Liu Jin, director of the Anesthesia Center of West China Hospital, who was on the hot search for donating 100 million yuan to the West China Hospital of Sichuan University where he worked before retiring and setting up a residency training development fund, told a story:
In the 1990s, after graduating with a bachelor's degree, he worked at the Second Hospital of Huangshi in Hubei Province. Once, a local gas station caught fire, and the hospital treated 11 patients with burns in more than 70 percent. At that time, the hospital set up a temporary rescue ward for the wounded, with Liu Jin on duty alone.
Despite the intervention of the military hospital, after more than 3 months of hard work and treatment, it is still unable to return to heaven.
"No ability, no way." Watching 11 lives pass away one by one under his own eyes, Liu Jin was heartbroken.
This is also an important reason why he has been committed to initiating and promoting the residential training system in China since then, and donated 100 million yuan to this end.
During his tenure as a deputy to the National People's Congress from 2003 to 2013, Liu Jin put forward proposals and proposals for "establishing a national standardized training system for resident physicians and including its expenses in the national financial budget" for 10 consecutive years. Liu Jin said in an interview that if you refer to the United States, the national training of resident physicians in the United States has been 100 years now, and China has gone through the process of at least the first sixty years of the United States in 7 years, whether in terms of scale or training quality, it has entered the best stage in China's history, and even said to be the forefront of the world.
However, everything has two sides, and for various reasons, there have been some deviations between the residential training system and the original idea, and in the process of implementation, there have been many obstacles.
Liu Jin's WeChat name is "Old Man Liu", which is humble, but for Liu Jin and the residential training system, there have always been different voices in the outside world.
Since 2014, the residency standardized training system (hereinafter referred to as residential training) has been in operation for 8 years. The original intention of the establishment of the residential training system is to strengthen and improve the clinical ability of doctors, and the main content is clinical time, professional compulsory courses and public compulsory courses.
In addition, the initiators and advocates of the residential training system have a more ambitious goal, that is, they hope that this system can help China's graded diagnosis and treatment.
Starting from the individual, it is worth more people to think about how to make medical students and medical environment better.
Liu Jin donated 100 million yuan to west China Hospital
(Image source: CCTV news video screenshot)
The same is a resident, why is the difference so big?
"Every day before going to work, I would find a corner in the hospital, take a white coat from my backpack and change it into a department. Don't ask why, just our hospital didn't give Pearson's wardrobe."
"Breaking news: The secretary of the anesthesiology department of a hospital once punished the student for re-signing 100 times because the color of the signature pen was not black; and on the grounds of scribbling the signature, he asked multiple students to rewrite the signature 100 times. If there is a delay in handing in, the students will be threatened to report it to the Research and Management Office." ——In the Lilac Garden Residency Section, many residents wrote down the real treatment faced by themselves or those around them.
Low status and little money, it is the most complained about by Peisheng.
"After graduating from a master's degree in 2020, the hospital will give 200 yuan a month, and the doctor's qualification certificate will still be 200 yuan." One night shift for 5 days, no night shift fee." A resident Pearson sighed, "Some resident Pearson year-end awards can get 20,000 or 30,000 yuan, but our work is the same, but only 200 yuan a month." When we work, we are resident trainees, and when we pay money, we are students."
"Residents are the lowest-ranking hospitals, almost a consensus, and can be summoned and verbally attacked by senior seniors and educators at will." Tang Wei (pseudonym), who attended the pediatric department of a hospital in Changsha, Hunan Province, told the health community, "Some of my superiors really made me feel uncomfortable, and I didn't have the consciousness of teaching, and I threw up my face at every turn."
She confessed that she had encountered workplace bullying, but she did not want to think about it again.
Moving medicine boxes, taking takeaways, sending couriers, watching the gate, pulling hooks on surgery, etc., in Tang Wei's eyes, Zhu Peisheng is like a tool person, where it is needed, and the substantive work related to clinical practice is difficult to contact.
