The top three medical stories from China this week

Medical exam fraud: A medical examination cheating ring has been uncovered in Hebei after a 29 year old woman was found to be taking a postgraduate exam in place of someone else. The woman was arrested after it was found the ID card did not match the details of the doctor who was supposed to be taking the test, who was from Chengdu. The woman said she was paid 60,000 yuan (about US$9000) to take the test on behalf of another person. The woman, who was originally a doctor, said she had given up her job in 2013 after she discovered she could make more money through exam fraud.

Influenza deaths: There have been three severe cases including one death from severe H5N6 influenza in Guangdong and a further death of an overseas visitor from H1N1 influenza, according to media reports. Chinese media said that a a 25-year-old man from Shenzhen, was in a serious condition in hospital. A 26 year old woman died of the same infection in Shenzhen last week, while a third person in Zhaoqing, Guangdong was in a serious condition. Meanwhile a Guyanese man has died of H1N1 influenza in a Miami hospital after returning from China. The infections are presumed to have come from exposure to live poultry and it is not thought there is a high risk of human-to-human transmission.

Air pollution harms fetus: Pregnant women who are exposed to the high level of air pollution in China are likely to have low birth weight babies, a study shows. Exposure to high levels of PM2.5 particles, as found in China's smogs, was linked to a decrease in birth weight and an increased risk of low birth weight, according to a study by specialists at the Guangdong Women and Children Hospital, Guangzhou. The doctors said the effect of air pollution on fetal growth was similar to that seen with cigarette smoke, and was due to immature fetuses being more susceptible to air pollution because they are in critical periods of organogenesis.

Cancer treatment unaffordable | Drug pricing corruption | Premier tackles HIV stigma | Rare diseases not reimbursed | US medical exams popular in China

Public punchbag to pay son's cancer fees
In Beijing a man who cannot afford the Y700,000 ($114,000) medical bills for his son with leukaemia has offered himself as a public punchbag to raise money. The man called Xia Jun stands outside Guomao station and asks for 10 Yuan to be thumped. He says he has collected 10,000 yuan in one day without anyone taking up the opportunity to hit him.

Corruption on drug price setting cited as reason for abolition
The recent move to abolish price caps for prescription medicines was triggered by corruption in the agency charged with setting drug prices. Critics said officials in the National Development and Reform Commission (NDRC) were under investigation by the anti-corruption and bribery bureau under the Supreme People's Procurate for taking bribes. Pharma company executives said the current pricing system forced them to pay bribes to regulators to set higher procurement prices.

Premier lends support to ending HIV stigma
Premier Li Keqiang has shown public support for people with HIV and aimed to dispel prejudice and ignorance about the infection by visiting  a HIV clinic at the inspected Beijing You'an Hospital.
 For World AIDS Day, the Premier met HIV patients and healthcare workers and said the old attitudes of fear surrounding the topic of HIV must be abandoned and HIV patients need more care.

Rare diseases slip through the health insurance cracks
China's health system is not working for children with rare diseases, as their families face high treatment costs and no access to medical fee reimbursement, according to an article in the SCMP. One mother of a 3-year old boy with Langerhans cell histiocytosis (LCH) said his bills for diagnosis and treatment had reached nearly 200,000 yuan ($33,000), of which just 4,800 yuan ($780) had been reimbursed by the rural medical insurance scheme.

US medical exams popular in China
Thousands of China's medical students and young doctors are studying for the US Medical Licensing Examination (USMLE) that will allow them to practice medicine in the US. However, despite studying for up to 1500 hours for the exam, many of them say they are taking it to improve their medical skill rather than just to get a better paying job. Many Chinese students said the US medical exams taught them a more patient-centred approach and put more emphasis on communication and empathy rather than just rote-learning of medical facts. The test is also taken by many of the 60,000 foreign students studying medicine in China.

Intern scheme concerns | Telehealth ban sparks backlash | Rural residents too poor to pay for care

Internship scheme will create bottlenecks and headaches
Doctor training moves to a three-year internship system next year but many medics believe the changes will leave hospitals with even worse staffing shortages. The new system which will see newly-graduated doctors rotate through various hospital departments to gain experience is intended to bring China into line with other countries and to create a uniform high standard of medical practitioners. However, critics warn that the additional three years of being a trainee will mean that doctors earn very little and the low income will deter many from entering the medical profession. Another drawback of the new system is that doctors will serve as interns in tertiary 'teaching hospitals' and will then refuse to be 'downgraded' to work in smaller local country and township hospitals.

