.16;OR = 1.148,P = 0.038), participated in GP trainer' training(78.46 ± 12.70; OR = 1.484,P = 0.014), or had teaching experiences in CHS(80.44 ± 12.18; OR = 5.174,P < 0.001) got a higher score. GPs who received GP standardized training got a lower score(76.27 ± 12.39; OR= -1.858,P = 0.001). (Fig. 4 ). Table 4 GPs’ communication skill and coordination ability Index Mean ± SD Interpersonal communication skill 3.75 ± 0.765 Patient communication skill 3.99 ± 0.677 Team collaboration 4.05 ± 0.677 Organization and management 3.52 ± 0.774 Discussion Summary Our study showed that the mean score of GPs' patient care ability, teaching ability and communication skill and coordination ability were 76.93 ± 12.55, 63.47 ± 28.97, and 76.31 ± 20.25, respectively. There was still a large space for improvement, especially in teaching ability. GPs who were 30–39 years old, worked in urban CHSs, and participated in GP trainer’s training or had teaching experience got higher scores in patient care ability. Those GPs who worked for 5–20 years in CHS, worked in training CHSs, and participated in GP trainer’s training program had higher scores in teaching ability. As for communication skill and coordination ability, GPs who were older than 30–39 years old, with a senior professional title, worked in training CHSs, participated in GP trainer’s training and had teaching experiences in CHS can got higher scores Strengthens And Limitations Firstly, this study had the largest sample of 2592 GPs among the published analogous studies in China. there were only 5000 registered general practitioners in Shanghai until 2016 ( 15 ), and the sample population accounted for about 1/2 of the total number of general practitioners. Because of the scientific sampling, the population was almost representative of GPs in Shanghai. Secondly, though the questionnaire we used was self-designed, we had referred to existing ones. It had good reliability, with completed content and reasonable structure, thus, the results and conclusions should be reliable. But there were still some limitations. The main limitation was inherent for cross-sectional study. Secondly, measurement and recall bias were investible, because the data we used were collected from GPs’ self-assessment. Some objective ways should be adapted into GP’s work competence assessment in the future. Finally, The conclusion may not be suitable completely to other areas. because general practice in Shanghai developed earlier and faster, whose number of GP per 10 thousand people ( 16 ) was far more than that of most other areas in China, and the development gap of general practice are recognized in different areas of China, especially between eastern and western area. Comparison With Existing Literature Patient care ability GPs' mean score of patient care ability was 76.93 ± 12.55, it was proved that such ability of GPs in Shanghai could meet the daily working requirement( 17 ). Some analogous studies in China showed the similar results as our study in GPs’ patient care ability( 18 ). Patient care ability is the basic ability of GPs( 19 ), and was put firstly in both domestic and abroad assessment of GP( 20 ) .It was also one of the reasons that many GPs hoped to participate in postgraduation training( 21 ) ( 22 ). In past GP training, the phenomenon of concerning theory but ignoring practical skills was common( 23 ). Pan Xiaoyan and et al( 24 ) discovered that the operating score of GPs in Guangxi Province of China was only 63 points. Such problem was also easy to be seen among GPs in England and Germany( 25 ) ( 26 ) ( 27 ). Teaching ability GPs' mean score of teaching ability was 63.47 ± 28.97. A perfect admitted criteria were established and used to select eligible GP teachers in many developed countries. In UK, an investigation for specialists in both general practice and education showed that to be a qualified GP, 18 competencies were necessary, among which 6 items were related to teaching( 28 ). In GMC in 2013, doctors are required that “you must be competence in all areas of your work, including… teaching”(p.6)”, “You should be prepared to contribute to teaching and training doctors and students”(p.14)”( 29 ). Administration as NHS, MRCGP and AMRC were reminded of GPs’ teaching ability( 30 ). In China, expert group suggested that teaching ability was one of three first-class indicators of the criteria for GP teachers( 31 ). Communication skill and Coordination ability No matter domestic or abroad, communication and coordination ability were shortcomings of GPs, though in this study they got 76.31 ± 20.25. Some countries have already paid attention to the training and assessment of such abilities( 32 ). For example, the workplace based assessment(WPBA) in MRCGP is aimed to evaluate a doctor’s performance across 13 areas of professional competence in the workplace( 33 ). Implications For Research And Practice Our study also discovered that GPs who aged from 30 to 39 years old, worked in an urban CHS, participated in GP trainer' training or had teaching experience got a higher score in patient care ability. Most younger GPs had finished the GP standardized training were the main force in CHS, and were much more eager to learning, and they preferred to choose urban CHS because of low standard of living. But The majority of older GPs were transformed through on-the-job training program before 2010( 34 ), who were less-educated and less interested in learning. In addition ,teaching was a proof for better medical care work competence, GPs who were competent in daily work would be selected to participate in trainer' training on behalf of their CHS. It is urgent and vital to improve GPs' teaching ability, in order to ensure the quality of standardized training of general practice and optimize the overall quality of GP training. However, failure in teaching was a big problem, similar to our study( 35 ). Some GP teachers even have not accepted any forms of general practice education in china, and their own ability was far away from the standard( 36 ). Interests was the basic of teaching ability, Our study discovered that nearly 25% GPs were “ unwilling to spend time in teaching or accept related training”. One of the reason may be that GPs were busy in work, and the reward of teaching was so little that GPs were not willing to spend time and energy on teaching. Another lack of teaching ability was that GPs were unable to skillfully apply various teaching methods. In community training activities, students hoped to get more practical skill, exploring the way of how to offer superior medical service in CHS. But most of time, GP teachers could not apply teaching methods appropriately, so as to fail to achieve the expected effect. The cultivation of excellent GPs needed excellent GP teachers who need enough training time and grasp various teaching methods( 37 ). In the way of improving GPs’ teaching ability, what we need to do first is to inspire their interests, establish the teaching