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To coincide with the China Medical Board's 100th anniversary celebratory conference in Beijing, today The Lancet publishes its fifth China theme issue on the future of China's health. This issue examines the rapid transition of China's burden of non-communicable diseases and injuries, health-system reform, and the long term future of the population's health. The success of China's health-care system will depend on an effective workforce that is talent driven and educated in a way that addresses the country's burden of disease. How can China's health professional education system better serve China's people?
In a Review in today's issue, Yang Ke and colleagues analyse the progress and challenges of China's health professional educational system after its 1998 reform. The ambitious reform merged many independent medical colleges into comprehensive universities and greatly expanded enrolment of health professionals. Ke's Review is a national follow-up assessment for China of The Lancet'sCommission on the Education of Health Professionals for the 21st Century. It is the first evidence-based examination of the institutional design of health professional education in China.
China has the world's largest medical education system, and more than 500 000 students graduated from 590 institutions in 2012. However, in stark contrast with their peers in high-income countries, many medical graduates in China do not enter into professional practice, but pursue employment in other areas such as industry. The reasons for these choices and the inefficiencies in the education system are not clear, but a core underlying factor is a mismatch of health professional education and employment opportunities.
Instilling the values, ethos, and ethics of professionalism into the education of health workers is crucial. This process will require broad learning including humanities, communication skills, ethics, and role models in clinical practice who demonstrate how to be ethically professional in every day practice. Unfortunately, Ke and colleagues point out that the curriculum system still focuses narrowly on biomedicine, medical technology, and clinical practice. Pedagogic methods are rigid: mostly teacher-controlled didactic lecturing, which requires rote memorisation by students. The increase of disputes between doctors and patients, and violence against doctors in China might be associated with these deficiencies in education. The curricular deficiencies are worsened by almost all clinical training being confined to hospitals, ignoring community clinics, home-based care, or rural practice settings. Therefore, it is not surprising that the graduates . . . . . read more


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