Ban on telehealth consultations triggers backlash
There has been a major backlash against an announcement that doctors will be banned from conducting online consultations by the National Health and Family Planning Commissioning. The NHFPC said this week that 'remote' consultations are illegal except through accredited medical institutions because all doctor consultations need to be carried out according to the regulations of the NHFPC as currently laid down for hospitals and clinics. The NHFPC said remote consultations should be viewed as no different to any other kind of consultation and therefore all the usual regulations on medical practice apply. However, after a major backlash from health groups and online health providers such as www.haodf.com, the NHFPC said it would look again at the legislation and would 'listen to the opinion of the masses' in interpreting the legislation.

Rural health insurance not working
People who live in remote rural areas of China are so poor they cannot afford to seek medical attention when they are sick,  a study from Hebei has found. More than 50% of people living in the Dabie mountain areas of Hebei said they would not seek medical care if they felt unwell. The main reason (for 38% of people) was financial difficulty. Other reasons included inconvenience and preference to self medicate. Researcher Dr Fang Pengqian and colleagues from the Tongji Medical College, Wuhan said the findings suggested that the universal health coverage from the New Cooperative Medical Scheme (NCMS) was was not working for people in poorer highland areas. They said the locals could not afford to pay the necessary insurance premiums to  cover basic care and the low reimbursement meant they faced high out-of-pocket costs.

Medical schools in China: outdated and unpopular

Some insider views of the Chinese medical education system have been published as part of The Lancet special China-themed issue this week. The rather gloomy conclusion is that China's vast medical education system is failing to attract good students and failing to produce graduates who are able and willing to work as doctors.

A review article notes that China made some major reforms to medical education in 1998, greatly expanding the number of students to produce half a million would-be doctors a year. However, many of these medical graduates do not enter medicine but take up other careers. Why is this? The review authors say there "is a mismatch of health professional education and employment opportunities".

Another article in the same issue of the Lancet throws further light on the lack of enthusiasm for medicine as a career: Dr Yang Pengfei of the Changhai Hospital, Second Military Medical University, Shanghai, says most doctors now advise their children against taking up a career in medicine and only 7% would recommend it. He cites the breakdown in trust and respect between patients and doctors and the tide of violence against medical staff - 30 killings in recent years by disgruntled patients and their families. Dr Yang notes that even the best medical schools such as Peking Union Medical College are now struggling to attract high quality students.

"The national admission score for a graduate student majoring in medicine has also declined for three consecutive years, according to the Chinese Ministry of Education. It is no longer the best students who go to medical school. This is a growing concern: who will be tomorrow's doctors?" he asks.

The review article says the problem of poor relations between patients and doctors is due in part to the narrow and inflexible education system that fails to instil students with the values, ethos, and ethics of the medical profession and also fails to produce doctors with good communication skills and characteristics such as empathy.

"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," it says.

Another problem with medical education in China is that it is still rigidly hospital focused and geared towards producing narrow specialists rather than generalists who can work in the community or in rural health.

"Therefore, it is not surprising that the graduates have limited knowledge about primary care services and prevention of diseases."

Will things improve in the near future? It's hard to see how, as huge class sizes are a barrier to more innovative teaching methods such as problem-based learning, and encouraging interaction and discussion.

China's medical schools may need to take a leaf from the book of China's factories. Instead of mass producing unpopular low quality products they could adapt the best foreign know-how and methods through joint ventures to produce a wider range of higher quality sought-after products.

Shenzhen to pioneer clinical-focused medical training in place of faux-research and academic exams

by Michael Woodhead
Shenzhen is to lead the Chinese medical career pathway away from its traditional emphasis on exams and academic research into a system with more focus on clinical medicine. 
Experts say that medical training and career pathways in China have become dominated by academic achievement at the expense of dealing with patients. This has led to a system in which 'academic essay heroes' get ahead, while those with better clinical skills are overlooked and languish at the bottom end of the career ladder and in smaller hospitals. According to doctors in Shenzhen, the system based on research and academic study is suitable for a few doctors but should not be the backbone of the stem. It puts a huge and unnecessary burden on doctors and also leads to the system in which patients say it is impossible to get to see a good doctor. The academic focus means that doctors build up their titles and certificates, but their clinical skills remain weak from lack of attention.
Under the new system, doctors will be graded according to nine levels of clinical skill and on clinical outcomes and performance. This means that doctors with good clinical skills will be able to achieve career advancement and also increase their remuneration, an article in the Guangzhou Daily says.

