- Email: [email protected]
Inadequate evaluation of medical doctors in China
Correspondence
1 2
3
The Lancet. Ending violence against doctors in China. Lancet 2012; 379: 1764. Xu J, Wang W, Li Y, et al. Analysis of factors influencing the outpatient workload at Chinese health centres. BMC Health Serv Res 2010; 10: 151. Pan XL, Hassan HD, Wang XH, Zhang H. Service utilization in community health centers in China: a comparison analysis with local hospitals. BMC Health Serv Res 2006; 6: 93.
Internationalisation of Chinese medical schools There are 1193 institutions of higher education in China certified by the Ministry, including those in Hong Kong and Macao: 31 are medical schools teaching traditional Chinese medicine (TCM), and 152 are medical schools teaching western medicine—52 offer an English Bachelor of Medicine, Bachelor of Surgery (MBBS) degree, equivalent to the American Medical Degree. 30·9% of western medicine medical schools and 63·5% of MBBS medical schools enrol international students, 36·2% and 65·4% of western medicine medical schools and MBBS medical schools offer courses on international and global health. 23·0% of western medicine medical schools and 46·2% of MBBS medical schools employ international experts. The geographical distribution of western medicine medical schools in China matches with population and financial resource distribution, with east China having the greatest number of western medicine medical schools. Despite a large wealth gap between regions, east China and south-central China have a similar number of western medicine medical schools (44 vs 41). However, east China has 20 MBBS medical schools, whereas south-central China has 12. The number of TCM medical schools is similar between the two regions. More than a quarter of TCM medical schools enrol international students, and more TCM medical schools have international student exchange 1984
programmes and scholarships than do western medicine medical schools. Many Chinese people rely on TCM for their medical care, and there is a high demand from Chinese students to learn TCM. In the past 20 years, TCM has been largely exported: acupuncture clinics and herbalists have opened in Europe and the USA. Just like a generation of Chinese doctors travelled to learn western medicine, a new generation of international students is going to China to learn TCM. With students and faculty exchanges, global health courses, and interaction with international affiliates, Chinese medical institutions have taken an important first step towards the internationalisation of their education system. Such trends affect the global nature of medical curricula and the medicine discipline itself. Medical training is no longer culturally distinct. Programmes in Chinese medical universities support student and doctor exchanges, but more importantly, they promote idea exchanges between different cultures, leading to a harmonisation between eastern and western perspectives on medicine.
This evaluation system leads to doctors spending a long time writing articles, and spending less time treating their patients, affecting the quality of treatment and the doctorpatient relationship. Because of this pressure to publish articles, doctors have falsified data, and ghostwriter companies are growing rapidly, resulting in untrustworthy articles. This evaluation system relying on SCI articles damages China's scientific research capability and credibility.1, 2 Just like an appeal3 published in The Lancet changed China’s organtransplantation system,4 we hope this Correspondence could end the evaluation system based on SCI articles, and lead to a more reasonable and efficient evaluation system for medical doctors in China. We declare that we have no conflicts of interest.
*Bo Ye, Ae-Huey Jennifer Liu [email protected] Medical College,Shanghai Jiaotong University, Shanghai, 200030, China (BY); and West China Center of Medical Sciences, Sichuan University, Sichuan, China (A-HJL) 1 2
We declare that we have no conflicts of interest.
*Angela Fan, Russell Kosik, Qi Chen
3
[email protected]
The Lancet. Scientific fraud: action needed in China. Lancet 2010; 375: 94. Qiu J. Publish or perish in China. Nature 2010; 463: 142–43. Caplan AL, Danovitch G, Shapiro M, et al. Time for a boycott of Chinese science and medicine pertaining to organ transplantation. Lancet 2011; 378: 1218. Huang J, Millis JM, Mao Y, et al. A pilot programme of organ donation after cardiac death in China. Lancet 2012; 379: 862–65.
National Yang-Ming University School of Medicine,Taipei, Taiwan (AF); Santa Clara Valley Medical Center, San Jose, CA, USA (RK); and Nanjing Medical University, Nanjing, China (QC)
4
Inadequate evaluation of medical doctors in China
Ya’an earthquake
Since the late 1980s, the majority of the large hospitals in China use publishing in the Science Citation Index (SCI) as the main indicator for medical career evaluation, promotion, and also recognition. Most medical doctors in China are under a huge amount of pressure to publish articles each year.
