Clinical training in China needs to be improved: A cross-sectional study of MD graduates

Background: China is experiencing medical education reform to construct national quality standards, modernise and standardise health professionals, and advance health delivery system requirements. Graduate medical education (GME) is being piloted as a merger of Doctor of Medicine (MD) and PhD programs to improve academic research and clinical training. However, the academic degree-centred system has led to a preoccupation with academic research rather than clinical training. Quality information regarding the clinical training of MD graduates from Chinese medical schools is lacking. This general investigation aims to provide an overview from the perspective of recent MD graduates in China. Methods: Self-reports on MD clinical training were obtained from 432 MD graduates in 2017 via an online survey. The reports included information on overall satisfaction, educational supervision, supervised learning events, curriculum coverage, local teaching, teamwork, educational governance, workload, supportiveness of the environment, feedback, clinical experience, patient safety, handovers, and reporting systems. Descriptive analysis was used to summarise the outcome. Results: Of the 432 MD graduates surveyed, only 37.4% reported satisfaction with the overall clinical training quality; 54.6% rated the informal and bedside quality as “good”; 64.4% reported that they knew who provided clinical supervision; only 35.5% highly rated the quality of clinical supervision; 51.8% reported that they judged senior physicians as “not competent”; 48.1% believed that their concerns about education and training would be addressed; 41.9% agreed that the staff treated each other respectfully; 97.4% admitted that they worked beyond the mandatory hours and claimed they were regularly short of sleep; 84.2% raised concerns about patient safety; 45.3% reported that they received regular informal feedback. Conclusions: This study suggests that the quality of clinical training for MD graduates needs to be improved; however, even though most participants seemed satisfied with their clinical training. The overall satisfaction with the teaching quality was acceptable, whereas the quality of many clinical training aspects was scored poorly. Each aspect may encourage a deeper investigation into the understanding of causes and possible remediation. Some suggestions include improving safe and effective care, providing positive clinical supervision, offering appropriate practice opportunities, providing health care services, and maintaining optimal patient safety.