Needs assessment for enhancing the preparation of general practitioners enrolling in the Peruvian mandatory rural service: a cross-sectional study.

Needs assessment for enhancing the preparation of general practitioners enrolling in the Peruvian mandatory rural service: a cross-sectional study. | 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 Needs assessment for enhancing the preparation of general practitioners enrolling in the Peruvian mandatory rural service: a cross-sectional study. Javier Alejandro Flores-Cohaila, Cesar Copaja-Corzo, Brayan Miranda-Chavez, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3877654/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 Peru’s Rural and Marginal Urban Health Service (SERUMS) aims to improve healthcare in rural and marginal areas. Despite its objectives, a gap exists between training General Practitioners (GPs) and the competencies required for SERUMS. This study assesses GPs' self-perceived competencies and training needs for SERUMS. Methods A cross-sectional analytical study was conducted involving GPs who enrolled in SERUMS between 2020 and 2022. A questionnaire was developed based on the Ministry of Health's competency framework, assessing 21 minimal achievement conditions. The survey was distributed via Google Forms and included sections on sociodemographic information, SERUMS characteristics, self-perceived competencies, and training needs. Results Out of 190 GPs who participated, most were female, over 27 years old, and graduates from private universities with mixed-setting internships. The highest self-perceived competencies were in low-complexity problem management, communication, and professionalism. However, competencies in research, leadership, and health system management were rated lowest. The primary resource for training was self-study, with a preference for active learning methods for future training. Perceived training needs were in therapeutic competencies, the Peruvian health system, diagnostic competencies, administrative tasks, and interprofessional competencies. Conclusions This study reveals significant gaps in the training and competencies of Peruvian GPs for SERUMS. It emphasizes the need for a tailored curriculum incorporating active learning and focusing on clinical reasoning, leadership, and interprofessional competencies. This approach would better prepare GPs for SERUMS and enhance their self-efficacy and effectiveness in primary care. Leading to a better quality of care for these neglected populations. Rural service medical education Peru needs assessment Figures Figure 1 Figure 2 Figure 3 Background Peru's Rural and Marginal Urban Health Service (SERUMS, abbreviature in Spanish), established in 1981 and regulated in 1997 by the Ministry of Health (MINSA, abbreviature in Spanish), has as its main mission to improve health care in rural and marginal urban areas [ 1 , 2 ]. This program is essential in providing healthcare services in such areas by assigning trained health professionals. Although one study has suggested that the SERUMS has reduced inequity in healthcare for neglected communities [ 3 ], several studies highlighted the lack of training from General Practitioners (GPs) for this major task [ 4 – 7 ]. Hence, despite its noble objective, the lack of training of GPs hinders the quality of care for neglected populations. In response to these shortcomings, MINSA has established a profile of key competencies comprising 8 domains and 13 competencies [ 8 ]. Although this is a major advance in Peruvian medical education, the discrepancy between this profile and actual training for the SERUMS has not yet been sufficiently explored. Therefore, we conducted a needs assessment to evaluate how GPs perceived their SERUMS competencies and their perceived training needs. Methods We conducted a cross-sectional analytical study of needs assessment to evaluate how GPs perceived their SERUMS competencies and their perceived training needs. The questionnaire development followed Artino Jr.'s recommendations [ 9 ]. This manuscript was written following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) [ 10 ] and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) [ 11 ]. Participants For this study, we considered GPs who enrolled in the SERUMS between 2020 and 2022. We included GPs who agreed to participate in the study. Participants who did not completely fill out the questionnaire or conducted their SERUMs before 2020 were excluded. Procedures Survey development We developed the questionnaire employing the framework for essential competencies for GPs of the Ministry of Health from Peru [ 8 ]. We used the “minimal condition of achievement” for each item, resulting in 21. To rate each item, we employed a 5-Likert scale where 1 was “Not confident at all” and 5 was “completely confident”. This rating scale was chosen as it resembles entrustment [ 12 ]. Administration After approval from the ethics committee, we conducted the national survey on Google Forms. The survey comprised six sections: informed consent, sociodemographic information, SERUMS characteristics, self-perceived competencies, self-perceived needs, and sent confirmation. The survey was distributed through email, WhatsApp, and telegram groups related to the SERUMS from May 1 to May 28, 2023. The survey was open to everyone to complete, but GPs must agree on informed consent. As an incentive, we offered access to medical questions applications. Due to the limitations of Google Forms, there was no randomization of items nor the total number of visitors. Study variables Self-perceived competencies We assessed 21 minimal achievement conditions under three dimensions: the clinician (5 items), the health promoter (4 items), and the holistic doctor (6 items). Minimal achievement conditions that did not fit into dimensions were also reported. Each minimal achievement condition had five possible responses from “not confident at all” to “completely confident”. The dimensions described above were considered the dependent variable to identify associated factors. Self-perceived needs We considered self-perceived needs as resources, formative needs, and preferred training modalities. Therefore, we assessed the following: (1) resources received for SERUMS preparation after graduation, which comprised resources from their university, paid courses, courses from the Peruvian medical college, courses from the national school of public health, and self-directed or selected resources; (2) resourced that the GPs considered were most beneficial for SERUMS, which comprised the same in the previous question; (3) formative needs, which were the self-perceived competencies but rephrased and grouped when suitable for better understanding, and an open-ended question for competencies or skills that we did not consider and (4) preferred modality for future training, which comprised online lectures, asynchronous learning, in-person lectures, simulation training, case or problem-based learning, and workshops or hands-on activities, later these were classified as passive teaching methods (online lectures, asynchronous learning and in-person lectures) versus active teaching methods (the remaining) to further analysis. Other variables Other variables were age, sex, university, setting of their internship, SERUMS period and modality, poverty quintile, SERUMS employer, and SERUMS role. Age was categorized into two groups (equal or under 27 years old and older than 27 years). The university was then categorized into public or private according to Peruvian data [ 13 ]. The