| BackgroundWe have been cultivated a number of outstanding medical elites since Peking Union Medical College(1991) and the Department of Medicine in Peking University(2001) piloted Eight-Year System Medical Education Program. With the internationalization boosting of medical education and the rising demand for high-quality medical talents after2004, there are about seventeen colleges and universities have been running eight-year MD education. Many existed problems needed to be studied and solved immediately to improve the overall quality of education when compared with developed countries due to the program is in the pilot. With the globalization of medical education, international exchange of academic medicine are growing increasingly. Excellent medical talents will be internationally occupational mobility. We must improve the international competitiveness of medical students of Eight-Year System. Medical education in USA has a history of200years. It has become a successful model for world medical education after continual development and perfection. Many countries use its successful experience to promote native medical education reform. It is necessary to take the advanced education concepts of USA and find out the ways for education reform in our country based on its successful experiences in order to solve these problem. It is even more imperative to realize students' and instructors' leaders' attitudes and suggestions to related eight-year education problems, then we can put forward some suggestions and assumption and offer references for education reformation in our country.ObjectiveOur study is to update the education concept and put forward the proposal through investigating the problems of Eight-Year System and comparing the Eight-Year System Medical Education Program's development process, recruitment, training, degree-granting, after-graduate convergence and so on between China and USA. Meanwhile, we will also boost the education reform of Eight-Year System Medical Education Program in our country.1.To understand the characteristics of the current eight-year MD education model in China and America and explore the differences of Eight-Year System Medical Education Program;2.To define students', instructors' and leaders' attitudes and suggestions to the related eight-year education problems;3. To explore the education reform and enhance the scientifically and rationality of Eight-Year System Medical Education Program reform based on the above analysis of the success of American medical education initiatives.MethodIn this paper, we used three methodologies:literature review, comparative study and survey. Firstly, by retrieving materials and all kinds of information, we collected information of the best of21medical schools. It represented the status of current Eight-Year System Medical Education Program's vision, course mode, teaching methods, assessment methods, ethics, clinical ability, degree granting and medical assessment. Then we concluded the differences and the sources of the difference, exploring the ways of improving this system. At last, based on the information of admission, education, degree granting and graduate requirements, we made survey and sent self-designed questionnaire to600students who come from11different colleges and72experts who come from7universities. After analyzing the above information, we discussed and analyzed the different ideas between different school types, different respondent groups and different grade of students. Study contents1.Comparative Study on the education for Medical Doctor in Eight-year Program between China and USA(1)The descripsion of developing history and status of eight-year MD education model in China and America;(2)The characteristics of the current Eight-Year System Medical Education Program's vision, course mode, teaching methods, assessment methods, ethics, clinical ability, degree granting and medical assessment in China and America;(3)The differences and the sources of the difference between china and the USA in Eight-Year System Medical Education Program;2. Reform survey of Eight-Year System Medical Education Program in our country(1)The design of questionnare on the Eight-Year System Medical Education Program reform survey.(2) Students' and instructors' leaders' attitudes and suggestions to the related eight-year education problems.(3)Analysis of the difference ideas between different school types, different respondent groups and different grade of students.ResultsEnrollment:in china, colleges require students who are eligible for the Eight-Year System Medical Education Program are high school graduators and based on their college entrance examination score. While the students who are eligible for the Eight-Year System Medical Education Program are bachelors and the enrollments are based on the following information in United States:medical college entrance examination score, interviews with experts, recommendation letters, social activities and so on.Cultivation objectives:Our country is mainly educating composite medical elite talents who gain solid medical basic theory, knowledge, skills, as well as strong clinical ability, lifelong learning ability and qualified professional ethics. The medical education in U.S is mainly focusing on cultivating rough medical talents who gain solid theory knowledge, clinical ability, growing potential and basic professional ethics.Curriculum mode, teaching and assessment methods:schools that have kinds of curriculum modes in America can freely choose curriculum pattern, organ system curriculum pattern, problem-based pattern or integrated curriculum pattern. But schools in china take traditional curriculum model and some schools have been set integrated curriculum. Schools in America take the way of group discussion while that in china take lecture based teaching. What is more, schools in America require students taking the first and the second phases of the Doctor Qualification Examination during their studying period while our country does not have such requirement.Professionalism education:schools in the United States own complete professionalism education and evaluation system and emphasize clinical education, setting up kinds of lectures on ethics. However, schools in China begin to emphasize Professionalism education and mainly focus on humanistic education.Clinical ability training:compared with the Eight-Year System Medical Education Program in China, schools in USA have lower level requirement and more flexible internship arrangement, they emphasize community medical practice. In addition, Simulation-based medical education and standardized patients applications are more popular in USA than that in China.Degree granting and medical admission and after-graduation connection:in china, students must finish thesis. And medical license can be awarded if candidate pass the exam before graduation. But some school might require certain training before the issue of license. The US does not require finished thesis