performance appraisal system and reward mechanism( 38 ). Upper hospitals and medical colleges could found a GP teacher training center, holding training lectures regularly( 39 ), infiltrating advanced educational theories and methods into CHS. Teaching score showed a positive correlation with GPs’ working period. And GPs who worked in training CHS, accepted GP trainer' training showed a higher teaching ability. This result was consistent with the reality. From 2012, Shanghai began the construction of teaching CHS. In 2016, there were 57 training CHSs, 36 in urban areas and 21 in rural areas. Compared with the non-training CHS, the training CHS must be better in both facility configuration and GPs' teaching ability. GP trainer' training was an on-job training especially for improving teaching ability and popularizing advanced methods. Usually, it would introduce teaching theory, methods, share experiences, spread some latest medical information and hold academic lectures. After training, GPs would do better in teaching. In addition, communication skill and coordination ability is one of the necessary ability for GP to get residents’ trust and to improve the understand and cooperation with team. A good GP should not only know every detail of their clinical job, but also be active in the management of their team. Coordination is to solve residents’ healthy problem in a easiest way in community condition( 40 ), which was also an important work of GPs. The study showed that GPs who worked in teaching CHS, accepted in GP trainer’ training or had teaching experiences got a higher score in communication skill and coordination ability. And it was surprising that GPs who accepted GP standardized training got a lower score in communication skill and coordination ability. Firstly, the standardized training of general practice in China does not pay enough attention to the communication skill training today. Secondly, most of the GPs who receive the standardized training are relatively young and lack of medical and management experience. So we should strengthen communication skill training in standardized training of general practice and continue medical education in the future. Conclusion There is a large space to improve the patient care ability, teaching ability, communication skill and coordination ability for GPs in Shanghai’s CHSs ,especially in teaching ability. At present the most urgent task was to improve the teaching ability of GPs by strengthening the training, inspiring their teaching enthusiasm and making full use of teaching resources. Meanwhile, the deficiency in communication skill and coordination ability also need to be made up. List Of Abbreviations ACGME Accreditation Council for Graduate Medical Education; AMRC The Association of Medical Research Charities; CFPC The College of Family Physicians of Canada; CHS community health service center; GP general practitioner; MRCGP Membership of the Royal College of General Practitioners; NHS National Health Service; WONCA the World Organization of National Colleges, Academies and Academic Association of General Practitioners/Family Physicians; WPBA The workplace based assessment. Declarations Ethics approval and consent to participate Documentation of informed consent was secured at the beginning of the survey, all GPS having read and agreed to the Informed Consent agreement. All methods were performed in accordance with the relevant guidelines and regulations (Declaration of Helsinki). The confidentiality of all GPs was guaranteed, and the study protocol was approved by The Medical Ethics Committee of Zhongshan Hospital of Fudan University Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they do not have any conflicts of interests. Funding This study was supported by the Foundation of General Practice Project of Key Development Disciplines of Shanghai Municipal Commission of Health and Family Planning (2015ZB0601). The funding bodies had no role in the design, collection, analysis, or interpretation of the data, or writing of this article. Author’s contributions PZG is responsible for the design and funding of the research. WTH, ZY, ZXJ, GJ and LLM designed the questionnaire. WTH, RXY,ZY and GJ carried out the data collection, PZG supervised the project. 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Shanghai Actively Promotes the Construction of General Practitioners Training into Gatekeeper of Health. Shanghai: Ministry of Health; 2013. Yin Z. The cultivation of general medical students in Britain. Continuing Medical Education. 2015;29(11):46–7. Additional Declarations No competing interests reported. Supplementary Files Appendix.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-289916","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":15552696,"identity":"31abfa5e-c392-4b3a-aafc-35b89337729f","order_by":0,"name":"Tianhao Wang","email":"","orcid":"","institution":"Zhongshan Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Tianhao","middleName":"","lastName":"Wang","suffix":""},{"id":15552697,"identity":"bed64908-c056-4b6d-9973-cd8c367f5bc7","order_by":1,"name":"Xueying Ru","email":"","orcid":"","institution":"Zhongshan Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Xueying","middleName":"","lastName":"Ru","suffix":""},{"id":15552698,"identity":"6bb24e95-1464-4be0-8a21-0a9611fd69f1","order_by":2,"name":"Yuan Zhang","email":"","orcid":"","institution":"Zhongshan Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Zhang","suffix":""},{"id":15552699,"identity":"b5e02c0b-6a6a-47ad-838b-4c32935b45ca","order_by":3,"name":"Xiangjie Zhang","email":"","orcid":"","institution":"Zhongshan Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Xiangjie","middleName":"","lastName":"Zhang","suffix":""},{"id":15552700,"identity":"cd7bc1c9-0f18-4ecb-a080-22304a669cd8","order_by":4,"name":"Jian Gong","email":"","orcid":"","institution":"Zhongshan Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"Gong","suffix":""},{"id":15552701,"identity":"3466675f-6e61-4154-93d3-ed9e79a09fbe","order_by":5,"name":"Limin Lao","email":"","orcid":"","institution":"Zhongshan Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Limin","middleName":"","lastName":"Lao","suffix":""},{"id":15552702,"identity":"2b9bff52-43a5-4a67-af83-2be4c867ec0e","order_by":6,"name":"Junling Gao","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Junling","middleName":"","lastName":"Gao","suffix":""},{"id":15552703,"identity":"eac427bd-5a54-4140-b05e-6d0e4f710956","order_by":7,"name":"Zhigang Pan","email":"data:image/png;base64,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","orcid":"","institution":"Zhongshan Hospital of Fudan University","correspondingAuthor":true,"prefix":"","firstName":"Zhigang","middleName":"","lastName":"Pan","suffix":""}],"badges":[],"createdAt":"2021-03-02 09:59:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-289916/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-289916/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":7036852,"identity":"7ead230c-9a47-44ea-af8d-5f2b53346b94","added_by":"auto","created_at":"2021-03-16 