| Educational scale, structure, quality, and efficiency are four basic components in the development of education system, whose coordination plays a key role in the operation of a school. With the progress of economic, social, scientific globalization, the change of medical model and disease spectrum, the implementation of new medical reform policy and its specification, as well as the introduction of new educational reform policy and relevant medical educational standard, new requirements are presented in higher medical education. Quality improvement has become the core task in current and future higher medical education, while nurturing health talents in different professions is a strategic goal. The optimization of eduational scale and structure serves as a precondition as well as an important strategy to improve educational quality and efficiency.1. Objective and SignificanceBased on the analysis of basic characteristics of health care professionals in Guangdong province under the health system reform and the demand forcast, we are to analyse the difference between current higher medical education scale and structure in Guangdong province(including educational level, form, discipline and specialty) and the demand for health care professionals, and to pinpoint the structural problem of higher medical education and its causes, concerning other factors affecting the scale and structure of higher medical education with a view to provide optimization strategies accordingly.The analysis of the evolution of higher medical education scale and structure in Guangdong province and the introduction of optimization strategies in accordance to the health care demand under new medical reform provides suggestions on the adjustment of the scale and structure of higher medical education and the classification and postion of higher education institution. It further gears higher medical education to the demand for reform and development of health cause, by facilitating coordination of the scale, structure, quality and efficiency of higher medical education and improving the training quality and increasing employment rate of medical talents.2 MethodsSystematic literature review is conducted to examine related policy and research of health system and education reform; descriptive analysis and dynamic series analysis are used to study the history and current status of health talents in Guangdong, higher medical education and secondary medical education; grey prediction method is used to predict the supply and demand of health professionals and the population development in Guangdong; manpower:population ratio method is employed to figure out the demand of health technicians in Guangdong. Logistic model is used to predict the development of population and the annual health workforce in the future; age shifting algorithm is introduced to predict the number of higher medical graduates of different professions; combination forcasting method isintroduced to enhance the accurancy of prediction. PEST analyzing model and five-force model are used to investigate the interior and exterior driving factors of higher medical education development in Guangdong.3 Results3.1 The Historical, Statu Quo and Demand Forcasting Analysis of Health Personnel Scale and Structure in Guangdong Province3.1.1 The history and statu quo of health personnel scale and structureAnalysis of data of health personnel in Guangdong province in 2010 shows that health human resources is lacking in Guangdong province:despite the fact that the total number of health personnel in Guangdong province ranked second in the country and health technicians first, per thousand residence population, there were 1.68 practising (or assisting) physicians,1.61 registered nurse, which stands lower than the national average. The education background of the health technicians in Guangdong province is distributed unevenly:compared against the national level, the majority of health technicians held a master degree or a secondary degree, while bacholers take up a small proportion. Among them, the assisting physicians and registered nurses hold a relatively low education degree.3.1.2 Forcasting analysis of health techniciansUsing the 2006-2010 data as a baseline, we used the grey prediction method in GM(1,1) to predict the number of health care professional, practicing (or assisting) physicians, registered nurses, professionals in pharmacy or testing in short term and mid-term; we found that each prediction model is excellent.In light of the planning index of health personnel in the short term and mid-term personal development plan in medine and health introduced by the ministry of health in 2011, the total number of health personnel in Guangdong province and planned number of each kind of professionals in the same year were acquired by manpower: population ratio method, basd on a prediction of the population in Guangdong province in 2015 and 2020 respectively. Logistic model was used to calculate the number of each kind of professionals in each year.A comparison of the two forcasting results indicates that except for the professionals in pharmacy, the predictive value obtained from Logistic model and manpower:population ratio method is lower than that from GM (1,1) model.3.2 Historical, Statu Quo and Trend Analysis of Higher Medical Education Scale and Structure in Guangdong Province3.2.1 The history and statu quo of the higher medical education in GuangdongAnalysis of educational data of Guangdong province in 2010 manifests:the overall medical educational scale in Guangdong province is small in proportion. Medical post-graduates and adult medical colleges and universities take up a large proportion in the overall medical educational scale while general medical colleges and universities and online medical education makes up a low proportion. Medical post-secondary education is a relatively common. These features of