Guide
After 11 years of hard work, why does one stone stir up a thousand waves?
Source: Yimaitong Author: Mizi This article is edited and written by Yimaitong, please do not reprint without authorization.
This year, Academician Wang Chen submitted a proposal on the integration of post-graduation medical education and medical professional degree training at the National People's Congress and the National People's Congress of the People's Republic of China.
Unexpectedly, this proposal quickly came into reality.
On March 28, 2024, the Hainan Provincial Health Commission issued a notice on the "Hainan Provincial Measures for the Management of Standardized Training for Resident Doctors", in which Article 26 clearly mentions:
Explore and implement the organic connection between the standardized training of residents and the postgraduate education of the professional degree of medical master, and gradually unify the content and methods of standardized training of resident physicians and the training of professional degree students of medical master's degree.
Clinicians who have obtained the Certificate of Standardized Training for Residents and meet the requirements of the national degree can be awarded a professional degree of Master of Medicine, and those who meet the requirements of standardized training for residents and have been trained and assessed in accordance with the Content and Standards of Standardized Training for Residents formulated by the state can obtain the Certificate of Standardized Training for Residents.
Source: Screenshot of the official website
Medical master's degree graduates implement the "four-in-one" model, and the postgraduate training and resident standardized training are carried out at the same time, and they can obtain the standardized training certificate of resident doctors after graduation, which has been implemented as early as ten years ago, which is nothing new.
The biggest highlight of the Hainan policy is: after passing the undergraduate residency training, clinicians who meet the national degree requirements can directly obtain a master's degree in medicine!
11 years of hard work,
Why does one stone stir up a thousand waves?
As you may all remember, the standardized training of resident doctors was officially launched at the end of 2013 at the end of 2013, which came from the "Guiding Opinions on the Establishment of a Standardized Training System for Resident Doctors" jointly issued by 7 departments including the former National Health and Family Planning Commission.
But most people may have forgotten, or even completely noticed, that Article 14 of the original guidance had almost the same content:
Source: Screenshot of the official website
Historically, the entire medical industry has treated doctors with "emphasis on academic qualifications and light on ability", and the formulation of the residency training system is to break this inherent traditional concept and encourage clinical medicine graduates to participate in residency training, so as to promote the real return of medical education to clinical practice.
Up to now, this should have been a widely popularized system and regulation, but why can it still "stir up a thousand waves with one stone" after 11 years of hard work?
The main reason is that it has not been fully implemented, and because of its rarity, everyone feels heavy.
There are three main types of trainees in mainland China: first, "unit people" who have been employed after graduating from colleges and universities, second, "social people" who have not yet been employed after graduation, and third, medical master's degree students who have received residential training in accordance with the policy.
Among them, the "unit person" has a medical institution to escort him, and the graduate student has a residential training system to protect him from the wind and rain, and only the "social person" has become a special existence.
For those "social people" who are not employed after graduation and receive residential training, the treatment in the training process, as well as the dispatch and settlement after the completion of the training, are their biggest worries in real life.
They should be an important part of the team of physicians, and they should have the same treatment as the residents of their own units and obtain decent income, but most of the resident training units position them as "trainees", and their main task is to train them, so it is difficult for them to implement the same treatment conditions as the residents of their own units.
In addition, it is difficult for most medical institutions to change this kind of employment orientation of "academic qualifications rather than clinical ability" in a short period of time, so medical undergraduate graduates are more keen to apply for clinical master's degree programs rather than participate in residential training.
Perhaps it is precisely because of the long-term solidification of "class" in prejudice and concept that there is a fault line in the behavior of medical institutions in determining "equal conditions and equal treatment".
Two equal treatment,
Can it open the stepping stone of a big hospital?
In 2020, the State Council issued the "Guiding Opinions of the General Office of the State Council on Accelerating the Innovation and Development of Medical Education", which is a major breakthrough in the construction of the residential training system and an important milestone on the road to medical reform.
In this document, there is a reference to "two equal treatments":
The first equal treatment is that if the training targets of fresh graduates of ordinary colleges and universities recruited by the society are qualified to be employed in medical and health institutions in the year of training, they shall be treated the same as the fresh graduates of the current year in terms of recruitment, dispatch, and settlement.
This means that it is clearly pointed out that the resident doctors recruited by the society are no longer "students" during the training period, but "resident doctors", which belong to the status of practitioners, and at the same time, such personnel can solve the relevant problems in the process of career selection as fresh graduates after the completion of the training, which is a recognition and affirmation of their value.
The second equal treatment is that clinicians with a bachelor's degree who have passed the standardized training of residents will be treated the same as those with master's degrees in clinical medicine and traditional Chinese medicine in terms of personnel recruitment, title promotion, job hiring, and remuneration.
In other words, as long as undergraduates pass the residency training, they can be treated the same as clinical medicine masters. From the perspective of training goals, the training goals of postgraduates and residents are the same, both of which are aimed at cultivating excellent doctors who can see patients, and from the perspective of training process and quality, the two are also the same, and they can be recognized by all parties such as teachers, training bases and employers after many years.