22:43:38","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36054,"visible":true,"origin":"","legend":"A distribution of the sampled CHS by training and location","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-289916/v1/684ea5ee82d98a78043005ae.jpg"},{"id":7036853,"identity":"3e633ad6-5ef5-463d-8c5f-2c2a97f1ed45","added_by":"auto","created_at":"2021-03-16 22:43:38","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":71919,"visible":true,"origin":"","legend":"Liner regression analysis for patient care ability","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-289916/v1/32db6a417bbaa3a751af76e0.jpg"},{"id":7037090,"identity":"cab4d103-e74c-41ba-afdc-35fe4c8e5dbc","added_by":"auto","created_at":"2021-03-16 22:46:38","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":30214,"visible":true,"origin":"","legend":"Liner regression analysis for teaching ability","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-289916/v1/59ffc9188cb1eaa62ee5746e.jpg"},{"id":7037091,"identity":"f7bdf8af-0d67-45e2-bb70-e900f055a4ec","added_by":"auto","created_at":"2021-03-16 22:46:38","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":53589,"visible":true,"origin":"","legend":"Liner regression analysis for Communication skill and Coordination abilit","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-289916/v1/7a88dd7e498c13950fa0b339.jpg"},{"id":13680804,"identity":"2256e0f8-5bd6-478f-831c-c760399520db","added_by":"auto","created_at":"2021-09-17 11:48:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":564687,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-289916/v1/d34db6ea-ba25-4311-8733-31fc5a4966af.pdf"},{"id":7036856,"identity":"a7791259-07d0-4b4c-9e17-0a67cb08d78f","added_by":"auto","created_at":"2021-03-16 22:43:39","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21020,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-289916/v1/d0dbbfed54120b790045341d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The work competence of Shanghai’s GPs: a cross-sectional study based on self-assessment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGPs play a crucial role in a new medical model(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) recently introduced in China. With the exception of provision of patient care, GPs have taken new challenges as requested in the model including team organization management, communication and teaching in their daily works(\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) In the countries where general practice is well developed, the requirement for GPs\u0026rsquo; competence has been well-documented and implemented appropriately in medical practice(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e) (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e).There are some well-known standards abroad, such as the WONCA Tree model(\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e), the 13 competency model put forward by the Membership of the Royal College of General Practitioners(MRCGP) in England(\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e), and the ACGME Program Requirements for Graduate Medical Education in Family Medicine in the United States(\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e). The above standards and assessment systems, do not simply emphasize medical care, and they have begun to underline the non-clinical contents such as management, leading power, and referral or cooperation with specialists(\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e) (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e). Nevertheless, it is generally considered that there is a lack of a standard in China that can be generalized to assess GPs\u0026rsquo; work competence. Some scholars designed questionnaires through Dephi expert consultation method and literature review, and carried out empirical studies(\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e).The indexes cited in these study have obtained good reliability and validity, however, there are some inherent limitations including small and convenience samples, incomplete contents or less representative objects in the studies.\u003c/p\u003e\n\u003cp\u003eTo assess GP\u0026rsquo;s work competence in Shanghai\u0026rsquo;s community health services(CHS) in China, a cross-sectional study was conducted by using a self-designed questionnaires. On the basis of previous researches on ability evaluation of GPs(\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e), the questionnaires were generated and has since been considered informative and pragmatic.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eSample\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA stratified and proportional cluster sampling was used in the cross-sectional study during Jan,2016 through Feb,2016 in CHSs of Shanghai, China.\u003c/p\u003e\n\u003cp\u003eThere were 16 districts and 245 CHSs in Shanghai in 2016,seven urban districts with 75 CHSs and nine rural districts with 170 CHSs, Sampling was stratified by location of CHS and CHS type (CHS was classified as training CHS and non-training CHS, training CHS means the one which was qualified to afford the teaching affairs of GP standardized training by Shanghai Health and Family Planning Commission. Until 2016 ,57 CHS was qualified as training CHS ) .In this study, all of the training CHSs were chosen, and non-training CHSs were selected in a ratio of 1 to 1 with the training ones. Because the number of training CHS in each districts was different, The number of non-training CHS sampled in each district(N) was calculated as follow formula:\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;The number of non-training CHS in each district/The number of non-training CHS in Shanghai \u0026times; The total number of non-training CHS needed.\u003c/p\u003e\n\u003cp\u003eFinally, a total of 116 CHSs was sampled. Among them, 75 CHSs are located in the urban area including 36 training CHSs and 39 non-training CHSs; the remaining 41 CHSs are located in the rural areas including 21 training CHSs and 20 non-training CHSs. All GPs working in the sampled CHS were invited to take part in the investigation. A distribution of the sampled CHS by location and CHS type was shown in \u003cstrong\u003eFig.\u0026nbsp;1.\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\u003cp\u003e\u003cstrong\u003eDesign Of Questionnaire\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe questionnaire was designed on the basis of indicator system to evaluate basic capacities of general practitioners trainer constructed by Zhang Yuan. The GP\u0026rsquo;s work competence was characterized in the questionnaires as follow: patient care ability, teaching ability and communication skill and coordination ability. The questionnaire consisted of the following 4 sectors:\u003c/p\u003e\n\u003cp\u003e(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)demographic variables including age, sex, education background, professional title, whether accepted GP standardized training(Yes/No), working in an urban or rural CHS, whether accepted GP trainer' training(Yes/No) and years of working and teaching experiences.