In the present cross-sectional study, we investigated the Chinese national-level CME programs in general practice from 2016 to 2023. In total, 3,815 CME programs were subjected to statistical analysis, providing insights into the distribution of CME providers across various regions. Furthermore, 2,895 CME programs were comprehensively evaluated for content and capability. Our study represents a potentially unprecedented cross-sectional survey of general CME programs in the history of Chinese healthcare education, offering a profound understanding of the current status of CME in China. While it serves to inform about the present circumstances, it does not offer recommendations for future enhancements or improvements.
Medical schools, nonprofit physician membership organizations, publishing/education companies, and hospitals are some of the primary CME providers in China. These entities are also considered the most common CME providers in most countries [10, 11]. The CME resources offered by distinct CME providers may vary; however, they can also have a complementary function. Subsequently, having diverse providers is beneficial in terms of enhancing the learning content. In this research, we noted that hospitals and publishing/education companies are the primary CME providers in China, accounting for more than 70% of CME programs. Since 2019, the number of CME programs offered by publishing/education companies has gradually increased, making them the primary providers. This shift is primarily owing to the online nature of the CMEs offered by them. Since the emergence of the COVID-19 pandemic in 2019, the convenience and accessibility of online CMEs have contributed to their rapid growth, with persistence in the post-pandemic era as well. By 2023, online CME will account for approximately 50% of the CME market. Many empirical studies have revealed that online CME has emerged as an extremely popular modality of CME, potentially being the preferred modality for use in the future [12]. Overall, online CME exhibits significant advantages [13], particularly for medical personnel in remote or rural regions, those with limited time, and young doctors.
We noted significant differences in the regional distribution of CME programs. The resources are scarce in the western regions, with training resources being primarily concentrated in areas such as Beijing(355), Shanghai(522), and Guangdong(216). Consistent with the findings of the present study, several studies have revealed that rural healthcare workers in western China have minimal access to CME [14]; however, they have a considerable demand for CME. The problem of differences in the regional distribution of CME resources is also common in other countries [15]. The distribution of CME resources may be associated with factors such as the economic development level and income of GPs. Studies have revealed that training opportunity is an important factor affecting the retention of the health workforce in rural and remote areas. A sufficient opportunity for CME is associated with lower odds of having turnover intent [16]. Therefore, strengthening CME programs in remote and impoverished areas, including the Western region, will not only enhance and improve the professional abilities of medical personnel but also demonstrate important significance for the future supply of GPs in the Western region [17].
Recently, the training of GP trainers has garnered a high degree of value in China [4]. However, a significant dearth remains in Chinese GP trainers, with questionable teaching capabilities. In China, these trainers are certified after only 5 days of theoretical courses and course design assignments [6]. Furthermore, most GP trainers are hospital specialists who are not aware of how to manage common medical conditions in the community. While some GP trainers are practicing general medicine in the community, their current focus on minor illnesses may result in negative role modeling [6]. Therefore, training GP trainers in China is urgently warranted. General practice CME serves as the primary mode for training GP trainers. Subsequently, in this study, we conducted a discrete statistical analysis specific to the training of GP trainers and revealed that the proportion of training GP trainers was 3.5–7.3%. Furthermore, we noted a significant portion of the training, i.e., approximately 10%, is training for GP trainers. At present, training programs for GP trainers are primarily focused on enhancing their clinical diagnosis and treatment capabilities. In contrast, the cultivation of teaching theories and abilities remains relatively underdeveloped, as confirmed in our previous research [18]. Therefore, medical schools must play a more significant role in this regard, providing additional training in teaching theories and abilities. Furthermore, we emphasize the importance of GP trainers acquiring the required skills to deliver primary care in community settings.
We also conducted separate statistical analyses on the training of TCM. Recently, the nation has persistently reinforced its commitment to the advancement of TCM. The significance of TCM in the medical field is being increasingly emphasized, particularly in grassroots medical institutions, where its effect is particularly significant and widely appreciated by patients [19]. In this study, we observed an increase in the proportion of TCM-related training in CMEs for GPs, reaching 20% in 2023. Nevertheless, owing to the lack of clarity in training objectives and the uneven distribution of training content for GPs in TCM, it is susceptible to challenges such as impractical training and divergence from clinical settings. Subsequently, the question remains: what should GPs learn in TCM? The scope of practice for GPs is extensive and comprehensive. From an academic perspective, the formulation of teaching objectives for GPs tends to be more intricate than that for specialist physicians. This is primarily because the learning content for GPs encompasses multiple specialties, with each having distinct and varying degrees of learning requirements. Therefore, it is challenging to formulate comprehensive but tailored objectives that address these diverse learning needs. In an academic context, teaching objectives must be formulated with a heightened level of specificity, particularly in niche specialties such as TCM, ophthalmology, otology, and oral medicine. These fields warrant a nuanced understanding of their respective theoretical frameworks, practical applications, and clinical nuances, necessitating the development of objectives that are precisely tailored to their specific educational needs. Owing to differences in personal abilities and practice models, easily developing CME training content predicated on the scope of practice is untenable. Therefore, CME training cannot meet the needs of all individuals. However, effective CME should cater to the needs of most GPs, necessitating an assessment and comprehension of trainee learning needs before determining the training content and implementing training based on more in-demand content [20].