In 2021, the policy of "two equal treatments" was further refined, and the state clearly pointed out that the graduates of the bachelor's degree and the master's degree will be provided with equal employment opportunities with the master's students, and the graduates of the bachelor's degree and the master's degree will be treated equally in the setting of professional title declaration and evaluation conditions, job conditions and remuneration and benefits.
In addition, it is specifically pointed out that this work will be included in the high-quality development of public hospitals and other related assessments, and included in the core indicators of the evaluation of residential training bases.
Despite this, the real implementation of policies is often far from the original intention of their formulation.
According to Dr. Zhang from a tertiary hospital, "It is undeniable that after the policy is issued, there will be many hospitals to implement the regulations, but I personally think that it is difficult to be completely equal in practice, after all, hospitals have a very independent interpretation of these two requirements, so we see that most large hospitals still start with a master's degree in the recruitment conditions of doctors, and undergraduates still can't open the hospital's recruitment stepping stone." The two are treated equally, which is equivalent to correcting the problem from the root of the tail, rather than correcting the problem from the beginning, and the treatment of highly educated medical students will definitely be better than that of other echelons. ”
education and ability,
How do you really strike a balance?
This policy of Hainan has returned to the original version of the national residential training system, which is equivalent to upgrading the "two equal treatments" again. But at the same time, new questions arise: what if medical students are not admitted to graduate school?
When I sent this question to Dr. Zhang, he didn't answer it directly, but asked me two questions in turn:
1. Why do you think hospitals like to recruit fresh graduates?
In Dr. Zhang's eyes, fresh graduates have several advantages: good energy, strong learning ability, strong plasticity, and relatively transparent. They have not worked in other hospitals, and it is easier for them to be trained into the basic workforce unit that adapts to this hospital, because they are blank sheets of paper.
He may have worked in other hospitals for two years after graduating from his bachelor's degree, and then came to this hospital for training, he is more or less familiar with the light and dark relationship in the unspoken rules of personnel, finance, administration, etc., which is a restless factor, in case the hospital spends a lot of money to train him, what if he finally leaves? This is what the hospital will definitely take into account in the recruitment process.
Although the social student has a few more years of work experience than the fresh graduate, the actual skill improvement and job improvement he can bring are far less than the cost of hospital management. So in reality, non-fresh graduates are not easy to employ, and a large part of it is because of this.
2. What kind of doctors do you think the hospital wants to recruit?
Dr. Teo gave an example:
If Hospital A strictly implements this system, the qualified undergraduate students and the postgraduates are treated equally, while Hospital B does not strictly implement the system, and is inclined to graduate students in all aspects of treatment. So let's think about it, if 100 qualified undergraduate students go to apply, how many will go to Hospital A and how many will go to Hospital B? If 100 graduate students apply for the job, how many will go to Hospital A and how many will go to Hospital B? From the perspective of the hospital, who of these 200 people is more in line with the future development and training needs of the hospital?
The answer is actually quite obvious. It is also difficult for hospitals, and they have to roll up in the case of self-financing, both scientific research and clinical, and if there is no strong talent reserve, the hospital will face great risks.
Dr. Zhang believes that in addition to academic qualifications, master's degree students also have scientific research ability, clinical work ability, academic ability, communication ability and in-depth thinking of medical knowledge.
In addition to their own attributes, the hospital will also consider many other characteristics of the other party when recruiting, and it is not as simple as netizens said, "If you want to take the scientific research route, you will be admitted to graduate school, and if you don't want to take the scientific research route, you will be trained".
"The mainland's medical reform system has made great progress now, and the formulators have good intentions, but because we have a large population and a huge system, I personally think that this system is difficult to go on. Although good policies are in front of us, there are still many practical factors that cannot be escaped, and I think most medical students will not easily defy the law by themselves, after all, this is a major event related to their personal life. ”
How to better balance clinical and scientific research, academic qualifications and abilities is a historical problem that needs time to be polished.
It's hard to want to be 100% perfect, but we're working in the right direction and getting closer, aren't we?
Finally, let's take a look at a set of survey data conducted by the Chinese Medical Doctor Association on the implementation of residential training:
80% of the supervising physicians and 96% of the managers believed that the comprehensive ability of the residents had been significantly improved or greatly improved after the training.
80% of the supervising physicians and 92% of the administrators believed that the residents were trained to practice medicine independently;
All residents who participated in the survey self-rated that they had improved their competencies in many aspects after receiving the training;
77% of the supervising physicians believed that their medical level had been significantly or greatly improved through teaching.
93% of the managers believe that the implementation of residential training has greatly or greatly improved the overall medical level and teaching level of the hospital.
Editor-in-charge|Yongo Atai
Cover image source: Visual China
Yimaitong is a professional online doctor platform, and the mission of the platform is to "sense the pulse of the world's medicine and help China's clinical decision-making". Yimaitong has a series of products such as "Clinical Guidelines", "Medication Reference", "Medical Literature King", "Yizhiyuan", "eYantong" and "ePulse", which fully meet the needs of medical workers in clinical decision-making, obtaining new knowledge and improving scientific research efficiency.