Medical Teacher
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
China's evolving residency training Zhenzhen Cao & Long Wang To cite this article: Zhenzhen Cao & Long Wang (2015) China's evolving residency training, Medical Teacher, 37:9, 884-885, DOI: 10.3109/0142159X.2014.1001346 To link to this article: http://dx.doi.org/10.3109/0142159X.2014.1001346
Published online: 06 Feb 2015.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [68.189.108.187]
Date: 05 November 2015, At: 17:30
Letters to the Editor
Medical Teacher 2015.37:884-885.
times. This strategy enables the teacher to take useful notes and determine if its content matches with students’ knowledge. While it is important is to recognize the factual mistakes of the film, we consider that, sometimes, plausibility may be better than accuracy. The best films for medical education are those that are focused on a few critical and concrete points rather that those with a vague plot. However, it is recommended that the film not only considers medical aspects, but also social and humanistic aspects of diseases. Once the film is chosen, set up the activity in the classroom like any other of the syllabus. This should include the definition of educative objectives, a general introduction of the activity, the preparation of some points to spark debate and the establishment of realistic assessments. Regarding this last item, teachers should also aim to measure the contribution of the activity to the improvement of students’ knowledge, as there is a lack data regarding this aspect in medical literature. In summary, we would highlight the importance of choosing an appropriate film, the need for careful planning and an adequate assessment of students following the activity. More research evidence is needed to clarify the actual value of using feature films in the training of medical students. Josep E. Ban˜os and Fe`lix Bosch, Universitat Pompeu Fabra, CEXS, Dr. Aiguader 88, Barcelona 08003, Spain. E-mail: [email protected]
Declaration of interest: The authors report no conflicts of interest.
References Alexander M, Lenahan P, Pavlov A. 2005. Cinemeducation. A comprehensive guide to using film in medical education. Oxford: Radcliffe Publishing. Darbyshire D, Baker P. 2012. A systematic review and thematic analysis of cinema in medical education. Med Humanit 38:28–33.
Exploring the lack of interest in geriatric medicine
expressed the belief that older patients often do not fully recover, and often get well enough to be discharged to a different environment only then to come back to hospital shortly after (‘‘a vicious circle, it wasn’t achieving much’’). In the second theme, being a ‘‘general doctor’’, participants reported that geriatricians needed to remain very general in terms of their medical and clinical knowledge. Participants regarded this as negative because they saw it as challenging: geriatricians are ‘‘not specialised in a system. You are specialised in seeing patients who are old. So you need to know about everything in older people’’ and the branch of medicine was described as ‘‘vague’’. In the third theme, Understaffed and overworked, doctors typically described geriatric wards as ‘‘massively unsupported’’, so junior doctors felt they ‘‘had no idea what we were doing. . .. as far as we knew, we were resuscitating everyone, treating everyone fully, everyone was for escalation to HDU [High Dependency Unit] to ITU [Intensive Care Unit]’’. Overall, even those interested in the speciality were grappling with negative beliefs, in keeping with previous findings regarding the low prestige of geriatrics. Our findings indicate that junior doctors may need focused training that equips them with an understanding of the unique value in maintaining a broad knowledge base in order to treat older patients in geriatrics as well as how geriatrics can improve patients’ quality of life. We believe that without addressing the beliefs of junior doctors with training and education, it becomes more likely that today’s junior doctors will not become tomorrow’s geriatricians. Rajvinder Samra, Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK. E-mail: [email protected] Amanda Griffiths, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG8 1DD, UK Tom Cox, Department of Organizational Psychology, Centre for Sustainable Working Life, Birkbeck, University of London, London WC1E 7HX, UK Declaration of interest: The authors report no conflicts of interest.
Dear Sir There is an increasing need for geriatricians to take care of the growing older patient population, but the appeal of geriatric medicine in the UK is lower than most other specialties (McNally 2008). Experience as a junior doctor may affect career decisions to pursue geriatric medicine, but these have been largely ignored in favour of medical students’ beliefs (Chro´inı´n et al. 2013). We interviewed 22 junior doctors (75% participation rate) at an English teaching hospital on whether they intended to pursue a career in geriatric medicine. Descriptions as to why geriatric medicine did or did not appeal to participants were then explored and this resulted in three main themes. In the first theme, limited capacity of geriatricians to make a difference, participants described various ways in which they thought geriatric medicine achieved less than other disciplines. Some participants 884
References Chro´inı´n DN, Cronin E, Cullen W, O’Shea D, Steele M, Bury G, Kyne L. 2013. Would you be a geriatrician? Student career preferences and attitudes to a career in geriatric medicine. Age Ageing 42:654–657. McNally SA. 2008. Competition ratios for different specialties and the effect of gender and immigration status. JRSM 101:489–492.
