First, the reform experience of "5+3" talent training mode in clinical medicine
On 20 10, Shanghai began the reform pilot work of combining the education of medical master's degree with the standardized training of residents, which became one of the earliest comprehensive reform projects of the national education system. In practice, Shanghai pays attention to the close combination of the development of medical education and medical and health undertakings, the breakthrough of personnel training mode and institutional mechanism reform, the remarkable improvement of medical students' professional ethics and clinical practice ability, and the obvious strengthening of medical education quality assurance system, and has formed a series of innovative, practical and exemplary successful experiences.
1. Through "5+3", a talent training system with clinical practice ability as the core was constructed, and the model innovation was realized.
In order to meet the overall requirements of China's medical and health system reform, a "5+3" training model for clinical medical talents with clinical practice ability as the core was put forward in the reform experiment of combining Shanghai medical master's degree education with standardized training for residents, and a training system for clinical medical talents with organic connection of medical specialist education, post-graduation education and continuing education was established for the first time in China.
2. Through the definition of "dual identity", it is clear that master of medicine is a directional resident, which embodies the concept innovation.
The standardized training object of Shanghai residents is to receive training as "social people in the industry". In the pilot reform of postgraduate education for medical master's degree, medical master's degree graduates (residents) who participated in the national unified examination and were admitted to colleges and universities were recruited as "residents" and obtained postgraduate status in a "directional" way, that is, they obtained dual identities of "residents" and "graduates". This mode breaks through the traditional mode that undergraduate medical graduates can only "either one or the other" between "employment (residency)" and "study (postgraduate)", and lays a theoretical foundation for the innovation of training mechanism and management system in the pilot project.
3. Through the "three combinations", the whole process of training is effectively connected to form a mechanism innovation.
Supported by the Shanghai Municipal Education Commission and led by Shanghai Medical College of Fudan University, it has completed four research projects, including the Pilot Program for Comprehensive Reform of Postgraduate Education of Shanghai Medical Master's Degree, and formulated specific rules and regulations, such as the Implementation Measures for the Reform of Shanghai's Standardized Resident Training and Medical Master's Degree Education, and realized the combination of postgraduate enrollment and resident recruitment, postgraduate training process and standardized resident training, and the combination of professional degree awarding standards and clinician access system.
4. The contradiction between the professional degree and the qualification of medical practitioners was solved through the "four certificates in one", and the system innovation was realized.
The "four certificates in one" of this project includes the qualification certificate of medical practitioners, the standardized training certificate of Shanghai residents, the postgraduate degree certificate and the professional degree certificate of master of medicine. Through the system innovation of "four certificates in one", the close combination of medical education and health industry training in the process of doctor training has been realized. The training hospital will organize the graduate students majoring in clinical medicine of this project to take the qualification examination of medical practitioners during the training period, which effectively solves the risk of illegal medical practice faced by graduate students majoring in clinical medicine in clinical ability training and training.
The "5+3" talent training mode implemented in Shanghai has been highly valued and praised by all walks of life. In July, 20 1 1, "Guiding Opinions of the State Council on Establishing General Practitioner System" proposed to gradually standardize the training of general practitioners as "5+3" mode. 20 12 On May 7th, the Ministry of Education and the Ministry of Health jointly issued "Several Opinions on Implementing Comprehensive Reform of Clinical Medical Education", which made it clear that one of the key points of the national clinical medical education reform was to "build a clinical medical personnel training system based on' 5+3'". On May 6, 20 13, the Ministry of Education and the National Health and Family Planning Commission jointly issued the Notice on Approving the First Batch of Pilot Universities for the Reform of Postgraduate Training Mode of Medical Master's Degree, requiring 64 pilot universities such as Peking University to formulate the pilot implementation plan according to the comprehensive reform goal of clinical medical education and the training law of medical master's degree, and pay attention to the implementation of the supporting policies and specific measures of local health administrative departments.
Second, the main contents of the reform of "5+3+X" talent training mode in clinical medicine
On May 8, 20 13, the Shanghai Municipal Health and Family Planning Commission, the Shanghai Municipal Finance Bureau and the Shanghai Municipal Education Commission jointly issued the Notice on Printing and Distributing Standardized Training for Specialists [5], which officially started the standardized training for specialists. The training goal of specialists is clear, and the discipline of training hospitals must be doctoral programs; The comprehensive assessment standards for students' leaving the department, annual assessment and graduation were formulated; A series of supporting measures have been introduced, such as taking the standardized training of specialists as one of the important bases for the comprehensive evaluation of hospitals, the evaluation of hospital grades, the evaluation of key medical disciplines and clinical medical centers, and taking the standardized training certificate of specialists as a priority condition for promoting the qualifications of senior professional and technical positions in clinical medicine; A special fund has been set up, which is shared by designated units, training hospitals and the government.
