Medical education in China for the 21st century

Traditional Chinese Medicine: Communicating Informational and Symbolic Functions in the Linguistic Landscape

While dissemination of information is a key function of health communication, signage at medical facilities has other functions: signs can be a type of marketing (e.g., services offered), can promote credibility and inspire trust, can exacerbate or ameliorate social inequalities and can provide educational opportunities. All of these functions are influenced by cultural, contextual and social factors as evidenced by a linguistic landscape (LL) perspective. Traditional Chinese medicine (TCM) is a particularly instructive case for considering the functions of signage in healthcare LL as it has a strong cultural component from its historical Chinese roots, but its practice has been popularized around the globe in recent years. Given the role of TCM as a main or complementary medical treatment and healthcare option, this study investigates TCM LLs as sites of healthcare communication. Specifically, we analyze a set of 1,659 signs from two TCM hospitals in a multilingual, ethnic minority region of China as a case study which can be useful for healthcare providers when considering their own use of LL. We describe the way language and other sign features are used for informational, symbolic and other functions, showing how explicit communication channels as well as implicit ideological channels can impact healthcare communication. We discuss these findings in light of the need for healthcare communication which is sensitive to stakeholder needs.

Medical Education Systems in China: Development, Status, and Evaluation

Since 1949, China has made many changes to develop its medical education system and now has a complex array of medical degrees. The current system comprises a 3-year junior college medical program, 5-year medical bachelor's degree program, "5 + 3" medical master's degree program, and 8-year medical doctoral degree program; these programs each provide a different path to earning a medical degree. The advantages and drawbacks of such complexity are open to discussion. Since the government set a strategic goal of "Healthy China" in 2019, it has sought to increase the training capacity of its medical education system to establish a high-quality health service system. This article reviews medical education reform in China, discusses the current medical education system, and presents evaluations of medical education programs based on assessments by 1,025 participants (medical students and doctors) recruited from 31 provinces of China. These assessments were compiled via a multicenter self-reported questionnaire administered July 1 to 5, 2021. Participants were training for a medical degree or practicing doctors trained in the 5-year program, "5 + 3" program, 8-year program, or "4 + 4" program. The authors assessed the medical education system to which each of the participants belong and their career stage and career satisfaction, and they requested that participants name the 3 most promising programs. The 8-year program ranked first in work satisfaction (7.92/10), education program satisfaction (7.78/10), and potential (1.91/2). Scores of the 5-year program and "5 + 3" programs were 7.25 and 7.17 for system satisfaction, respectively, and the "4 + 4" program (7.00/10) ranked the next highest. The innovations that have occurred in the Chinese medical education system have offered opportunities to meet the needs of more patients, but the lack of consistency has also posed challenges. Currently, Chinese medical education is becoming more uniform and standardized.

Exploring the situational motivation of medical students through clinical medicine level test: a cross-sectional study

China's Clinical Medicine Level Test (CMLT) was designed to evaluate the key factors that affect the learning outcome of medical students prior to entering clinical practice. In this study, we systemically analyzed the performance of a cohort of medical students at Jinan University School of Medicine participating in the recent CMLT. The analytical results of the medical students' written and objective structured clinical examination (OSCE) scores showed that their academic performance was predominantly associated with students' internship allocations, although other demographic characteristics such as sex, age, geographical origin of students, and grade point average (GPA) might be sporadically related to the students' OSCE performance at different OSCE stations. To explore the inherent reasons behind this, a survey was implemented among the medical students who participated in the examination to further interpret the factors influencing the students' learning outcome. The findings of this questionnaire manifested that intrinsic motivation and identified regulation acted as the major motivational profiles for the medical students from three different internship sites, whereas external regulation emerged as the crucial factor to make the students perform well academically in the CMLT. The result of this study suggested that strengthening the quality control of the clinical learning environment and improving medical administration may still be the most effective approaches to ensure the quality of clinical medical education.

