Ministry revamps medical education

China is to upgrade the education and training of doctors and medical practitioners who serve rural areas, to include a period of on-the-job training and move towards world-class medical education, as the population demands more and higher quality health care.

A new medical education system announced by the education ministry this week sets out a 10-year programme to improve medical students’ clinical practice. It will require students to go through a two- or three-year formal residency (medical internship) and training in medical ethics before they can qualify to become doctors.

In rural areas, as part of their training students will be required to assist general medical practitioners.

Currently, the majority of China’s medical students go straight to work as practitioners after graduation, so that the quality of their practical training is highly dependent on individual hospitals or rural medical mentors, with no uniform system for training in place across the country.

According to the official Xinhua news agency the government has made efforts to standardise medical education by publishing national standards on clinical medicine education and by increasing cooperation between domestic medical schools and overseas institutions to learn better teaching methods.

But there is still no accreditation system for surgery and medical specialisms, making standards highly variable across the country.

In addition, rapid expansion of medical education in the past 10-15 years has compromised quality and made it more difficult for medical graduates to find jobs in preferred cities, making medicine a less sought-after career for young people.

Ministry figures show that enrolment into higher medical education increased six-fold from 75,000 in 1998 to almost 450,000 in 2008, and to 600,000 by 2011.

According to some reports, student-teacher ratios in medicine rose from 7:1 in the late 1990s to around 20:1 a decade later. Medical school teachers, speaking anonymously, say anatomy had to be taught through multimedia rather than students learning by dissecting cadavers.

Meanwhile the national admissions scores for medical students have been declining as medicine becomes a less sought-after profession due to low salaries, long hours and tensions with patients’ families that can often turn violent.

A large number of students drop out before completing their courses and many junior doctors prefer to work for international pharmaceutical companies or research establishments rather than becoming practitioners.

Li Ling, a professor at the National Development Research Institute of Beijing University and an expert in China’s medical reform told local media that out of the 600,000 medical students that are trained each year, only some 100,000 actually become doctors.

Currently, undergraduate medical education in China is overwhelmingly theoretical, while the focus of advanced medical training has been to produce medical researchers rather than practitioners.

Academics in Hong Kong who have worked in medical schools in mainland China said residency training has been piloted in a number of hospitals in recent years in preparation for it being rolled out across China.

Some 125 universities in China have been designated as the first batch of institutions to train medical students under the new scheme, some of them in collaboration with teaching hospitals, the ministry said.

Medical degrees can last from five years for a bachelor degree to eight years for an MD. The shorter degrees are for rural primary care practitioners.