educational distribution resemble the educational background distribution of health technicians in Guangdong.Data of 2004-2010 shows:in terms of educational level, enrolment scale of associates and undergrates tends to stable after 2008. The enrolment scale of doctoral candicates ticks up; postgraduate:graduate ratio is going up and associate undergraduate ratio has increased. As to educational form, general eduation and adult education is the major avenue to higher medical education in Guangdong Province, while the latter has become more common. In the professional structure, clinical medicine, pharmacy, TCM (Traditional Chinese Medicine), nursing and Chinese pharmacology takes up the largest proportion. Since 2008, proportion of graduates in different professions began to stabilize, while the emrolment scale tended to stability since 2009.3.2.2 Prediction of higher medical graduates in GuangdongAs the general higher medical education scale and the professional structure tend toward stability, based on the number of enrolled students in 2010 and the number of undergraduates, comparison between the number of undergraduates and graduates by grade shifting algorithm (after the students are enrolled) predicts that the number of graduates are going to stand at 71,000 since 2014. Among them, the number of post-graduates accounts for 7,000, the number of associates and undergraduates 23,000, and the number of post-secondary students 41,000. The proportion of higher education students is on the low side (about 41%).In accordance to main goal the educational and human resources development stated in the short term and mid-term educational reform and development progrma planning in Guangdong Province, if medical education take up a stable share in the general education level in Guangdong province, desired value of medical education in Guangdong in 2015 and 2020 respectively can be extracted. Then we calculate the annual number of graduates from higher medical institution from 2011 to 2020 using Logistic model.Comparison between the above two calculating result, we learn that before 2015, the number of students in general higher education and secondary medical education make little difference with both methods. But the difference become increasingly significant after 2015.3.3 Analysis of Medical Institution Scale and Structure in Guangdong ProvinceIn 2011, there are in total six medical institutions in Guangdong (accounting for 3.5% in national level), of which five is for undergraduates. In terms of the number, medical institution in Guangdong Province takes up a low share in the national level. As institutional scale, undergraduate schools dominate in medical education in Guangdong province (accounting for 71.92%), especially in general medical education and adult education. Higher medical institutions for undergraduates in Guangdong carries a distinct feature of multidisciplinary structure, while their medical advantages are diminishing,28% of non-medical students take up 40% of medical resources in medical institution.3.4 Comprehensive Analysis on the Scale and Structure of Guangdong Higher Education3.4.1 Analysis on the Employment of Guangdong Medical Education (the Supply and Demand of Medial Technical personnel) from 2006 to 2010From the comparison between the increasing number of various levels graduates of Guangdong medical education from 2006 to 2010 and that of various levels Guangdong medical technical personnel from 2005 to 2010, we find a series of facts that although supply and demand were at equilibrium on the whole, demand exceeded supply before 2007, and the situation was just reversed after 2007; that the supply and demand of different types health workers vary from each other:the demand of nurse exceeded the supply, while the supply of pharmaceutical personnel exceeded the demand sharply (excluding those employments not belonging to the medical structure), and as for test technicians, the supply also exceed the demand; that the supply and demand of various levels medical personnel also vary from each other: too many of them graduated from a technical secondary school, but only a few of them got a bachelor degree.3.4.2 Forecasting Analysis on the supply and demand of Guangdong Medical Technical Personnel from 2011 to 2020.From the comparison of the forecasting supply and demand based on the year-shifting algorithm under the measurement and stable scale of Guangdong health workers in accordance with the health planning objectives from 2011 to 2020 (based on the students enrollment scale and proportion in 2010), we can predict that the supply of medical technical personnel will exceed the demand on the whole before 2018, but will become lower than the demand after 2018; that Compared to that of medical and health institutions, the supply-demand ratio of pharmaceutical personnel training will be higher; that the supply of the nursing staff training will basically keep meeting the increasing demand before 2016, but the situation will be reversed after 2016, and if considering the high separation rate of nursing workers, the reversion will probably occur in advance; the physician training would just meet the present increasing demand, but the actual situation in the past was like this:the demand for undergraduate doctors was decreasing in both the secondary and tertiary hospitals in developed cities, while the hospitals in local places were in great need of doctors, because the undergraduates were not willing to work in these local hospitals, which resulted in the structural unemployment; that the medical technician training would also just meet the present increasing demand; that the supply-demand ratios of other medical technical personnel will remain higher than 1.5, but this is the result not considering the personnel structure change posed by the health system reform.According the analysis on the education level, there will be 41% of