The total number of rural grassroots doctors in the 12 target township health centers was 489, among which 272 respondents met the inclusion criteria, for an effective response rate of 55.6%.
Demographic characteristics of the respondents
In this study, the age of the respondents varied from 23 years to 64 years (p25=30 years, p50=36.5 years, p75=46 years). The service years of the respondents varied from 1 year to 42 years (p25=7 years, p50=13 years, p75=25 years), and the monthly income (the response rate of this question is 31.6%) span was also significant, from 1000 yuan to 20000 yuan (p25=5000 yuan, p50=6000 yuan, p75=8000 yuan). Among all the respondents, 47.1% were male, 79.0% had a bachelor’s degree, 41.9% were from northern Jiangsu, 80.1% were trained by institutions within the province, and 34.2% were from the Department of General Practice. The details can be found in Table 1.
Table 1. Demographic characteristics of the respondents
|
|
N
|
Percentage
|
Gender
|
Male
|
128
|
47.1%
|
|
Female
|
144
|
52.9%
|
Education level
|
Vocational school or below
|
6
|
2.2%
|
|
Junior college degree
|
48
|
17.6%
|
|
Bachelor’s degree
|
215
|
79.0%
|
|
Master’s degree or above
|
3
|
1.1%
|
Location
|
Northern JS
|
114
|
41.9%
|
|
Central JS
|
59
|
21.7%
|
|
Southern JS
|
99
|
36.4%
|
Graduation institution
|
Within JS
|
218
|
80.1%
|
|
Without JS
|
54
|
19.9%
|
Department
|
General Practice
|
102
|
37.5%
|
|
Internal Medicine
|
55
|
20.2%
|
|
Surgery
|
33
|
12.1%
|
|
Public Health
|
16
|
5.9%
|
|
Traditional Chinese Medicine
|
24
|
8.8%
|
|
Stomatology
|
5
|
1.8%
|
|
Others
|
37
|
13.6%
|
Job competence self-evaluation of the respondents
Because job competence is related not only to medical education before graduation but also to practices in the workplace after graduation, respondents were grouped by region to test whether there were differences. Overall, they had the highest self-evaluation of their professional spirit (4.19±0.834) and the lowest self-evaluation of their academic abilities (3.53±0.952). In addition to public health services, the vast majority of items show regional differences, and rural grassroots doctors in southern Jiangsu showed absolute advantages. The details are shown in Table 2.
Table 2. Job competence self-evaluation of the respondents
|
Total
|
Northern JS
|
Central JS
|
Southern JS
|
F
|
P
|
P(NC)
|
P(NS)
|
P(CS)
|
Clinical ability
|
3.81±0.848
|
3.62±0.886
|
3.76±0.751
|
4.04±0.807
|
6.805
|
0.001
|
0.294
|
<0.001
|
0.043
|
Professional
spirit
|
4.19±0.834
|
4.09±0.826
|
4.10±0.845
|
4.37±0.815
|
3.653
|
0.027
|
0.916
|
0.012
|
0.046
|
Ability to
learn and use
|
3.93±0.810
|
3.80±0.822
|
3.85±0.715
|
4.13±0.816
|
5.020
|
0.007
|
0.701
|
0.003
|
0.031
|
Doctor‒patient communication
|
4.03±0.780
|
3.92±0.800
|
3.95±0.753
|
4.19±0.752
|
3.628
|
0.028
|
0.821
|
0.011
|
0.057
|
Performance
in teamwork
|
4.04±0.779
|
3.91±0.771
|
4.02±0.777
|
4.20±0.769
|
3.773
|
0.024
|
0.398
|
0.007
|
0.146
|
Ability of public
health services
|
3.96±0.793
|
3.89±0.784
|
3.86±0.776
|
4.10±0.802
|
2.516
|
0.083
|
0.865
|
0.048
|
0.069
|
Information
manage ability
|
3.91±0.801
|
3.85±0.801
|
3.75±0.779
|
4.08±0.791
|
3.882
|
0.022
|
0.409
|
0.036
|
0.011
|
Research ability
|
3.53±0.952
|
3.36±0.979
|
3.46±0.837
|
3.78±0.943
|
5.524
|
0.004
|
0.515
|
0.001
|
0.039
|
The service content of rural primary care in China includes prevention, medical treatment, first aid, rehabilitation, health management, nursing, women-children-elders care (WCEC), and the question “What services can you offer? What kind of service do you reluctant to offer? What services can you not offer?” were asked. The details are shown in Figure 1.
WCEC: Women–Children–Elders Care
Figure 1. Services can offer/reluctant to offer/unable to offer
Residents’ standardized training situation
Among the 272 respondents, only 113 (41.5%) had received standardized resident training. The average duration of college graduates was 22.091±2.503 months (24 months required), and the average duration of university graduates was 29.417±0.953 months (36 months required). Based on the characteristics of Jiangsu Province and the varying levels of hospital development in different regions, respondents were grouped by region to check their standardized medical training situation and their opinions on departments that require extended practice hours. In terms of the needs of the rotation departments for regular training, rural grassroots doctors in southern Jiangsu showed interest in surgery, pediatrics, B-ultrasound, community and other departments. Details can be found in Table 3 and Table 4.