As an emerging field, many GPs have undertaken copious amounts of work in health checkup and consultation. However, with the establishment of health checkup and consultation as an independent secondary discipline, exploring and clarifying the positioning and role of GPs in this discipline is essential. Within the burgeoning realm of health checkup and consultation, several GPs have undertaken significant efforts and contributions, exemplifying their dedication and commitment to this emerging field. However, owing to the emergence of health checkup and consultation as a distinct and autonomous secondary discipline, delving deeper into and clarifying the precise positioning and fundamental role of GPs in this discipline is vital.
To enhance the safety and quality of healthcare delivery, medical education has increasingly shifted toward a competency-based approach [21]. In the present study, we conducted a competency-based evaluation of general CME by using the ACGME-ABMS six core competency framework. In Chinese general practice CME training, PC core competencies are primarily emphasized, followed by MK core competencies. However, the least amount of importance is given to the training involving ICS core competencies. Consistent with the findings of the present study, John E. Delzell et al. [22] discovered that program directors believe that PC is the most essential competency. Furthermore, Becher Al Halabi et al. [23] reported that sufficient attention is not paid to specific competency domains, including ICS, PBLI, PROF, and SBP. How to effectively teach ICS is daunting. In our previous study, we reported that GP trainers encounter difficulties teaching communication classes [18].
The Family Medicine Milestones [9] are divided into two categories: harmonized and non-harmonized Milestones. Harmonized Milestones are those that come under the ICS, PBLI, PROF, and SBP core competencies because they are consistent across different specialties. On the other hand, non-harmonized Milestones are those that come under the PC and MK core competencies because they reflect the unique educational needs of different specialties. To enhance the learning and training of GPs in the ICS, PBLI, PROF, and SBP core competencies, exploring the possibility of sharing learning resources with other specialties is advised. Furthermore, it is recommended that experts from relevant fields, including healthcare policymakers and medical school teachers, deliver lectures or conduct relevant CME programs, rather than clinical workers.
We noted that the elderly demographic comprises the most significantly affected patient cohort in the context of training endeavors. With the continuous aging of China’s population, elderly patients have emerged as the primary focus for GPs in the diagnostic and therapeutic process, underscoring the need for tailored training in this realm. In the realm of disease categories, the training program primarily emphasizes chronic health conditions such as diabetes, hypertension, cardiovascular diseases, osteoporosis, chronic obstructive pulmonary disease, neoplastic disorders, and cerebrovascular disease. This focus extends not only to the diagnosis and treatment of these illnesses but also to their primary care management strategies. As primary healthcare providers and guardians of public health, GPs are responsible for managing chronic diseases. According to the data on the prevalence rates (‰) of chronic illnesses among residents aged 15 and above in the surveyed region, as reported in the 2022 edition of the China Health Statistics Yearbook[24], circulatory system disorders, notably hypertension (181.4‰), heart disease (39‰), and cerebrovascular disease (22.9‰), are some of the most prevalent chronic conditions, collectively contributing to a staggering 251.0‰ of this category. Furthermore, diabetes (53.1‰), musculoskeletal and connective tissue diseases (58.6‰, with arthritis-like conditions accounting for 11.6‰), digestive system diseases (43.8‰, with acute gastritis being a predominant condition at 20.0‰), respiratory system diseases (26.1‰, with chronic bronchitis at 9.6‰), and urogenital system diseases (16.3‰) occupy prominent positions in the landscape of chronic diseases. Considering the findings of the aforementioned analysis, a discernible disparity may be present between the current curriculum for GP training and the prevalence patterns of chronic diseases observed among the resident population. This suggests the need to reassess and realign educational content to better align with the healthcare demands and epidemiological realities of managing chronic illnesses. Furthermore, our study findings underscore the inherent constraints of the present training content, highlighting areas of improvement. Notably, the capacity of any training program to comprehensively address the educational requirements and learning needs of the trainees is an essential metric for assessing applicability and efficacy.