\u003c/p\u003e\n\u003cp\u003e(\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e)patient care ability containing 16 indexes, measured within the following 3 fields\u0026mdash;basic public health service, diagnosis and treatment of community common diseases and community clinical skills.\u003c/p\u003e\n\u003cp\u003e(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e)teaching ability mainly examining the teaching knowledge and skills, containing 10 indexes.\u003c/p\u003e\n\u003cp\u003e(\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e)communication skill and coordination ability, containing 4 indexes.\u003c/p\u003e\n\u003cp\u003eFor each question, there were 5 various answers, which represented 5 tiers of level, i.e. worse ,poor, fair, good and excellent in an ability tested. The above tiers were converted into 1,2,3,4 and 5 points respectively.\u003c/p\u003e\n\u003cp\u003eThe reliability(Cronbach \u0026alpha;) of the questionnaire was 0.826.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe questionnaire was used to investigate the participants\u0026rsquo; demographic data and work competence. Administrator in each CHS was responsible for issuing and collecting questionnaires. Ineligible ones were deleted. All scores were converted into percentage system.\u003c/p\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were presented by percentage, means, and standard deviation. The chi-square test, Fisher exact test, Mann-Whitney U test and Kolmogorov-Smirnov test were used to compare the work competence in different population. Multiple liner regression was conducted to explore the effect of demographic characteristics on the 3 categories of ability.\u003c/p\u003e\n\u003cp\u003eData was analyzed using SPSS Statistics software, version25.0(SPSS Inc. Chicago).P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral condition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 2594 GPs were sent a questionnaire, and 2592 eligible pieces were returned, where the respond rate was 99.9%. The demographic data of the 2592 GPs was presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Based on the data received, more females(1526, 58.9%) participated in the study than males(746, 28.8%). Mean age of the GP population was 39.41\u0026thinsp;\u0026plusmn;\u0026thinsp;7.92 years old. Of the 2592 GPs, 1956(75.5%) worked in urban CHS, and 1562(60.3%) received GP trainer' training. In additions, less than half(1138, 43.9%) of the GPs had teaching experiences in CHS.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDemographic variables of all the 2592 GPs\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN(%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNum. of CHS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e116(100.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNum. of GPs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2592(100.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e746(28.8)\u003c/p\u003e\n\u003cp\u003e1526(58.9)\u003c/p\u003e\n\u003cp\u003e320(12.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge(y)\u003c/p\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e\n\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n\u003cp\u003e≧\u0026thinsp;50\u003c/p\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e186(7.2)\u003c/p\u003e\n\u003cp\u003e1276(49.2)\u003c/p\u003e\n\u003cp\u003e793(30.6)\u003c/p\u003e\n\u003cp\u003e286(11.0)\u003c/p\u003e\n\u003cp\u003e51(2.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEducational level\u003c/p\u003e\n\u003cp\u003eTechnical secondary school\u003c/p\u003e\n\u003cp\u003ecollege\u003c/p\u003e\n\u003cp\u003euniversity\u003c/p\u003e\n\u003cp\u003epostgraduate and above\u003c/p\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32(1.2)\u003c/p\u003e\n\u003cp\u003e265(10.2)\u003c/p\u003e\n\u003cp\u003e2052(79.2)\u003c/p\u003e\n\u003cp\u003e241(9.3)\u003c/p\u003e\n\u003cp\u003e2(0.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProfessional title\u003c/p\u003e\n\u003cp\u003eprimary\u003c/p\u003e\n\u003cp\u003eintermediate\u003c/p\u003e\n\u003cp\u003esenior\u003c/p\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e420(16.2)\u003c/p\u003e\n\u003cp\u003e1848(71.3)\u003c/p\u003e\n\u003cp\u003e190(7.3)\u003c/p\u003e\n\u003cp\u003e134(5.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYears of working(y)\u003c/p\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n\u003cp\u003e5\u0026ndash;9\u003c/p\u003e\n\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\n\u003cp\u003e≧\u0026thinsp;20\u003c/p\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e458(17.7)\u003c/p\u003e\n\u003cp\u003e605(23.3)\u003c/p\u003e\n\u003cp\u003e934(36.0)\u003c/p\u003e\n\u003cp\u003e583(22.5)\u003c/p\u003e\n\u003cp\u003e12(0.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDid you receive GP standardized training\u003c/p\u003e\n\u003cp\u003eyes\u003c/p\u003e\n\u003cp\u003eno\u003c/p\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1384(53.4)\u003c/p\u003e\n\u003cp\u003e1204(46.5)\u003c/p\u003e\n\u003cp\u003e4(0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDid you worked in\u003c/p\u003e\n\u003cp\u003etraining CHS\u003c/p\u003e\n\u003cp\u003eyes\u003c/p\u003e\n\u003cp\u003eno\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1296(50.0)\u003c/p\u003e\n\u003cp\u003e1296(50.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCHS location\u003c/p\u003e\n\u003cp\u003eUrban area\u003c/p\u003e\n\u003cp\u003eRural area\u003c/p\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1956(75.5)\u003c/p\u003e\n\u003cp\u003e628(24.2)\u003c/p\u003e\n\u003cp\u003e8(0.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDid you receive\u003c/p\u003e\n\u003cp\u003egeneral teaching training\u003c/p\u003e\n\u003cp\u003eyes\u003c/p\u003e\n\u003cp\u003eno\u003c/p\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1562(60.3)\u003c/p\u003e\n\u003cp\u003e1018(39.3)\u003c/p\u003e\n\u003cp\u003e12(0.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDid you have\u003c/p\u003e\n\u003cp\u003eteaching experience in CHS\u003c/p\u003e\n\u003cp\u003eyes\u003c/p\u003e\n\u003cp\u003eno\u003c/p\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1138(43.9)\u003c/p\u003e\n\u003cp\u003e1417(54.7)\u003c/p\u003e\n\u003cp\u003e37(1.