Standardized residency programs in China: perspectives on training quality

There have been momentous changes in graduate medical education in China in the past few years. While the standardization of residency training programs has been a topic of national conversation for decades, the Chinese Medical Association under the commission of the Ministry of Health released mandatory residency training standards in 2012.1 The training standards were divided into four sections for each specialty: training objectives, rotation length requirements, training content, and reference material. The vast majority of its pages, however, were devoted to training content, which consisted of a list of diseases and skills to master for each specialty. At the end of 2014, 8,500 residency programs had been established in 559 hospitals enrolling 55,000 resident physicians.2 The Chinese government implemented a plan for the nationwide initiation of 3-year standardized residency training programs beginning 2015.3 The government has stated that by 2020, any physician applying for clinical work must have completed training in one of these new residency programs. These changes affect the health of a fifth of the world’s population and may interest medical educators who wish to advance international educational practices. Before the implementation of standardized national residency training, there were many residency programs being piloted. A survey of trainees and faculty from randomly selected hospitals in China in 2006 found that trainees and faculty perceived their residency programs for the most part met basic global standards for postgraduate medical education.4 However, some of the leading programs reported inadequate supervision,5 unstandardized teaching,6 and wide variations in the use of case discussions.7 A Chinese literature review concluded that the existing training processes suffered from a lack of standardization across different training hospitals.8 Despite the initiation of national standardization of residency programs and curricula in the most populous country in the world, there has been no published literature in English describing these programs. Therefore we sought to understand residents’ perceptions of their training programs at a teaching hospital in a provincial capital in China, regarding program organization, quality of clinical teaching, and teaching of competencies. We report here the lessons we learned from our surveys of the residents. Program organization Residents noted important limitations to the organization of their training programs. While regular case discussions were present, they most often occurred only once a week or less, which is likely too infrequent to provide an environment conducive to learning, especially since rounds are often teacher-centered and involve passive learning for the residents.9 Even less frequent were journal clubs, which can be an invaluable resource to counteract uncritical attitudes toward medical tradition by encouraging trainees to appraise evidence-based recommendations for changes to current standards of practice.10 Furthermore, not having access to previous performance evaluations, as reported by more nearly half of the residents, denied resident trainees the opportunity to critically evaluate their approach to learning.