There are so many people studying medicine in China, why is there still a shortage of good doctors?

As a major coffee in the field of cardiovascular disease in China, Ge Junbo has many titles, he is an academician of the Chinese Academy of Sciences, the president of the First Affiliated Hospital of the University of Science and Technology of China, and the president of the Institute of Biomedical Research of Fudan University. At this year's two sessions, as a member of the National Committee of the Chinese People's Political Consultative Conference, he brought a proposal on "reasonably shortening the training time of doctors".

Medical education has its own special regularity, and is recognized at home and abroad as a continuum composed of college education, post-graduation education and continuing education. Among them, post-graduation education is divided into two stages: standardized training for residents (hereinafter referred to as standardized training) and standardized training for specialists (hereinafter referred to as specialized training).

Ge Junbo said that at present, the post-graduation education and postgraduate training of domestic medical students are separated, and the system is relatively chaotic, and a scientific system that is more conducive to the growth of medical talents and in line with national conditions should be established to make talent training more high-quality and time-saving. Focusing on related topics, Ge Junbo recently accepted an exclusive interview with China Newsweek.

Ge Junbo, academician of the Chinese Academy of Sciences and dean of the Institute of Biomedical Sciences of Fudan University, Photo/Reporter Yin Liqin

The master of medicine and the doctor of medicine should be combined for training

China Newsweek: At the two sessions, you proposed to "reasonably shorten the training time of doctors".

Ge Junbo: After the reform and opening up, China has been exploring a reasonable path that conforms to the law of medical education and China's national conditions, and gradually established a domestic master's and doctoral training system in clinical medicine. In recent years, although the medical education system has become more mature after some exploration, there are still shortcomings.

First of all, medical school academic education and post-graduation education are not completely connected. The Ministry of Education is responsible for the education and degree awarding of domestic medicine, and the continuing education after graduation is coordinated by the Health Commission. Doctors are a lifelong profession to learn, and the two should be well connected.

Second, academic education is not the same as clinical practice ability. For a medical student, higher education may mean stronger research ability, but it does not mean higher clinical level. I myself took the master's degree, then the doctorate, and then I went abroad to study as a postdoc, and then I became a doctor. Looking back now, I actually took a lot of detours.

Therefore, I hope to shorten the training time of doctors as much as possible, so that they can avoid detours, master the knowledge of various subdisciplines in the shortest possible time, and become a good doctor and even a medical scientist.

China Newsweek: You mentioned that at present, the internal laws and logic of the training of master's and doctoral students in clinical medicine and the training system of resident doctors have not yet been clarified. Can you explain it specifically?

Ge Junbo: In the past, the training time of Chinese medical students was not consistent, there were three-year specialty, five-year undergraduate, five-year clinical medicine undergraduate plus regular training, "5+3" integration (master's degree in clinical medicine) and eight-year master's degree in clinical medicine (hereinafter referred to as the eight-year program).

In previous years, medical school enrollment began to implement "5+3" integrated training, but still retained the eight-year system. The eight-year program is equivalent to the elite education of medicine, and there are only more than ten colleges and universities in the country. However, the time for eight-year medical students to write a thesis is only about half a year, and some students' thesis level may not meet the requirements for doctoral graduation.

At present, the Master of Medicine and Doctor of Medicine include clinical and scientific research. For research-oriented medical doctors, it is generally three years to graduate. In the first year, students should take basic courses, in the second year, they should do experiments and prepare for graduation thesis, and then they should take the medical practice certificate to prepare for employment. Due to time constraints, most of the papers written by medical students at this stage repeat what others have done, and lack innovation.

In my opinion, it is necessary to combine master's and doctoral training, because it is difficult to learn "real materials" by simply studying for a master's degree in medicine. In my opinion, a medical student who completes 5 years of medical education and 3 years of regular training can fully obtain a doctorate degree in clinical medicine. The 5-year stage is to learn the basics of medicine, and the 3-year stage is to rotate in each department to learn the diseases of each system, and the entire training period is not mandatory to do scientific research. Therefore, it is urgent to standardize the entire medical education system, which is why I made this proposal.

As far as training is concerned, master's and doctoral graduates who have graduated from the five-year undergraduate program in clinical medicine, and then continue their studies can apply. At present, the domestic regulation and training system has been fully established, which is a good system in principle, but there are problems in implementation. For example, a clinical medical student who graduated from a bachelor's degree directly enters the training stage without entering graduate school, and needs to rotate in multiple departments such as gastroenterology and respiratory medicine, and after completing the rotation, he can start seeing a doctor after passing the license examination of a licensed physician. However, in the past 3 years, the medical student did not have a degree, and finally could only obtain a medical license. This is a bit "out of touch" with the same batch of medical students who were entering graduate school and studying for Bo at that time.

