Medical Education Reform in China in the 21st Century: A Literature Review

Abstract

Facing resource shortages and increasing gaps between regions and populations during the 20th century, around the 70s, the Chinese government authorized local governments to independently operate their own medical system, including medical education, to provide basic medical services and meet healthcare needs. These multiple independent but unparallel medical education systems throughout the nation inevitably created education quality disparities. Around the beginning of the 21st century, the Chinese government started a medical education standardization reform. This study aims to review and critically analyze these reform efforts toward standardization in medical schools and postgraduate and continuing education. All the background information, data, findings, government measures, etc. presented in this article were obtained through literature searches on PubMed, Baidu Scholar, and respective official online documents. Some of the key search criteria are, but not limited to, medical education reform in China and medical education history in China. These data were accessed in 2022. Standardization has been the core of reform in all three phases of medical education in China since the beginning of the 21st century. The three/five/eight principle, which refers to years of medical school, has been the backbone of medical school education in pursuing the "2030 healthy China" goal. The government streamlined postgraduate education further by establishing official licensing examination and launching a five+three+X model, which represents years required for medical school education, standardized residence, and specialty training, respectively. The standardization of continuing education is ongoing. Official and unified appraisal tests are in the pilot stage, whereas other areas have yet to change. Hopefully, this study will provide insight for future reform or research, or inform other countries.

Keywords: China; continuing education; medical education; postgraduate; reform.

Figure 1

The flows of educational routes for doctors in China at the beginning of the 21^st century: There were multiple medical education programs for secondary graduates to gain full licensure, which issued different degrees. However, these routes interconnected with each other for the participants to be able to gain higher education as they were en route to the medical licensing examination.

Figure 2

Comparison of postgraduate training years based on the various medical school programs under the existing system.

Figure 3

Doubletrack system: Instead of spending 5–6 years to complete both the MM and SRT in the original system, graduates of the five-year program need only three years in the new “doubletrack” system to accomplish both.