China’s evolving residency training Dear Sir Home to one fifth of the world’s population, China has an aging demography. In order to meet the increased demand
Medical Teacher 2015.37:884-885.
Letters to the Editor
for the qualified general practitioners, the National Health and Family Planning Commission of China (NHFPC) recently introduced a series of documents on standards of residency training which is the most critical step to turn the medical graduates into qualified practitioners. Accordingly, the national resident standardization training will start in 2015 and all the medical graduates are required to receive mandatory training from 2020. The primary model is a five-year course in a medical school plus three years of residency training. However, it still faces significant challenges. Firstly, in comparison with the USA’s 22,000 medical graduates in 2012, China has a large and diverse group of 144,000 graduates. Sixtyseven thousand are 5-year medical students, 34,000 are master or doctoral level graduates and 63,000 graduates have only 3 years of medical education (Hou et al. 2014). The inconsistency across previous educational backgrounds is a challenge when implementing residency training objectives and contents. Secondly, the resident standardization training contents issued by NHFPC (Hou et al. 2014) are heavily focused on medical technology, with little content about humanities, ethics, communication skills and public health. As one of the earliest authorized residency training bases, Xiangya’s three affiliated hospitals, with collaboration with the Yale School of Medicine, researched and established a comprehensive model of residency education from 2007. We set six core competencies as the training goals: professional skill, professionalism, patient safety, medical ethics, team spirit, innovation and self-development. Under each competency, detailed requirements are provided. This Xiangya’s training model may be copied nationwide. Thirdly, many medical graduates have lost their enthusiasm in pursuing their career because of insufficient salaries, heavy workloads and patient–doctor tensions (Zeng et al. 2013). An additional 3 years of residency training with inadequate income may prevent more talented graduates from going into this field. How residency training develops in the years ahead will be a key determinant influencing the healthcare reform in China. Efforts should focus on several aspects: a more detailed framework for differently educated individuals; more humanistic and pragmatic training content and acceptable salaries which will attract higher enrollment. Zhenzhen Cao, Department of Gynecologic Oncology, The Affiliated Tumor Hospital of Xiangya Medical School, Central South University, Changsha, Hunan, China Long Wang, Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China. E-mail: [email protected]
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
References Hou J, Michaud C, Li Z, Dong Z, Sun B, Zhang J, Cao D, Wan X, Zeng C, Wei B, et al. 2014. Transformation of the education of health
professionals in China: Progress and challenges. Lancet 384(9945):819–827. Zeng J, Zeng XX, Tu Q. 2013. A gloomy future for medical students in China. Lancet 382(9908):1878.
The use of Q2 engage model (EQ2) for educational scholarship in Shiraz University of Medical Sciences (SUMS) Dear Sir Nowadays with the higher demand for more effective medical educators, developing a scholarship culture has become high on the priority lists of many universities. Medical faculties mostly focus on their clinical skills rather than teaching abilities. Although necessary, having good clinical skills is not sufficient for academic citizenship and certainly does not make a person scholar. For academic excellence, faculties must also acquire teaching abilities and scholar engagement. Therefore, measures must be taken to motivate them to put quality teaching on their agenda. In SUMS, the EQ2 has become a criterion for academic promotion.Through this model, the quality and quantity of the members’ educational activities as well as their engagement is evaluated in four categories which include: Teaching, Advising and mentoring, Curriculum development and Learner assessment (Simpson et al. 2007). In each category, the members can get up to 5, 10 and 10 points respectively for quantity, quality and engagement. An educational Index will then be produced by summing up the scores achieved in all the categories (Maximum ¼ 100). For academic citizenship 70 points per year is the minimum acceptable level. This index will then affect the income and reward system for faculties’ activities. The quality is measured through the student or peer evaluations, curriculum presentations and the use of any new teaching methods. For this purpose a direct observation of faculty’s lecture or round may also be conducted. The quantity is measured by the number of prote´ge´s one has or the frequency of courses and other educational activities. In short we investigate how much, how often and with whom the educational activities are conducted. And last, the engagement is evaluated through their contribution to advancement of their filed as well as their attempt to remedy the global educational problems, whether it is: An original innovation (like introducing a more effective curriculum) or even service activities that are specifically tied to their field of expertise (such as serving in a committee or evaluating articles for journals). Presenting a work with exceptional values which would be recognized and rewarded globally would be defiantly the hall mark of educational engagement. The Educators seeking academic promotion must present evidence for all these categories.