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\u003cp\u003e\u003cstrong\u003eGPs' Patient Care Ability\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe mean score of patient care ability for GPs were 76.93\u0026thinsp;\u0026plusmn;\u0026thinsp;12.55, respectively. The index \u0026ldquo;up on the chronic management approaches\u0026rdquo;,\u0026ldquo;knowing the latest guidelines well\u0026rdquo;and\u0026ldquo;indwelling gastric tube or urethral catheter\u0026rdquo; had the lowest score in each of the 3 fields(Basic public health service, Diagnosis and treatment of community common diseases and Community clinical skills), which were 3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.923, 3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.774 and 3.66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.070, respectively(Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eGPs\u0026rsquo; patient care ability\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSecond index\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;s\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eThird index\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;s\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eBasic public health service\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e18.91\u0026thinsp;\u0026plusmn;\u0026thinsp;5.62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEstablishment of individual and family healthy record\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.941\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHealthy education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.855\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFamily visit\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.926\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChronic disease rehabilitation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.864\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eup on the chronic management approaches\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.923\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eDiagnosis and treatment of community common diseases\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e20.06\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eScreening of community common diseases\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.748\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiagnosis of community common diseases\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.708\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFamiliar with the latest guidelines\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.774\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSuitable prescribing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.726\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFamiliar with referral indications\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.748\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eCommunity clinical skills\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"6\" align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e22.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEKG skills\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.854\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eX-ray judging\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.841\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDebridement and dressing changing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.894\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIndwelling gastric tube or urethral catheter\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.070\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExplaining laboratory inspection reports\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.748\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCPR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.791\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThrough the multiple liner regression, GPs who were 30 to 39 years old(78.12\u0026thinsp;\u0026plusmn;\u0026thinsp;18.61; OR\u0026thinsp;=\u0026thinsp;5.491, P\u0026thinsp;=\u0026thinsp;0.005), worked in urban CHS(77.21\u0026thinsp;\u0026plusmn;\u0026thinsp;19.63; OR\u0026thinsp;=\u0026thinsp;2.451,P\u0026thinsp;=\u0026thinsp;0.024), participated in GP trainer' training(77.65\u0026thinsp;\u0026plusmn;\u0026thinsp;20.32; OR\u0026thinsp;=\u0026thinsp;2.332,P\u0026thinsp;=\u0026thinsp;0.024) or had teaching experiences(79.00\u0026thinsp;\u0026plusmn;\u0026thinsp;19.21; OR\u0026thinsp;=\u0026thinsp;3.628, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) got a higher score in the patient care ability. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eGPs' Teaching Ability\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe assessment of GPs' teaching ability was done within those GPs with teaching experiences. Mean score in this sector was 63.47\u0026thinsp;\u0026plusmn;\u0026thinsp;28.97. Only 75% GPs were willing to spend time in teaching. The index \u0026ldquo;interesting in teaching\u0026rdquo; got the lowest score, which was 3.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.800. In teaching skills, the index\u0026ldquo; applying of various teaching methods\u0026rdquo; was the lowest, which was 3.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.720 points(Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Multiple liner regression indicated that GPs who have worked for 5 to 20 years(65.72\u0026thinsp;\u0026plusmn;\u0026thinsp;27.56; OR\u0026thinsp;=\u0026thinsp;7.159,P\u0026thinsp;=\u0026thinsp;0.003 and 65.61\u0026thinsp;\u0026plusmn;\u0026thinsp;27.28; OR\u0026thinsp;=\u0026thinsp;5.135,P\u0026thinsp;=\u0026thinsp;0.013) ,worked in a training CHS(69.24\u0026thinsp;\u0026plusmn;\u0026thinsp;24.71; OR\u0026thinsp;=\u0026thinsp;13.379,P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), or participated in GP trainer's training(67.74\u0026thinsp;\u0026plusmn;\u0026thinsp;25.81; OR\u0026thinsp;=\u0026thinsp;18.092,P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) got a higher score in teaching ability. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eGPs\u0026rsquo; teaching ability\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIndex\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD/proportion(%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWilling to spend time in teaching\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e75.1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWilling to accept related training\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEncourage student in teaching\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e81.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGiving timely feedback\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e80.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEvaluating students every month\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e78.