Study On The Specialty Training In The Graduate Students For Clinical Professional Degree

[Background] There are big differences in medical education system between China and western countries. At present, China is actively exploring to establish medical education system that is fit to its characteristics and gradually improving the "three-stage" model of medical education. Postgraduate education and residency training are two ways of graduate medical education that plays an important role in training medical professionals at higher level and in linking higher medical education to lifelong continuing medical education. It is meaningful to medical education if two ways of graduate medical education can be combined. In addition, as blurred boundaries between science degree and professional degree, postgraduate training and clinical residency training are overlapped. But considering inadequate clinical competence of postgraduates, they have to continue their clinical specialty training in the program of residency training.[Objective] The objective of the study was to analyze the possibility of combining postgraduate education for clinical professional degree with residency training in order to provide the evidence for the reform of postgraduate education for clinical professional degree.[Contents and Methods] In the study, the policies related to the education of clinical professional degree, the situation of postgraduate training for clinical professional degree in one tertiary hospital in Shanghai and the evaluation of specialty training from the stakeholders in the education were analyzed. In addition, the data were collected through literature review, hospital survey, questionnaire survey of postgraduates and their supervisors and expert interviews. One-way ANOVA, nonparametric test, Chi square test, Logistic regression analysis and other statistical methods were used in statistical analyses.[Results] We found that "Interim Measures for Clinical Professional Degree", formally issued by Academic Degrees Committee in 1998, clearly defined that the clinical professional degree is designed to train clinical professionals with higher competence in clinical analytical thinking, clinical professional skills and clinical research. From that time, the education for clinical professional degree became a major way to train high-level clinicians in our country. However, with the rapid development of medical industry in China, the government is emphasizing more on health issues and exploring the way to combine postgraduate education for clinical professional degree with residency training. Currently, it is feasible to establish national standardized residency training system.The questionnaire survey of the current postgraduates for clinical professional degree and their supervisors in one tertiary hospital of Shanghai showed that it was feasible to combine the clinical specialty training of postgraduate students with residency training. Technically, the clinical departments and training requirements of rotations and the supervisors of the two types are almost the same; socially, the forms of the two types are similar, which is easy for mutual recognition; economically, it can take advantage of state subsidies given to graduate students and can reduce the duplication in educational input if residency training is integrated into postgraduate education for clinical professional degree.The study showed that the surveyed the postgraduate students and their supervisors satisfied with current clinical training of postgraduate students for professional degree.81.7% of the students believed that all or most of the postgraduate students for professional degree could meet the requirements of residency training.68.4% of the supervisors generally satisfied with clinical competence of those postgraduate students.73.7%of the supervisors believed that all or most of the students met the requirements of residency training.The study also showed that there were difficulties for the combination of postgraduates for clinical professional degree and residency training:one was clinical qualification of postgraduate students.46.2% of the students and 42.2% of the supervisors believed that postgraduate students for professional degree generally could not practice in clinical departments due to no clinical license. Postgraduate students can take the examination for clinical license only after they graduate. Another was clinical competence of postgraduate students for professional degree. Rotation time for the postgraduate education and the residency training was different.49.77% of the students wished to be given a certification to recognize the level of their clinical competence and the certification should be identified directly by the hospitals that provided the residency training. The postgraduate students did not agree with the way by which their clinical competence was accredited.84.2% of the supervisors believed that it was necessary to integrate the postgraduate education for professional degree into residency training, while only 51.7% of the postgraduate students considered that it was necessary and 77.8% of the doctor-degree students believed that it was not necessary.[Discussion and Suggestions] According to the study results, the author suggested that:①the model of standardized residency training should be improved, licensing for clinical specialists should be regulated, and postgraduate education for clinical professional degree should be combined with standardized residency training;②the levels of clinical postgraduate education should be simplified and medical education system in China should be reformed;③unified, rigorous and specific system for assessment and examination and national standards for residency training accreditation and certification system should be established;④postgraduate students for professional degree should be allowed to take the qualification examinations to get their licenses after certain periods of clinical rotated training, and laws and regulations that were related to clinical training should be established and improved;⑤the pilot reform project of clinical graduate education for master degree in Shanghai should be continuously improved.