885
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
China's evolving residency training Zhenzhen Cao & Long Wang To cite this article: Zhenzhen Cao & Long Wang (2015) China's evolving residency training, Medical Teacher, 37:9, 884-885, DOI: 10.3109/0142159X.2014.1001346 To link to this article: http://dx.doi.org/10.3109/0142159X.2014.1001346
Published online: 06 Feb 2015.
Submit your article to this journal
Article views: 84
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [68.189.108.187]
Date: 05 November 2015, At: 17:30
Letters to the Editor
Medical Teacher 2015.37:884-885.
times. This strategy enables the teacher to take useful notes and determine if its content matches with students’ knowledge. While it is important is to recognize the factual mistakes of the film, we consider that, sometimes, plausibility may be better than accuracy. The best films for medical education are those that are focused on a few critical and concrete points rather that those with a vague plot. However, it is recommended that the film not only considers medical aspects, but also social and humanistic aspects of diseases. Once the film is chosen, set up the activity in the classroom like any other of the syllabus. This should include the definition of educative objectives, a general introduction of the activity, the preparation of some points to spark debate and the establishment of realistic assessments. Regarding this last item, teachers should also aim to measure the contribution of the activity to the improvement of students’ knowledge, as there is a lack data regarding this aspect in medical literature. In summary, we would highlight the importance of choosing an appropriate film, the need for careful planning and an adequate assessment of students following the activity. More research evidence is needed to clarify the actual value of using feature films in the training of medical students. Josep E. Ban˜os and Fe`lix Bosch, Universitat Pompeu Fabra, CEXS, Dr. Aiguader 88, Barcelona 08003, Spain. E-mail: [email protected]
Declaration of interest: The authors report no conflicts of interest.
References Alexander M, Lenahan P, Pavlov A. 2005. Cinemeducation. A comprehensive guide to using film in medical education. Oxford: Radcliffe Publishing. Darbyshire D, Baker P. 2012. A systematic review and thematic analysis of cinema in medical education. Med Humanit 38:28–33.
Exploring the lack of interest in geriatric medicine
expressed the belief that older patients often do not fully recover, and often get well enough to be discharged to a different environment only then to come back to hospital shortly after (‘‘a vicious circle, it wasn’t achieving much’’). In the second theme, being a ‘‘general doctor’’, participants reported that geriatricians needed to remain very general in terms of their medical and clinical knowledge. Participants regarded this as negative because they saw it as challenging: geriatricians are ‘‘not specialised in a system. You are specialised in seeing patients who are old. So you need to know about everything in older people’’ and the branch of medicine was described as ‘‘vague’’. In the third theme, Understaffed and overworked, doctors typically described geriatric wards as ‘‘massively unsupported’’, so junior doctors felt they ‘‘had no idea what we were doing. . .. as far as we knew, we were resuscitating everyone, treating everyone fully, everyone was for escalation to HDU [High Dependency Unit] to ITU [Intensive Care Unit]’’. Overall, even those interested in the speciality were grappling with negative beliefs, in keeping with previous findings regarding the low prestige of geriatrics. Our findings indicate that junior doctors may need focused training that equips them with an understanding of the unique value in maintaining a broad knowledge base in order to treat older patients in geriatrics as well as how geriatrics can improve patients’ quality of life. We believe that without addressing the beliefs of junior doctors with training and education, it becomes more likely that today’s junior doctors will not become tomorrow’s geriatricians. Rajvinder Samra, Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK. E-mail: [email protected] Amanda Griffiths, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG8 1DD, UK Tom Cox, Department of Organizational Psychology, Centre for Sustainable Working Life, Birkbeck, University of London, London WC1E 7HX, UK Declaration of interest: The authors report no conflicts of interest.
Dear Sir There is an increasing need for geriatricians to take care of the growing older patient population, but the appeal of geriatric medicine in the UK is lower than most other specialties (McNally 2008). Experience as a junior doctor may affect career decisions to pursue geriatric medicine, but these have been largely ignored in favour of medical students’ beliefs (Chro´inı´n et al. 2013). We interviewed 22 junior doctors (75% participation rate) at an English teaching hospital on whether they intended to pursue a career in geriatric medicine. Descriptions as to why geriatric medicine did or did not appeal to participants were then explored and this resulted in three main themes. In the first theme, limited capacity of geriatricians to make a difference, participants described various ways in which they thought geriatric medicine achieved less than other disciplines. Some participants 884
References Chro´inı´n DN, Cronin E, Cullen W, O’Shea D, Steele M, Bury G, Kyne L. 2013. Would you be a geriatrician? Student career preferences and attitudes to a career in geriatric medicine. Age Ageing 42:654–657. McNally SA. 2008. Competition ratios for different specialties and the effect of gender and immigration status. JRSM 101:489–492.