setting of the internship, according to whether it included primary care or not in their rotations and due to the scarce number of GPs across quintiles, we categorized them into quintile 1 and non- quintile 1 (comprising GPs from quintile 2 to 5). Data analysis For the descriptive analysis, we employed absolute and relative frequencies for categorical variables while measures of central tendency and dispersion for numeric ones. Ethical considerations This study protocol was approved by the ethics committee from the Universidad Privada de Tacna (CODE: 025-05-2023). Results After excluding 31 GPs due to not giving consent and having conducted the SERUMS before 2022, 190 GPs participated in this study. The key characteristics of the included GPs are shown in Table 1 . Most were older than 27 (57.37%), females (63.68%), came from a private university (67.37%), and did the internship in a mixed setting (45.26%). Regarding the SERUMS characteristics, most GPs were from the 2022–2023 cohort (53.16%), were in the paid modality (95.79%), conducted the SERUMS in extreme poverty settings (56.32%), had the MINSA as the employer (85.26%) and worked solely as a clinician (58.95%). Table 1 Characteristics of the general practitioners enrolled in the SERUMS between 2020 to 2022 (n = 190) Characteristics N (%) Age* Younger or equal than 27 81 (42.63) 0lder than 27 109 (57.37) Sex Male 69 (36.31) Female 121 (63.68) University Public university 62 (32.63) Private university 128 (67.37) Internship setting Primary care setting 20 (10.53) Hospital setting 84 (44.21) Mixed 1 86 (45.26) SERUMS period 2020–2021 26 (13.68) 2021–2022 63 (33.16) 2022–2023 101 (53.16) SERUMS modality Paid 182 (95.79) Non-paid 8 (4.21) Poverty quintile Quintile 1 107 (56.32) Non-1 quintile 83 (43.68) SERUMS employer Minister of Health 162 (85.26) EsSalud 11 (5.79) Other 27 (14.21) SERUMS role Role as clinician 112 (58.95) Role as clinician and manager 78 (41.05) SERUMS – Rural and Urban Marginalized Health Service; EsSalud – Social Health Insurance 1 If the internship took place at the first level of care and in the hospital setting. 2 Includes employers such as the armed forces, national police, and private companies. Figure 1 shows the rating of self-perceived confidence among 21 minimal conditions of achievement. The three conditions where most GPs were completely confident were “Perform comprehensive treatment of low complexity health problems.” (31.1%), “Demonstrate commitment to the well-being and health of individuals and society” (28.9%), and “Communicate effectively with patients, their families, and the community” (28.4%). The four conditions where most GPs were not confident at all were “Conduct research oriented to the needs of your population” (14.2%), “Manage the health establishment and implement improvement plans” (9.5%), “Operate within the legal framework of the Peruvian health system” (6.8%) and “Lead the health team” (6.8%). Figure 1 . Rating of the 21 minimal conditions of achievement of the general practitioners enrolled in the SERUMS between 2020 and 2022 As shown in Fig. 2 , the resources most used for GPs self-studied (n = 82) and received courses from the National School of Public Health (n = 77), while the least training was received through university (n = 9). However, when comparing used and perceived benefits for SERUMS, all resources had major differences, such as university (9 versus 0), paid courses (40 versus 12), Peruvian medical college (43 versus 2), and National School of Public Health (77 versus 4). However, when comparing self-studying, there were minor differences between received and perceived benefits (82 versus 51). Figure 2 . Resources from which general practitioners received and perceived training. Lastly, Fig. 2 depicts the self-perceived needs for training of GPs. The upper image shows the preferred modality for training, demonstrating a preference for active learning methods such as workshops (n = 119), case or problem-based learning (n = 105), and simulation training (n = 98). In contrast, passive learning methods were the least preferred. In the lower image, the perceived need for training is depicted. GPs reported that future training should be conducted in the realm of therapeutic competencies (n = 129, 68%), Peruvian health system (n = 127, 67%), Diagnostic competencies (n = 122, 64%), Administrative and management tasks (n = 119, 63%) and Interprofessional competencies (n = 113, 59%). Figure 3 . Self-perceived needs in terms of competencies and preferred instructional methods Discussion Summary of findings Here, we conducted a needs assessment on self-perceived competencies and training needs from 190 GPs who conducted the SERUMS between 2020 and 2022. Our major findings are as follows: 1) Competencies related to diagnosis and management of low complex problems, communication, and professionalism were the highest among GPs; 2) Competencies related to research, leadership, and management were the lowest among GPs; 3) While GPs received training from different resources, they solely perceived “self-study” resources as most beneficial; 4) GPs recommended that future training should focus on active learning methods such as workshops, case-based learning and simulation training; and 5) GPs perceived that training should focus on competencies such as clinical reasoning in diagnostic and therapeutic competencies, the Peruvian health system, management and interprofessional competencies. Strength and limitations This study had strengths, such as following established reporting guidelines and developing a questionnaire based on the national competency framework. However, some limitations must be considered. The cross-sectional nature of this study impedes establishing causality, the responses may be biased due to voluntary participation, and although it provides important information, the measurement of self-perceived competencies may not reflect the true level of these competencies, as social desirability bias or inaccurate self-assessment may influence on the choices. Comparison with prior work Research, leadership, and management competencies were rated lowest among Peruvian GPs. Previous studies conducted in Peru and South America have found similar results [ 5 , 7 ]. This deficiency likely originates from a lack of comprehensive training in research methodologies and evidence-based medicine [ 9 ] and in leadership training [ 7 ]. Furthermore, the lack of training in these competencies for Peruvian and South American GPs is reflected in the global literature, as there is a lack of representations in a systematic review on leadership training and evidence-based medicine in undergraduate medical education [ 14 , 15 ]. This situation underscores the urgent need to prioritize enhancing teaching methods and assessment strategies for these crucial competencies in medical education. A major concern identified in our study is the perception among GPs that the existing training resources do not adequately prepare them for SERUMS. This perspective is unique, as no known studies specifically explore GPs' views on the effectiveness of training resources for SERUMS. The root of this issue lies in the dominant pedagogical approach of Peruvian medical education, which is largely centered around passive learning and traditional lecture-based teaching methods. This approach starkly contrasts the active participation and engagement methods preferred by GPs for future training, as indicated by their responses in our study. This discrepancy highlights a significant mismatch between the