The reform of "5+3+X" training mode for clinical medical talents is the deepening of the reform of "5+3" training mode. The core content is to closely combine the professional degree education of doctors in clinical medicine with the standardized training of specialists, so as to effectively improve the clinical thinking, clinical skills and clinical research ability of graduate students in clinical medicine.
1. doctoral enrollment is combined with resident recruitment.
The enrollment of doctoral students majoring in clinical medicine is closely related to the recruitment of specialists. According to the number of students who participate in specialist training in Shanghai every year, the number of doctoral enrollment plans for each major is reasonably determined. The examination system of doctoral enrollment application is linked to the recruitment of specialists, and the trainees need to pass the doctoral entrance examination of relevant universities-the national unified foreign language examination for medical doctors, submit application materials, and participate in the re-examination of specialist recruitment organized by universities and training hospitals.
2. The training process of doctoral students is combined with the standardized training of experts.
During the training period, the standardized training object of Shanghai College signed the Training Labor Contract with the training hospital, and the graduate students admitted to colleges and universities obtained the postgraduate status in a "directional" way. The flexible academic system is generally 3 years, and individual specialties are 4 years (such as neurosurgery). According to the discipline (specialty) requirements of postgraduate training and the ability requirements of doctor training, the education system of clinical doctor degree should be reformed and the training scheme different from clinical doctor degree should be formulated. The degree course consists of three parts: specialized foreign languages, basic theory courses and specialized courses, with a total duration of not less than four courses. The basic theory courses and specialized courses correspond to the basic theory and specialized knowledge courses in the standardized training of specialists respectively. According to the detailed rules for the implementation of standardized training for specialists in Shanghai, the goal of standardized training for specialists is to strengthen the training of clinical practical skills related to specialties under the guidance of teaching doctors in training hospitals. The specific training contents of each specialty shall be implemented according to the Detailed Rules for Standardized Training of Specialists in Shanghai, and the training time shall be implemented according to the relevant regulations of the Ministry of Health. The focus of off-campus assessment, annual assessment and graduation comprehensive assessment is clinical practice ability, and completing the prescribed clinical training amount (including training time, the number of diseases and cases to be trained, and the number of clinical diagnosis and treatment operations) is a prerequisite for signing up for the assessment. The examination defense committee consists of 5~7 experts with the title of associate professor or deputy chief physician of clinical medicine, more than half of whom are clinical medical experts with the title of clinical professor or chief physician (including 1~2 clinical doctoral supervisors and experts from other units). Examination results should be used as the basis for obtaining the certificate of standardized training for specialists. Those who pass the standardized training examination for specialists shall obtain the standardized training certificate for specialists uniformly printed by the Ministry of Health.
Table 1 Comparison of two disciplines of national doctor's degree in clinical medicine and sub-majors trained by Shanghai College
Professional degree of doctor of clinical medicine (two disciplines) specialist training associate specialist (X years)
10020 1 Internal Medicine (including Cardiovascular Medicine, Hematology, Respiratory Medicine, Gastroenterology, Endocrinology and Metabolism, Kidney Diseases, Rheumatology, Infectious Diseases) Cardiovascular Medicine 3, Hematology 3, Respiratory Medicine 3, Gastroenterology 3, Kidney Diseases 2, Rheumatology 2 and Infectious Diseases 2.
100202 Pediatrics
100203 Department of Geriatrics
100204 neurology
100205 psychiatry and mental health psychiatry
100206 dermatoses and sexually transmitted diseases
100207 imaging medicine and nuclear medicine
100208 clinical laboratory diagnosis
100209 nursing
1002 10 surgery (including general surgery, orthopedics, urology, thoracic and cardiovascular surgery, neurosurgery, plastic surgery, burn surgery, field surgery) General surgery 2, orthopedics 3, urology 2, thoracic surgery 3, cardiovascular surgery 3, neurosurgery 4, plastic surgery 3, burn surgery 2.
1002 1 1 obstetrics and gynecology
1002 12 ophthalmology
1002 13 Otolaryngology Department
1002 14 oncology, tumor surgery, tumor radiotherapy
1002 15 Rehabilitation Medicine and Physiotherapy
1002 16 sports medicine
1002 17 anesthesiology
1002 18 emergency medicine
Note: At present, the professional degree domain code has been adopted for the enrollment of master of medicine, and the two disciplines code of scientific degree is still adopted for the enrollment of doctor of clinical medicine.
3. The criteria for granting doctoral degrees are combined with the training criteria for specialists.
The doctoral students majoring in clinical medicine completed the course study, passed the examination of clinical skills, obtained the standardized training certificate of specialists uniformly printed by the Ministry of Health, passed the defense of dissertations, and obtained the graduation certificate of doctoral students and the doctoral degree certificate of clinical medicine through the examination of degree-granting units (universities). It is required that the topic selection of doctoral dissertations in clinical medicine should be closely combined with clinical practice; The research results have certain application value for clinical work; The paper shows that the applicant has the ability to solve clinical practical problems and engage in clinical scientific research by using the knowledge he has learned.