China’s evolving residency training Dear Sir Home to one fifth of the world’s population, China has an aging demography. In order to meet the increased demand
Medical Teacher 2015.37:884-885.
Letters to the Editor
for the qualified general practitioners, the National Health and Family Planning Commission of China (NHFPC) recently introduced a series of documents on standards of residency training which is the most critical step to turn the medical graduates into qualified practitioners. Accordingly, the national resident standardization training will start in 2015 and all the medical graduates are required to receive mandatory training from 2020. The primary model is a five-year course in a medical school plus three years of residency training. However, it still faces significant challenges. Firstly, in comparison with the USA’s 22,000 medical graduates in 2012, China has a large and diverse group of 144,000 graduates. Sixtyseven thousand are 5-year medical students, 34,000 are master or doctoral level graduates and 63,000 graduates have only 3 years of medical education (Hou et al. 2014). The inconsistency across previous educational backgrounds is a challenge when implementing residency training objectives and contents. Secondly, the resident standardization training contents issued by NHFPC (Hou et al. 2014) are heavily focused on medical technology, with little content about humanities, ethics, communication skills and public health. As one of the earliest authorized residency training bases, Xiangya’s three affiliated hospitals, with collaboration with the Yale School of Medicine, researched and established a comprehensive model of residency education from 2007. We set six core competencies as the training goals: professional skill, professionalism, patient safety, medical ethics, team spirit, innovation and self-development. Under each competency, detailed requirements are provided. This Xiangya’s training model may be copied nationwide. Thirdly, many medical graduates have lost their enthusiasm in pursuing their career because of insufficient salaries, heavy workloads and patient–doctor tensions (Zeng et al. 2013). An additional 3 years of residency training with inadequate income may prevent more talented graduates from going into this field. How residency training develops in the years ahead will be a key determinant influencing the healthcare reform in China. Efforts should focus on several aspects: a more detailed framework for differently educated individuals; more humanistic and pragmatic training content and acceptable salaries which will attract higher enrollment. Zhenzhen Cao, Department of Gynecologic Oncology, The Affiliated Tumor Hospital of Xiangya Medical School, Central South University, Changsha, Hunan, China Long Wang, Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China. E-mail: [email protected]
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
References Hou J, Michaud C, Li Z, Dong Z, Sun B, Zhang J, Cao D, Wan X, Zeng C, Wei B, et al. 2014. Transformation of the education of health
professionals in China: Progress and challenges. Lancet 384(9945):819–827. Zeng J, Zeng XX, Tu Q. 2013. A gloomy future for medical students in China. Lancet 382(9908):1878.
The use of Q2 engage model (EQ2) for educational scholarship in Shiraz University of Medical Sciences (SUMS) Dear Sir Nowadays with the higher demand for more effective medical educators, developing a scholarship culture has become high on the priority lists of many universities. Medical faculties mostly focus on their clinical skills rather than teaching abilities. Although necessary, having good clinical skills is not sufficient for academic citizenship and certainly does not make a person scholar. For academic excellence, faculties must also acquire teaching abilities and scholar engagement. Therefore, measures must be taken to motivate them to put quality teaching on their agenda. In SUMS, the EQ2 has become a criterion for academic promotion.Through this model, the quality and quantity of the members’ educational activities as well as their engagement is evaluated in four categories which include: Teaching, Advising and mentoring, Curriculum development and Learner assessment (Simpson et al. 2007). In each category, the members can get up to 5, 10 and 10 points respectively for quantity, quality and engagement. An educational Index will then be produced by summing up the scores achieved in all the categories (Maximum ¼ 100). For academic citizenship 70 points per year is the minimum acceptable level. This index will then affect the income and reward system for faculties’ activities. The quality is measured through the student or peer evaluations, curriculum presentations and the use of any new teaching methods. For this purpose a direct observation of faculty’s lecture or round may also be conducted. The quantity is measured by the number of prote´ge´s one has or the frequency of courses and other educational activities. In short we investigate how much, how often and with whom the educational activities are conducted. And last, the engagement is evaluated through their contribution to advancement of their filed as well as their attempt to remedy the global educational problems, whether it is: An original innovation (like introducing a more effective curriculum) or even service activities that are specifically tied to their field of expertise (such as serving in a committee or evaluating articles for journals). Presenting a work with exceptional values which would be recognized and rewarded globally would be defiantly the hall mark of educational engagement. The Educators seeking academic promotion must present evidence for all these categories.
885
