SPECIAL ARTICLE Family Medicine Training in China Honglei Dai, MD, MS; Lizheng Fang, MD; Rebecca A. Malouin, PhD, MPH; Lijuan Huang, MD, MS; Kenneth E. Yokosawa, MD; Guozhen Liu, MD BACKGROUND AND OBJECTIVES: In 2010, six ministries of the evaluated solely by their mentors. Chinese government jointly issued a plan for building team-based This paper describes the different primary care led by family physicians, prompting the creation of types of family medicine training in new models of family medicine training across the country. The China using sources such as litera- purpose of this paper is to describe examples of existing family ture and Internet reviews from both physician training models in China, to present advantages and dis- China and the United States and di- advantages of the various models, and to present a specific model rect observations from the Chinese of family medicine residency training implemented at the Zhejiang and American faculty involved in University Medical School-affiliated Sir Run Run Shaw Hospital in training programs in China. collaboration with the Michigan State University-affiliated Genesys Regional Medical Center. Primary Care in China (Fam Med 2013;45(5):341-4.) As a result of recent social and eco- nomic development in China and the strong evidence base supporting the he Chinese medical education final written examination offered by relationship between primary care system differs greatly from the national government. Generally, and improved health outcomes, Chi- Tthe American medical educa- over the past 15 years, medical grad- nese health authorities have recog- tion system. Most Chinese medical uates with a 5-year degree work in nized the value and importance of students are recruited directly from rural community clinics while those accessible, continuous, coordinated, high school following a standard- with 7- and 8-year degrees work in and comprehensive care.6-8 Addition- ized college entrance examination. hospitals and become subspecialists. al factors promoting family medi- Students rank colleges and univer- Those with a 3-year degree work un- cine in China include the aging of sities, and are matched based on der a licensed physician but can be- the population, increased urbaniza- merit. The length of post-second- come independent physicians after tion, increased infectious and chron- ary medical training is 3, 5, 7, or 8 several years of practice and success- ic disease, and rising costs of health 1-4 years. Three-year programs are ful completion of a series of exami- care.9 In an effort to achieve better equivalent to a physician assistant nations. Increasingly, students are primary care, the Chinese govern- program in the United States. How- enrolling in 7- and 8-year programs. ment has been heavily investing in ever, few medical schools offer 3-year Until recently, a structured, stan- improving the infrastructure of rural programs. Students with 5 years of dardized residency training program clinics, community health centers, medical education receive a bachelor did not exist for any specialty. Fam- and hospitals. Despite all of these of medicine degree, and those with 7 ily medicine is the first specialty to efforts, consistently high-quality, or 8 years of medical education are begin a 3-year residency program awarded a master’s or doctoral de- similar to an Accreditation Coun- 5 From the Department of Family Medicine, Sir gree in medicine, respectively. cil for Graduate Medical Education Run Run Shaw Hospital, Zhejiang University Irrespective of length of medical (ACGME)-accredited family residen- Medical School, China (Drs Dai, Fang, and education, all are considered medical cy program in the United States. The Huang); Department of Family Medicine and Department of Pediatrics and Human students until they graduate from majority of medical school graduates, Development, Michigan State University (Dr their respective programs. To gradu- including general practitioners, are Malouin); Family Practice Residency Program, ate and practice as an independent trained through an apprenticeship Genesys Regional Family Medicine and Department of Family Medicine, Michigan physician, each student must pass a model, and their competency is State University (Drs Yokosawa and Liu). FAMILY MEDICINE VOL. 45, NO. 5 • MAY 2013 341 SPECIAL ARTICLE rigorous medical training for family Reform Commission of China im- practicing physicians and physician physicians and other primary care plemented a free training program assistants have been selected by pro- providers is lagging.10 A shortage of for medical students.16 Participat- vincial governments to be retrained. well-trained family physicians and ing medical students must agree to The retraining period is for 1 year other primary care providers in ru- practice in an underserved area for (full-time) or 2 years (part-time) in ral areas and a lack of easily acces- at least 6 years after graduation. The hospital-based family medicine res- sible continuing medical education training is for a 5-year medical de- idency training programs affiliated have posed additional challenges to gree and includes free tuition and ac- with a medical school or universi- improving the quality of care. Conse- commodation and a discounted meal ty. 11,12,19 Financial support for this quently, six ministries of the Chinese plan.1-4 Five thousand medical stu- training is provided by the local and central government jointly issued a dents from 24 provinces, including provincial governments. plan for building family physician- autonomous regions and municipal- The training format includes lec- led primary care teams. ities in the central and western re- tures in small groups, interactive gions of China, have been enrolled case presentation and discussion of Current Models of Family in 51 medical schools through this patients, small-group discussion, Medicine Education in China program.17 role playing, simulation training, Although there are several estab- and demonstrations of procedures.13 lished primary care physician de- Retraining Existing Practicing Alternatively, physicians may elect velopment programs nationwide,11-15 Physicians to Become Family supervised self-study following suc- these programs lack uniformity, Physicians cessful completion of all require- consistency in training, and overall According to the 2010 China Health ments within a family medicine quality. Examples of existing models Statistics Yearbook, in 2009, the to- residency department. Retraining include (see Table 1): tal number of practicing physicians of practicing physicians has been and physician assistants in China carried out in Beijing, Shanghai, Free Training for Medical was 2,329,206, of which 123,448 or Guangdong, and other areas.11,12,19 Students Serving Underserved 5.3% are family physicians and fam- Regions of China ily physician assistants.18 Standardized Family Medicine To address health care provider To increase the number of well- Residency Training shortages in rural areas of China, trained, qualified family physicians Medical students interested in fam- particularly in central and west- and to provide high-quality pri- ily medicine, generally from 5-year ern regions, the Development and mary care for rural areas, 50,000 programs, may enter into a family Table 1: Advantages and Disadvantages of Family Medicine Training Models Training Models Advantages Disadvantages Free training for medical students • Provides tuition to students from • Absence of practical clinical serving underserved areas underserved areas experience • Increases medical services in rural and other underserved areas Family doctor retraining • Transitional measure to establish • Family medicine training period is family medicine in the community too short setting • Quality of the training is not • Retrained community physicians standardized and often only have clinical experience and can theoretical or simply a combination of quickly become family physicians and rotations in various specialties serve the community Standardized training after graduation • Standardized postgraduate • Due to inequalities in resident curriculum. salary, in recognition of academic training, and in future employment • Residents are rigorously trained by options, as compared to other medical faculty trained in family medicine. specialties, family medicine residency programs do not currently attract the • Residents benefit from training most competitive students in both inpatient and outpatient settings at the hospital as well as at community health centers 342 MAY 2013 • VOL. 45, NO. 5 FAMILY MEDICINE SPECIAL ARTICLE medicine residency training program formal agreement between the two is the first training program in Chi- following graduation from medical institutions includes a plan for fac- na to collaborate with an ACGME- school. The total length of the train- ulty development for the Chinese accredited family medicine residency ing is 36 months20 and consists of family medicine faculty, intensive training program and has set a goal three parts: (1) didactic instruction training of current Chinese fami- to become the first program in China in family medicine theory and prin- ly medicine residents employed by to be accredited by ACGME interna- ciples of managing common prob- SRRSH, a new standardized curric- tional while simultaneously meeting lems, (2) 1- to 4-month rotations in ulum and rotation schedule for new all requirements of the Ministry of different clinical departments, and family medicine residents at SRRSH, Health