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInterests in teaching\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.800\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFamiliar with medical service in CHS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.687\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntegration teaching resources\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.688\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFamiliar with GP teaching requirement and contents in CHS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.692\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFinishing the teaching plans set and carried out suitable for students\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.674\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAdjusting teaching contents and progress according to students\u0026rsquo; learning\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.679\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eapplying of various teaching methods\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.720\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eClinic teaching\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.678\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTeaching ward round\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.775\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCase discussion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.775\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLecture\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.784\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eGPs' Communication Skill And Coordination Ability\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eMean score in this sector was 76.31\u0026thinsp;\u0026plusmn;\u0026thinsp;20.25. The index \u0026ldquo;organization and management ability\u0026rdquo; got the lowest score, 3.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.774.(Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) Multiple liner regression indicated that GPs who were older than 30\u0026ndash;39 years old(78.91\u0026thinsp;\u0026plusmn;\u0026thinsp;13.62; OR= -2.224, P\u0026thinsp;=\u0026thinsp;0.033), in senior professional title(82.08\u0026thinsp;\u0026plusmn;\u0026thinsp;13.11; OR=-3.578; P\u0026thinsp;=\u0026thinsp;0.008), worked in training CHS(78.32\u0026thinsp;\u0026plusmn;\u0026thinsp;12.16;OR\u0026thinsp;=\u0026thinsp;1.148,P\u0026thinsp;=\u0026thinsp;0.038), participated in GP trainer' training(78.46\u0026thinsp;\u0026plusmn;\u0026thinsp;12.70; OR\u0026thinsp;=\u0026thinsp;1.484,P\u0026thinsp;=\u0026thinsp;0.014), or had teaching experiences in CHS(80.44\u0026thinsp;\u0026plusmn;\u0026thinsp;12.18; OR\u0026thinsp;=\u0026thinsp;5.174,P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) got a higher score. GPs who received GP standardized training got a lower score(76.27\u0026thinsp;\u0026plusmn;\u0026thinsp;12.39; OR= -1.858,P\u0026thinsp;=\u0026thinsp;0.001). (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" style=\"width: 371px;\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eGPs\u0026rsquo; communication skill and coordination ability\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003cth style=\"width: 252px; height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eIndex\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 103px; height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"width: 252px; height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eInterpersonal communication skill\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px; height: 35px;\" align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.765\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"width: 252px; height: 35px;\" align=\"left\"\u003e\n\u003cp\u003ePatient communication skill\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px; height: 35px;\" align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.677\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"width: 252px; height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eTeam collaboration\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px; height: 35px;\" align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.677\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"width: 252px; height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOrganization and management\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px; height: 35px;\" align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.774\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eSummary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study showed that the mean score of GPs' patient care ability, teaching ability and communication skill and coordination ability were 76.93\u0026thinsp;\u0026plusmn;\u0026thinsp;12.55, 63.47\u0026thinsp;\u0026plusmn;\u0026thinsp;28.97, and 76.31\u0026thinsp;\u0026plusmn;\u0026thinsp;20.25, respectively. There was still a large space for improvement, especially in teaching ability. GPs who were 30\u0026ndash;39 years old, worked in urban CHSs, and participated in GP trainer\u0026rsquo;s training or had teaching experience got higher scores in patient care ability. Those GPs who worked for 5\u0026ndash;20 years in CHS, worked in training CHSs, and participated in GP trainer\u0026rsquo;s training program had higher scores in teaching ability. As for communication skill and coordination ability, GPs who were older than 30\u0026ndash;39 years old, with a senior professional title, worked in training CHSs, participated in GP trainer\u0026rsquo;s training and had teaching experiences in CHS can got higher scores\u003c/p\u003e\n\u003c/div\u003e\u003cp\u003e\u003cstrong\u003eStrengthens And Limitations\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eFirstly, this study had the largest sample of 2592 GPs among the published analogous studies in China. there were only 5000 registered general practitioners in Shanghai until 2016 (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e), and the sample population accounted for about 1/2 of the total number of general practitioners. Because of the scientific sampling, the population was almost representative of GPs in Shanghai. Secondly, though the questionnaire we used was self-designed, we had referred to existing ones. It had good reliability, with completed content and reasonable structure, thus, the results and conclusions should be reliable.\u003c/p\u003e\n\u003cp\u003eBut there were still some limitations. The main limitation was inherent for cross-sectional study. Secondly, measurement and recall bias were investible, because the data we used were collected from GPs\u0026rsquo; self-assessment. Some objective ways should be adapted into GP\u0026rsquo;s work competence assessment in the future. Finally, The conclusion may not be suitable completely to other areas. because general practice in Shanghai developed earlier and faster, whose number of GP per 10 thousand people (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e) was far more than that of most other areas in China, and the development gap of general practice are recognized in different areas of China, especially between eastern and western area.