Medical students' perceptions and performance in an online regional anatomy course during the Covid-19 pandemic

The present study evaluated the students' psychological well-being, experiences, performance, and perception of learning regional anatomy remotely. A regional anatomy remote learning curriculum was designed and learning materials were delivered virtually to 120 undergraduate medical students at Jinan University, China. All the students consented and voluntarily participated in this study by completing self-administered online questionnaires including the Zung's Self-Rating Anxiety and Depression Scales at the beginning and end of the learning session. A subset participated in focus group discussions. Most of the students (90.0%) positively evaluated the current distance learning model. More than 80% were satisfied with the content arrangement and coverage. Many students preferred virtual lectures (68.2%) and videos showing dissections (70.6%) during the distance learning sessions. However, writing laboratory reports and case-based learning were the least preferred modes of learning as they were only preferred by 23.2% and 14.1% of the students, respectively. There was no significant lockdown-related anxiety or depression reported by students using depression and anxiety scales as well as feedback from focus group discussions. The surveyed students' confidence scores in distance learning were significantly higher after 5 weeks than at the beginning of the session (3.05 ± 0.83 vs. 3.70 ± 0.71, P < 0.05). Furthermore, the present results showed no significant differences between the current group's academic performance in the unit tests as well as the final overall evaluation for different parts of the course compared to that of the previous year's cohort. The findings above were congruent with focus group discussion data that the use of the online teaching platform for regional anatomy significantly improved the students' confidence in virtual and self-directed learning and did not negatively affect their academic performance.

Survey of Gross Anatomy Education in China: The Past and the Present

Medical education in mainland China has undergone massive expansion and reforms in the past decades. A nation-wide survey of the five-year clinical medicine programs aimed to examine the course hours, pedagogies, learning resources and teaching staff of anatomy both at present and over the past three decades (1990-1999, 2000-2009, and 2010-2018). The directors or senior teachers from 90 out of the 130 five-year clinical medicine programs were invited to fill out a factual questionnaire by email. Ultimately, sixty-five completed questionnaires were received from 65 different schools. It was found that the total number of gross anatomy course hours has decreased by 11% in the past 30 years and that systematic and regional anatomy have been increasingly taught separately among the surveyed medical schools. Problem-based learning has been adopted in thirty-five (54%) of the surveyed schools, and team-based learning is used in ten (15%) of the surveyed schools. The surveyed schools reported receiving more donated cadavers in recent years, with the average number increasing from 20.67 ± 20.29 in 2000-2009 to 36.10 ± 47.26 in 2010-2018. However, this has not resulted in a decrease in the number of students who needed to share one cadaver (11.85 ± 5.03 in 1990-1999 to 14.22 ± 5.0 in 2010-2018). A decreasing trend regarding the teacher-student ratio (1:25.5 in 2000-2009 to 1:33.2 in 2010-2018) was also reported. The survey demonstrated the historical changes in gross anatomy education in China over the past thirty years.

The multi-tiered medical education system and its influence on the health care market-China's Flexner Report

BACKGROUND

Medical education is critical and the first step to foster the competence of a physician. Unlike developed countries, China has been adopting a system of multi-tiered medical education to training physicians, which is featured by the provision of an alternative lower level of medical practitioners, or known as a feldsher system since the 1950s. This study aimed to illustrate the impact of multi-tiered medical education on both the equity in the delivery of health care services and the efficiency of the health care market.

METHODS

Based on both theoretical reasoning and empirical analysis, this paper documented evidence upon those impacts of the medical education system.

RESULTS

First, the geographic distribution of physicians in China is not uniform across physicians with different educational training. Second, we also find the evidence that high-educated doctors are more likely to be hired by larger hospitals, which in turn add the fuel to foster the hospital-center health care system in China as patients choose large hospitals to chase good doctors. Third, through the channels of adverse selection and moral hazard, the heterogeneity in medical education also imposes costs to the health care market in China.

DISCUSSION

Overall, the three-tiered medical education system in China is a standard policy trade-off between quantity and quality in training health care professionals. On the one hand, China gains the benefit of increasing the supply of health care professionals at lower costs. On the other hand, China pays the price for keeping a multi-tiered medical education in terms of increasing inequality and efficiency loss in the health care sector. Finally, we discuss the potential policy options for China to mitigate the negative impact of keeping a multi-tiered medical education on the performance of health care market.

