Keywords
Generalist Surgeon
Rural Health
Competency-Based Medical Education
Emergency Response
China Health Reform
Categories
How to Cite
Abstract
Background Strengthening the capacity of primary care is central to China’s ongoing reform toward hierarchical service delivery and county medical alliances. Although community programs for chronic disease management have matured, significant gaps remain in acute, trauma, and surgical response at the grassroots level. This paper outlines a practical pathway for cultivating first-response generalist surgeons—physicians able to stabilize patients, perform essential procedures within a defined scope, and support safe referral in resource-limited contexts.
Methods The paper draws on a narrative-informed and policy-grounded perspective, combining first-hand clinical experience, national health strategies, WHO guidance on surgical capacity, and the principles of competency-based medical education (CBME). International rural generalist programs in Australia, Canada, and the United States are reviewed to inform the proposed framework.
Results A four-stage training model is proposed:(1) early exposure to emergency and procedural skills at the undergraduate level, (2) standardized residency focusing on stabilization and essential surgical competencies, (3) county-level rotations for trauma and emergency immersion, and (4) continued tele-supervision and quality assurance. The framework identifies three layers of core competence—rapid emergency recognition and stabilization, basic surgical and pre-transfer management, and long-term postoperative follow-up—supplemented by modules specific to China’s system, such as county-level referral coordination and AI-assisted remote support.
Conclusion Cultivating first-response generalist surgeons represents both a policy-aligned and ethically responsible approach to strengthening China’s primary healthcare. The model underscores scope discipline, teamwork, and moral humility—emphasizing not only knowledge, but the readiness to act where life first calls for help.
References
[1] Meara, John G., Leather, Andrew J. M., Hagander, Lars, Alkire, Blake C., Alonso, Nivaldo, Ameh, Emmanuel A., … Yip, Winnie. 2015. “Global Surgery 2030: Evidence and Solutions for Achieving Health, Welfare, and Economic Development.” Lancet 386(9993): 569–624.
[2] Kornelsen, Jude, Geller, Brian, Janke, Fred, Iglesias, Stuart. 2018. “Learners’ Experiences of an Enhanced Surgical Skills Training Program for Family Physicians.” Canadian Medical Education Journal 9(4): e46–e58.
[3] Ten Cate, Olle. 2017. “Competency-based Postgraduate Medical Education: Past, Present and Future.” GMS Journal for Medical Education 34(5): Doc69.
[4] Charon, Rita. 2001. “Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust.” JAMA 286(15): 1897–1902.
[5] Hafferty, Frederic W., & Castellani, Brian. 2010. “The Increasing Complexities of Professionalism.” Academic Medicine 85(2): 288–301.
[6] Greenhalgh, Trisha, & Papoutsi, Christina. 2018. “Studying Complexity in Health Services Research: Desperately Seeking an Overdue Paradigm Shift.” BMC Medicine 16(1): 95.
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