Grey’s Anatomy, Scut Work, Burnout, & Rural Shortages in China too…
My husband and I recently traveled to Wuhan Medical School in the Hubei Province in central China. Our medical school has partnered with Wuhan to help inform their curricular reform efforts. We spent 4 days touring the hospitals and teaching facilities, meeting students and faculty, going on rounds, and giving talks. Although the language barrier was challenging, we had incredible translators who worked to translate every slide we spoke into Chinese. We also had the opportunity to observe and talk to students, residents, and faculty through translators to better understand their experiences.
Preclinical Student Education Interestingly, the preclinical students told me they watch Grey’s Anatomy and House and wonder if that is what medicine is like. I told them that US medical students and premeds have wondered that too! And just like our preclinical students, these students are very excited to get to the wards and desire earlier exposure to patient care. Fortunately, Wuhan has already started instituting reforms for a pilot group of preclinical students through a more integrated block style curriculum that focuses on incorporating clinical medicine into the preclinical teaching. They also have state of the art simulation to help students practice clinical medicine. As one attending said, “the book is book, but practice is practice.”
One big difference is that Chinese medical students are a lot younger – starting right after high school and have little understanding about a medical career. A standardized national exam in high school dictates whether students will get to go to medical school. The default pathway for students that don’t get into medical school is often nursing school. Therefore, many of the nursing students are disengaged. Once in medical school, the standard pathway is the 5 year option, with smaller 7 and 8 year options for select few who desire more clinical training and research. Wuhan also has a foreign medical student population that include students from India, Canada, Africa and even the U.S. who spend 4 hours a day studying Chinese on top of their preclinical studies so they can eventually interact with Chinese patients. And yes, they don’t have Facebook or Twitter and use Baidu instead of Google.
Rounds and Clinical Rotations Probably the most fascinating part of our trip was observing teaching rounds in 2 Chinese hospitals. The patients were three to a room and were wearing their own clothes instead of gowns. It is cold in the hospital since the buildings are not heated (I was wearing my winter coat the whole time). In both hospitals we were in, the clinical students did not ‘follow’ patients but worked as a group (4 to 5) with one attending physician to see all the patients.
Through the long streams of Chinese, we could make out the terms “COPD” in a lung ward or “Framingham” when observing a cardiologist teaching medical students. Students who were thirsty for clinical teaching were furiously taking notes in little books. The familiar tradition of the attending ‘pimping’ the students was also observed. Students did not ask a lot of questions, which is consistent with more of the passive learning style documented in Chinese medical education –one thing that Wuhan very much wants to reform. Students were also carrying all the charts for the rounds and expected to do other clerical tasks. When I explained the term ‘scut work’ to our Chinese medical student translator, she told me that this work is actually part of their ‘cooperation score’ on the evaluation symbolizing teamwork.
Residency and Clinical Practice There is currently no required residency training but formal residency training is on the verge of starting across China. Currently, some graduating medical students will do an internship at the hospital underneath a senior doctor. One of the interns we met with said that she lives at the hospital (in a dorm) working 6 days a week with one day off working roughly 70-80 hours per week taking overnight call once a week. Since not every department has an intern every year, the attendings sometimes have to take call weekly too. As a result, the doctors we met with reported being fatigued and burned out and wondering how to balance work and life (sound familiar?). And lastly, as described in several articles in this week’s issue of Academic Medicine in the US, there is also a major shortage of Chinese doctors in rural areas since everyone wants to live in urban areas.
Even though we were there to teach, we ended up learning that we had a lot in common. A special thank you to all of our hosts at Wuhan Medical School who went above and beyond to make us feel welcome!
Vineet Arora, MD