The trend and features of physician workforce supply in China: after national medical licensing system reform

BACKGROUND

The annual number of newly licensed physicians is an important indicator of medical workforce supply, which can accurately reflect an inflow into the health care market over a period. In order to both regulate medical professions and improve the quality of health care services, China established its medical licensing system from the point of the implementation of 'Law on Practising Doctors' in 1999. The objective of this study is to depict the trend and structure of newly licensed physicians thereafter.

METHODS

This study analyses a unique census data set that provides the headcount of newly licensed physicians from 2005 to 2015 in China. We also review a short history of medical licensing system reform in China since the 1990s.

RESULTS

The annual number of first-time licensed physicians in China increased from 159 489 in 2005 to 221 639 in 2015. Up to 2015, over half of newly licensed physicians had not received a medical education equivalent to a bachelor degree or higher. Around 51% of China's newly licensed physicians were female in 2005, while the same ratio for females in 2015 was 56%.

CONCLUSION

This article first provides an exploratory analysis of physician inflow into health care market in China using physician licensing data. The medical licensing system in China allows entering physicians with a broad range of educational levels. Moreover, the feminisation of the physician supply in China has become increasingly apparent and its impacts on health care provision still require more rigorous examination.

How to overcome violence against Healthcare professionals, reduce medical disputes and ensure patient safety

BACKGROUND & OBJECTIVE

In recent years there have been many cases of violence against healthcare professionals (HCPs) in China leading to the death of some doctors as well as nurses by patient's relatives. Our objective was to identify the causative factors for these violent acts and address these isssues which is vital to ensure patient safety.

METHODS

A multidisciplinary research task force was formed to do a root cause analysis of the violent acts against the healthcare professionals. A flowchart was developed to identify the steps in the process and discover the potential links.

RESULTS

There are complex reasons behind the violence against HCPs. However, the main reasons were found to be poor quality of medical services and increased awareness of patients' rights and their willingness to knock at the doors of courts to seek justice. The feasible counter measures includes stimulating hospital directors to improve patient safety, aligning incentives with quality of service provided in healthcare facilities, monitoring educational quality of HCPs, making necessary changes in medical education programmes besides setting up a reasonable academic promotion mechanism for health professionals based on merit and competence.

CONCLUSION

Poor quality of medical services, increased awareness among patients about their rights has resulted in increase in medical disputes and at times violence against healthcare professionals. A number of effective measures can be undertaken by the government, hospitals, and medical schools ensuring patient safety. However, it is essential to sensitize the hospital directors to elevate their quality of medical services.

Factors Affecting Definitions of and Approaches to Integrative Medicine: A Mixed Methods Study Examining China's Integrative Medicine Development

Aim. This study identifies existing definitions and approaches among China's integrative medicine (IM) experts and examines relationships with key characteristics distinguishing individual experts. Methods. Snowball sampling was used to select 73 IM experts for semistructured interviews. In this mixed methods study, we first identified definitions and approaches through analyzing core statements. Four key factors, including age, education, practice type, and working environment, were then chosen to evaluate the associations with the definitions. Results. Four unique definitions were identified, including IM as a "new medicine" (D1), as a combination of western medicine (WM) and Chinese medicine (CM) (D2), as a modernization of CM (D3), and as a westernization of CM (D4). D4 was mostly supported by those working in WM organizations, while D3 was more prominent from individuals working in CM organizations (P = 0.00004). More than 64% clinicians had D2 while only 1 (5.9%) nonclinician had D2. Only 1 clinician (1.8%) had D4 while almost 30% nonclinicians had D4 (P = 0.0001). Among nonclinicians working in WM organizations, 83.3% of them had D4 (P = 0.001). Conclusion. Findings indicate that institutional structure and practice type are factors affecting IM approaches. These results carry implications for the ways in which western countries move forward with the definition and implementation of IM.

