The trainers
Working towards the 2010 goal, in 2005 more than 1000 doctors from other specialties who were interested in family medicine were trained at the Center of Family Medicine Training of Ministry of Health. They became the core trainers at the provincial training centres. Consequently, in 20 provinces and municipalities, courses to train the trainers were conducted. In Zhejiang Province, about 500 trainers were trained. Theoretically, their role was to provide family medicine training and education at all levels and to play a role in family medicine research.
The training bases and materials
In nine provinces and municipalities, including Beijing, Zhejiang, Henan, and Chongqing, 149 clinic training bases were established; while in a further 13 provinces and municipalities 143 community training bases were established. The Teaching Material Office of the Ministry of Health, edited teaching materials for colleges, technical schools, and for GP training, for example, the Training Center of the Ministry of Health translated a set of American family medicine textbooks and the Center of Family Medicine Training of Zhejiang Province published a set of training textbooks. At least eight different sets of relevant textbooks have been published in China.
The difficulties
Despite these many brave strides towards establishing family medicine, the grass-roots reality is probably still a far cry from the Ministry of Health targets. For example, there is concern that in all the areas where training has occurred, it has been a theoretical exercise with no experience of community patients provided to doctors, and no teaching of the practical skills required to manage these patients.
Additionally, the GP training-in-service programme has actually only been established in the provincial capital cities of economically developed areas and certainly not in other areas, for example, all the big and medium-sized cities in China. This appears to be backed up by a more recent national community health service survey, which showed that still at least 60 to 70% of doctors in the community have received no GP in service training.
The GP residency training projects, initially started in 2000 (see Table 2), have proved impossible to spread beyond the first three provinces. Furthermore, the reality for the few who have completed their residency training is that they are unable to find appropriate community-based jobs. Instead, these trained family medicine practitioners have ended up working at first aid centres or other medical departments of hospitals. This is not a GP residency training at the core of family medicine education in China.
Other difficulties for the few GPs who have successfully obtained the national GP residency training certificates is that they are then required to attend continued education in family medicine yearly, for example, in Beijing. A minimum of 40 credit points for the compulsory courses of continued medical science are required every 2 years. With respect to undergraduate medical education, again there appears to be a gap between the dictum and the reality on the ground. Twenty out of the 99 medical colleges in China have an optional course of family medicine available.
Although this indicates a lack of family medicine teaching departments in most medical colleges, it would still potentially be very encouraging if one takes into account the short time span in which this change has occurred. However, the reality is that family medicine education is often delivered by public health lecturers who have never been formally trained in family medicine. Hence most medical students have little constructive education in family medicine at medical school.