current educational methodologies and the needs and preferences of medical professionals serving in rural areas. While GPs perceive their diagnostic and therapeutic competencies as satisfactory in self-assessments, they still express a need for further training in these areas. This training should also encompass understanding the Peruvian health system, management, and interprofessional competencies. These findings resonate with global trends, such as the emphasis on medical law training in the United Kingdom and the noted deficiency in leadership and management training [ 16 ]. This situation reflects a broader need for a standardized curriculum, particularly focusing on clinical reasoning training, as evidenced by studies [ 17 , 18 ]. Additionally, the gap in interprofessional collaboration training is not unique to Peru; it is a recognized issue in other countries, including Pakistan [ 19 ]. This highlights a global challenge in medical education, underscoring the necessity of addressing these key areas to better equip GPs for their diverse roles and responsibilities. Implications Our study identifies a critical deficiency in training for General Practitioners, especially in non-clinical roles such as management and collaboration with other health professionals. Notably, SERUMS often marks the first time GPs assume managerial responsibilities and work extensively with other health professionals, contrasting their previous experiences. This new environment necessitates skills that many GPs lack, as evidenced by a study indicating a decline in their interest in primary care post-SERUMS [ 4 ]. This trend may be attributed to insufficient training in essential competencies, adversely affecting GP’s self-efficacy. To address this, we advocate for incorporating interprofessional education and leadership training into GP curricula, aligning with MINSA's essential competencies framework. Additionally, transitioning undergraduate medical education from a predominantly hospital-based model to a community-based approach would more accurately reflect the realities of SERUMS and better prepare GPs for these unique challenges. Despite a consensus among GPs regarding the need for active learning methods in training, the current educational offerings primarily consist of traditional lectures with limited learner participation. According to best practices in continuous professional development and adult learning theories [ 20 , 21 ], courses should solve current problems of GPs, employ active learning methods focused on urgent needs rather than “just-in-case knowledge,” must take into account the experience of learners, and consider that most adult-learners are self-directed learners. Consequently, we suggest creating a SERUMS curriculum aligned with MINSA’s proposed competencies or one more specifically tailored to the unique barriers and struggles faced by GPs in rural areas. Until such a curriculum is implemented, our study underscores the urgent need to equip GPs with training in non-clinical competencies. While this study provides insights into undergraduate medical education and continuous professional development, it also highlights the need for further research in key areas. Future studies should engage larger samples and embrace various methods, including observations in simulated scenarios, record audits, and mixed-method approaches, to gain a more comprehensive understanding of the needs of GPs. For research within the Peruvian context, we recommend using the MINSA profile of essential competencies as a guiding framework. Conclusions This study examines the competencies and training needs of General Practitioners (GPs) serving rural areas in Peru. It reveals that while GPs are confident in their diagnostic abilities, communication, and professionalism, they feel less secure in research, leadership, and management skills. They also view existing training programs as inadequate for SERUMS, advocating for active, problem-based learning methods. These findings underscore deficiencies in Peru’s undergraduate medical education, emphasizing the need for incorporating clinical reasoning, community-based practice, and leadership into the curriculum. Furthermore, tailored problem-based education that recognizes GPs as self-directed adult learners and offers them educational credits is recommended for continuous professional development. Such reforms are crucial for enhancing GPs' self-efficacy and - the primary care workforce. Abbreviations GPs: General Practitioners. SERUMS: Servicio Rural y Urbano Marginal de Salud, is a mandatory rural health service program in Peru. MINSA: Ministerio de Salud, the Ministry of Health of Peru. Declarations Ethics approval and consent to participate This study protocol was approved by the ethics committee from the Universidad Privada de Tacna (CODE: 025-05-2023). Informed consent was obtained from all subjects. Consent for publication Not applicable Availability of data and materials The data related to this study are available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Funding This research was self-funded. Authors' contributions Conceptualization: J.F.C., C.C.C., B.C.M and M.R.H.; Methodology: : J.F.C., C.C.C. and B.C.M; Software: J.F.C.; Validation: J.F.C and C.C.C.; Formal analysis: J.F.C.; Investigation: J.F.C., C.C.C., B.C.M and M.R.H.; Data Curation: J.F.C., C.C.C., B.C.M and M.R.H.; Writing - Original Draft: J.F.C; Writing - Review & Editing: J.F.C., C.C.C., B.C.M and M.R.H.; Project administration: J.F.C. All authors reviewed and approved the final draft and are responsible for the manuscript’s content and similarity index. Acknowledgments Not applicable. References MINSA. Normativa sobre SERUMS 2023. https://www.gob.pe/institucion/minsa/colecciones/669 (accessed September 28, 2023). Mayta-Tristán P, Poterico JA, Galán-Rodas E, Raa-Ortiz D. El requisito obligatorio del servicio social en salud del Perú: discriminatorio e inconstitucional. Revista Peruana de Medicina Experimental y Salud Publica 2014;31:781–7. Núñez M, Mendoza P, del Campo J, Chilca M. Efecto del programa SERUMS en la equidad de la distribución de recursos humanos del primer nivel de atención en Perú. Anales de La Facultad de Medicina 2021;82:290–300. https://doi.org/10.15381/anales.v82i4.22019. Bendezu-Quispe G, Mari-Huarache LF, Taype-Rondan Á, Mejia CR, Inga-Berrospi F. Percepción de médicos que realizan el Servicio Rural y Urbano-Marginal de salud en Perú sobre el primer nivel de atención. Rev Peru Med Exp Salud Publica 2021;37:636–44. https://doi.org/10.17843/rpmesp.2020.374.5294. Romero-Robles MA, Soriano-Moreno DR, García-Gutiérrez FM, Condori-Meza IB, Sing-Sánchez CC, Bulnes Alvarez SP, et al. Self-perceived competencies on evidence-based medicine in medical students and physicians registered in a virtual course: a cross-sectional study. Med Educ Online 2022;27:2010298. https://doi.org/10.1080/10872981.2021.2010298. Zafra-Tanaka JH, Pacheco-Barrios K, Inga-Berrospi F, Taype-Rondan A. Self-perceived competencies in the diagnosis and treatment of mental health disorders among general practitioners in Lima, Peru. BMC Med Educ 2019;19:464. https://doi.org/10.1186/s12909-019-1900-8. Bustamante García M, Inga-Berrospi F, Bazán Guzmán M, Cuba-Fuentes S, Bustamante García M, Inga-Berrospi F, et al. Factores asociados a la percepción de competencias gerenciales en médicos peruanos recién egresados. Revista Del Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo 2021;14:447–51. https://doi.org/10.35434/rcmhnaaa.2021.144.1319. Dirección General de Personal de la Salud. M de S-P. Documento Técnico: Perfil de competencias esenciales que orientan la formación de los profesionales de la salud 2021. https://cdn.www.gob.pe/uploads/document/file/3287973/Perfil%20de%20competencias%20esenciales%20que%20orientan%20la%20formaci%C3%B3n%20de%20los%20profesionales%20de%20la%20salud.