A survey of resident physicians' perceptions of competency-based education in standardized resident training in China: a preliminary study - BMC Medical Education - BMC Medical Education

Training medical residents is internationally recognized as a continuing education process that aims to cultivate novice physicians' ability to work independently. China's resident-training program has undergone important changes in recent decades. In the 1990s, the objective of the program was to provide continuing education that transformed medical graduates into qualified clinical physicians; however, a prominent characteristic of this period was that resident training varied considerably across different hospitals. Each province conducted its training according to its own standards. In order to standardise the quality of Chinese doctor, standardized resident training (SRT) mainly led by the National Health and Family Planning Commission (NHFPC) was launched in China in 2014. The Chinese Medical Doctor Association (CMDA) under direct governance of the NHFPC has been commissioned to manage the details of SRT (e.g., creating training content and accreditation standards).The SRT tracks residents into 36 specialties: 27 for clinical medicine, 7 for dentistry, and 2 for traditional Chinese medicine (TCM). The length of the US residency training or the UK specialty training varies according to the specialties.However, China's SRT programs were set at 3 years in length regardless of specialty and residents had to comply with prescribed guidelines from Chinese national government issued curriculum document for each specialty in details [1]. The rotation process for each specialty consisted of three sections: 'rotation purpose'(i.e. topics to understand or master), 'basic requirements'(i.e. lists of diseases and skills and the number of cases required for the rotation), and 'advanced requirements'. Medical graduates in China, after completing schooling, are required to finish 33 months of training in different departments in their chosen specialties and finally pass the residency certification exam. Since 2020, the adoption of SRT in a standardized pattern as mentioned above has been mandated across the country [2]. From this angle, SRT in China is an essential means through which medical graduates receive training in the sub-specialty of their chosen career. Residents can only be employed in hospitals after successful completion of this program. Thus, the SRT has an important influence on China's overall health-care system and medical services.

With the continuous world wide development of the 3rd generation of reformation in medical education, competency-based medical education (CBME) has become a global reform movement [3]. CBME is a redesigned framework for health-professional education that emphasizes the acquisition of demonstrable competencies throughout residency. This approach seeks to transform traditional time-based and teacher-centered learning into performance-based and learner-centered learning, and has been adopted in many countries (e.g., Canada, the United States, and the United Kingdom) [4,5,6,7]. When compared with previous postgraduate medical education, CBME comprises seven key fundamental characteristics [8]: 1) Its primary goal is for graduates to achieve their desired competencies; these competencies should be aligned with the roles the graduates will perform in the next stage of their careers. 2) The predefined competencies contained in CBME are derived from the needs of patients, learners, and institutions. 3) Time is considered a learning resource rather than the basis of progression of competence. 4) Teaching and learning experiences are sequenced to facilitate an explicitly defined, stage-based progression of learners' ability. 5) Learning is tailored, in some manner, to each learner's progression. 6) Numerous direct observations and focused feedback are used to assist effective learner development of expertise. 7) Assessment is planned, systematic, systemic, and integrative. These fundamental characteristics demonstrate a high focus on needs-based outcomes, authenticity, and learner-centeredness.

In alignment with the global medical-education community, the government-issued guidelines for SRT in China have been changing from focusing on process measures to emphasizing outcomes and competency [9]. In 2015, researchers from China Medical University have developed a competency framework that is consistent with the Chinese medical context [10]. It involves eight competency factors: information and management, professionalism, clinical skills and patient care, interpersonal communication, health promotion and disease prevention, medical knowledge, academic research skills, and teamwork.However, Chinese graduate medical education system lacks a mature competency framework to guide the education of residents for a long time. Some researchers and accredited training bases in China have begun to explore the construction of relevant curriculum systems based on the competency model. Implementation and evaluation of the curriculum are also discussed [11, 12]. Encouragingly, China Consortium of Elite Teaching Hospitals for Residency Education, a non-profit academic group composed of 9 leading teaching in China, including Peking Union Medical College Hospital, Peking University first hospital, Fudan University Zhongshan Hospital, Sichuan University West China Hospital, the first affiliated hospital of Zhejiang University school of medicine, Central South University Xiangya Hospital, the first affiliated hospital of Sun Yat-sen University, Hong Kong University Li Jiacheng Medical College (Queen Mary Hospital) and Peking University Third Hospital issued the first consensus on the core competency framework for resident doctors in China in 2018 [13], which marks the on-set for the transformation of the standardized training of Chinese residents to competency oriented medical education. The framework consists of six core competences:professionalism, medical knowledge and skill, patient care, communication and collaboration, teaching and life learning.The consensus provided an important theoretical basis for future exploration of reform in SRT such as setting training goal, curriculum design, assessment and evaluation, faculty development and teaching-resources improvement, etc. However, the scale of the training programs and the number of residencies is huge and the level of training quality is mal-distributed and imbalanced, so the implementation in the future will face great challenges and still needs to be constantly revised and improved in practice. Much of the literature concerning competency-based training is written from the perspective of educators and administrators who are involved in designing, planning, and overseeing the implementation of CBME. As we know, medical residents are the main participants in CBME, it is important to understand how they view CBME and their perceptions of CBME may help inform approaches for effectively incorporating CBME in SRT. SRT in China is at the stage of transition to CBME. There are few published studies that examine residents' perspectives in China. Considering this, we conducted this preliminary survey to identify Chinese residents' perceptions of CBME. We also sought to determine whether experience of CBME impacts such residents' career decisions.