For information on eligibility and the application process, please click here. Peking Union Medical College Hospital PUMCH celebrated the th anniversary of its founding on September 16, a significant milestone that was recognized at a ceremony attended by senior government officials, PUMCH leaders, senior faculty members, and distinguished guests. The program aims to bring together a network of outstanding low- and middle-income country LMIC training sites across different regions that have the infrastructure, leadership, and mentoring experience to provide high-quality global health training to the CMB fellows.
Skip to main content. Latest News. January 3, December 28, December 15, Metrics details. Data came from all examinees of the MLE for rural general practice in Hainan province, China.
Chi-square tests and multivariable logistic regression were used to identify examinee characteristics associated with passing Step 1 and Step 2, respectively. Junior college medical graduates were 2. Other characteristics, including age, gender, forms of study and years of graduation, were also significantly associated with passing Step 1.
Peer Review reports. Many countries have developed a medical licensing examination MLE system to determine and monitor the inflow of newly licensed doctors into the health workforce. The law requires that all practicing doctors in China must pass the MLE and register as a licensed doctor or a licensed assistant doctor in order to practice legally.
Graduates of the mainstream pathway can take the relevant MLE after working in a health organization for 1 year and register as a licensed doctor if passing the MLE. This alternative pathway, which often offers three-year medical education at the secondary school or junior college level, represents a historical legacy of the Soviet Union medical education modality.
There is no nationally standardised curriculum for these instant programmes, and the three-year condensed curriculum often consists of one-year basic medical sciences, one-year clinical medicine and one-year clerkship [ 3 , 4 ]. These education entities at the secondary school or junior college level are like sort of vocational training institutes in high-income countries.
Graduates of the alternative pathway are also required to have one-year working experience before taking the relevant MLE and can register as a licensed assistant doctor after passing the MLE. In , China had about 3 million licensed doctors and 0. Theoretically, rural primary care providers graduated from the alternative pathway are all supposed to pass the relevant MLE and register as licensed assistant doctors, but this transition has been very slow.
Some of them hold a village doctor certificate that allows them to prescribe and treat patients at village clinics with very limited scope of practice; the rest who do not have the certificate can only conduct the so-called public health tasks [ 7 ]. The low practicing qualification of many rural primary care providers is not only a challenge to the availability of qualified practicing doctors in rural China, but also a threat to the quality of care provided for rural residents.
In , the central Chinese government added a new MLE for rural general practice into the existing MLE system to boost the number of qualified practicing doctors in rural areas [ 8 ]. The new MLE is designed specifically for providers who have worked in rural primary care facilities but not yet obtained the qualification of licensed assistant doctors.
Successors of this MLE can register as rural general practitioners as part of the licensed assistant doctor group and are allowed to practice general medicine independently with full prescribing authorities at rural township health centres or village clinics. More importantly, this MLE provides greater incentives in retaining rural primary care providers. The MLE for rural general practice was piloted in nine provinces in , then further expanded to another 15 provinces in , and finally implemented nationwide in Consistent with the existing MLEs, this MLE also consists of two steps, but its content is tailored more to general practice in rural settings.
The Step 1 examination is a five-station practical skills test, and the five stations consist of medical history taking, physical examinations, basic clinical operations, basic public health operations, and basic traditional Chinese medicine TCM operations [ 10 ]. China has set the goal that by , the majority of village doctors should obtain the qualification of licensed assistant doctors [ 12 ]. However, evidence regarding the performance of this MLE is very limited.
To our knowledge, only two domestic analyses examined the performance of this MLE across the nine piloted provinces in [ 13 , 14 ]. One of these analyses also showed that Step 1 pass rate varied by gender, ethnicity, education level, years of graduation and major.
Nonetheless, evidence is still lacking on subgroup performance differences in Step 2, as well as the performance in other provinces after this MLE was expanded. In this study, we aimed to extend the literature by examining a broader range of examinee characteristics and their association with passing Step 1 and Step 2, respectively, using data from all examinees of the MLE for rural general practice in in Hainan province, one of the provinces that started this MLE in This database contains information for all examinees of the MLE in Hainan, including gender, date of birth, major, forms of study, educational level, graduation school, graduation year, practice location, type of examination that was taken and examination score.
All examinees of the MLE for rural general practice in in Hainan were included in this analysis. The cut-off passing score was 60 for Step 1 and for Step 2.
Because an examinee must pass Step 1 before taking Step 2, we created another dummy variable for Step 1 passers who received a score and above in Step 2. We calculated the pass rates for Step 1 and Step 2, respectively, and compared pass rates by examinee characteristics, using Pearson Chi-square tests.
We then constructed multivariable logistic regression models to examine predictors of passing Step 1 and Step 2, respectively. Models were run separately for those who took Step 1 and those who took Step 2 after passing Step 1.
In the model testing Step 2 success, we also added a categorical variable of Step 1 score in addition to examinee characteristics. Step 1 score was reclassified by quartile using the percentile rank for each score. An alpha level of 0. All analyses were performed using Stata 15 StataCorp. Table 1 presents the characteristics of examinees of the MLE for rural general practice in Hainan in Table 2 presents the overall pass rate and pass rates of the MLE Step 1 practical skills examination and Step 2 written examination in Hainan.
The bivariate analysis shows that in the Step 1, pass rates vary significantly by age, gender, educational level, and forms of study.
In Step 2, pass rates vary significantly only by major. Table 4 presents the regression analysis results of characteristics associated with passing Step 1 and Step 2. Junior college graduates were 2. Examinees who studied full-time in school were 1. Examinees aged above 45 were 0. Compared to female examinees, male examinees were 1.
In addition, Step 1 score positively predicts the Step 2 success. China has launched a new MLE for rural general practice to increase the number of qualified practicing doctors in rural China. Our analysis presents new evidence on the performance of this MLE, as well as examinee characteristics associated with passing the Step 1 practical skills examination and the Step 2 written examination.
Findings of this study, coupled with prior results [ 10 , 11 ], indicate a low overall pass rate of this new MLE, suggesting that this new MLE has not yet met its expectation of increasing qualified doctor supply in rural China. Although more than two-thirds of examinees passed Step 1, the clinical knowledge of examinees is insufficient to pass Step 2. We found that age, gender, educational level, and years of graduation were significantly associated with passing Step 1.
As a legacy of the Soviet Union education model, the alternative education has not yet been standardised and may create many challenges to quality of care. This alternative pathway even consists of two levels of education: the secondary school level education and the junior college level education, which offers a 3-year medical training that emphasizes on a low level of clinical competency and little on systematic clinical knowledge.
Our findings support the abolishment of the secondary school medical education [ 15 ]. More importantly, the secondary school medical education may offer programmes of rural medicine or community medicine, in addition to regular medicine [ 16 , 17 ].
These programmes reflect the low-level overspecialisation at a too early stage in the Soviet Union model. We found that examinees majored in rural medicine or community medicine were less likely to pass the final written examination compared to those majored in general western medicine, suggesting the misappropriation of offering specialisations in the secondary school level education.
Foreign students and students from Taiwan, Hong Kong and Macao can choose one of three types of exams - clinical medicine, traditional Chinese medicine or dentistry, based on their field of study.
The exam will be offered in mid-November each year, and its content is the same for foreign and domestic students, with a written part and another part on practical skills. More than 9, students from abroad and Taiwan, Hong Kong and Macao have received their medical education on the Chinese mainland, and 3, of them have studied traditional Chinese medicine, according to Wang. China Daily October 26, Web Link.
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