%20Documento%20t%C3%A9cnico.%20Primera%20fase%3A%20M%C3%A9dico%28a%29%20y%20enfermero%28a%29%20peruano%28a%29.pdf?v=1655938218 (accessed September 6, 2023). Artino AR, La Rochelle JS, Dezee KJ, Gehlbach H. Developing questionnaires for educational research: AMEE Guide No. 87. Medical Teacher 2014;36:463–74. https://doi.org/10.3109/0142159X.2014.889814. Cheng A, Kessler D, Mackinnon R, Chang TP, Nadkarni VM, Hunt EA, et al. Reporting Guidelines for Health Care Simulation Research: Extensions to the CONSORT and STROBE Statements. Simul Healthc 2016;11:238–48. https://doi.org/10.1097/SIH.0000000000000150. Eysenbach G. Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 2004;6:e34. https://doi.org/10.2196/jmir.6.3.e34. Hennus MP, Jarrett JB, Taylor DR, ten Cate O. Twelve tips to develop entrustable professional activities. Medical Teacher 2023;45:701–7. https://doi.org/10.1080/0142159X.2023.2197137. SUNEDU. III Informe Bienal 2021. James E, Evans M, Mi M. Leadership Training and Undergraduate Medical Education: a Scoping Review. MedSciEduc 2021;31:1501–9. https://doi.org/10.1007/s40670-021-01308-9. Carberry C, McCombe G, Tobin H, Stokes D, Last J, Bury G, et al. Curriculum initiatives to enhance research skills acquisition by medical students: a scoping review. BMC Medical Education 2021;21:312. https://doi.org/10.1186/s12909-021-02754-0. Jaques H. Medical students lack confidence in medical law. BMJ 2011;342:d3213. https://doi.org/10.1136/bmj.d3213. Elvén M, Welin E, Wiegleb Edström D, Petreski T, Szopa M, Durning SJ, et al. Clinical Reasoning Curricula in Health Professions Education: A Scoping Review. J Med Educ Curric Dev 2023;10:23821205231209093. https://doi.org/10.1177/23821205231209093. Cooper N, Bartlett M, Gay S, Hammond A, Lillicrap M, Matthan J, et al. Consensus statement on the content of clinical reasoning curricula in undergraduate medical education. Medical Teacher 2021;43:152–9. https://doi.org/10.1080/0142159X.2020.1842343. Zechariah S, Ansa BE, Johnson SW, Gates AM, Leo GD. Interprofessional Education and Collaboration in Healthcare: An Exploratory Study of the Perspectives of Medical Students in the United States. Healthcare (Basel) 2019;7:117. https://doi.org/10.3390/healthcare7040117. Kaufman DM. Applying educational theory in practice. BMJ 2003;326:213–6. Filipe HP, Silva ED, Stulting AA, Golnik KC. Continuing Professional Development: Best Practices. Middle East Afr J Ophthalmol 2014;21:134–41. https://doi.org/10.4103/0974-9233.129760. Additional Declarations No competing interests reported. Supplementary Files 4dataset.xlsx 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. 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04:50:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3877654/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3877654/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50454811,"identity":"b3f47d50-3239-45e3-83f2-3d8d24a0a465","added_by":"auto","created_at":"2024-01-31 18:35:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":393235,"visible":true,"origin":"","legend":"\u003cp\u003eRating of the 21 minimal conditions of achievement of the general practitioners enrolled in the SERUMS between 2020 to 2022 (n=190)\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3877654/v1/d839105d4b2d7dd9656675c7.png"},{"id":50455447,"identity":"9ed5732d-8a39-4eef-ae63-c6e72c311483","added_by":"auto","created_at":"2024-01-31 18:43:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":149045,"visible":true,"origin":"","legend":"\u003cp\u003eResources from which general practitioners received and perceived training (n=190)\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3877654/v1/3c475ca818774a87bb14ffe8.png"},{"id":50455448,"identity":"0fe76578-c258-4f17-b5a3-f15edda7c64c","added_by":"auto","created_at":"2024-01-31 18:43:47","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":75106,"visible":true,"origin":"","legend":"\u003cp\u003eSelf-perceived needs in terms of preferred instructional methods and competencies (n=190)\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-3877654/v1/5e2531e787c32aa8d22b8563.png"},{"id":51929434,"identity":"b6c85a8e-fb5b-492f-9212-c74807becbf7","added_by":"auto","created_at":"2024-03-04 04:43:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":687215,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3877654/v1/65e0da24-49d2-4cac-bceb-cc984528d5d8.pdf"},{"id":50454808,"identity":"f96a3119-ebbb-4635-af61-9b9d3a2c4a10","added_by":"auto","created_at":"2024-01-31 18:35:47","extension":"xlsx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":52518,"visible":true,"origin":"","legend":"","description":"","filename":"4dataset.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-3877654/v1/2821fbd43cc619ae53fb7869.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Needs assessment for enhancing the preparation of general practitioners enrolling in the Peruvian mandatory rural service: a cross-sectional study.","fulltext":[{"header":"Background","content":"\u003cp\u003ePeru's Rural and Marginal Urban Health Service (SERUMS, abbreviature in Spanish), established in 1981 and regulated in 1997 by the Ministry of Health (MINSA, abbreviature in Spanish), has as its main mission to improve health care in rural and marginal urban areas [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This program is essential in providing healthcare services in such areas by assigning trained health professionals. Although one study has suggested that the SERUMS has reduced inequity in healthcare for neglected communities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], several studies highlighted the lack of training from General Practitioners (GPs) for this major task [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHence, despite its noble objective, the lack of training of GPs hinders the quality of care for neglected populations. In response to these shortcomings, MINSA has established a profile of key competencies comprising 8 domains and 13 competencies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Although this is a major advance in Peruvian medical education, the discrepancy between this profile and actual training for the SERUMS has not yet been sufficiently explored. Therefore, we conducted a needs assessment to evaluate how GPs perceived their SERUMS competencies and their perceived training needs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe conducted a cross-sectional analytical study of needs assessment to evaluate how GPs perceived their SERUMS competencies and their perceived training needs. The questionnaire development followed Artino Jr.'s recommendations [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This manuscript was written following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eFor this study, we considered GPs who enrolled in the SERUMS between 2020 and 2022. We included GPs who agreed to participate in the study. Participants who did not completely fill out the questionnaire or conducted their SERUMs before 2020 were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eProcedures\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eSurvey development\u003c/h2\u003e \u003cp\u003eWe developed the questionnaire employing the framework for essential