China's evolving residency training

Dear Sir

Home to one fifth of the world's population, China has an aging demography. In order to meet the increased demand for the qualified general practitioners, the National Health and Family Planning Commission of China (NHFPC) recently introduced a series of documents on standards of residency training which is the most critical step to turn the medical graduates into qualified practitioners. Accordingly, the national resident standardization training will start in 2015 and all the medical graduates are required to receive mandatory training from 2020. The primary model is a five-year course in a medical school plus three years of residency training.

However, it still faces significant challenges. Firstly, in comparison with the USA's 22,000 medical graduates in 2012, China has a large and diverse group of 144,000 graduates. Sixty-seven thousand are 5-year medical students, 34,000 are master or doctoral level graduates and 63,000 graduates have only 3 years of medical education (Hou et al. 2014). The inconsistency across previous educational backgrounds is a challenge when implementing residency training objectives and contents.

Secondly, the resident standardization training contents issued by NHFPC (Hou et al. 2014) are heavily focused on medical technology, with little content about humanities, ethics, communication skills and public health. As one of the earliest authorized residency training bases, Xiangya's three affiliated hospitals, with collaboration with the Yale School of Medicine, researched and established a comprehensive model of residency education from 2007. We set six core competencies as the training goals: professional skill, professionalism, patient safety, medical ethics, team spirit, innovation and self-development. Under each competency, detailed requirements are provided. This Xiangya's training model may be copied nationwide.

Thirdly, many medical graduates have lost their enthusiasm in pursuing their career because of insufficient salaries, heavy workloads and patient–doctor tensions (Zeng et al. 2013). An additional 3 years of residency training with inadequate income may prevent more talented graduates from going into this field.

How residency training develops in the years ahead will be a key determinant influencing the healthcare reform in China. Efforts should focus on several aspects: a more detailed framework for differently educated individuals; more humanistic and pragmatic training content and acceptable salaries which will attract higher enrollment.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.