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eComparison With Existing Literature\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePatient care ability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGPs' mean score of patient care ability was 76.93\u0026thinsp;\u0026plusmn;\u0026thinsp;12.55, it was proved that such ability of GPs in Shanghai could meet the daily working requirement(\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e). Some analogous studies in China showed the similar results as our study in GPs\u0026rsquo; patient care ability(\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e). Patient care ability is the basic ability of GPs(\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e), and was put firstly in both domestic and abroad assessment of GP(\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e) .It was also one of the reasons that many GPs hoped to participate in postgraduation training(\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e) (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e). In past GP training, the phenomenon of concerning theory but ignoring practical skills was common(\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e). Pan Xiaoyan and et al(\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e) discovered that the operating score of GPs in Guangxi Province of China was only 63 points. Such problem was also easy to be seen among GPs in England and Germany(\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e) (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e) (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTeaching ability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGPs' mean score of teaching ability was 63.47\u0026thinsp;\u0026plusmn;\u0026thinsp;28.97. A perfect admitted criteria were established and used to select eligible GP teachers in many developed countries. In UK, an investigation for specialists in both general practice and education showed that to be a qualified GP, 18 competencies were necessary, among which 6 items were related to teaching(\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e). In GMC in 2013, doctors are required that \u0026ldquo;you must be competence in all areas of your work, including\u0026hellip; teaching\u0026rdquo;(p.6)\u0026rdquo;, \u0026ldquo;You should be prepared to contribute to teaching and training doctors and students\u0026rdquo;(p.14)\u0026rdquo;(\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e). Administration as NHS, MRCGP and AMRC were reminded of GPs\u0026rsquo; teaching ability(\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e). In China, expert group suggested that teaching ability was one of three first-class indicators of the criteria for GP teachers(\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunication skill and Coordination ability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo matter domestic or abroad, communication and coordination ability were shortcomings of GPs, though in this study they got 76.31\u0026thinsp;\u0026plusmn;\u0026thinsp;20.25. Some countries have already paid attention to the training and assessment of such abilities(\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e). For example, the workplace based assessment(WPBA) in MRCGP is aimed to evaluate a doctor\u0026rsquo;s performance across 13 areas of professional competence in the workplace(\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eImplications For Research And Practice\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eOur study also discovered that GPs who aged from 30 to 39 years old, worked in an urban CHS, participated in GP trainer' training or had teaching experience got a higher score in patient care ability. Most younger GPs had finished the GP standardized training were the main force in CHS, and were much more eager to learning, and they preferred to choose urban CHS because of low standard of living. But The majority of older GPs were transformed through on-the-job training program before 2010(\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e), who were less-educated and less interested in learning. In addition ,teaching was a proof for better medical care work competence, GPs who were competent in daily work would be selected to participate in trainer' training on behalf of their CHS.\u003c/p\u003e\n\u003cp\u003eIt is urgent and vital to improve GPs' teaching ability, in order to ensure the quality of standardized training of general practice and optimize the overall quality of GP training. However, failure in teaching was a big problem, similar to our study(\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e). Some GP teachers even have not accepted any forms of general practice education in china, and their own ability was far away from the standard(\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e). Interests was the basic of teaching ability, Our study discovered that nearly 25% GPs were \u0026ldquo; unwilling to spend time in teaching or accept related training\u0026rdquo;. One of the reason may be that GPs were busy in work, and the reward of teaching was so little that GPs were not willing to spend time and energy on teaching. Another lack of teaching ability was that GPs were unable to skillfully apply various teaching methods. In community training activities, students hoped to get more practical skill, exploring the way of how to offer superior medical service in CHS. But most of time, GP teachers could not apply teaching methods appropriately, so as to fail to achieve the expected effect. The cultivation of excellent GPs needed excellent GP teachers who need enough training time and grasp various teaching methods(\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e). In the way of improving GPs\u0026rsquo; teaching ability, what we need to do first is to inspire their interests, establish the teaching performance appraisal system and reward mechanism(\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e). Upper hospitals and medical colleges could found a GP teacher training center, holding training lectures regularly(\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e), infiltrating advanced educational theories and methods into CHS.\u003c/p\u003e\n\u003cp\u003eTeaching score showed a positive correlation with GPs\u0026rsquo; working period. And GPs who worked in training CHS, accepted GP trainer' training showed a higher teaching ability. This result was consistent with the reality. From 2012, Shanghai began the construction of teaching CHS. In 2016, there were 57 training CHSs, 36 in urban areas and 21 in rural areas. Compared with the non-training CHS, the training CHS must be better in both facility configuration and GPs' teaching ability. GP trainer' training was an on-job training especially for improving teaching ability and popularizing advanced methods. Usually, it would introduce teaching theory, methods, share experiences, spread some latest medical information and hold academic lectures. After training, GPs would do better in teaching.