China's medical internship scheme starts in 2015 - but it comes at a price

by Michael Woodhead
From 2015, all Chinese medical students who wish to become a full doctor must complete a three year internship scheme at a hospital, the National Health and Family Planning Commission has announced. 
The aim is to give all medical graduates in China a practical grounding in all clinical areas, and to achieve consistent standards for medical practitioners across China. The scheme will mean that once medical students have graduated they will obtain an internship at a hospital and do standardised training in various rotations such as surgery, psychiatry and paediatrics as well as receive additional training in areas such as communication with patients. During the three years the interns will have assessments and exams that they will have to pass to gain a licence to be a full doctor.
The plan will bring China into line with most other countries that have medical internship systems, but Chinese medical students are not happy. They say the new internship scheme will add another three years to an already lengthy medical training - and will also mean three more years of penury. At present, the competitive education system means that most medical students have to complete a Masters or even a PhD in order to obtain a training place in a city hospital. This takes at least seven or eight years, so would-be doctors now face a training period of at least 10 years  - or possibly 12 years - before they become a fully fledged doctor. And during this long period, students earn little or nothing. Current internship schemes at Nanjing hospitals, for example, see interns earning about 2000 yuan a month - well below the average incomes of other students who have done masters or doctoral degrees. Students say the new internship scheme will mean that the total costs of studying to be a doctor will be at least 150,000 yuan.
"Undergraduate, masters, doctorate  - at least eight years then three years more of training - that means you will be at least 30 before you are a doctor. What about marriage and having children?" said one medical student who predicted that the new system would turn many bright students away from studying medicine.
The internship plan will come into effect in all Chinese provinces from 2015 and the full standardised internship  system must be up and running by 2020, the NHFPC says.
Source: Nanjing News

Seven important items of medical research from China

N95 masks don't work for Chinese faces
The specialised N95 face masks used to protect against infections such as influenza are not shaped to fit Chinese faces and most would fail to prevent transmission because of poor fit and leakage, tests by Wuhan researchers have shown. Evaluation tests on ten different types of N95 mask found that only two performed within acceptable limits to prevent transmission of infections. Performance of some masks was better when users were trained and they were specially fitted, the study in PLOS One showed.
"This study indicated that widely used N95 filtering facepiece respirators in China didn't fit well and can't provide desired protection for respirator users," the researchers concluded.

Malaria from Africa now a problem in China
Malaria has been virtually eliminated in China but doctors now face the problem of treating malaria in Chinese workers who have returned from Africa. In Jiangsu there have been 918 malaria cases and six deaths in the last decade due to malaria imported from other countries. The imported cases make up 12% of all malaria cases and account for all malaria deaths, according to researchers from the Jiangsu Institute of Parasitic Diseases, Wuxi, writing in the Malaria Journal.

No cardiovascular treatment for many Chinese patients
Two out of three Chinese people with cardiovascular disease are still going untreated, a major study has found. Data from of 512,891 Chinese adults showed that 5% had a history of cardiovascular disease. However, of these only 35% had been treated with any cardiovascular medicine for secondary prevention such as statins, antiplatelet drugs or antihypertensives. The findings from a team from Oxford and Beijing universities, are published in the International Journal of Cardiology.

Shenzhen women have high rates of HPV
More than one in ten women in Shenzhen are have HPV serotypes that put them at risk of cervical cancer, researchers say. A study of 4, 413 women measured HPV infection rates and the prevalance was 14%. The high risk HPV types 16 and 18 that are likely to cause cervical cancer were found in 3.5% of women and 1.27% of women, according to the study published in the Asia Pacific Journal of Cancer Prevention.

Avian H7N9 flu virus on way to mutation
The H7N9 influenza virus is genetically much more diverse than previously thought, suggesting that it is reassorting and closer to mutating into a pandemic virus, researchers from the Jiangsu Provincial Center for Disease Control and Prevention, have shown. They report their findings in Nature.

Medical teacher burnout
Staff at medical colleges in China have high rates of burnout, a study from Shanxi shows. Staff who had a love of teaching and those who received praise and recognition were less likey to suffere burnout, according to the study in Archives of Environmental & Occupational Health.

