China medical school and residency training

My husband and I recently traveled to Wuhan Medical School in the Hubei Province in central China.

Our medical school has partnered with Wuhan to help inform their curricular reform efforts. We spent 4 days touring the hospitals and teaching facilities, meeting students and faculty, going on rounds, and giving talks. Although the language barrier was challenging, we had incredible translators who worked to translate every slide we spoke into Chinese. We also had the opportunity to observe and talk to students, residents, and faculty through translators to better understand their experiences.

Preclinical student education

Interestingly, the preclinical students told me they watch Grey’s Anatomy and House, MD and wonder if that is what medicine is like. I told them that US medical students and premeds have wondered that too! And just like our preclinical students, these students are very excited to get to the wards and desire earlier exposure to patient care. Fortunately, Wuhan has already started instituting reforms for a pilot group of preclinical students through a more integrated block style curriculum that focuses on incorporating clinical medicine into the preclinical teaching. They also have state of the art simulation to help students practice clinical medicine. As one attending said, “the book is book, but practice is practice.”

One big difference is that Chinese medical students are a lot younger — starting right after high school and have little understanding about a medical career. A standardized national exam in high school dictates whether students will get to go to medical school. The default pathway for students that don’t get into medical school is often nursing school. Therefore, many of the nursing students are disengaged.

Once in medical school, the standard pathway is the 5 year option, with smaller 7 and 8 year options for select few who desire more clinical training and research. Wuhan also has a foreign medical student population that include students from India, Canada, Africa and even the U.S. who spend 4 hours a day studying Chinese on top of their preclinical studies so they can eventually interact with Chinese patients. And yes, they don’t have Facebook or Twitter and use Baidu instead of Google.

Rounds and clinical rotations

Probably the most fascinating part of our trip was observing teaching rounds in 2 Chinese hospitals. The patients were three to a room and were wearing their own clothes instead of gowns. It is cold in the hospital since the buildings are not heated (I was wearing my winter coat the whole time). In both hospitals we were in, the clinical students did not ‘follow’ patients but worked as a group (4 to 5) with one attending physician to see all the patients.

Through the long streams of Chinese, we could make out the terms “COPD” in a lung ward or “Framingham” when observing a cardiologist teaching medical students. Students who were thirsty for clinical teaching were furiously taking notes in little books. The familiar tradition of the attending ‘pimping’ the students was also observed. Students did not ask a lot of questions, which is consistent with more of the passive learning style documented in Chinese medical education — one thing that Wuhan very much wants to reform.

Students were also carrying all the charts for the rounds and expected to do other clerical tasks. When I explained the term ‘scut work’ to our Chinese medical student translator, she told me that this work is actually part of their ‘cooperation score’ on the evaluation symbolizing teamwork.

Residency and clinical practice

There is currently no required residency training but formal residency training is on the verge of starting across China. Currently, some graduating medical students will do an internship at the hospital underneath a senior doctor. One of the interns we met with said that she lives at the hospital (in a dorm) working 6 days a week with one day off working roughly 70-80 hours per week taking overnight call once a week.

Since not every department has an intern every year, the attendings sometimes have to take call weekly too. As a result, the doctors we met with reported being fatigued and burned out and wondering how to balance work and life (sound familiar?). And lastly, as described in several articles in a recent issue of Academic Medicine in the US, there is also a major shortage of Chinese doctors in rural areas since everyone wants to live in urban areas.

Even though we were there to teach, we ended up learning that we had a lot in common.

A special thank you to all of our hosts at Wuhan Medical School who went above and beyond to make us feel welcome!

Vineet Arora is an internal medicine physician who blogs at FutureDocs.

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  • ninguem

    And you can go to the anatomy lab and visit the Chinese athletes that didn’t make the Bronze at the Beijing olympics.

  • http://ilookchina.net Lloyd Lofthouse

    My wife is Chinese and has experienced first-hand medical care during Mao’s Cultural Revolution and medical care in China today. The gap is huge, but at least Mao did attempt to provide medical care for rural Chinese through his “Bare Foot Doctor” program, which I talked about in a post on iLookChina.net (http://wp.me/pN4pY-br).

    My wife told me that anyone who wanted to be a doctor could be. Mao told the people if this is something you have a passion for, let nothing stop you. Then the applicants watched a few films and were given some printed information before being sent into the countryside or return to their village to provide crude medical care.

    Today, medical care in China is a cash only system. Several years ago, we took some friends to China. We warned them not to eat food from a street vender so one night when we were not with them, they went into a donut shop and bought chocolate-coated donuts. The next day Neil was throwing up and had severe diarrhea. My wife and I went with him to the closest Shanghai hospital where he spent the day on an IV. He had a variety of tests. There was more than one doctor and nurses. Several hours after admission, Neil was sent back to the hotel to recover and the total cost was $50. In America, emergency care like that would probably cost several thousand.
    I’ve read that the central government has promised rural Chinese basic medical care clinics near their villages in the next few years and a new national health plan has been or soon will be implemented so everyone has some form of health care in China.

    There’s another similarity in China to America. Members of the Communist Party have the best health care plan in China just like Congressional Representatives and Senators in Washington DC, who voted themselves the best lifetime health care plan in America. They also get to vote for their raises. I often wonder how much China is learning from America.

  • BobBapaso

    A good example of how a cash only system can keep costs low. If we all had health care savings accounts, we could do the same thing.

  • Marilyn Blundin

    What a wonderful perspective. Thanks for this writing. Seems that slave labor is the same world wide. So is burn out. I don’t find these elements a positive contribution to medical education or humanity for that matter.
    About the cold Hospital….I notice here (Italy) that windows and doors are left open for the air. Air is on the highest recommendations to eliminate infection. Now this is something that US can think about. As for the gowns….this too is of personal attention here….we wear our own until it’s time to go to OR. We bring our linen for the shower and bathroom….I prefer it. There are many things in US medical organization that deserve the question “why” in terms of “added value”.