Medical resident training in China

Medical education is key for the successful development of a health system in a country.1 In China, medical education starts after high school and varies from three to six years at the undergraduate level, followed by additional years at the graduate level. In most medical universities in China, the undergraduate curriculum comprises four years of basic courses and clinical sciences, followed by one year of a clinical internship. The internship involves rotations in various departments; each rotation lasts for a couple of months. After graduation, most of the graduates who get jobs in hospitals or clinics will work as resident physicians for a specified period. During this period, they learn from experienced physicians, further develop their knowledge and skills, and get familiar with the working environment. This period is termed resident training. Medical resident training is internationally recognized as a continuing medical education process, aiming to cultivate the ability of novice physicians to work independently. Training of the residents is thus crucial to the quality and development of medical services.2-4 In China, the resident training program has experienced necessary changes in the past few decades to cope with the drastic increase in people's needs of high-quality medical services as well as the rapid development of medical science and technology. Given the fact that the world today is increasingly globalized and local health care resources have to address the needs of not only residents but also immigrants and visitors from other parts of the world, it is valuable to introduce medical resident training in China to an international audience. In this way, the rest of the world may develop some understanding of our situation, and at the same time, we can learn from their feedback to further improve our programs. To our knowledge, there are few articles regarding Chinese medical resident training. This article provides an overview of the development of the training programs in China with a purpose to raise attention and elicit opinions from international medical and educational professionals. Resident training in the past The emergence of medical resident training in China dates back to the early 1920s. Peking Union Medical College Hospital, one of the early medical colleges in China, set up the first residency program in China in 1921.5 However, the development of a residency program did not go off smoothly. Before the establishment of the People's Republic of China in 1949, medical education in the country remarkably lacked due to the chaos and poverty caused by wars.6 After 1949, the medical education system was gradually taking shape. However, the Cultural Revolution from 1966 to 1976, a decade of internal turmoil, disrupted the normal function of medical institutions and resulted in essential and nationwide cease of medical education.7 A new historical era was ushered in after the end of the Cultural Revolution. In 1979, the Ministry of Health (MOH) issued the Trial Assessment of Resident Training in Hospitals Affiliated to Medical Colleges. Since then, resident training has been officially acknowledged and institutionalized. Some areas were selected for the trial of the training system. The affiliated hospitals of some medical colleges in these areas set up training programs which aimed to equip medical graduates with specialized knowledge in the field of clinical medicine. The trials were performed only in hospitals affiliated to medical colleges but not in other types of hospitals. Also, the resident training for becoming a clinical doctor was abbreviated and neglected. In 1993, MOH reorganized and issued the Trial Measures for Standardized Resident Training of Clinical Residents. Since then, all second-level grade-A hospitals and third-level hospitals set up resident training programs under the MOH guidelines. The primary objective of the programs, in this period, was to provide continuing education that turned medical graduates into qualified clinical physicians. One prominent characteristic of this period is that resident training in different hospitals varied considerably. Not every hospital provided a training program. Hospitals that ranked higher usually offered more and better training opportunities. There was not yet a unified standard for resident training and evaluation at the national level. In this situation, the continuing education of medical graduates relied largely on what hospitals they worked with. If a graduate was employed by a high-level hospital, he would be likely to receive comprehensive and organized training at the position of a resident physician, which would help significantly in his development of professional knowledge and skills. In contrast, those in hospitals where a well-organized residency program was not available would have no such chances and have to rely on the experience learned at college or through an internship. This means that graduates who had gone through the same or similar curriculum at college might develop very differently in their post-graduation professions due to the differences between the hospitals where they worked. This difference might further influence the balance in the distribution of medical resources and the quality of health service as a whole.