Pancreatic cancer in Shanghai
The diagnosis and treatment of pancreatic cancer in Shanghai has room for improvement, according to researchers from Fudan University. In a review of management of pancreatic cancer published in Cancer Letters, they report that most patients miss out on the recommended histologically verified diagnosis and the 1-year and 2-year survival rates were 35% and 14.4%, respectively.

Medical research in China: seven samples from this week's journals

China's medical education system is broken
Chinese medical education is not fit for purpose, a review by Dr  Wu Lijuan of the School of Public Health, Capital Medical University, Beijing, finds. Too many students have to get a an additional Masters or even a Doctorate in academic medicine to get a position at a hospital, and miss out on valuable clinical training. At the same time the clinical component of many degrees is not recognised by some institutions and has to be repeated.
Medical Education Online.

Chinese ethnicity protects against pre-eclampsia
A study of of 67 746 pregnant Chinese women found that 1.92% nulliparous women developed pre-eclampsia. The prevalence of mild and severe pre-eclampsia was 1.42% and 0.49%, respectively. The study authors said the prevalence of pre-eclampsia in China was low compared with Causcasians, perhaps due to differences in BMI or lifestyle.
Journal of Human Hypertension.

Allergic triggers in Guangzhou
The main allergic triggers among allergic people in Guangzhou are cow's milk, eggs in younger children and then the house dust mite allergens Der pteronyssinus and Der farinae in later years, a four year observational study has found.
Multidisciplinary Respiratory Medicine.

New cause of hand foot and mouth disease in Guangdong
An unusual enterovirus type, CVA6, has been identified as a new and major serotype associated with an hand foot and mouth disease epidemic in Guangdong.
Essential Microbiology.

Annual health checks urged for rural residents
About two out of three elderly have physical examinations by a healthcare professional at least annually, a survey of more than 1100 people from four provinces has found.However, rural residents suh as farmers were only half as likely to have a regular check up, prompting the study authors to suggest that  government and public health institutions should assist farmers to acquire the habit of having annual physical examinations. "Village doctors should be supported in delivering health information to the elderly in rural areas," they said.
BMC Healthcare Research.

Rats the source of hemorrhagic fever in China
There are about 1.4 million cases of hemorrhagic fever with renal syndrome every year in China and rats seem to be the main reservoir for infection, a study shows.Trends in cases were associated with the local rodent reservoir, climatic factors and socioeconomic conditions suggesting that it may be possible to develop an "early warning system" for the control and prevention of hemorrhagic fever, researchers said.
PLOS Neglected Tropical Diseases.

What are the most cost effective treatments for myocardial infarction in China?

A study from Beijing Anzhen Hospital and Capital University has found the most cost effective treatment for myocardial infarction in China would be optimum use of the four drugs aspirin, β-blockers, statins, and ACE inhibitors in all eligible patients, or unfractionated heparin in non–STEMI myocardial infarction. Other treatments such as reperfusion therapies in eligible patients with STEMI myocardial infarction and clopidogrel would be less cost effective, the study found. Use of all hospital-based AMI treatment strategies together would be cost-effective and reduce the total CHD mortality rate in China by about 10%. 

Circulation.

China medical education gets internships | Saving for medical bills | Women have hysterectomies for profit

 China will set up a standardised internship training program in 2015 for medical graduates before they become qualified to be doctors, according to the National Health and Family Planning Commission. Officials said China does not currently have a national standard for training, and training to become resident doctors depends on the hospitals where they are employed, leading to differential medical levels across regions. The new standardised "5 + 3" year training system will ensure that graduates get experience in several branches of clinical medicine before getting a full licence to practice medicine. According to the Global Times, the training bases will first be set up in top level hospitals and some lower level hospitals based on the local situation. They will be subsidized by the governments and central finance.
 
One of the main reasons why Chinese people save so much is to prepare to pay for future medical bills, a report says. In China, 64% of people surveyed were actively saving for health issues, according to ECNS. Savings rates for health were higher in China compared to other countries surveyed, and Chinese people used diversified strategies in saving for health issues, with local currency, whole life insurance and pure term life insurance among the choices.

