The "Dragon" is awaking. Part 2 – Recent reforms in medical education in China

El "Dragón" se está despertando. Parte 2 – Reformas recientes en la educación médica en China

Profesor Andrzej Wojtczak MD., PhD

The medical education of doctors in China is carried out in the Medical Colleges or Faculties, which enroll graduates of the high-schools. There are two categories of programs: a certificate-oriented 3-year program, and a degree-oriented 5, 7 and 8 years programs. Among 185 Medical Institutions, 9 runs 8 year program resulting in MD degree, 43 - 7 year program of Master in Medicine, 15 runs 5-year program of Bachelor in Medicine, and 20 a certificate-oriented 3 year program of Associate in Medicine. Diversity of educational programs is focused on different national, regional and local needs. The 5 year program will be a most popular format for a long time, and 3-year one will be disappearing.

Since year 2000, 63 medical schools have been merged into the "Comprehensive Universities" among them 10 of 11 medical institutions that previously reported to the Ministry of Health. All of them now report directly or indirectly to the Ministry of Education, except the Peking Union Medical College (PUMC) which still reports to the Ministry of Health. However, the specific character of medical education and requirements in these "Comprehensive Universities" are too often not adequately recognized i.e. separation of the Medical Colleges from the Teaching Hospitals. The rapid expansion of students' enrollment, especially at local medical schools, without adequate compensation with human and financial resources and hospital facilities, can undermine the quality of education. Time is needed to evaluate the effects of these "mergers" on medical schools.

The most medical schools still continue the traditional "teacher-centered" curriculum, overcrowded with lecture hours and overemphasis on teaching and examinations, resulting in a passive students' learning attitude. However, in the past two decades, in the leading medical schools, many curriculum innovations were carried out. These schools have made efforts to incorporate into their curriculum integrated teaching principles, courses in humanities, ethics and society, informatics and computer sciences, knowledge of English. They also have focused on small group tutorials, problem solving skills, doctor-patient relationship and life-long learning attitudes. The present challenge for both, the government and the medical schools is an improvement of the quality of medical education to train qualified personnel who can adapt to rapidly changing medical practice and needs of Chinese people.

The Chinese Ministry of Education has been fully committed to use the best available expertise and international standards, from outside of the country, to enhance the academic and professional excellence of educational institutions. The best example of that was the invitation, of the Ministry of Education extended to the Institute for International Medical Education (IIME), to administer, in eight leading medical schools, assessment of graduates' competences envisaged in the Global Minimum Essential Requirements (GMER) document. The examination was followed by the process of defining international standards at the student-level and school-level. It has permitted to prepare the detailed reports on performances of individual students and each school and to hand them. The summary report on aggregated strengths, borderline areas and areas needing improvement of all eight schools together, which constitute a blueprint for medical education reform in China, was presented to the Minister of Education. The "GMER" evaluation process has left also a group of well-trained medical educators in each site who can continue to assess students by using international-quality tools. As the result of all of that, a significant acceleration of outcome-oriented reforms, in increasing number of medical schools in China, has taking place. (End of an article)