An Assessment Research on Consultation Competence of RTME graduates Trained via the“5+3”Pathway in Township Health Centers in Guangxi Zhuang Autonomous Region postprint

Abstract: Background  Rural-oriented Free Tuition Medical Education（RTME）program is a key policy in China aiming to relieve general practitioner（GP）deficiency in rural areas and to enhance effectively competence trainings of rural primary health care workforce. However，its long-term effects of competence cultivation have not been examined soundly. Objective  The research，via evaluating consultation competence of RTME graduates trained by the "5+3" pathway in real rural township health center settings in Guangxi Zhuang Autonomous Region，aimed to examine reliably effects of RTME upon talent competence cultivation and to provide optimization strategies for enhancing competence trainings of rural primary health care workforce. Methods  From July to August，2023，the research，by combining stratified sampling with cluster sampling，included 75 RTME graduates as the study group who were working in township health centers amid four cities in Guangxi Zhuang Autonomous Region，as referenced to Nanning，Wuzhou，Guigang，and Chongzuo，and 41 GPs and assistant GPs as the control group who had not been trained by the "5+3" pathway and were working in the same township health centers as the study group. A total of 8 standardized patients（SPs）with qualified simulations had been sent to the sampled township health centers，visited all the subjects，and videoed the whole process of each encounter between subject and SP. Relevant experts were invited to evaluate subjects' performance in videotapes according to the assessment indicator system for consultation competency of GP developed in our previous study. Cumulative logits model was used to identify potential factors influencing consultation competence. Results  The study group showed significantly higher total score for domain 1-7 combined and for domain 1-6 combined as well as for any single dimension than the control group did. However，the score for the dimension of encountering and taking history，of patient management，of doctor behavior and relationship with patients，and of preventive care in the study group failed to pass and so did all the 7 dimensions in the control group. The consultation competence of subjects correlated with attendance of residency program，writing health record，academic degree，consultation duration，and location，and the consultation competence of RTME graduates with academic degree and writing health record. Conclusion  The RTME graduates trained via the "5+3" pathway displayed significantly higher consultation competence in practical rural primary healthcare settings than did local GPs and assistant GPs without the "5+3" cultivation，which suggests that the RTME program's long-term effects on competence cultivation have lived up to expectations. But，several measures，including sustainable implementation of RTME，reforming continuing medical education pattern in rural，enhancing trainings of basic clinical medicine knowledge and skills，amplifying undergraduate and postgraduate medical education with practices in rural primary health care settings，and emphasizing importance of writing health record，are needed to sustainably promote RTME graduates' clinical competence and to enhance competence cultivation of rural primary health care workforce.