And in Taiwan it is claimed that  many of the 20,000 women who have a hysterectomy each year do so to gain thousands of dollars in infertility compensation from the Labor Insurance Fund.
According to the China Post, researchers said Taiwan had the largest percentage of “womb-less women”and this might be due to the lure of  infertility benefits amounting to more than NT$100,000for women under 45 who have a hysterectomy.

A gloomy future for medical students in China

Article in The Lancet by Dr Zeng Jie of the Mental Health Institution of the Second Xiangya Hospital, Central South University, Changsha, Hunan

 

in The Lancet:According to the Chinese Medical Doctor Association, there were 17 243 cases of violent attacks against health-care workers in 2010, in China. On Oct 25, a patient beat a senior doctor (head of the Ear, Nose, and Throat department) to death, adding a new victim on this too-long list.

Hospitals in China are deemed as dangerous working places, and being a medical practitioner has turned into a life-threatening job. The deteriorated relationship between health-care providers and patients not only affects the present generation of professionals, but also the future generation of doctors. National medical colleges warn that the number of medical students is decreasing, and medical students in their last year of MD or PhD programmes are hesitating to continue their career.

Five medical students found dead in Beijing

Five students from a medical college were found dead Monday morning in a rented house in Beijing, probably due to carbon monoxide poisoning, police said.
Arriving at the rented house in Chaoyang District at around 8:30 a.m., emergency doctors found the five men, from Harbin Medical University in northeast China's Heilongjiang Province, had all stopped breathing and had no pulse, police said.
The students were immediately rushed to a nearby hospital for treatment. But they died despite doctors' efforts.
They had been working as interns at the Sino-Japan Friendship Hospital in Beijing, according to the police. Six people were living in the house, but one of them had not been present on the night the tragedy occurred.
Initial investigation showed the five were killed by carbon monoxide, although the exact cause of their deaths is still being investigated.
Source: CRI

China to train 60,000 GP teachers

The Chinese government will train 60,000 general practitioner (GP) teachers by 2015, according to a circular published by the Ministry of Health on Wednesday.
A GP is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and all sexes.
Jointly issued by the Ministry of Health, the Ministry of Education, the Ministry of Finance and the State Administration of Traditional Chinese Medicine, the circular says candidates for GP training will be classified into three categories: core GP teachers, clinical GP teachers and grassroots GP teachers.
According to the circular, training will last no less than two months and focus on clinical GP teachers and grassroots GP teachers, with the goal of training 6,000 core GP teachers.
The circular stipulates that clinical GP teachers should have a bachelor's degree or above and be qualified as an attending doctor or above. Grassroots GP teachers are expected to have finished junior college and be experienced in clinical practice and public health service.
The Ministry of Health will set up a database of core GP teachers, while provinces nationwide will establish their own databases of GP teachers, the circular said.
Source: EastDay