Table 3. The situation of "Resident Standardization Training"
|
|
Northern JS
|
Central JS
|
Southern JS
|
|
p
|
Participated in "Resident Standardization Training"
|
Yes
|
54
|
17
|
42
|
5.561
|
0.062
|
|
No
|
60
|
42
|
57
|
|
|
Training hospital level
|
Provincial Hospital
|
5
|
2
|
9
|
11.253
|
0.081
|
|
Municipal Hospital
|
33
|
13
|
22
|
|
|
|
County/District Hospital
|
2
|
2
|
11
|
|
|
Reached training duration
|
Yes
|
28
|
6
|
30
|
5.691
|
0.058
|
|
No
|
25
|
9
|
12
|
|
|
Table 4. Interned departments of respondents and departments require extended practice hours
|
Interned departments
|
Departments require extended practice hours
|
|
Northern JS(yes/no)
|
Central JS(yes/no)
|
Southern JS(yes/no)
|
|
P
|
Northern JS(yes/no)
|
Central JS(yes/no)
|
Southern JS(yes/no)
|
|
P
|
Internal Medicine
|
52/2
|
16/1
|
40/2
|
5.875
|
0.209
|
36/18
|
15/2
|
27/15
|
8.207
|
0.084
|
Surgery
|
48/6
|
15/2
|
37/5
|
5.732
|
0.220
|
22/32
|
12/5
|
16/26
|
9.843
|
0.043
|
Gynecology
|
44/10
|
11/6
|
36/6
|
8.849
|
0.065
|
8/46
|
5/12
|
10/32
|
7.900
|
0.095
|
Pediatrics
|
47/7
|
14/3
|
37/5
|
6.051
|
0.195
|
9/45
|
7/10
|
16/26
|
12.659
|
0.013
|
Emergency
|
47/7
|
14/3
|
36/6
|
5.941
|
0.240
|
30/24
|
11/6
|
23/19
|
5.965
|
0.202
|
Electro cardiogram Room
|
20/34
|
9/8
|
20/22
|
7.321
|
0.120
|
8/46
|
3/14
|
10/32
|
6.973
|
0.137
|
B Ultrasound Room
|
5/49
|
3/14
|
9/33
|
8.615
|
0.071
|
4/50
|
3/14
|
10/32
|
10.954
|
0.027
|
Radiology Department
|
12/42
|
6/11
|
17/25
|
9.681
|
0.041
|
7/47
|
3/14
|
10/32
|
7.610
|
0.107
|
Primary health centers
|
35/19
|
12/5
|
32/10
|
7.128
|
0.129
|
3/51
|
2/15
|
10/32
|
12.617
|
0.013
|
We also collected subjective information from respondents on “What other aspects of training do you think should be added?” The answers included “emergency” (7 mentions), “clinical operational skills” (7 mentions), “Chinese traditional medicine” (5 mentions), “public health skills” (4 mentions), “chronic disease management” (2 mentions), “doctor‒patient communication”, “B-ultrasound”, “rehabilitation”, “cardiovascular diseases”, “digestive diseases”, “data interpretation”, and “medical document writing”.
Rural grassroots service skills that should be mastered at different stages of medical education
According to the respondents, some specific service skills need to be mastered in different stages of medical education; for example, 90.8% and 89.7% of the respondents claimed that first aid and medical treatment skills needed to be mastered during the academic stage; 63.2% and 58.1% of the respondents believed that additional class hours are required for first aid and rehabilitation skills; and 90.8% and 84.9% of the respondents considered that first aid and medical treatment skills needed to be mastered during the Resident Standardization Training, respectively. The details are shown in Figure 2 to Figure 4.
Figure 2. Service skills need to be mastered in the academic stage
Figure 3. The service skills that require additional class hours
Figure 4. The service skills needed to be mastered during resident standardization training
Courses need to be improved or strengthened
The most intuitive aim of this study is to determine the key courses that need to be improved or strengthened according to the respondents. All the courses in the education stage were divided into four categories: humanities, biomedical, public health and clinical medicine. Prominent results include Doctor–Patient Communication and Psychology in Humanities; Anatomy and Pathology in Biology; Epidemiology and Health Education in Public Health; and Diagnostics and Internal Medicine and Surgery in Clinical Medicine. The ranking of each course category is detailed in Figure 5-Figure 8.
Figure 5. Ranking of courses that need to be strengthened in humanities
Figure 6. Ranking of courses that need to be strengthened in biomedical
Figure 7. Ranking of courses that need to be strengthened in public health
OHNS: Otolaryngology and Head and Neck Surgery
TCM: Traditional Chinese Medicine
Figure 8. Ranking of courses that need to be strengthened in clinical medicine