before students'graduation. And the medical license can be awarded once the candidates pass the qualification test. The premise to take the test is at least one year experience as intern doctor. After the issue of doctor license, the candidate can accept training for resident doctors.The result of the Eight-Year System Medical Education Program reform survey:660questionnaires for students were collected, with551effective ones and effective rate of83.5%. And72questionnaires for experts were collected, with57effective ones and effective rate of79.2%.Enrollment-side result:57.4%of students and73.3%of experts think enrollment should focus on assess the overall capability of candidates; Most students doubt the fairness of interview and second-round enrollment should consider sophomores (41.7%); Most experts think the interview is fair and they recommend sophomores and graduated students as candidate for second round enrollment.Educational process and curriculum:students have the following ideas:65%of students hold the view that decreasing general education time) and64.4%of students think that keeping basic medical education time the same as before.55%of students think that increasing clinical medicine education time is reasonable while keeping internship and thesis period the same as before (73.5%and58.1%). Experts have the following ideas:54.4%of experts think that the time of gaining general education should decrease and66.7%of experts agree that the time of gaining basic medical education should decrease. In addition, in their opinion, keeping the clinical education time the same and increasing internship and thesis period are reasonable. For the suggestion on curriculum setting,52.7%of students choose add medical integrated courses in basic medical education and64.9%of experts choose add basic forefront medicine courses.74.3%of students and63.2%of students are all agree adding clinical ability training courses.The Overall education plan:8year medical education is aiming for compound knowledge based talents (students56.4%, experts52.6%), it should have a strict eliminate system (students66.4%, experts95.5%). They advise colleges to use general education, basic medical education and clinical education in order to implement elimination process, setting up a specific clinical ability standard; From English aspect,37%of the students focus on English writing and59.6%of the experts focus on English communication skill. Besides, only for passing the standardized training, she or he can be a lead Physician. Most students and experts believe that Bilingual education is necessary. But it is not necessary to implement PBL in all classes.Graduation issue:the thesis requirement level should lower for Eight-Year System Medical Education Program students than that for current doctors (students59.9%,experts59.6%)while the degree paper should have the same requirement level (students33.6%, experts47.4%). The short time period is the main problem for eight-year students to finish thesis (students57.1%, experts64.9%) and they believe that decreasing the time gaining general education can make up for the short thesis period.The stress for eight-year program students is mainly from job seeking and they showed highly satisfied with clinical education stage in all stages. The problems about education process are unreasonable curriculum setting (82.4%), unreasonable education planning and time, inflexible teaching methods (41.6%). Experts advise to emphasize Humanities Education (71.4%), self-learning cultivation (71.4%) and students advise to emphasize clinical ability cultivation (73%) and clinical medical education (69.7%).The survey results of secondary selection, training orientation, time arrangement of general education and practice, research and thesis, English requirements are statistically significant in different subjects.The survey results of time arrangement of general education, basic medicine education practice, research and thesis, eliminated mechanism and method, academic paper publishing requirements, learning satisfaction are statistically significant in different types of school.The survey results of training orientation, time arrangement of general education, clinical medical education, practice, research and thesis and learning satisfaction are statistically significant in different grades of students.ConclusionHere are some differences between china and the USA in Eight-Year System Medical Education Program.The USA aims to cultivate rough-type medical talents while China aims to bring up the compound medical elites in cultivation orientation. In enrollment pattern, the United States is characterized by a comprehensive evaluation and China is characterized by college entrance examination plus second selection. With curriculum mode, the USA has full discretion in choosing curriculum pattern and integrated curriculum is the main mode, while discipline-based courses and course modules are the main mode in China. Group discussion is the main teaching methods in the USA while China takes lecture-based teaching. Ethical education in USA has been developed to be mature while China is in early stages. As to clinical ability training, the United States is characterized by lower requirement and earlier contacting clinic and more emphasis on community medical practice. In addition, China is characterized by the short training time, high requirements, all-round training. Dissertation is not required in the USA and can not be qualified as a doctor immediately after graduation.Dissertation is required for eight-year program in China and can be qualified as a doctor.The regularly educational evaluation, carrying out teaching reform actively, selection of high quality new student, student-centered teaching methods and course offering, multi-channel training mode of clinical competence, and the impeccable engagement with graduate medical education of medical education in USA are good references to educational reformation development of eight-year program in our country.The proposals of experts and students for Eight-Year System Medical Education Program:taking comprehensive admission system; decreasing the time of graining general education by half a year thus graining additional internship experience; setting basic medical education frontier courses, medical integrated courses at the stage of basic medical education courses, and setting clinical skill training courses and patient communication courses at the stage of clinical education; implementing PBL and bilingual education method; keeping the requirement of thesis consistence but allowing the number of published paper for students who take eight-year medical education lower than normal doctors; organizing school's strict three-stage elimination examination. In addition, we should cultivate the students' clinical abilities and self-learning abilities, and enhance the overall quality of humanities education and clinical knowledge education.
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