A US oncologist's impressions of a Chinese medical school

Paul R Helft, MD

by  Paul R. Helft, MD
I just returned from a week-long trip to Southeastern China, where I visited a large and well-respected Chinese medical school in the city of Guangzhou in Guangdong Province.
My University has a relationship with this sister school in China, Sun Yat-sen University, and I was lucky to receive an invitation from the faculty involved in the medical school bioethics curriculum, because the group is in the process of revising their undergraduate ethics curriculum. I got to meet with faculty, the dean of education for the medical school, many undergraduate medical students, post-graduate residents, and students from the integrated schools of public health and nursing.
I visited one of the affiliated specialty hospitals (specializing in liver disease and liver transplantation) and got experience as a patient in the main university hospital, where I was treated by a traditional Chinese physician for back pain after registering as a patient in the Chinese health care system.
As is nearly always the case with international travel, and especially in a place so different from what we are accustomed to in the United States, the whole experience was delightfully eye-opening, both for those dimensions of medical care and education that struck me as remarkably similar, as well as those that seemed wholly foreign. One of the more striking things I learned about the undergraduate ethics curriculum at this medical school, which in its original form has been in place for nearly ten years, was that most of it was based on cases and principles derived from Western references. This was striking to me, given how radically different Chinese culture is from US and Western culture (as if either of these were homogeneous enough to make such a statement!). Take abortion or transplant ethics, for example. Abortion is widespread and commonplace in China, in part because of the one child per family policy that is in place for families who reside in urban areas. Many Chinese people consider themselves atheists. How could the debate about abortion, which polarizes along lines such as those represented by the pro-life and pro-choice viewpoints in the Western world, possibly have the same outlines in such a different culture? Procuring organs for transplant, as another example, is not done on a completely voluntary basis in China. So the ethical framework for organ procurement and transplantation is just different, and analysis of a case based on Western experiences will have a completely different valence. One suggestion I talked a lot about during my meetings with faculty was to develop a curriculum based on Chinese cases, using a Chinese framework. This suggestion was not popular.
I stood in several long lines to register to become a patient, to obtain a medical record document, to be evaluated by one physician, then to be treated by another. It was clear to me that no one has his or her own physician. I stood in line again to pick up a prescription that had been entered into a computer by the treating physician and was then sent electronically to one of about 30 pharmacy windows, where it was ready for me when I arrived there to pick it up.
Even though throngs of people stood in line everywhere (including to get into the parking garage—police had created a special lane of traffic along the boulevard just to handle those awaiting entry), it did not feel inordinately chaotic, and I didn’t identify anyone who appeared upset or witness anyone complaining (although I might have missed this, given how limited my Chinese language skills are). I was told by students and residents and faculty that the sense of communitarianism that permeates Chinese culture would make it unusual for any one person or family to demand special treatment.
I did not leave China with the sense that there was very much about the Chinese healthcare or medical education system that we should adopt, but as we enter an era of healthcare reform after decades of prioritizing doctors’ individual rights and authority, as well as patients’ expanded ability to demand treatments no matter how expensive, I wonder where we will get a bit more communitarian spirit, and I begin to see many of the choices we will have to make in the light of our collective and interconnected lives. I remain anxious that our prospects for being successful at this are limited.
Dr. Helft is an Associate Professor of Medicine at the Indiana University School of Medicine; his clinical work is based in the Gastrointestinal Oncology Program at the Indiana University Melvin and Bren Simon Cancer Center. Dr. Helft is also director of the Charles Warren Fairbanks Center for Medical Ethics at Indiana University Health in Indianapolis.
Source: Cancer Network

Eight Tibetan medical students get five years in jail for protesting

Medical students were angry at disparaging remarks made by Chinese about the Dalai Lama

Eight Tibetan students of the Sorig Lobling medical school in Chabcha, eastern Tibet have been sentenced to five years in prison even as the school continues to remain under strict surveillance for the third straight week.
The eight students have been identified as Rabten, Wangdue Tsering, Jampa Tsering, Choekyong, Tashi Kunsang, Dola Tsering, Sangye Dhondup, and Kunsang Bum.
Speaking to Phayul, Shawo Dorjee, a Tibetan living in Switzerland said that all those sentenced were below 23 years of age.
“The students were sentenced on December 5 on charges of their involvement in the students’ mass protest in Chabcha on November 26,” Dorjee said citing sources in the region.
“Chinese authorities have accused the eight students of leading the protests because of their role as school prefects.”
It is not known where the students have been jailed.
On November 26, over a thousand Tibetan students from the Chabcha Sorig Lobling School staged a major protest rally against the Chinese government, raising slogans calling for freedom, equality of nationalities, freedom of language, respect for truth, and re-establishment of governance.
Chinese armed forces used violent force to break up the demonstration, injuring many young protesters and hospitalising around 20 students. The school was subsequently placed under complete lock down and Chinese security forces barred students from meeting their parents and relatives.
The next day, three of the medical school’s students, Wangchen Tsering of Ba County, Mama and an identified student were arrested in connection with the protest.
At the beginning of this month, three Tibetan monks of the Chamru Monastery, identified as Sungrab Gyatso, Dragsang, and Yeshe Sangpo were arrested for their reported role in sending out information on the protest.
According to earlier reports, arrested students were interrogated, tortured, and barred from having any visitors.
The protest were triggered after local Chinese authorities distributed a ten-point political questionnaire to the students, critical of the self-immolation protests in Tibet and gave “patriotic education” sessions that contained disparaging remarks against His Holiness the Dalai Lama.
Source: Phayul