competencies for GPs of the Ministry of Health from Peru [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. We used the \u0026ldquo;minimal condition of achievement\u0026rdquo; for each item, resulting in 21. To rate each item, we employed a 5-Likert scale where 1 was \u0026ldquo;Not confident at all\u0026rdquo; and 5 was \u0026ldquo;completely confident\u0026rdquo;. This rating scale was chosen as it resembles entrustment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAdministration\u003c/h2\u003e \u003cp\u003eAfter approval from the ethics committee, we conducted the national survey on Google Forms. The survey comprised six sections: informed consent, sociodemographic information, SERUMS characteristics, self-perceived competencies, self-perceived needs, and sent confirmation. The survey was distributed through email, WhatsApp, and telegram groups related to the SERUMS from May 1 to May 28, 2023. The survey was open to everyone to complete, but GPs must agree on informed consent. As an incentive, we offered access to medical questions applications. Due to the limitations of Google Forms, there was no randomization of items nor the total number of visitors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eSelf-perceived competencies\u003c/h2\u003e \u003cp\u003eWe assessed 21 minimal achievement conditions under three dimensions: the clinician (5 items), the health promoter (4 items), and the holistic doctor (6 items). Minimal achievement conditions that did not fit into dimensions were also reported. Each minimal achievement condition had five possible responses from \u0026ldquo;not confident at all\u0026rdquo; to \u0026ldquo;completely confident\u0026rdquo;. The dimensions described above were considered the dependent variable to identify associated factors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eSelf-perceived needs\u003c/h2\u003e \u003cp\u003eWe considered self-perceived needs as resources, formative needs, and preferred training modalities. Therefore, we assessed the following: (1) resources received for SERUMS preparation after graduation, which comprised resources from their university, paid courses, courses from the Peruvian medical college, courses from the national school of public health, and self-directed or selected resources; (2) resourced that the GPs considered were most beneficial for SERUMS, which comprised the same in the previous question; (3) formative needs, which were the self-perceived competencies but rephrased and grouped when suitable for better understanding, and an open-ended question for competencies or skills that we did not consider and (4) preferred modality for future training, which comprised online lectures, asynchronous learning, in-person lectures, simulation training, case or problem-based learning, and workshops or hands-on activities, later these were classified as passive teaching methods (online lectures, asynchronous learning and in-person lectures) versus active teaching methods (the remaining) to further analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eOther variables\u003c/h2\u003e \u003cp\u003eOther variables were age, sex, university, setting of their internship, SERUMS period and modality, poverty quintile, SERUMS employer, and SERUMS role. Age was categorized into two groups (equal or under 27 years old and older than 27 years). The university was then categorized into public or private according to Peruvian data [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The setting of the internship, according to whether it included primary care or not in their rotations and due to the scarce number of GPs across quintiles, we categorized them into quintile 1 and non- quintile 1 (comprising GPs from quintile 2 to 5).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eFor the descriptive analysis, we employed absolute and relative frequencies for categorical variables while measures of central tendency and dispersion for numeric ones.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e This study protocol was approved by the ethics committee from the Universidad Privada de Tacna (CODE: 025-05-2023).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAfter excluding 31 GPs due to not giving consent and having conducted the SERUMS before 2022, 190 GPs participated in this study. The key characteristics of the included GPs are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Most were older than 27 (57.37%), females (63.68%), came from a private university (67.37%), and did the internship in a mixed setting (45.26%). Regarding the SERUMS characteristics, most GPs were from the 2022\u0026ndash;2023 cohort (53.16%), were in the paid modality (95.79%), conducted the SERUMS in extreme poverty settings (56.32%), had the MINSA as the employer (85.26%) and worked solely as a clinician (58.95%).\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\u003eCharacteristics of the general practitioners enrolled in the SERUMS between 2020 to 2022 (n\u0026thinsp;=\u0026thinsp;190)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCharacteristics\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\u003eAge*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYounger or equal than 27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e81 (42.63)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0lder than 27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e109 (57.37)\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\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e69 (36.31)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e121 (63.68)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUniversity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePublic university\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e62 (32.63)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrivate university\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e128 (67.37)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInternship setting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary care setting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20 (10.53)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital setting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e84 (44.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMixed\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e86 (45.26)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSERUMS period\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2020\u0026ndash;2021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26 (13.68)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2021\u0026ndash;2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e63 (33.16)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2022\u0026ndash;2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e101 (53.16)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSERUMS modality\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePaid\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e182 (95.79)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-paid\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8 (4.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePoverty quintile\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQuintile 1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e107 (56.