\u003c/p\u003e\n\u003cp\u003eIn addition, communication skill and coordination ability is one of the necessary ability for GP to get residents\u0026rsquo; trust and to improve the understand and cooperation with team. A good GP should not only know every detail of their clinical job, but also be active in the management of their team. Coordination is to solve residents\u0026rsquo; healthy problem in a easiest way in community condition(\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e), which was also an important work of GPs.\u003c/p\u003e\n\u003cp\u003eThe study showed that GPs who worked in teaching CHS, accepted in GP trainer\u0026rsquo; training or had teaching experiences got a higher score in communication skill and coordination ability. And it was surprising that GPs who accepted GP standardized training got a lower score in communication skill and coordination ability. Firstly, the standardized training of general practice in China does not pay enough attention to the communication skill training today. Secondly, most of the GPs who receive the standardized training are relatively young and lack of medical and management experience. So we should strengthen communication skill training in standardized training of general practice and continue medical education in the future.\u003c/p\u003e"},{"header":"Conclusion","content":" \u003cp\u003eThere is a large space to improve the patient care ability, teaching ability, communication skill and coordination ability for GPs in Shanghai\u0026rsquo;s CHSs ,especially in teaching ability. At present the most urgent task was to improve the teaching ability of GPs by strengthening the training, inspiring their teaching enthusiasm and making full use of teaching resources. Meanwhile, the deficiency in communication skill and coordination ability also need to be made up.\u003c/p\u003e "},{"header":"List Of Abbreviations","content":"\u003cp\u003eACGME Accreditation Council for Graduate Medical Education; AMRC The Association of Medical Research Charities; CFPC The College of Family Physicians of Canada; CHS community health service center; GP general practitioner; MRCGP Membership of the Royal College of General Practitioners; NHS National Health Service; WONCA the World Organization of National Colleges, Academies and Academic Association of General Practitioners/Family Physicians; WPBA The workplace based assessment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDocumentation of informed consent was secured at the beginning of the survey, all GPS having read and agreed to the Informed Consent agreement. All methods were performed in accordance with the relevant guidelines and regulations (Declaration of Helsinki). The confidentiality of all GPs was guaranteed, and the study protocol was approved by The Medical Ethics Committee of Zhongshan Hospital of Fudan University\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they do not have any conflicts of interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Foundation of General Practice Project of Key Development Disciplines of Shanghai Municipal Commission of Health and Family Planning (2015ZB0601). The funding bodies had no role in the design, collection, analysis, or interpretation of the data, or writing of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePZG is responsible for the design and funding of the research. WTH, ZY, ZXJ, GJ and LLM designed the questionnaire. WTH, RXY,ZY and GJ carried out the data collection, PZG supervised the project. RXY , WTH and GJL analyzed the data ,RXY and WTH drafted the first manuscript and responsible for revision. All authors participated in the critical revision of the manuscript and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the sources of funding that supported this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZX Y. 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Continuing Medical Education. 2015;29(11):46\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"general practitioners, work competence, patient care ability, teaching ability, communication skill and coordination ability ","lastPublishedDoi":"10.21203/rs.3.rs-289916/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-289916/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eGeneral practitioners(GPs) have taken new challenges as requested in a new model introduced in China recently. Unlike some countries where general medicine are well developed, there is a lack of a standard in China that can be generalized to assess GPs’ work competence. The aim of the study was to investigate work competence of GPs in Shanghai’s community health services(CHS) in China by self-assessment, providing evidences for effectiveness of GPs’ post-education and training. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA stratified and proportional cluster sampling method was adopted in this cross-sectional study from 116 CHS in Shanghai.(n=2954). We collected data on GPs demographic variables and work competence which was separated as patient care ability, teaching ability, communication skill and coordination ability, using a self-designed questionnaire. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The mean score of patient care ability, teaching ability, communication skill and coordination ability were 76.93±12.55, 63.47±28.97, and 76.31±20.25 on a scale of 100, respectively. GPs who were 30-39 years old, worked in urban CHSs, and participated in GP trainer’s training or had teaching experience got higher scores in patient care ability. Those GPs who worked for 5-20 years in CHS, especially in training CHSs which is involved in post-graduate GPs training program, and participated in GP trainer’s training program had higher scores in teaching ability. As for communication skill and coordination ability, GPs who were older than 30-39 years old and with a senior professional title, worked in training CHSs, participated in GP trainer’s training and had teaching experiences in CHS can got higher scores.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThere is a large space to improve the patient care ability, teaching ability, communication skill and coordination ability for GPs in Shanghai’s CHS ,especially in teaching ability.\u003c/p\u003e","manuscriptTitle":"The work competence of Shanghai’s GPs: a cross-sectional study based on self-assessment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-03-16 22:43:37","doi":"10.21203/rs.3.rs-289916/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9b2006ae-01bb-4976-a84b-48e482fa5b90","owner":[],"postedDate":"March 16th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":3013407,"name":"General Practice"}],"tags":[],"updatedAt":"2021-04-09T04:44:04+00:00","versionOfRecord":[],"versionCreatedAt":"2021-03-16 22:43:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-289916","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-289916","identity":"rs-289916","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}