Demand oriented improvement based on education of rural grassroots doctors training system in Jiangsu Province

Abstract

Primary healthcare is related to the fairness of health, and the quality at the primary level determines to what extent primary healthcare can be fully utilized. This study aimed to improve the existing training system for rural grassroots doctors, starting by exploring the educational needs of rural primary healthcare, as the phase 1 section of this study. Utilizing a mixed-methods approach, the research investigates the perspectives of key stakeholders in grassroots healthcare (rural inhabitants, grassroots doctors, and township hospital directors) through both quantitative and qualitative research.

For a number of 203 rural inhabitants’ research objective, the study primarily employs quantitative methods to assess their views on grassroots healthcare and doctors’ roles, revealing several key findings: 86.7% of inhabitants utilize grassroots medical services, and 60.1% place greater importance on the medical experience of rural doctors. Approximately 55.7% believe that grassroots doctors play a partial role in health maintenance, but they rate their medical professionalism and treatment effectiveness as low. Furthermore, 64.5% of inhabitants feel that the service capabilities of grassroots doctors need improvement. In the eyes of rural inhabitants, primary healthcare mainly encompasses diagnosis and treatment, health education, physical examinations, and doctor-patient communication.

For grassroots doctors, the study first gathers broad perspectives on their educational needs through quantitative methods. Key findings from this quantitative research indicate that in self-assessments, doctors rated their research and clinical skills as the lowest, with fewer than half having received standardized clinical training. They consider disease diagnosis and treatment, as well as emergency care, to be crucial throughout their medical education. Therefore, there is a need to emphasize certain courses, including communication and psychology in humanities, anatomy and pathology in foundational courses, epidemiology and health education in public health, and diagnostics and internal medicine in clinical courses.

This study conducts qualitative research on grassroots doctors and township hospital directors to explore the educational needs in grassroots healthcare. Findings regarding the needs of directors and doctors indicate that improvements are required across all stages of medical education (including school education, clinical practice, and continuing education), as well as in educational methods. Moreover, the previously overlooked importance of medical humanities was mentioned, particularly in enhancing medical students’ doctor-patient communication skills, proactive engagement in their work and studies, and their sense of responsibility and values.

The conclusions from the first phase were transformed into the question of "how to enhance students' empathy and professional identity through diverse teaching methods." Based on this question, two cycles of action research was initiated. In every cycle, over a six-week intervention period, data was collected from student film reviews, course evaluations, and teachers' reflective diaries. The results showed that in circle 1, students' emotional empathy was 16% higher than that of the non-intervention group, cognitive empathy was 33.7% higher, professional beliefs were 40% higher, and professional confidence was 28% higher; in circle 2, students' emotional empathy was 18.7% higher than that of the non-intervention group, cognitive empathy was 15.7% higher, professional beliefs were 61.4% higher, and professional confidence was 54.7% higher, which demonstrated that the revised intervention plan still significantly improved medical students' empathy and professional identity.

In conclusion, this study found that the rural inhabitants want a functional primary health care which highlights rural grassroots doctors clinical skills. The demands from rural grassroots doctors and township hospitals for medical education are enhance basic medical knowledge teaching, strengthen clinical practice ,offer flexible further medical education; increase the Increase the content of medical humanities education and improve the teaching methods. Through action research, integrating narrative medicine and professional identity education with medical curricula using diverse teaching methods can enhance medical students' empathy and professional identity.

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