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-1 quintile\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e83 (43.68)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSERUMS employer\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMinister of Health\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e162 (85.26)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEsSalud\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11 (5.79)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27 (14.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSERUMS role\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRole as clinician\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e112 (58.95)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRole as clinician and manager\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e78 (41.05)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\"\u003eSERUMS \u0026ndash; Rural and Urban Marginalized Health Service; EsSalud \u0026ndash; Social Health Insurance\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\"\u003e\u003csup\u003e1\u003c/sup\u003eIf the internship took place at the first level of care and in the hospital setting.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\"\u003e\u003csup\u003e2\u003c/sup\u003eIncludes employers such as the armed forces, national police, and private companies.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e shows the rating of self-perceived confidence among 21 minimal conditions of achievement. The three conditions where most GPs were completely confident were \u0026ldquo;Perform comprehensive treatment of low complexity health problems.\u0026rdquo; (31.1%), \u0026ldquo;Demonstrate commitment to the well-being and health of individuals and society\u0026rdquo; (28.9%), and \u0026ldquo;Communicate effectively with patients, their families, and the community\u0026rdquo; (28.4%). The four conditions where most GPs were not confident at all were \u0026ldquo;Conduct research oriented to the needs of your population\u0026rdquo; (14.2%), \u0026ldquo;Manage the health establishment and implement improvement plans\u0026rdquo; (9.5%), \u0026ldquo;Operate within the legal framework of the Peruvian health system\u0026rdquo; (6.8%) and \u0026ldquo;Lead the health team\u0026rdquo; (6.8%).\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Rating of the 21 minimal conditions of achievement of the general practitioners enrolled in the SERUMS between 2020 and 2022\u003c/p\u003e\n\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, the resources most used for GPs self-studied (n\u0026thinsp;=\u0026thinsp;82) and received courses from the National School of Public Health (n\u0026thinsp;=\u0026thinsp;77), while the least training was received through university (n\u0026thinsp;=\u0026thinsp;9). However, when comparing used and perceived benefits for SERUMS, all resources had major differences, such as university (9 versus 0), paid courses (40 versus 12), Peruvian medical college (43 versus 2), and National School of Public Health (77 versus 4). However, when comparing self-studying, there were minor differences between received and perceived benefits (82 versus 51).\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. Resources from which general practitioners received and perceived training.\u003c/p\u003e\n\u003cp\u003eLastly, Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e depicts the self-perceived needs for training of GPs. The upper image shows the preferred modality for training, demonstrating a preference for active learning methods such as workshops (n\u0026thinsp;=\u0026thinsp;119), case or problem-based learning (n\u0026thinsp;=\u0026thinsp;105), and simulation training (n\u0026thinsp;=\u0026thinsp;98). In contrast, passive learning methods were the least preferred. In the lower image, the perceived need for training is depicted. GPs reported that future training should be conducted in the realm of therapeutic competencies (n\u0026thinsp;=\u0026thinsp;129, 68%), Peruvian health system (n\u0026thinsp;=\u0026thinsp;127, 67%), Diagnostic competencies (n\u0026thinsp;=\u0026thinsp;122, 64%), Administrative and management tasks (n\u0026thinsp;=\u0026thinsp;119, 63%) and Interprofessional competencies (n\u0026thinsp;=\u0026thinsp;113, 59%).\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. Self-perceived needs in terms of competencies and preferred instructional methods\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSummary of findings\u003c/h2\u003e \u003cp\u003eHere, we conducted a needs assessment on self-perceived competencies and training needs from 190 GPs who conducted the SERUMS between 2020 and 2022. Our major findings are as follows: 1) Competencies related to diagnosis and management of low complex problems, communication, and professionalism were the highest among GPs; 2) Competencies related to research, leadership, and management were the lowest among GPs; 3) While GPs received training from different resources, they solely perceived \u0026ldquo;self-study\u0026rdquo; resources as most beneficial; 4) GPs recommended that future training should focus on active learning methods such as workshops, case-based learning and simulation training; and 5) GPs perceived that training should focus on competencies such as clinical reasoning in diagnostic and therapeutic competencies, the Peruvian health system, management and interprofessional competencies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrength and limitations\u003c/h2\u003e \u003cp\u003e This study had strengths, such as following established reporting guidelines and developing a questionnaire based on the national competency framework. However, some limitations must be considered. The cross-sectional nature of this study impedes establishing causality, the responses may be biased due to voluntary participation, and although it provides important information, the measurement of self-perceived competencies may not reflect the true level of these competencies, as social desirability bias or inaccurate self-assessment may influence on the choices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eComparison with prior work\u003c/h2\u003e \u003cp\u003eResearch, leadership, and management competencies were rated lowest among Peruvian GPs. Previous studies conducted in Peru and South America have found similar results [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This deficiency likely originates from a lack of comprehensive training in research methodologies and evidence-based medicine [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and in leadership training [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore, the lack of training in these competencies for Peruvian and South American GPs is reflected in the global literature, as there is a lack of representations in a systematic review on leadership training and evidence-based medicine in undergraduate medical education [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This situation underscores the urgent need to prioritize enhancing teaching methods and assessment strategies for these crucial competencies in medical education.\u003c/p\u003e \u003cp\u003eA major concern identified in our study is the perception among GPs that the existing training resources do not adequately prepare them for SERUMS. This perspective is unique, as no known studies specifically explore GPs' views on the effectiveness of training resources for SERUMS. The root of this issue lies in the dominant pedagogical approach of Peruvian medical education, which is largely centered around passive learning and traditional lecture-based teaching methods. This approach starkly contrasts the active participation and engagement methods preferred by GPs for future training, as indicated by their responses in our study. This discrepancy highlights a significant mismatch between the current educational methodologies and the needs and preferences of medical professionals serving in rural areas.