Transformation of the education of health professionals in China: progress and challenges

In this Review we examine the progress and challenges of China's ambitious 1998 reform of the world's largest health professional educational system. The reforms merged training institutions into universities and greatly expanded enrolment of health professionals. Positive achievements include an increase in the number of graduates to address human resources shortages, acceleration of production of diploma nurses to correct skill-mix imbalance, and priority for general practitioner training, especially of rural primary care workers. These developments have been accompanied by concerns: rapid expansion of the number of students without commensurate faculty strengthening, worries about dilution effect on quality, outdated curricular content, and ethical professionalism challenged by narrow technical training and growing admissions of students who did not express medicine as their first career choice. In this Review we underscore the importance of rebalance of the roles of health sciences institutions and government in educational policies and implementation. The imperative for reform is shown by a looming crisis of violence against health workers hypothesised as a result of many factors including deficient educational preparation and harmful profit-driven clinical practices.

Knowledge levels and training needs of disaster medicine among health professionals, medical students, and local residents in Shanghai, China

Background

Disaster is a serious public health issue. Health professionals and community residents are main players in disaster responses but their knowledge levels of disaster medicine are not readily available. This study aimed to evaluate knowledge levels and training needs of disaster medicine among potential disaster responders and presented a necessity to popularize disaster medicine education.

Methods

A self-reporting questionnaire survey on knowledge level and training needs of disaster medicine was conducted in Shanghai, China, in 2012. A total of randomly selected 547 health professionals, 456 medical students, and 1,526 local residents provided intact information. The total response rate was 93.7%.

Results

Overall, 1.3% of these participants have received systematic disaster medicine training. News media (87.1%) was the most common channel to acquire disaster medicine knowledge. Although health professionals were more knowledgeable than community residents, their knowledge structure of disaster medicine was not intact. Medical teachers were more knowledgeable than medical practitioners and health administrators (p = 0.002). Clinicians performed better than public health physicians (p<0.001), whereas public health students performed better than clinical medical students (p<0.001). In community residents, education background significantly affected the knowledge level on disaster medicine (p<0.001). Training needs of disaster medicine were generally high among the surveyed. ‘Lecture’ and ‘practical training’ were preferred teaching methods. The selected key and interested contents on disaster medicine training were similar between health professionals and medical students, while the priorities chosen by local residents were quite different from health professionals and medical students (p<0.001).

Conclusions

Traditional clinical-oriented medical education might lead to a huge gap between the knowledge level on disaster medicine and the current needs of disaster preparedness. Continuing medical education and public education plans on disaster medicine via media should be practice-oriented, and selectively applied to different populations and take the knowledge levels and training needs into consideration.

Medical education reform in wuhan university, china: a preliminary report of an international collaboration

BACKGROUND

In 2008 Wuhan University Medical School in China proposed to reform its curriculum by adapting the curriculum of the University of Chicago Medical School.

DESCRIPTION

An assessment of Wuhan University Medical School's traditional curriculum conducted in 2009 informed the reform directions, which included course integration, use of clinical cases, improved relevance of basic sciences to clinical medicine, reduction of lecture time, increase in group and independent learning, and the use of formative assessments. Fifty student volunteers per year were chosen to participate in the reform, and the rest remained in the traditional curriculum.

EVALUATION

A student survey was conducted in 2011 to evaluate the reform by comparing the attitudes of those in the reform and standard curricula.

CONCLUSIONS

The reform met the needs of the school, was generally well received, improved satisfaction in reform participants, and had a positive impact on students. Areas needing improvement were also identified.

A survey on financial support and research achievement of medical education research units in China

AIM

To investigate the current situation of financial support and research achievement of medical education research units in China.

METHODS

A total of 46 individuals in 46 medical schools completed a questionnaire including information about affiliation of the unit, financial support, published articles and achievement awards of the units.

RESULT

Of the 46 schools, 24 had independent medical education research units, 36 had financial support, and 30 had research funding. The mean number of published articles was 2.53 per staff. The mean number of achievement awards was 3.80 per unit. There was a significant difference in funding and published articles between independent medical education research units and other types of units; and in published articles and achievement awards between the units with funding and without funding.