What made Tang Wei feel even more embarrassed was that she could only get a basic subsidy of 1400 yuan per month, and there was nothing else.
As a second-year graduate student, her peers have entered the society, and some have been promoted and raised, while she is still just a student.
Since the construction of the standardized training system for resident physicians was launched in 2014, the central government has established a regular subsidy mechanism in accordance with the standard of 30,000 yuan / person / year, and the funds are mainly used for training objects and necessary teaching and practice activities.
Because of the status of students, in principle, there is no salary for trainees like Tang Wei, and there is only state subsidies and living allowances every month.
However, compared to Tang Wei's situation, some people were much happier.
In a third-class hospital in Guangdong, a resident trainee said that he was undergoing residential training as a "social person", and the atmosphere of his department was very harmonious.
"I did learn a lot of things here that I couldn't learn from books. It is not just about writing medical records, changing medicines, and prescribing medical advice. On the contrary, the brothers, sisters, and directors I met would basically ask me for treatment opinions, and what I said was wrong and would be corrected. When it comes to following up, I'm basically dealing with it alone, which really improves my ability." The above-mentioned resident Pearson said.
The salary strips posted by the resident Pearsons will also make most of the resident Pearsons envious. One of the most eye-catching is "March 2022, income after tax of 14,486 yuan".
Compared with most negative energy posts, his posts exude a rare positive energy, but the result is that it has triggered a verbal "siege" for many people.
In the face of questioning, the resident Pearson replied: "This is the real situation, posting the pay slip, is to show that the hospital where he is located is thoroughly implementing the national policy, not lip service."
Salary slip posted by The Planning Trainee (Source: Lilac Garden APP Planning Training Section)
The above-mentioned trainees arrived at the "siege" of some of their peers early after posting their pay slips.
(Image source: Lilac Garden APP regulation training section)
What makes everyone wonder is that the same is a resident Pearson, why is the difference so big?
In fact, there are three types of residential trainees: graduate students, social people, and unit people.
Postgraduate students, that is, medical professional degrees (master's degrees) "four certificates in one" ("Practicing Physician Qualification Certificate", "Residency Standardized Training Qualification Certificate", "Master's Degree Graduation Certificate" and "Master's Degree Certificate"), master's degree study and standardized training are carried out at the same time; social people refer to people who do not have a residence training certificate and have no work unit (have not found a job or have resigned), participate in the residence training in their personal capacity; the unit is also called entrusted to live training (commission training), that is, the existing work unit. People who are sent by their work units to the residential training base (hospital) for residential training.
Judging from the above situation, social and unit people have paid "three insurances and one gold" or "five insurances and one gold" due to the state and the original unit, plus some performance subsidies, night shift fees, overtime pay, etc., the treatment is relatively good in the residential training.
Because the graduate student is still a student, there is no unit to provide other benefits such as salary, five social insurance and one gold, so the treatment is relatively low.
However, for graduate students who have obtained the "four certificates in one", it means that school attendance and residential training will be carried out at the same time. Upon graduation, they will be qualified to practice medicine. Compared with the other two types of residential pears, it is possible to save 3 years of time.
This is the real problem faced by Sumitomo Pearson, "time" and "income" can not be combined.
Recently, Tang Wei rotated to other departments and met some good colleagues
(Image source: Screenshot of Weibo of the interviewee)
How to spend 3 years in Supei?
Cultivate "moderators": we should not pay too much attention to the system and treatment, but should correct our mentality and pay attention to ourselves
In the training section with 560,000 followers and 29,000 posts, the most discussed by the resident trainees was the treatment of the residential training base and the level of the teachers.
Someone specially opened an electronic document, which is filled out by the resident trainees from all over the world to fill in the "red and black list" of the residential training base.
On the black list, some people complained about the ultrasound department of a third-class hospital in Kawauchi: "Obviously, there are rotations in the departments of heart, obstetric ultrasound, obstetric ultrasound, and superficial ultrasound in the residential training plan, but the resident pearson rotates to other departments, and may also be called back to help, and one person will do two jobs."