these personnel coming from a technical secondary school after 2014. This is already far from the present requirement of medical and health institutions, and if this situation cannot be changed, the contradiction between supply and demand will become more serious:on the one hand, the medical and health institutions cannot recruit enough relatively high level staff; on the other hand, those low level graduates cannot find a job.3.4.3 The Relevant Factors Influencing the Optimization of Guangdong Higher Medical Education Scale and StructureThe external environment factors influencing Guangdong higher medical education industry refer to the macro driving factors of the development of Guangdong higher medical education, including political factors, economic factors, technological factors and socio-cultural factors. Among these factors, which have relatively greater influence on Guangdong higher education scale and structure include:national and Guangdong provincial policies and projects about the medical and health system reform, education reform, and education health management system (political factors); the decrease of learning-age population of secondary and higher education, the increasing process of aging of population, the high expectation on the quality of health care from the society, and social equality(socio-cultural factors); the opportunity for medical schools to develop new interdisciplinary majors provided by the differentiation and comprehensive development of medical technology (technological factors).And the internal environment factors influencing Guangdong higher medical education industry refer to the direct driving factors relevant to the development of higher medical education, which mainly include the competition and collaboration between the higher medical education schools in Guangdong, the demand for the health care human resource, students resource, the substitute of the graduates from the secondary medial education, and the students enrollment and employment of those higher medical education schools from other provinces.The development of higher medical education was driven and influenced by both the four kinds of external environmental factors and the five internal basic forces of higher medical education industry listed above.4 ConclusionsThe scale and structure of Guangdong higher medical education experienced an enrollment expansion volatility (from 2003 to 2004), a rapid growth (from 2005 to 2008), and has now reached a relatively stable period (from 2009 to now). However, with external changes such as new demand of the health system reform and new development of educational reform, new tendency of the student rescource; with internal changes from old contradictions handed down by its own rapid development, there are several main problems existing in the scale and sturcture of Guandong higher medical education:● Insufficiency of system integration between the external and the internal departments. For example, few communication and view exchange are made btween education and hygiene, schools, higher and secondary education and between those educations in the department of education administration.● Mismatch of the overall training scale development and Guangdong health officers.●Inadequacy of the actual situation and the development scale of Guangdong education.● Incongruent hierarchy of the employing needs in medical institutions for high proportion of the lower level.●Inappropriateness of specialty structure and development needs from Guandong health officers.● Ill-structured educational running form with extensive vocational schools and adult education.● Tendency of multidisciplinary education in Guangdong higher medical schools and consequently they lose their characteristics.In view of the above problems, suggestions are provided to optimize the scale and structure of Guangdong higher medical education as follows:● Clear overall subject positioning:quality first and strictly control the scale to first achieve high quality and level.● To achieve macro plan development of Guangdong medical education; to establish coordinating mechanism in prediction, planning, monitoring, early warning and regulation of scale and structure in Guangdong medical education; and to tentatively carry out integration in Guangdong higher medical education.● Scale development strategy:to plan according to the general demand and secondary medical education.● Hierarchical structure development strategy:an overall development towards the high level, to reduce the size of the secondary medical education, and to steadily develop higher medical vocational education, and strive to develop the undergraduate and graduate education.● Specialty structure development strategy:to achieve professional layered orientation; to match the level posts and demands in health institutions.● Formal schemata development strategy:to match the increasing number of ordinary college students and graduate students as well as to adult this specialized subject lays to and existing low academic on-the-job personnel situation match adult college students and workers with low-levels of education.● Guangdong medical colleges and universities shoud focus on the basis of overall subject and own characteristics to reach characteristic development.● To establish mechanism that increases medical education investment.To sum up, as About Some Ideas Improving Higher Education Quality of Teaching All Round has been put forward and department of education administration in Guangdong province are working out practical solutions, this reaserch is wrting with the hope to provide valuable reference to Guangdong higher medical education in working on "Optimizing structure and strengthening characteristics", "Exploring and establishing college classification system" and "Comprehensive reform of medical education" as well. |
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