CONCLUSION

The financial support from the school was the main source of medical education research units in China. More attention should be paid to the development of medical education research units, to their ability to produce high quality research and support the improvement of medical care in China.

A survey on the professional staff of medical education research units in China

BACKGROUND

Professional staff engaged in medical education research was important for enhancing the quality of medical education.

AIM

To look at the current condition of professional staff in medical education research units in China.

METHODS

A total of 46 related-to-insiders in 46 medical schools completed a questionnaire including the affiliation and mission and activities of the units, and the number and characteristics of the professional staff.

RESULTS

Of the 46 schools, 24 (52.2%) had independent medical education research units. Of the 170 staff in the 24 units (mean = 7.1), 43.5% achieved Bachelor's degree or less and 61.8% had senior-level title, 27.6% middle-level title, and 10.6% junior-level title. Of the 24 units, 4.2% did not have any full-time professional staff, 16.7% had 1-2 full-time professional staff, 4.1% did not have any professional staff achieved Master's degree and above, and 87.5% cited educational research, 70.8% program evaluation, 58.3% sponsoring journals 54.2% teaching, 45.8% teacher evaluation, 41.7% faculty development, and 33.3% student evaluation in their mission and activities statements.

CONCLUSION

The professional staff in medical education research units were insufficient in China. The composition of their education and professional title should be improved. The mission of the units was too narrow.

Medical education reform: the Asian experience

Medical education reform is taking place all over the world including Asia, which has 60% of the world's population. Confronted with diverse social and cultural needs as well as resource constraints, various regions in Asia have carried out medical education reform at different levels and directions. In this article, the authors describe the application of Western-inspired reforms and localization and adaptation of Western models to fit the cultural and community needs in the five different subregions of Asia: (1) Eastern Asia, (2) Southern Asia, (3) Southeastern Asia, (4) Central Asia, and (5) Western Asia. The article reviews whether the medical education reforms brought improvement to the medical curricula and effectively fulfilled the cultural and social needs of Asian countries. The authors also explore the establishment of medical education departments in many Asian medical schools and the incorporation of research findings into medical practice. Departments of medical education will facilitate localization and promote further development of medical education reform in Asia despite the challenges ahead.

Current perspectives on medical education in China

CONTEXT

China has a long tradition of education and medicine. However, limited economic conditions and a huge population mean that further development of medical education in China must be tailored to meet the country's needs.

OBJECTIVES

The aim of this paper is to describe current medical education practice in China with reference to the general and historical purposes of education in China and how they have affected and continue to affect student learning. Reference is also made to both Western medicine and traditional Chinese medicine.

METHODS

It is argued that traditional educational practices in China have encouraged rote learning and that creativity is not cultivated. This affects the way many Chinese students learn medicine. Since 1949, the Chinese medical education system has developed according to its own needs. The current system for training medical students is complex, with medical school curricula lasting 3-8 years. However, medical education reform is taking place and new teaching methods are being introduced in some schools.

DISCUSSION

Medical education is important to China's large population. The undergraduate medical education system is being streamlined and national standards are being established. Innovations in medical education have recently been encouraged and supported, including the adoption of problem-based learning. It is important that the momentum is kept up so that the health care of a fifth of the world's population is assured.

Clinicians and the governance of hospitals: A cross-cultural perspective on relations between profession and management

This paper explores similarities and differences in the value stances of clinicians and hospital managers in Australia, England, New Zealand and China, and provides some new insights into how we theorise about the health profession and its relations with management. The paper draws on data derived from a closed-ended questionnaire administered to 2637 hospital-based medical, nursing and managerial staff. We examine variations between the countries in the value orientations of doctors, nurses and managers by considering their assessments of issues that are the focus of reform. In particular, we examine the ways in which the Chinese findings differ from those of the other countries. Whereas the results from the Commonwealth hospitals showed a marked division between clinicians and managers about issues that can affect clinical autonomy, this was not the case in the Chinese hospitals. The concluding discussion traces these differences to a number of cultural, organisational and policy-based factors. The implications of our findings on how we conceive the relationship between professionals and organisations are then discussed, as are further lines of research.