Residential training, that is, standardized training for resident physicians. In order to further improve the clinical practice ability of young doctors, medical students need to spend 3 years to carry out clinical training after graduating from undergraduate.
In the past three years, they need to go to eligible residential training bases (most of which are top three hospitals) to conduct practical training to improve clinical capabilities and improve their clinical diagnosis and treatment level faster.
This medical education system, which originated in Germany and matured in the United States, was transferred from pilot to national promotion in China in 2014, with the purpose of using the advantages of abundant medical resources and teaching resources in the residential training base, the higher level of doctor diagnosis and treatment, and the strong teaching team, so that young medical graduates can quickly improve the level of medical services in a relatively short period of time through systematic, standardized and strict clinical training at the beginning of their careers, and continuously narrow the gap between the medical level between the east, the middle and the west, and between urban and rural areas.
However, in the actual implementation process, the housing and training system also faces some difficulties, including the problem of "whether the talents sent out by the president of the county-level hospital can still come back".
Some people believe that county-level hospitals send employees out to participate in residential training, and once they "grow up", they will choose to quit their original unit jobs, and "find another high branch", and there is a risk of brain drain in county-level hospitals.
Is this really the case? The health community interviewed the administrators of several county-level hospitals.
County Hospital Administrator: Too small to look at us
"Undergraduates who work in county hospitals for one year, do they participate in residential training or resign from graduate school?"
Young doctors who have just joined the company are particularly hesitant and confused about life choices, and there are many such workplace confusions on social platforms.
Such a statement is not uncommon: the county hospital entrusts employees to the training base, bears their basic salary, social security and various subsidies, and hopes that they can bring back real talents and practical learning to help the hospital construction.
However, a few eye-opening employees are no longer willing to commit themselves to the county hospital, not hesitate to pay liquidated damages, but also to "find another high branch", in the end, the hospital is "bamboo basket to hit the water empty".
As a manager of a county hospital, Sun Qingcai, secretary of the party committee of Surabaya County People's Hospital in Jining City, has been dealing with residential training for many years and has a front-line interpretation of the operation of the residential training system in county hospitals.
"Only after the doctor is sent out and after the residential training can he better improve his clinical ability, and can also help him smoothly promote the title, if he does not participate in the residential training, in the future, both the hospital and the individual doctor will lack competitiveness, so it is necessary to live in training." Sun Qingcai told the health community.
In response to the statement that "county hospital employees jumped to the top three after participating in the residency training", Sun Qingcai said: "It is too small to look at us (county-level hospitals)!"
In his view, the flow of talents is a normal social phenomenon, the "two eight principle" is a natural law, "hospital managers should relax their hearts a little, can not because one or two people want to go, we will not promote the residential training, residential training for our doctors to improve the level of clinical practice, everyone can see, as long as the majority of come back, we are victorious!" 」
In recent years, jining first people's hospital has been responsible for the work of hospitals in Surabaya County. As a residential training base, Tang Changdong, general secretary of the surgical party branch of the hospital, told the health community that the problem of residential training should be viewed dialectically. The original intention of residential training is to give full play to the advantages of high-quality medical resources and teachers of higher-level medical and health institutions, strengthen the standardized training of clinicians in grass-roots hospitals, and further enhance the medical service capabilities of county-level medical institutions.
The phenomenon of "going out and not coming back" is a natural ending in many cases. This is not a matter of "grabbing people", but a problem of "consensuality and free love", which is in line with the general trend of talent flow.
"When the country did not implement the residential training system, there was also a brain drain in primary medical and health institutions. The free flow of talent is not a bad thing, there is no need to restrict or make a fuss." Tang Changdong said.
Speaking of residential training, Sun Qingcai staged the "true incense" scene and expressed full recognition of the residential training system: "The ability of doctors who have returned from residential training has been improved, because the 3-year residential training will rotate in various departments and get full clinical practice, and the final residential training examination also puts forward higher requirements for them, so the work done by the employees who participated in the residential training is very beautiful after they return, and basically everyone can pick the beam!" 」
Before the establishment of the residential training system, Chinese medical students directly went to work in medical and health institutions at different levels after graduation, lacking standardized and standardized clinical practice ability training, and after a few years, the difference in the clinical level of doctors appeared, and the development of residential training just made up for this shortcoming.