In China, medical students face mid-course crisis

The transition from academic to clinical training causes psychological stress for medical students

by Michael Woodhead
Medical students in China go through a peril of severe stress because they are unprepared for the transition from academic to clinical training, a study has found.
In a study of almost 1700 medical students, researchers from the Centre for Medical Education at China Medical University, Shenyang found that students showed major impairments to "psychological health and social relations" in the third year of their studies.
They say this may be because third year students face greater academic pressure, with longer hours of lectures and practical work  compared to those in other academic years. The third year represents the transition to the clinical years in China but students have more academic courses and little education about communication with patients and end of life issues.
"At this time they are experiencing contact with real patients for the first time and yet they do not have enough knowledge and skills to interact with patients, especially dying patients. Therefore, medical schools need to take measures to give more support for third year students," they suggest.
"Medical educators could carry out curriculum reforms that introduce problem-based learning (PBL), integrated courses and early exposure to clinical training.  These reforms would relieve students’ academic load through balancing the curriculum of basic science and clinical medicine in different years. It is also very important that we give students more support, which includes enhancing student competency in communication and professionalism and giving students the necessary tools and instruction on how to relieve stress and strain during their medical training. All this could reduce the impairment in physical and mental health of medical students.
The study also found that medical students from rural areas were also found to have poor psychological health and social relations. This may be because they have had to leave their homes and adapt to new life in the city,  facing "urban culture shock". Students from poor rural areas tend to have lower self-esteem and problems in dealing with social relationships, and they may feel that their experience scope is more limited and that their living situations may be more difficult.
Rural students are also less wealthy and may struggle financially.
"Medical schools need to pay attention to showing concern for their psychological problems and give them the necessary psychological counseling and financial support."
Source: PLOS One

Qinghai medical school under lockdown after protest

Tibetan medical students were unhappy about disparaging remarks

The Sorig Lobling medical school in Chabcha (Ch: Gonghe), eastern Tibet, continues to remain under military lockdown following yesterday’s mass student protests against the Chinese government. Also, three of its students, Wangchen Tsering of Ba County, Mama and an identified student, have been arrested.
IChinese armed forces continue to cordon off the school, keeping the students captive within the school premises. Parents and relatives, on the second consecutive day, have been barred from meeting the students.
Five students, who were severely injured in police beatings, are said to be in critical condition and have been shifted to a bigger hospital in Tsongon. Around 20 students are still admitted in hospitals in Chabcha. Chinese security personnel have not allowed them visits from their family members.
Yesterday, over a thousand students from the Sorig Lobling medical school carried out a massive protest, raising slogans for equality of nationalities, freedom of language, respect for truth, and re-establishment of governance.
In a short video clip that has reached exile, students can be seen running on the streets, raising slogans.
Chinese armed forces used violent force to break up the demonstration, injuring many young protesters in the process.
The protest occurred after local Chinese authorities distributed a ten-point political questionnaire to the students and gave “patriotic education” sessions that contained disparaging remarks against His Holiness the Dalai Lama.
Read more: click here

China's medical schools produce 'underperforming' African graduates

Liberian medical council says poor selection of students to study in China may be to blame for underperforming graduates

Medical authorities in Liberia have called on the government to stop sending medical students to study in China because Chinese medical school graduates are substandard.
The Liberia Medical and Dental Council has called on the Ministry of Health and Social Welfare and the Ministry of Education to place a hold on awarding scholarship to medical students for study in China.
Speaking at a news conference held in Monrovia on November 26, the council through its Chairman, Professor Robert Kpoto, said medical practitioners graduating from Chinese medical schools are performing below expectation.
According to him, this could be that the selection process of these students for the scholarship program was not done properly.
"Medical practitioners graduating from Chinese medical schools are performing below expectation. They are even incomparable with doctors who are here. I mean, they are failure and something must be done about this," Professor Kpoto said.
"I want to think that something might have gone wrong in the selection and vetting processes of these students who have been given scholarship to study medicine in China," said Prof Kpoto. He recommended that the medical council be part of the entire selection and vetting processes so as to get the proper students for such scholarship.
Read more: AllAfrica

China is 'missing' 200,000 paediatricians

China has limited numbers of paediatricians and childrens' hospitals

by Michael Woodhead
China has at least 200,000 'missing' pediatricians, because the growing need for pediatric medical services has not been matched by increases the number of paediatricians, lsays Professor Zhu Zonghan,  vice president of the Chinese Medical Association and president of the CMA's pediatrician branch.
Speaking at a meeting of the CMA paediatrics bench in Changsha this week, Professor Zhu said there was severe asymmetry in paediatric needs and services and "the establishment of the Paediatric system with Chinese characteristics is necessary." 　　
He said that of China's total population of over 1.3 billion, about one-fifth of the proportion of children. However, the country only has 68 children's hospitals, accounting for 0.42% of the national medical institutions. There are only 258,000 paediatric beds representing 6.4% of total hospital beds in the country.
There is also a serious shortage of the pediatrician human resources, and a lack of any long term training program.
Over the past 15 years, thenumber of paediatricians has increased by only 5,000 nationally, says Professor Zhu.
It is proposed that the creation of a  Chinese College of Paediatics and Child Health will help to alleviate the lack of pediatricians. Institutions such as the Hunan Provincial Children's Hospital of Nanhua University, are leading the way in developing graduate and undergraduate training programs in pediatric medical services.
Read more: Health News/JiankanBao

Do doctors in China need to speak English?

