Primary care workforce and continuous medical education in China: Lessons to learn from a nationwide cross-sectional survey

Objectives: This study aimed to examine the education and training background of Chinese community health centres (CHCs) staff, continuous medical education (CME) and factors affecting participation in CME. Design: Cross-sectional survey. Setting: Community health centres (CHCs). Participants: All doctors and nurses working in selected CHCs (excluding those solely practising traditional Chinese Medicine). Main outcome measures: CME recorded by CHCs and self-reported CME participation. Methods: A stratified random sample of CHCs based on geographical distribution and 2:1 urban-suburban ratio was selected covering three major regions of China. Two questionnaires, one for lead clinicians and another for frontline health professionals, were administered between September-December 2015, covering the demographics of clinic staff, staff training and CME activities. Results: 149 lead clinicians (response rate 79%) and 1734 doctors and 1846 nurses completed the survey (response rate 86%). Of the doctors, 54.5% had a bachelor degree and only 47% were registered as general practitioners (GPs). Among the doctors, 10.5% carried senior titles. Few nurses (4.6%) had training in primary care. Those who have reported participating in CME were 91.6% doctors and 89.2% nurses. CME participation in doctors was more commonly reported by older doctors, females, those who were registered as a GP and those with intermediate or senior job titles. CME participation in nurses was more common among those with a bachelor degree or intermediate/senior job titles or those with longer working experience in the CHC. Conclusion: Only half of doctors have bachelor degrees or are registered as GPs as their prime registration in the primary care workforce in China. The vast majority of CHC staff participated in CME but there is room for improvement in how CME is organised.