County hospital administrators are not worried about brain drain, and there is a second reason: tertiary hospitals are also improving the starting point for talent recruitment. Sun Qingcai said: "Now many provincial and municipal hospitals have a doctorate, a master's degree is rare, and residents in county hospitals who want to stay are also facing great competitive pressure."
Also in favor of this is Wang Houming, president of the Tongliang District People's Hospital of Chongqing. Wang Houming confessed to the health community: "We are not worried that people who go out will not come back. Like a sieve, most people with good grades and strong abilities will stay in a better hospital when they graduate."
In his opinion, compared with other residents in the residential training base, the employees of the county hospital who go to the residential training are not much competitive.
Under the question posed by a 30-year-old county hospital resident pear who said that he wanted to go to graduate school, a comment elaborated: "I think it is completely unnecessary, after 3 years, maybe your academic qualifications will just meet the recruitment requirements of your hospital."
According to Sun Qingcai, at the Surabaya County Traditional Chinese Medicine Hospital where he previously worked, several batches of employees who have completed residential training have now all returned to the hospital.
The siege is down, and the attack is up
County hospitals have high tricks to retain people
While the brain drain problem doesn't seem to be on the head, county hospital administrators still need to plan ahead. In this case, the constraint is often the first method to be adopted.
"The hospital will bear the salary, social security, etc. of the participants in the residential training, so in this case, we will recover the cost of 3 years of residential training, the employee's salary plus bonus for 3 years, the pension insurance for 3 years and the penalty fee for 3 years, and sometimes the two sides will even go to court." Sun Qingcai said.
Of course, the siege is the bottom, the attack is the top, retaining talents needs more humanistic care, "playing the emotional card", Surabaya County People's Hospital "has a set".
When a young doctor comes to Surabaya County People's Hospital, his age, education, emotional status and other basic information will be mastered by the "Red Bride Association", Sun Qingcai introduced, "Red Bride Association" is set up to solve the personal problems of employees.
Since working in the hospital for more than 3 years, Sun Qingcai has basically not met an older single employee, he said, "Red Bride Model" is the hospital's inspiration by the residential training, not only to promote a pair of lovers, but also to stabilize the hospital's talent team.
Chen Ziyang, a general surgeon from a third-class hospital in southern Henan, also agrees with this method. In the early years, their hospital expanded to recruit many people, but later half of them "carried buckets and ran away". According to his observation, the common denominator of these people is that foreigners have no object and no family in the local area, while the other half of the people who stayed behind have found objects, bought houses, and "been trapped."
"Our leaders say that if we want to retain talent, we must solve the lifelong problem of talent. Our hospital trade union is very keen to network with all kinds of units." Netizen "boss" said that in the words of economics, it is called raising the cost of leaving. At the bottom, there is a comment: "True grounding... I do photodynamics, lasers, freeze cuts and ablation in the top three hospitals, and you let me go back to the county hospital to suck sputum, I'm afraid I don't think too much?" 」
After that, the netizen turned his head around: "Of course, if you send me another object and a house, in fact, I think it is not impossible to suck phlegm."
In addition to solving lifelong events, there are also hospitals that directly reward real money and silver, and the treatment of residents who have passed the training is higher than that of ordinary doctors, and the establishment and settlement fees are also many. When the residential training system was first implemented, the doctors who passed the residential training examination went to the county hospital to be fragrant, and the president said: "The residential training is equivalent to our hospital not using training, direct use, how good!" 」
Resident Peiling County Hospital "Troubled and Happy"
Training qualified residents is "happy" for improving the level of diagnosis and treatment in county hospitals, and "troubles" are real. Sun Qingcai summed up this state as "worrying and being happy."
It takes 3 years to live in training, which is a county hospital that is already tightly staffed, and the more people participate in the residential training, the more it will affect the daily work of some departments. Sun Qingcai said that they will have their own considerations when choosing residential training personnel, "trying to ensure the normal operation of the department."