In addition, the training time of different places and hospitals in different parts of the country is different, some hospitals are two years, and some hospitals are three years. In this regard, the whole country should be unified, and it cannot be said that it takes three years for training in first-tier cities and two years to lower standards in other cities.

Let good doctors and medical scientists coexist

China Newsweek: You mentioned that the whole system should be sorted out, what is the key to solving the problem?

Ge Junbo: The medical education system has not been clarified. This is also the fundamental reason why the country spends a lot of effort to train many medical students, but not so many people will eventually see a doctor. It is recommended that relevant departments hold a seminar with the participation of the Ministry of Education, the Health Commission and an advisory committee composed of well-known scholars to discuss the development of standardized medical training procedures. Because this involves subject education, the application of medical expertise, experts in various fields need to be involved, so that we can figure out where the shortcomings are and make improvements.

The key to solving the problem is to open up the existing education and training system of medical masters and medical doctors, and you can investigate the foreign medical education system to extract the rough and refined, so that domestic medical students can avoid detours.

China Newsweek: How are foreign medical students trained? Let's say the United States, and Germany where you worked?

Ge Junbo: In Germany, clinical medicine is not the familiar bachelor's-master-doctoral system, but similar to a university study course with a total of 6 years and 3 months, and the graduation certificate obtained is not an ordinary degree certificate or diploma, but a medical qualification certificate. The whole clinical medical study stage is divided into 2 years of clinical preparation course, 3 years of clinical course, and 1 year of clinical internship year. In the clinical internship stage, interns rotate in various departments, but when they leave the department, they must meet certain clinical assessment indicators.

All domestic clinical medical students are directly admitted to medical schools after graduating from high school, and graduated from medical schools after 5 years. In the U.S., students are required to study science and engineering or other majors for four years before enrolling in medical school. Medical students in the "4+4" model in the United States do not necessarily have to write a thesis, and they graduate equivalent to MD, that is, clinician doctors.

The medical training system of each country is different, and you can't just stick it on yourself. Now we need to let the doctor training system take a step forward on the original basis and avoid detours.

China Newsweek: What is the current progress of the domestic specialist training pilot? Is it time for standardization?

Ge Junbo: Doctors who have undergone specialized training do not mean that the level is higher, and most hospitals do not have mandatory rules that special training must be carried out. Now nationwide, special training has not been formalized, it is only a pilot. Five or six years ago, together with several other CPPCC members, I called for the establishment of a pilot training program in China. Later, with funding from the Ministry of Science and Technology, we began to launch a pilot project for specialist training across the country. At that time, I hoped to use this pilot to open a gap and slowly roll out the special training program across the country.

In 2017, three specialties, neurosurgery, respiratory and critical care medicine and cardiovascular disease, took the lead in launching the pilot training system, and most of the pilot hospitals were located in first-tier cities such as Beijing and Shanghai. Five or six years on, it is time to look back and see if a standardized system can be developed.

However, the question of who needs specialized training and at what stage to start specialized training is still inconclusive. After graduating and entering the hospital for 5 years, general medical students can apply for promotion to attending physician. We have also considered whether doctors above the position of attending doctor do not need special training, and the group of attending doctors accounts for a high proportion of hospitals. But if there is no special training, the knowledge of this group may not be so comprehensive, so do a pilot first to see the industry response.

China Newsweek: You call for a coordination mechanism so that good doctors and medical scientists can better coexist.

Ge Junbo: Different hospitals have different needs for medical talents. Large tertiary hospitals have undertaken more scientific research tasks, and for county hospitals, there is no need to assess the level of doctors' theses, or set the threshold for degrees very high. Because now the people see a doctor, 80% of the people go to the county hospital to see a doctor, for the county-level hospital, it is more important to see a good doctor.

Nowadays, many hospitals require doctors to see both doctors and do scientific research, in fact, it is not necessary, and doctors who see doctors daily do not need to achieve the level of both. Taking the United States as an example, doctors of the Chinese American Heart Association generally have their own independent clinics, which are more engaged in daily medical treatment and are less involved in scientific research. There are also some medical scientists who specialize in academic research. Discipline leaders in colleges and universities such as Harvard Medical School may have both. In China, clinicians doing scientific research seems to be a norm, and it is also an important indicator of domestic talent evaluation and promotion, and it is necessary to start from the assessment mechanism to change this.

Reporter: Niu He