\u003c/p\u003e \u003cp\u003eWhile GPs perceive their diagnostic and therapeutic competencies as satisfactory in self-assessments, they still express a need for further training in these areas. This training should also encompass understanding the Peruvian health system, management, and interprofessional competencies. These findings resonate with global trends, such as the emphasis on medical law training in the United Kingdom and the noted deficiency in leadership and management training [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This situation reflects a broader need for a standardized curriculum, particularly focusing on clinical reasoning training, as evidenced by studies [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Additionally, the gap in interprofessional collaboration training is not unique to Peru; it is a recognized issue in other countries, including Pakistan [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This highlights a global challenge in medical education, underscoring the necessity of addressing these key areas to better equip GPs for their diverse roles and responsibilities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eImplications\u003c/h2\u003e \u003cp\u003eOur study identifies a critical deficiency in training for General Practitioners, especially in non-clinical roles such as management and collaboration with other health professionals. Notably, SERUMS often marks the first time GPs assume managerial responsibilities and work extensively with other health professionals, contrasting their previous experiences. This new environment necessitates skills that many GPs lack, as evidenced by a study indicating a decline in their interest in primary care post-SERUMS [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This trend may be attributed to insufficient training in essential competencies, adversely affecting GP\u0026rsquo;s self-efficacy. To address this, we advocate for incorporating interprofessional education and leadership training into GP curricula, aligning with MINSA's essential competencies framework. Additionally, transitioning undergraduate medical education from a predominantly hospital-based model to a community-based approach would more accurately reflect the realities of SERUMS and better prepare GPs for these unique challenges.\u003c/p\u003e \u003cp\u003eDespite a consensus among GPs regarding the need for active learning methods in training, the current educational offerings primarily consist of traditional lectures with limited learner participation. According to best practices in continuous professional development and adult learning theories [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], courses should solve current problems of GPs, employ active learning methods focused on urgent needs rather than \u0026ldquo;just-in-case knowledge,\u0026rdquo; must take into account the experience of learners, and consider that most adult-learners are self-directed learners. Consequently, we suggest creating a SERUMS curriculum aligned with MINSA\u0026rsquo;s proposed competencies or one more specifically tailored to the unique barriers and struggles faced by GPs in rural areas. Until such a curriculum is implemented, our study underscores the urgent need to equip GPs with training in non-clinical competencies.\u003c/p\u003e \u003cp\u003eWhile this study provides insights into undergraduate medical education and continuous professional development, it also highlights the need for further research in key areas. Future studies should engage larger samples and embrace various methods, including observations in simulated scenarios, record audits, and mixed-method approaches, to gain a more comprehensive understanding of the needs of GPs. For research within the Peruvian context, we recommend using the MINSA profile of essential competencies as a guiding framework.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study examines the competencies and training needs of General Practitioners (GPs) serving rural areas in Peru. It reveals that while GPs are confident in their diagnostic abilities, communication, and professionalism, they feel less secure in research, leadership, and management skills. They also view existing training programs as inadequate for SERUMS, advocating for active, problem-based learning methods. These findings underscore deficiencies in Peru\u0026rsquo;s undergraduate medical education, emphasizing the need for incorporating clinical reasoning, community-based practice, and leadership into the curriculum. Furthermore, tailored problem-based education that recognizes GPs as self-directed adult learners and offers them educational credits is recommended for continuous professional development. Such reforms are crucial for enhancing GPs' self-efficacy and - the primary care workforce.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGPs: General Practitioners.\u003c/p\u003e\n\u003cp\u003eSERUMS: Servicio Rural y Urbano Marginal de Salud, is a mandatory rural health service program in Peru.\u003c/p\u003e\n\u003cp\u003eMINSA: Ministerio de Salud, the Ministry of Health of Peru.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study protocol was approved by the ethics committee from the Universidad Privada de Tacna (CODE: 025-05-2023). Informed consent was obtained from all subjects.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe data related to this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research was self-funded.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026apos; contributions\u003c/h2\u003e\n\u003cp\u003eConceptualization: J.F.C., C.C.C., B.C.M and M.R.H.; Methodology: : J.F.C., C.C.C. and B.C.M; Software: J.F.C.; Validation: J.F.C and C.C.C.; Formal analysis: J.F.C.; Investigation: J.F.C., C.C.C., B.C.M and M.R.H.; Data Curation: J.F.C., C.C.C., B.C.M and M.R.H.; Writing - Original Draft: J.F.C; Writing - Review \u0026amp; Editing: J.F.C., C.C.C., B.C.M and M.R.H.; Project administration: J.F.C. All authors reviewed and approved the final draft and are responsible for the manuscript\u0026rsquo;s content and similarity index.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMINSA. Normativa sobre SERUMS 2023. https://www.gob.pe/institucion/minsa/colecciones/669 (accessed September 28, 2023).\u003c/li\u003e\n\u003cli\u003eMayta-Trist\u0026aacute;n P, Poterico JA, Gal\u0026aacute;n-Rodas E, Raa-Ortiz D. El requisito obligatorio del servicio social en salud del Per\u0026uacute;: discriminatorio e inconstitucional. Revista Peruana de Medicina Experimental y Salud Publica 2014;31:781\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eN\u0026uacute;\u0026ntilde;ez M, Mendoza P, del Campo J, Chilca M. Efecto del programa SERUMS en la equidad de la distribuci\u0026oacute;n de recursos humanos del primer nivel de atenci\u0026oacute;n en Per\u0026uacute;. Anales de La Facultad de Medicina 2021;82:290\u0026ndash;300. https://doi.org/10.15381/anales.v82i4.22019.\u003c/li\u003e\n\u003cli\u003eBendezu-Quispe G, Mari-Huarache LF, Taype-Rondan \u0026Aacute;, Mejia CR, Inga-Berrospi F. Percepci\u0026oacute;n de m\u0026eacute;dicos que realizan el Servicio Rural y Urbano-Marginal de salud en Per\u0026uacute; sobre el primer nivel de atenci\u0026oacute;n. Rev Peru Med Exp Salud Publica 2021;37:636\u0026ndash;44. https://doi.org/10.17843/rpmesp.2020.374.5294.