As a national-level residential training base, the Affiliated Hospital of Ningbo University School of Medicine provides a solution to the above pain points. Liu Lin, secretary of the party committee of the hospital, said: "If the cooperative unit comes to live in Pei, they will send people, and we will also send people down." Because while we are cooperating, we are also helping these secondary hospitals, which are actually complementary."
Liu Lin has always advocated the construction of a regionalized medical group with the top three hospitals as the leader and covering several secondary hospitals, implementing hierarchical diagnosis and treatment internally, and personnel can also flow up and down.
There is a reward for paying, and people can go up, which is the result that the county hospital expects. Sun Qingcai recalled that when the Surabaya County Hospital of Traditional Chinese Medicine said that "to overcome all difficulties, we must also support everyone to live in the training", and the conditions of the Surabaya City Traditional Chinese Medicine Hospital were poor, so when a group of eight or nine employees who participated in the training all returned, the most excited was the president.
Sun Qingcai recalled that at that time, the picture was vividly remembered, and the then president of Surabaya County Hospital of Traditional Chinese Medicine excitedly said to him: "You see, the 'money' we sent out has returned, I have divided the department into two, and our talents have a place to play!"
"Direct access" is the most important feature of residents by hospital administrators.
Feeling the stones to cross the river, we need to give Sumipei some time
On September 27, 2021, Liu Jin, one of the initiators of China's residential training system and director of the Anesthesia Surgery Center of West China Hospital of Sichuan University, donated 100 million yuan to the West China Hospital Housing And Training Fund on his 65th birthday, hoping that West China Hospital would better carry out the work of residential training.
Liu Jin's move has caused a sensation in the medical community, and has once again placed the residential training system at the top of public opinion. Admiration and cursing followed, and the focus of the debate was the controversial education that had been discussed for 20 years.
All along, there has been no shortage of doubts about the residential training in the industry, mainly focusing on the problems of too long residence training time, large workload, low income, and low status, and there is a subtle connection between the three.
In the view of the health management department, 3 years of rotating in various departments of the hospital, seeing various cases, the opportunity is rare.
But when the ideal shines into reality, problems begin to appear.
Residents are so busy that sometimes they can't even squeeze in time for meals. A doctor who had attended the residential training in West China Hospital said that he had to go to the hospital at 7:15 every morning, and sometimes it was almost 11 o'clock in the evening to the dormitory, and if he could eat on time one day, it meant that the effort was not enough.
In addition to busy work, the meager salaries offered by some training sites also make residents feel cold. Three years for medical students with five or eight years of schooling may mean that at the age of 30, when peers can already support themselves by work or even go to management, and they are still holding a meager salary of thousands of yuan.
According to the data disclosed by the Department of Science and Technology Education of the National Health Commission, the central government has established a regular subsidy mechanism for residential training according to the standard of 30,000 yuan per capita per year. Since 2014, the central government has invested more than 37 billion yuan to support zhupei, and more than 10 billion yuan has been invested in local finance.
According to Zhang Xin (pseudonym), who just finished training from Peking University People's Hospital this year, her monthly salary was about 3,000 yuan in the first year of residential training, and then increased year by year, and her salary reached more than 5,000 yuan in the third year. In addition, at the department level, there will be corresponding subsidies for her. This is due to the fact that the wage distribution method implemented by Peking University People's Hospital is "equal pay for equal work, more work and more income".
Cheng Nansheng, vice president of West China Hospital, also suggested that the distribution of China's medical resources is uneven, and the level of teachers and teachers is uneven, and the national unified teacher selection, training, assessment standards and teaching standards should be further improved to achieve the homogenization of teachers in various training bases.
From top to bottom, the housing training system has been constantly improving, the solution of pain points must not be achieved overnight, while caring for the collective wisdom and efforts of the predecessors of the housing training, we may need to give this new system a little time.
Sources | the health community
The author | Luo Tianyi
Resources:
Southern Weekend Anesthesiologist's Long War: a $100 million donation with two decades of controversial educational experiments
https://www.toutiao.com/i7029238991895396895/?group_id=7029238991895396895
People's Daily Establish a complete residential training guarantee system to train high-quality clinicians
https://share.gmw.cn/politics/2021-12/03/content_35356348.htm
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