Development of undergraduate family medicine teaching in China

Response rate

All 128 medical schools in China sent back the completed questionnaire in time. The response rate was 100%.

Growth of family medicine units in undergraduate programmes in the past two decades

The first family medicine course was introduced in a medical school in 1992 but there was no growth in number until 1995. The number increased slowly from 1995 to 1996 with a growth of two and one respectively. From 1997 to 2008, a total of 55 medical schools began to include family medicine as part of the undergraduate curriculum, with an average growth rate of 13.75 schools every 3 years. This growth was 16 in 2000–2002, 14 in 2003–2005, and 14 in 2006–2008.

Undergraduate teaching programmes in different regions

China has very different levels of economic development and medical services per region.6 As economic development has a strong impact on educational level,7 we scored for very underdeveloped regions (GDP pre capita ≤$3000), underdeveloped regions (GDP pre capita >$3000 and ≤$5000) and relatively developed regions (GDP pre capita >$5000).8,9

The relationship between the economic status and the number of medical schools with undergraduate family medicine education in mainland China is shown in Table 1.

Course arrangement and hosted department

In addition, throughout China different approaches to developing undergraduate family medicine teaching are taken (Table 2).

A need for continuous growth of family medicine teaching in medical schools

Family medicine teaching in Chinese medical schools has changed very significantly in the last decade, expanding from zero to 59 schools. However, family medicine teaching in undergraduate medicine may not be enough to meet the demand for family medicine in such a highly-populated country.

Chinese policy on family medicine now plays an important role in developing family medicine teaching in Chinese medical schools.4 Before 1996, the Chinese government seldom provided any directions to encourage teaching on family medicine, which led to slow growth in that period. However, the China Ministry of Health and nine other ministries decided to develop urban community health service after 1996, which resulted in a rapid growth of family medicine teaching in medical schools. The government's emphasis on family medicine can be revealed by the policy document and stated directives. In 2009, the Chinese State Council established community health centre systems and designated three family physicians per 10 000 people on average all over the country in the near future.10 It also supported family medicine education through a series of policies that encouraged medical schools and affiliated hospitals to train up more family physicians.10

China requires a continuous growth of family medicine education in medical schools to provide more family physicians serving the primary care needs of the community and to deliver comprehensive, continuous, holistic, and person-centered care.

The mismatch with local need

This investigation showed that family medicine teaching in undergraduate level was not well-distributed in different regions in China associated with economic levels. Therefore, the government should pay more attention to the underdeveloped regions and support development of family medicine teaching in these regions.

Greater need for practice sessions in the curriculum

Curriculum family medicine education in medical schools includes lecture sessions and practice sessions. Our study demonstrates that Chinese medical schools lacked practice sessions.

Furthermore, there was a lack of standardised objectives and teaching content of family medicine in the academic sessions and the monitoring system on the teaching quality and feedback evaluation. Although the concept and principles of family medicine are well introduced in each of the 59 medical schools, other important topics are not incorporated in undergraduate family medicine teaching, such as ‘chronic disease management in family medicine’ and ‘life period care’. This may be the result of a lack of experienced teaching staff and/or well designed teaching material.

The undertaking of family medicine teaching requires a uniform model

Our further investigation of the teaching organisation of family medicine showed that the programme was confusing and was introduced inconsistently in different medical schools. In some schools, the family medicine curriculum was incorporated into the base medical unit or social unit. It is well known that family medicine undergraduate teaching in developed countries is mostly run by the clinic medical department or family medicine unit.11 For example, there are established family medicine departments in Estonia, Slovenia, Poland, and the Czech Republic.11

In Hong Kong, there are also established family medicine units in The Chinese University of Hong Kong and Hong Kong University and their teaching has been well utilised by the affiliated hospital.12 The reason why family medicine is partially undertaken by public health units in China requires further investigation. One of the explanations is that family medicine was first introduced in China by teachers from the public health department.4

A ‘whole person care’ and ‘holistic model’ of family care can be delivered well in China but there needs to be cooperation between clinical medicine and public health. In the future, family medicine undergraduate education can also be hosted by family medicine units as well as other clinical units including public health units. However, the way to establish a more structured undergraduate family medicine teaching still needs to be discussed and implemented.