School of Nursing, Xuzhou Medical University, Xuzhou, China.
Department of Neonatology, he Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
BMC Med Educ. 2021 May 10;21(1):266. doi: 10.1186/s12909-021-02647-2.
China is experiencing major medical education reforms that include establishing national training standards, standards for health professionals, and advanced health delivery system requirements. Graduate medical education (GME) is being piloted as a merger of Doctor of Medicine (MD) with PhD programs to improve academic research and clinical training. However, the academic degree-centred system has led to a preoccupation with research rather than clinical training. Unfortunately, there is a shortage of quality information regarding the clinical training of MD graduates from Chinese medical schools. To fill this gap, this general investigation aims to provide the perspective of recent MD graduates in China for the different subspecialties of clinical training as experienced in different contexts.
There were 432 MD graduates who participated in an online survey regarding their clinical training. Information collected included overall satisfaction, educational supervision, supervised learning events, curriculum coverage, local teaching, teamwork, educational governance, workload, supportiveness of the environment, feedback, clinical experience, patient safety, handovers, and reporting systems.
Only 37.4% reported satisfaction with the overall clinical training quality; 54.6% rated the informal and bedside quality as "good"; 64.4% reported they knew who provided clinical supervision; but only 35.5% rated the quality of clinical supervision as high; 51.8% reported that they judged senior physicians as "not competent"; 41.9% agreed that the staff treated each other respectfully; 97.4% admitted that they worked beyond the mandatory hours and claimed they were regularly short of sleep; 84.2% raised concerns about patient safety; 45.3% reported that they received regular informal feedback; 48.1% believed that their concerns about education and training would be addressed.
This study suggests that the quality of clinical training for MD graduates should be improved. While the overall satisfaction with the teaching quality was acceptable, the quality of many clinical training aspects scored poorly. A major problem seems an undue focus on research in MD/PhD training at the cost of the quality of clinical training, due to career perspectives that undervalue clinical competence. The findings of this study should benefit from a deeper investigation to understand the causes and possible remediation. Suggestions include defining subspecialties and training lengths; monitoring, evaluation, and integration SST with MD degree; providing funds or rewards for academic and clinical training; establishing supervising teams to guide clinical training; and establishing physician scientist task force to help overcome challenges.
中国正在进行重大的医学教育改革，包括建立国家培训标准、卫生专业人员标准和先进的医疗服务系统要求。住院医师规范化培训（GME）正在试行将医学博士（MD）与博士课程合并，以提高学术研究和临床培训水平。然而，以学术学位为中心的体系导致人们过于关注研究，而不是临床培训。不幸的是，关于中国医学院校 MD 毕业生的临床培训质量，缺乏高质量的信息。为了填补这一空白，本综合调查旨在为中国最近的 MD 毕业生提供不同临床培训专业的视角，这些毕业生在不同的背景下经历了不同的培训。
共有 432 名 MD 毕业生参与了一项关于他们临床培训的在线调查。收集的信息包括总体满意度、教育监督、监督学习活动、课程覆盖范围、当地教学、团队合作、教育治理、工作量、环境支持、反馈、临床经验、患者安全、交接和报告系统。
只有 37.4%的人报告对整体临床培训质量满意；54.6%的人对非正式和床边质量评价为“良好”；64.4%的人报告知道谁提供临床监督；但只有 35.5%的人评价临床监督质量高；51.8%的人报告他们认为高级医生“不胜任”；41.9%的人认为同事之间相互尊重；97.4%的人承认他们的工作时间超过了强制时间，并声称他们经常睡眠不足；84.2%的人对患者安全表示担忧；45.3%的人定期收到非正式反馈；48.1%的人认为他们对教育和培训的担忧将得到解决。
本研究表明，应提高 MD 毕业生的临床培训质量。虽然对教学质量的总体满意度是可以接受的，但许多临床培训方面的质量评分较低。一个主要问题似乎是由于对临床能力重视不够，过分强调 MD/PhD 培训中的研究，导致对临床培训的质量重视不够。本研究的结果应受益于更深入的调查，以了解原因和可能的补救措施。建议包括定义亚专科和培训长度；监测、评估和整合 SST 与 MD 学位；为学术和临床培训提供资金或奖励；建立指导临床培训的监督团队；建立医师科学家工作队，以帮助克服挑战。
