Institute of Medical Education, Peking University, Beijing, China.
China Medical Board, Cambridge, MA, USA.
Lancet. 2014 Aug 30;384(9945):819-27. doi: 10.1016/S0140-6736(14)61307-6.
In this Review we examine the progress and challenges of China's ambitious 1998 reform of the world's largest health professional educational system. The reforms merged training institutions into universities and greatly expanded enrolment of health professionals. Positive achievements include an increase in the number of graduates to address human resources shortages, acceleration of production of diploma nurses to correct skill-mix imbalance, and priority for general practitioner training, especially of rural primary care workers. These developments have been accompanied by concerns: rapid expansion of the number of students without commensurate faculty strengthening, worries about dilution effect on quality, outdated curricular content, and ethical professionalism challenged by narrow technical training and growing admissions of students who did not express medicine as their first career choice. In this Review we underscore the importance of rebalance of the roles of health sciences institutions and government in educational policies and implementation. The imperative for reform is shown by a looming crisis of violence against health workers hypothesised as a result of many factors including deficient educational preparation and harmful profit-driven clinical practices.
在这篇综述中，我们考察了中国在 1998 年对全球最大的卫生专业教育系统进行的雄心勃勃的改革所取得的进展和面临的挑战。改革将培训机构合并到大学中，并大幅扩大了卫生专业人员的招生规模。积极的成果包括增加毕业生数量以解决人力资源短缺问题，加速培养文凭护士以纠正技能组合失衡，并优先培训全科医生，特别是农村基层医疗工作者。这些发展伴随着一些担忧：学生人数的快速增长，但教师力量没有相应加强，担心质量会受到稀释，课程内容过时，以及狭隘的技术培训和越来越多的非第一志愿选择医学的学生入学对职业道德的挑战。在这篇综述中，我们强调了在教育政策和实施中重新平衡卫生科学机构和政府作用的重要性。对改革的迫切要求是由针对卫生工作者的暴力行为的危机假设所驱动的，这种危机假设是由多种因素引起的，包括教育准备不足和以盈利为导向的有害临床实践。
