The training contents, problems and needs of doctors in urban community health service institutions in China

Abstract

Background: The Chinese government offered various types of training programs for strengthening the role of doctors working in community health service institutions (CHSIs). The study intended to investigate the current training programs and training needs of doctors nationally in urban CHSIs in China, and to provide propositions for training more qualified doctors in the future.

Methods: Total 3098 doctors in 192 urban CHSIs were chosen from 9 provinces (Hebei, Liaoning, Shandong, Zhejiang, Fujian, Hunan, Guangxi, Guizhou, Ningxia) and one municipality (Beijing) among 31 provinces in eastern, central, and western regions by stratified sampling methods in Mainland China. All doctors in the selected CHSIs were investigated in this study. We discharged 3073 questionnaires, and the response rate was 98.0%. Descriptive statistics were used to describe the characteristics, training contents, problems and needs of doctors. Differences in training contents, problems and needs between eastern, central and western regions were analyzed with chi-square tests.

Results: 49.3% of doctors in CHSIs had Bachelor's degree and beyond. 12.9% of doctors had senior professional titles. The most frequent training topics for the doctors in eastern, central and western regions were "basic clinical theory knowledge" (52.4%), "community health service competency" (59.6%), "clinical practice skills" (45.9%) respectively. The most serious problem for doctors was "insufficient training time" in eastern (36.8%), central (36.5%) and western (39.6%). The biggest knowledge need for doctors both in eastern (79.8%) and central region (79.1%) was "the updated international medical knowledge", in western region it was "the updated domestic medical knowledge" (73.2%). The biggest skill-related training need for doctors in eastern region (84.1%) and central region (82.6%) was "communication skills", and "diagnosis and differential diagnosis" in western region (78.2%).

Conclusion: Government should design proper training contents according to the knowledge and skill needs of different design. Furthermore, a uniform, rigorous training and evaluation system focus on practicability should be established to promote community health service system in Mainland China.

Keywords: Doctors; Training needs; Training programs; Urban community health care service institutions.

Fig. 1

Sampling flow of CHSIs in urban China in 2011. Note: ^a The central district includes 10 provinces (Hebei^*, Shanxi, Jilin, Heilongjiang, Anhui, Jiangxi, Henan, Hunan^*, Hubei and Hainan). The eastern district includes six provinces (Liaoning^*, Shandong^*, Jiangsu, Zhejiang^*, Fujian^* and Guangdong) and three cities that are directly under the jurisdiction of the central government (Beijing^*, Shanghai and Tianjin). The western district includes 11 provinces (Inner Mongolia, Guangxi^*, Sichuan, Guizhou^*, Yunnan, Xizang, Shanxi, Gansu, Qinghai, Ningxia^*, and Xinjiang) and one city that is directly under the jurisdiction of the central government (Chongqing). ^* Provinces selected for the study. ^b Dalian is one of the five cities (Xiamen, Ningbo, Qingdao, Shenzhen, and Dalian) that are specifically designated in the state plan and similar in size and economic situation to a provincial capital. ^c The plan was to examine three districts per city, though some of the selected cities had fewer than three districts. ^d The plan was to sample three institutions per district per city, though some selected districts had fewer than three institutions

Fig. 2

The proportion of doctors registered in physician practice scope of clinical categories. Note: The Chinese government has ruled that doctors in primary health care institutions can register no more than three different specialties in one category. Source: National Health and Family Planning Commission of the People’s Republic of China. The notice of interim provisions on physicians practicing registered scope issued by Ministry of Health. Available from: http://www.gov.cn/gongbao/content/2002/content_61429.htm

Fig. 3

The types of training programs attended by the CHSIs doctors. Note: Doctors may attend more than one type of training, and some values overlapped