"A people's hospital in Guangdong Province, who has not been admitted to the medical examination twice, will retire me from training!" But the contract did not write twice that it had to be retired, and the commitment letter did not have this... Which hospital do you want to retire? Every night I worked overtime until eight or nine o'clock, and I didn't have the energy to study for the exam."
In contrast to the black list, there are also some residential training bases that have been named and praised by everyone, such as the Affiliated Cancer Hospital of Sun Yat-sen University in Guangzhou (hereinafter referred to as "Zhongxin") which was rated as the "best employer of residential training".
Pei Sheng, who was moderately swollen, said: "The hospital is highly treated, there is no PUA (mind control), most of the professors here are very friendly, you write a case, they will feel that you are hard." 」
Some resident trainees of Zhuhai People's Hospital said that the monthly living allowance for graduate students here is 3,000 yuan, the night shift fee is 75 yuan / one, and the meal card subsidy is 400 yuan. But it also said: "That is, the tuition fee is more expensive, 20,000 / year, but basically can get a scholarship of 6,000 yuan, which is also earned." Ordinary residential training treatment is also good, the first year to hand seven or eight thousand yuan, the shortage of professional tens of thousands of yuan!" 」
Zhang Zhao (pseudonym), a resident trainee from Xiaoshan People's Hospital who is a 2018 ultrasound major, worked in Xiaoshan District People's Hospital after graduation. After only two months of leaving the base, she has fully adapted to her new job.
"Every patient admitted will be carefully recorded, and once I accidentally found that there have been thousands of patients, each of which is really and carefully examined, which makes me extremely proud." 」 Zhang Zhao told the health community.
The health community has found an interesting phenomenon, although everyone has a lot of dissatisfaction with "housing training", but there is a consensus - "the original intention of housing training is good".
Sun Qingcai, secretary of the Party Committee of Surabaya County People's Hospital, once told the health community, "The ability of doctors who have returned from live-in training has been improved, and the operations are particularly beautiful, and basically everyone can pick up the beams!"
"Residential training is the only way for every medical student to learn to respect, put themselves in the right position, and strive to improve their professional level and professional knowledge. We are not as good as western countries, after all, the student base is relatively large, and the number of trainees participating in the residential training is uneven, but whether the 3 years are wasted or successful, the key lies in themselves." As a person who has come over, the Internet celebrity "Doctor Super Brother" hopes that everyone can focus on themselves instead of blindly complaining about the system.
"Doctor Chao Ge" is currently working in Weifang People's Hospital, and was previously a graduate of Harbin Medical University, and participated in the residential training from 2017 to 2020. Since then, in November 2021, he has become the moderator of the Sumitomo Pei section of the Lilac Garden Forum.
According to his recollection, he also experienced the same experience as everyone during his stay in Pei: "Bullying has appeared and seen it." Some teachers really don't respect students very much, especially graduates from the grassroots or schools, and teachers will inevitably look at people with colored glasses."
As the moderator of The Resident Training, the "Doctor Super Brother" admitted to the health industry that if he found someone attacking the Housing Training system, he would do the corresponding guidance to remind everyone to speak rationally. The vast majority of those who participate in the residential training are fresh graduates or low-senior residents, which will have a serious polarization in the interpretation of the system and policies.
"I also came from this stage and understand their situation and mentality very well, so I feel obligated to guide them properly and help them get through this period better." What we should do at this stage should not be overly concerned about the system, treatment, etc., but strive to improve their own gold content!" 」 Doctor Chao Brother said.
Teach colored glasses to see people, and train students to be inferior
How to ensure that the residential training process is standardized and the results are homogeneous?
Some resident trainees said that whether they have a good or bad life for three years, the key is to choose the right base and teachers, and experienced seniors will be enthusiastic about "clearing mines" for them.
This is also the reason why everyone will count the "red and black list" of the training base - to avoid pits.