Three, the implementation of clinical medicine "5+3+X" talent training mode related thinking
On the basis of the successful experience of "5+3" talent training mode reform in clinical medicine, we can solve the problems that may be faced in the reform of "5+3+X" talent training mode, such as funding guarantee, tutor guidance mode, postgraduate management mode, degree thesis evaluation standard, training quality guarantee mechanism and so on. However, there are great differences in the policies of different countries in the management of enrollment plans for professional master students and doctoral students. At present, the biggest policy bottleneck for Shanghai to carry out the reform of "5+3+X" talent training mode lies in the doctoral enrollment plan. The author's opinion is put forward below.
1. The doctoral enrollment plan of "5+3+X" training mode should be listed separately.
1The Trial Measures for Professional Degrees in Clinical Medicine, which was reviewed and adopted by the the State Council Academic Degrees Committee at its15th meeting in April, 1997, made it clear that professional degrees in clinical medicine were specially set up in order to improve China's medical degree system, speed up the cultivation of high-level talents in clinical medicine, improve the quality of clinical medical teams and the level of clinical medical work, promote the development of health undertakings and meet the needs of society for high-level clinicians. Professional degrees in clinical medicine are divided into master of medicine and doctor of medicine. In recent years, the state has strictly controlled the enrollment scale of doctoral students. Therefore, in order to promote the "5+3+X" reform and combine postgraduate education with standardized training of specialists, it is necessary to implement classified management of doctoral programs, that is, the enrollment plan management of doctoral students with clinical medical degrees should be different from that of doctoral students with scientific degrees to meet the needs of society for high-level clinicians. First of all, before 20 10, the number of people who obtained doctoral degrees in the United States did not include MD; Secondly, China's 8-year clinical medical education (MD) does not account for the national doctoral enrollment plan; Furthermore, the "5+3" reform in Shanghai has been strongly supported by the Ministry of Education, and the enrollment plan for Shanghai's "5+3" engineering postgraduates is listed separately, which does not occupy the enrollment plan of Shanghai universities under the jurisdiction of the state, and the training funds come from the Shanghai financial special project. Therefore, it is suggested that the reform of "5+3+X" talent training mode in Shanghai clinical medicine should continue the "5+3" project enrollment plan management mode, and the enrollment plan should be listed separately, and the funding for doctoral training should be paid by Shanghai finance.
2. The management of the enrollment plan for clinical doctoral students needs to coordinate the relationship between "certificate" and "double certificate".
Since 20 12, the Ministry of Education and the National Development and Reform Commission issued the national postgraduate enrollment plan, the doctoral enrollment plan began to be divided into "academic degree" and "professional degree". At present, there are only two ways for graduates with professional degrees, such as doctor of engineering, to take unified recruitment (double certificates), while those with doctoral degrees in clinical medicine (stomatology) have unified recruitment (double certificates) and equivalent academic qualifications (certificates). "Double certificates" means to obtain both a doctoral diploma and a professional degree certificate in clinical medicine, and "certificates" means to obtain only a professional degree certificate in clinical medicine. In recent years, under the pressure of discipline construction and scientific research tasks, due to the total control of the scale of the national doctoral enrollment plan, some universities with the right to award doctorates in clinical medicine began to recruit doctoral students with "double certificates" instead of or less than "double certificates", and used the enrollment plan to recruit doctoral students with degrees. At the same time, because "documents" do not account for the national doctoral enrollment plan, medical colleges and universities recruit "documents" for doctoral students in clinical medicine instead of recruiting "double certificates". Take Shanghai Medical College of Fudan University as an example. After the promulgation of the "Trial Measures for Professional Degrees in Clinical Medicine", about 50% graduates of professional degrees of medical masters switch to doctoral degrees every year. However, since 2005, Shanghai Medical College began to reduce the number of "double-certificate" doctoral students in clinical medicine, and the number of people who transferred to doctoral programs decreased from 77 in 2005 to 28 in 20 13 years. At the same time, from 20 10 to 20 13, the number of "documentary" doctoral students in clinical medicine has increased year by year, namely 13, 26, 37 and 44, and the number of "documentary" doctoral students has exceeded that of "double-certificate" doctoral students.
Therefore, by promoting the reform of "5+3+X" talent training mode, combining the education of doctoral students in clinical medicine with the standardized training of specialists, and coordinating the management of "double certificates" and "certificates" of doctoral students in clinical medicine on the basis of the classified management of doctoral enrollment plan, the enrollment scale and the number of graduates awarded degrees in China will remain relatively stable, and the quality of training of doctoral students in clinical medicine will be continuously improved.