\u003c/li\u003e\n\u003cli\u003eRomero-Robles MA, Soriano-Moreno DR, Garc\u0026iacute;a-Guti\u0026eacute;rrez FM, Condori-Meza IB, Sing-S\u0026aacute;nchez CC, Bulnes Alvarez SP, et al. Self-perceived competencies on evidence-based medicine in medical students and physicians registered in a virtual course: a cross-sectional study. Med Educ Online 2022;27:2010298. https://doi.org/10.1080/10872981.2021.2010298.\u003c/li\u003e\n\u003cli\u003eZafra-Tanaka JH, Pacheco-Barrios K, Inga-Berrospi F, Taype-Rondan A. Self-perceived competencies in the diagnosis and treatment of mental health disorders among general practitioners in Lima, Peru. BMC Med Educ 2019;19:464. https://doi.org/10.1186/s12909-019-1900-8.\u003c/li\u003e\n\u003cli\u003eBustamante Garc\u0026iacute;a M, Inga-Berrospi F, Baz\u0026aacute;n Guzm\u0026aacute;n M, Cuba-Fuentes S, Bustamante Garc\u0026iacute;a M, Inga-Berrospi F, et al. Factores asociados a la percepci\u0026oacute;n de competencias gerenciales en m\u0026eacute;dicos peruanos reci\u0026eacute;n egresados. Revista Del Cuerpo M\u0026eacute;dico Hospital Nacional Almanzor Aguinaga Asenjo 2021;14:447\u0026ndash;51. https://doi.org/10.35434/rcmhnaaa.2021.144.1319.\u003c/li\u003e\n\u003cli\u003eDirecci\u0026oacute;n General de Personal de la Salud. M de S-P. Documento T\u0026eacute;cnico: Perfil de competencias esenciales que orientan la formaci\u0026oacute;n de los profesionales de la salud 2021. https://cdn.www.gob.pe/uploads/document/file/3287973/Perfil%20de%20competencias%20esenciales%20que%20orientan%20la%20formaci%C3%B3n%20de%20los%20profesionales%20de%20la%20salud.%20Documento%20t%C3%A9cnico.%20Primera%20fase%3A%20M%C3%A9dico%28a%29%20y%20enfermero%28a%29%20peruano%28a%29.pdf?v=1655938218 (accessed September 6, 2023).\u003c/li\u003e\n\u003cli\u003eArtino AR, La Rochelle JS, Dezee KJ, Gehlbach H. Developing questionnaires for educational research: AMEE Guide No. 87. Medical Teacher 2014;36:463\u0026ndash;74. https://doi.org/10.3109/0142159X.2014.889814.\u003c/li\u003e\n\u003cli\u003eCheng A, Kessler D, Mackinnon R, Chang TP, Nadkarni VM, Hunt EA, et al. Reporting Guidelines for Health Care Simulation Research: Extensions to the CONSORT and STROBE Statements. Simul Healthc 2016;11:238\u0026ndash;48. https://doi.org/10.1097/SIH.0000000000000150.\u003c/li\u003e\n\u003cli\u003eEysenbach G. Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 2004;6:e34. https://doi.org/10.2196/jmir.6.3.e34.\u003c/li\u003e\n\u003cli\u003eHennus MP, Jarrett JB, Taylor DR, ten Cate O. Twelve tips to develop entrustable professional activities. Medical Teacher 2023;45:701\u0026ndash;7. https://doi.org/10.1080/0142159X.2023.2197137.\u003c/li\u003e\n\u003cli\u003eSUNEDU. III Informe Bienal 2021.\u003c/li\u003e\n\u003cli\u003eJames E, Evans M, Mi M. Leadership Training and Undergraduate Medical Education: a Scoping Review. MedSciEduc 2021;31:1501\u0026ndash;9. https://doi.org/10.1007/s40670-021-01308-9.\u003c/li\u003e\n\u003cli\u003eCarberry C, McCombe G, Tobin H, Stokes D, Last J, Bury G, et al. Curriculum initiatives to enhance research skills acquisition by medical students: a scoping review. BMC Medical Education 2021;21:312. https://doi.org/10.1186/s12909-021-02754-0.\u003c/li\u003e\n\u003cli\u003eJaques H. Medical students lack confidence in medical law. BMJ 2011;342:d3213. https://doi.org/10.1136/bmj.d3213.\u003c/li\u003e\n\u003cli\u003eElv\u0026eacute;n M, Welin E, Wiegleb Edstr\u0026ouml;m D, Petreski T, Szopa M, Durning SJ, et al. Clinical Reasoning Curricula in Health Professions Education: A Scoping Review. J Med Educ Curric Dev 2023;10:23821205231209093. https://doi.org/10.1177/23821205231209093.\u003c/li\u003e\n\u003cli\u003eCooper N, Bartlett M, Gay S, Hammond A, Lillicrap M, Matthan J, et al. Consensus statement on the content of clinical reasoning curricula in undergraduate medical education. Medical Teacher 2021;43:152\u0026ndash;9. https://doi.org/10.1080/0142159X.2020.1842343.\u003c/li\u003e\n\u003cli\u003eZechariah S, Ansa BE, Johnson SW, Gates AM, Leo GD. Interprofessional Education and Collaboration in Healthcare: An Exploratory Study of the Perspectives of Medical Students in the United States. Healthcare (Basel) 2019;7:117. https://doi.org/10.3390/healthcare7040117.\u003c/li\u003e\n\u003cli\u003eKaufman DM. Applying educational theory in practice. BMJ 2003;326:213\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eFilipe HP, Silva ED, Stulting AA, Golnik KC. Continuing Professional Development: Best Practices. Middle East Afr J Ophthalmol 2014;21:134\u0026ndash;41. https://doi.org/10.4103/0974-9233.129760.\u003c/li\u003e\n\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":"Rural service, medical education, Peru, needs assessment","lastPublishedDoi":"10.21203/rs.3.rs-3877654/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3877654/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePeru\u0026rsquo;s Rural and Marginal Urban Health Service (SERUMS) aims to improve healthcare in rural and marginal areas. Despite its objectives, a gap exists between training General Practitioners (GPs) and the competencies required for SERUMS. This study assesses GPs' self-perceived competencies and training needs for SERUMS.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional analytical study was conducted involving GPs who enrolled in SERUMS between 2020 and 2022. A questionnaire was developed based on the Ministry of Health's competency framework, assessing 21 minimal achievement conditions. The survey was distributed via Google Forms and included sections on sociodemographic information, SERUMS characteristics, self-perceived competencies, and training needs.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOut of 190 GPs who participated, most were female, over 27 years old, and graduates from private universities with mixed-setting internships. The highest self-perceived competencies were in low-complexity problem management, communication, and professionalism. However, competencies in research, leadership, and health system management were rated lowest. The primary resource for training was self-study, with a preference for active learning methods for future training. Perceived training needs were in therapeutic competencies, the Peruvian health system, diagnostic competencies, administrative tasks, and interprofessional competencies.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study reveals significant gaps in the training and competencies of Peruvian GPs for SERUMS. It emphasizes the need for a tailored curriculum incorporating active learning and focusing on clinical reasoning, leadership, and interprofessional competencies. This approach would better prepare GPs for SERUMS and enhance their self-efficacy and effectiveness in primary care. Leading to a better quality of care for these neglected populations.\u003c/p\u003e","manuscriptTitle":"Needs assessment for enhancing the preparation of general practitioners enrolling in the Peruvian mandatory rural service: a cross-sectional study.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-31 18:35:42","doi":"10.21203/rs.3.rs-3877654/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":"13cc80e9-704c-46c9-9dba-ea2d3be8edce","owner":[],"postedDate":"January 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-04T04:35:45+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-31 18:35:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3877654","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3877654","identity":"rs-3877654","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}