Everyone on the black list complained about their own encounters (image source: list screenshot)
On the red list, everyone shared the treatment of their own training base
(Image source: list screenshot)
As early as 2014, the former National Health and Family Planning Commission organized the formulation of the "Standards for the Identification of Standardized Training Bases for Resident Physicians (Trial)" (hereinafter referred to as the "Standards"), which clearly stipulates the relevant requirements for training bases and professional bases.
The "Standard" clearly states that the training base should be located in a tertiary first-class hospital. A synergy mechanism can be established between training bases to jointly undertake training tasks. According to the needs of the training content, other tertiary hospitals, maternal and child health hospitals and second-class first-class hospitals that meet the conditions for professional training, as well as grass-roots medical and health institutions and professional public health institutions, can be used as collaborative units to form a network of training bases.
In terms of teachers, in addition to the requirements for the position and working years of the base guidance physicians, the "Standards" also emphasize the need for good professional ethics, doctor-patient communication skills, teamwork skills, and the ability to lead by example and be a role model.
In 2014, the first batch of 450 training bases identified by the mainland were announced, which laid a good foundation for promoting the realization of the standardization of the residential training process and the homogeneity of the results.
However, in the course of 8 years of development, some residential training bases and a group of teachers with teaching have also been exposed to not paying attention to residential training and residential training, withholding subsidies for residential training, and insulting residential training, which has brought a negative impact on the residential training system and the base hospital where they are located.
Previously, a number of experts said that the mainland residential training work is still in its infancy, and the quality and level of training in various places vary greatly. It is indispensable and important to conduct objective and dynamic assessment of training bases, implement supervision with exit mechanisms, and promote standardized management.
The training base is an "incubator" for cultivating outstanding residents, which plays a decisive role in ensuring the standardized training level and quality of residents.
According to Qi Xuejin, vice president of the Chinese Medical Doctor Association, since 2015, the Chinese Medical Doctor Association has been conducting spot checks on the national residential training bases, and in 2020, the Medical Doctors Association adheres to the principle of "normal" and "do not disturb", and adopts the "four noes and two straights" method - no notice, no greeting, no report, no escort reception, directly to the grass-roots level, directly into the scene to organize the base assessment, and conduct "flight inspection" on the complained base to further increase the intensity of the residential training assessment.
As of 2020, the association has evaluated a total of 385 Western medicine training bases and 1988 professional bases, with a total of 224 bright cards. Among them, 32 yellow cards were shown for training bases, 168 yellow cards for professional bases, and 24 red cards for professional bases.
It evaluated 183 TCM training bases, including 9 bright yellow cards, and promoted the provincial health administrative departments to revoke the qualifications of 4 training bases, which played an important role in promoting the implementation of the policy system and supervising the provinces to carry out residential training work as a whole.
In 2021, the "Standards for Standardized Training Bases for Resident Physicians" and "Standardized Training Content and Standards for Resident Physicians" were comprehensively revised, and Qi Xuejin wrote an article in Health News, emphasizing the need to improve the quality of residential training: Chinese traditional culture has the saying that "the lonely sun is not long", and the construction of residential training quality is the same reason. It depends not only on the internal causes of the whole industry, but also on the systematic coordination of relevant departments such as personnel policy, financial input and education.
Qi Xuejin introduced that in the past two years, the central government has focused on the central and western regions, and has invested more than 58 million yuan to train 20,000 teachers in rotation. Teachers from Henan, Qinghai, Xinjiang and other places were selected and sent to Beijing and Shanghai for training, and teachers from advanced areas such as Ningxia were invited to send teachers to their homes, effectively improving the level of grass-roots teachers. In addition, the central government has invested 1.8 billion yuan in support of capacity building for the 559 residential training bases identified by the Chinese Medical Doctor Association according to the standard of 5 million yuan per family.
"The evaluation results show that 90% of the training bases have established clinical skills training centers, which has initially standardized the construction of the base." Qi Xuejin stressed.
Health Community Exhibits
Written by | Wang Dandan