Therefore, executing a comprehensive learning needs assessment for GPs is essential. However, in China, this vital aspect has garnered limited attention, resulting in a paucity of research endeavors focused on evaluating the demand for CME. Furthermore, the limited studies that attempt to delineate the training requirements of GPs are often overly generalized and lack specificity. Zhu Fu et al. [25] have reported that clinical practice skills, clinical theoretical knowledge, and community work experience are the three most crucial areas of knowledge or skills that are required by community GPs. Undeniably, the more specific and detailed the demand survey becomes, the more insightful and instructional it proves to be for guiding educational interventions and enhancing the proficiency of these healthcare professionals. Stephanie Dowling, James A. Allan, and their respective teams conducted rigorous examinations of the learning necessities of GPs. Stephanie Dowling’s comprehensive survey [26] of the national requirements for Irish GPs yielded findings that exhibit a considerable alignment with our research. Notably, the keywords "prescribing (updates/therapeutics)," "elderly medicine," and "management of common chronic conditions" emerged as prominent among the "top five" CME requirements identified in their study. However, a notable divergence emerges when comparing the learning needs assessment undertaken by James A. Allan et al. [27] specifically targeting Australian GPs with our findings. Their investigation highlighted dermatology, complementary medicine, psychiatry, and business and practice management as the most salient topics prioritized by the surveyed practitioners. This disparity underscores the regional variability in the demands placed on GPs, emphasizing the need for tailored approaches to CME programming. Therefore, to ensure the efficacy and pertinence of CME programs, it is imperative to acknowledge and address the distinctive needs and challenges confronted by healthcare professionals across diverse geographical contexts. By tailoring CME curricula to the specific requirements of GPs within each region, we can enhance the relevance and impact of these educational interventions, ultimately contributing to the continuous improvement of healthcare delivery.
In summary, to ensure the efficacy and efficiency of CME for Chinese GPs, the design and implementation of future CME courses should meticulously consider and endeavor to address these issues to the greatest extent possible. This approach requires a comprehensive understanding of the unique challenges faced by Chinese GPs as well as a commitment to developing tailored educational strategies that cater to their specific learning needs and aspirations.
First, the timing, location, and format of CME programs for Chinese GPs should be carefully selected to ensure their appropriateness and suitability. These programs should be implemented by prioritizing convenience for practitioners and minimizing disruptions caused by time constraints, work conflicts, geographical distances, or limitations imposed by a singular teaching format. Furthermore, adopting a flexible and adaptive approach that caters to the diverse needs and circumstances of the target audience is essential, thereby enhancing their engagement and overall satisfaction with the CME experience. Second, the teaching content of CME programs should be meticulously designed to comprehend and satisfy the specific learning needs of Chinese GPs. The curriculum should possess practical significance and applicability, ensuring that the knowledge and skills imparted are directly relevant to the daily work and professional development of GPs. In addition, by focusing on content that is both pertinent and actionable, CME programs can effectively contribute to the advancement of clinical practice and PC outcomes. Third, considering the diverse learning needs owing to factors such as differing educational backgrounds and professional environments, refining the target audience of the course is essential to ensure its relevance and effectiveness. This warrants a strategic narrowing of the scope, coupled with the implementation of personalized adjustments tailored to the unique characteristics of the diverse teaching audience. By acknowledging and addressing these differences, the course can better meet the individualized learning requirements of its participants, thereby enhancing the overall quality and effect of the educational experience [20].
Furthermore, based on the CRISIS standards [28], incorporating a self-assessment phase in the design and implementation process is essential. This phase serves as a rigorous and systematic means to evaluate and verify the learners' comprehensive understanding and proficiency across the diverse topics and subject areas included in the learning program. By engaging in self-assessment, learners can critically reflect on their progress and identify their areas of improvement. This fosters deeper learning and ensures that the educational objectives are met with a high degree of accuracy and thoroughness. Furthermore, enhancing classroom interaction and implementing innovative teaching strategies aimed at stimulating learner interest and engagement are paramount for fostering more effective educational outcomes. Nevertheless, offering a meticulously planned and structured program that ensures the comprehensive coverage of the subject matter is also important. This approach not only promotes the depth and breadth of knowledge acquisition but also fosters a learning environment conducive to optimal student engagement and achievement.