On April 20, at 0802 h local time, just 22 days before Wenchuan earthquake’s fifth anniversary, a magnitude 7 quake struck the province of Sichuan, China. The epicentre was Ya’an in Lushan county. More than 4000 aftershocks were felt in Ya’an in the following days. More than 100 aftershocks were above magnitude 3. 196 people have been killed, 11 470 people were injured, and more than 1 500 000 people www.thelancet.com Vol 381 June 8, 2013
1 2
3
The Lancet. Ending violence against doctors in China. Lancet 2012; 379: 1764. Xu J, Wang W, Li Y, et al. Analysis of factors influencing the outpatient workload at Chinese health centres. BMC Health Serv Res 2010; 10: 151. Pan XL, Hassan HD, Wang XH, Zhang H. Service utilization in community health centers in China: a comparison analysis with local hospitals. BMC Health Serv Res 2006; 6: 93.
Internationalisation of Chinese medical schools There are 1193 institutions of higher education in China certified by the Ministry, including those in Hong Kong and Macao: 31 are medical schools teaching traditional Chinese medicine (TCM), and 152 are medical schools teaching western medicine—52 offer an English Bachelor of Medicine, Bachelor of Surgery (MBBS) degree, equivalent to the American Medical Degree. 30·9% of western medicine medical schools and 63·5% of MBBS medical schools enrol international students, 36·2% and 65·4% of western medicine medical schools and MBBS medical schools offer courses on international and global health. 23·0% of western medicine medical schools and 46·2% of MBBS medical schools employ international experts. The geographical distribution of western medicine medical schools in China matches with population and financial resource distribution, with east China having the greatest number of western medicine medical schools. Despite a large wealth gap between regions, east China and south-central China have a similar number of western medicine medical schools (44 vs 41). However, east China has 20 MBBS medical schools, whereas south-central China has 12. The number of TCM medical schools is similar between the two regions. More than a quarter of TCM medical schools enrol international students, and more TCM medical schools have international student exchange 1984
programmes and scholarships than do western medicine medical schools. Many Chinese people rely on TCM for their medical care, and there is a high demand from Chinese students to learn TCM. In the past 20 years, TCM has been largely exported: acupuncture clinics and herbalists have opened in Europe and the USA. Just like a generation of Chinese doctors travelled to learn western medicine, a new generation of international students is going to China to learn TCM. With students and faculty exchanges, global health courses, and interaction with international affiliates, Chinese medical institutions have taken an important first step towards the internationalisation of their education system. Such trends affect the global nature of medical curricula and the medicine discipline itself. Medical training is no longer culturally distinct. Programmes in Chinese medical universities support student and doctor exchanges, but more importantly, they promote idea exchanges between different cultures, leading to a harmonisation between eastern and western perspectives on medicine.
This evaluation system leads to doctors spending a long time writing articles, and spending less time treating their patients, affecting the quality of treatment and the doctorpatient relationship. Because of this pressure to publish articles, doctors have falsified data, and ghostwriter companies are growing rapidly, resulting in untrustworthy articles. This evaluation system relying on SCI articles damages China's scientific research capability and credibility.1, 2 Just like an appeal3 published in The Lancet changed China’s organtransplantation system,4 we hope this Correspondence could end the evaluation system based on SCI articles, and lead to a more reasonable and efficient evaluation system for medical doctors in China. We declare that we have no conflicts of interest.
*Bo Ye, Ae-Huey Jennifer Liu [email protected] Medical College,Shanghai Jiaotong University, Shanghai, 200030, China (BY); and West China Center of Medical Sciences, Sichuan University, Sichuan, China (A-HJL) 1 2
We declare that we have no conflicts of interest.
*Angela Fan, Russell Kosik, Qi Chen
3
[email protected]
The Lancet. Scientific fraud: action needed in China. Lancet 2010; 375: 94. Qiu J. Publish or perish in China. Nature 2010; 463: 142–43. Caplan AL, Danovitch G, Shapiro M, et al. Time for a boycott of Chinese science and medicine pertaining to organ transplantation. Lancet 2011; 378: 1218. Huang J, Millis JM, Mao Y, et al. A pilot programme of organ donation after cardiac death in China. Lancet 2012; 379: 862–65.
National Yang-Ming University School of Medicine,Taipei, Taiwan (AF); Santa Clara Valley Medical Center, San Jose, CA, USA (RK); and Nanjing Medical University, Nanjing, China (QC)
4
Inadequate evaluation of medical doctors in China
Ya’an earthquake
Since the late 1980s, the majority of the large hospitals in China use publishing in the Science Citation Index (SCI) as the main indicator for medical career evaluation, promotion, and also recognition. Most medical doctors in China are under a huge amount of pressure to publish articles each year.
On April 20, at 0802 h local time, just 22 days before Wenchuan earthquake’s fifth anniversary, a magnitude 7 quake struck the province of Sichuan, China. The epicentre was Ya’an in Lushan county. More than 4000 aftershocks were felt in Ya’an in the following days. More than 100 aftershocks were above magnitude 3. 196 people have been killed, 11 470 people were injured, and more than 1 500 000 people www.thelancet.com Vol 381 June 8, 2013