In the 21st century, the proliferation of knowledge and global migration of people are transforming the world into an interdependent community. Cross-border academic exchange in the medical realm becomes necessary and increasingly frequent.
Although English as a language is a compulsory course in school in China, its teaching focuses on daily communication or general English (as designated by linguists). English language for medicine is ignored. Medical English in China is accessed via a list of terms provided by teachers of medicine, who are likely incapable of instructing learners in the correct pronunciation and are therefore unable to train students in language skills. Chinese doctors feel incompetent in prompting professional discussion, no matter how proficient they may be in talking about the weather. In view of this circumstance, our department, which is devoted to medical English teaching and research, initiated an in-career programme to train doctors in medical English.
At the Third Military Medical University,  Chongqing developed a programme after conducting surveys and tests to establish what was required. Once requirements were established, training sessions were offered to the departments of affiliated hospitals at a rate of one session per department. Departments that noted a requirement for training were asked to contact us and join the programme. Doctors were keen to improve their listening and speaking skills, especially for the purposes of participating in academic conferences. We selected materials accordingly and adopted a learning-centred methodology, emphasising both language acquisition and the learning process.
For language acquisition, medical terminology characterised by word-building rules was illustrated. Pronunciation was corrected and model texts were read aloud and imitated. We explained the functions of sentences and the contexts in which they are used. Trainees were asked to perform role-plays to practise communication skills.
To enhance the learning process, we chose materials that were comprehensible to the participants and arranged problem-solving activities that require participants to actively think about and try to make sense of what they see, feel and hear. As feelings evoked in the learning process crucially influence the results of learning, we attempted to create a sense of achievement in trainees by tailoring the materials to an appropriate level.
Generally, the programme is successful and helps doctors to make great progress in medical English. Data for a course run in February 2011, which was attended by doctors from the gastroenterology department of our second affiliated hospital, show that the 20 doctors who attended  obtained significantly higher scores on vocabulary and listening. Participants showed more confidence and greater fluency in speaking, and made fewer errors in pronunciation than they had before the course. They also successfully held the Sino–Japanese Symposium on Early Cancer of the Gastrointestinal Tract in September 2011. Most of the participating doctors felt satisfied with their performance and with the programme. The training programme has now been implemented for 2 years consecutively and will be continued in the coming year.
Read more: Medical Education

Chinese Medical Association warns of CME scam

The Chinese Medical Association (CMA) says it has received reports of a website purporting to offer medical CME credit certificates on behalf of the education activities accredited by the CMA.
The CMA says the website (www.cmacme.net ) is not recognized, is counterfeit and is nothing to do with the CMA.
"These acts of fraud interfere with the normal work of the Chinese Medical Association, causing a bad influence, and have caused great losses to the majority of participants, the CMA said in a statement.
"In order for healthy and orderly development of the CME industry as a whole, the Chinese Medical Association has warned the responsible person to stop this behavior and to eliminate the adverse effects. The Chinese Medical Association  retains the right for the relevant persons responsible be held accountable. It has also reminded students to be vigilant, and carefully identify various sources of continuing medical education credits certificate and check website. According to the CMA,  there are simple and effective steps for identification of acts of fraud. CME programs organized by the Chinese Medical Association have never given or sold trainees any password card, IC card or electronic credit certificate granted cards and other cards. Any payment card, is a scam. In addition, CME programs organized by the Chinese Medical Association award credits certificate that are collected by the project organizers and uploaded to the Society official website (www.cma.org.cn). Anything that can be added at any time to personal information such as names of participants, not projects focused unified release credits certificate information, is a hoax. Since 2011, the national CME programs organized by the Chinese Medical Association have issued printed paper credits certificate, and authenticity can be checked online.

Read more: CMA