Chengdu study finds public health training gap for GP residents

China's standardized "5 + 3" residency program was designed to build a stronger general practitioner workforce for primary healthcare institutions, with tertiary hospitals serving as the main teaching bases. A mixed-methods study evaluating this program across ten tertiary teaching hospitals in Chengdu found that residents reported relatively high overall competency, yet one domain lagged behind: public health service. The research, published in BMC Medical Education, surveyed 262 general practice residents and analyzed 70 open-ended responses to examine how training in large, specialized hospitals matches the preventive medicine and outpatient demands residents will later face in primary care.

The quantitative core of the study relied on the validated Competency Scale for General Practitioners in Primary Healthcare Institutions, which showed high internal consistency in this sample (Cronbach's α = 0.979). Residents rated their own abilities across five competency domains, yielding a mean overall self-reported score of 4.109 ± 0.695. The researchers found no statistically significant difference in overall scores across the ten training hospitals.

When the five domains were compared, however, scores differed: F(3.14, 818.06) = 40.79, p < .001, partial η² = 0.135. The Public Health Service domain recorded the lowest mean score at 3.884 ± 0.849 and scored lower than each of the other domains in adjusted pairwise comparisons. That gap relates to a structural mismatch at the heart of the training model.

Residents are trained mainly in specialized tertiary hospitals oriented toward inpatient care, while many will later work in primary care settings that emphasize preventive medicine and outpatient consultations. The qualitative strand of the study, based on thematic analysis of the open-ended responses, identified three themes that help interpret the numbers: limited alignment between tertiary hospital training and outpatient and public health needs; non-educational duties and unclear trainee roles; and limited financial incentives. The study also examined how residents' satisfaction with training related to their self-assessed abilities.

Training satisfaction was positively correlated with overall self-reported competency, Spearman's ρ = 0.508, 95% CI [0.402, 0.610], Holm-adjusted p < .001. The authors state that this association should not be interpreted as causal; the data alone cannot establish whether satisfaction drives perceived competency or the reverse. The researchers frame their conclusions with an important caveat: the scores reflect residents' perceptions rather than objectively assessed competence.

Self-reported competency scales capture how capable trainees believe themselves to be, which may differ from what external assessment would show. The findings carry implications for policy. The authors suggest that future reforms could consider standardizing primary care rotations, increasing supervised outpatient training, and reviewing remuneration mechanisms.

These suggestions correspond to the qualitative themes: the misalignment theme relates to outpatient exposure and standardized primary care rotations, while the financial incentives theme relates to how residents are paid. Quantitatively, the analysis used repeated-measures ANOVA, non-parametric tests, and Spearman's rank correlation, with Holm adjustment applied to control for multiple comparisons in the correlation analysis. The high Cronbach's α indicates that the competency scale measured a coherent construct in this sample.

The partial η² of 0.135 for domain differences quantifies the share of variance attributable to domain, alongside a statistically significant F test. For the broader question of whether training residents in tertiary, inpatient-centered hospitals prepares them for the preventive and outpatient realities of primary care, the Chengdu study offers a measured answer. Residents reported relatively high overall competency, but the domain most tied to primary care's public health mission scored lowest, and residents' own accounts attributed this to the settings in which they train, the duties they perform, and the pay they receive.

As China continues to strengthen its general practitioner workforce, the study's authors point to primary care rotations, supervised outpatient training, and remuneration as areas for future reform.

Subject of Research: Evaluation of general practice residency training programs in Chengdu, China

Article Title: Evaluation of general practice residency training programs in Chengdu, China: a mixed-methods study

Article References: Wang, X., An, K., Wang, J., Chen, R., Li, S., & Wang, F. (2026). Evaluation of general practice residency training programs in Chengdu, China: a mixed-methods study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10277-9

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10277-9

Keywords: general practice, residency training, primary care, public health, medical education, Chengdu, mixed methods, competency, China, tertiary hospitals, Evaluation, general