Standardized resident training refers to the systematic and standardized training imparted to medical graduates. This training is aimed at improving their clinical proficiency and is conducted in recognized training bases after the residents complete their medical graduate programs. The purpose of this system is to produce qualified doctors who can provide similar high standards of care [1]. The implementation of the standardized resident training system is concurrent with the growth of medical and health services and the growth of clinical medical talents. It is an important measure for establishing a long-term system for training medical personnel, strengthening the pool of medical and health personnel, and ensuring optimal and sustainable development of healthcare undertakings.
In the mid-19th century, Professor Langenbeck from the Berlin University in Germany first proposed the idea of establishing a resident system [2-3]. In 1876, in order to train surgeons, Dr. Horst — the director of surgery at Johns Hopkins Hospital — established the American resident system. In the 1920s, the standardization of the resident training system, largely aimed at the development of core competence, became an important part of medical education in the United States [4-5]. In 1929, the Royal College of Physicians and Surgeons of Canada was established and began to train residents [6]. In 1993, the CanMEDS system that highlighted the roles and responsibilities of family physicians — including Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar, and Professional along with seven core competencies — was proposed [7]. Subsequently, this system developed further to form a more mature, competency-oriented resident training system [8]. In 1948, the United Kingdom started standardized resident training [9], and in 2005, the Modern Medical Career program that emphasized the establishment of competency- and workplace-based assessment of resident training was promoted [10-11].
France, Japan, Australia, and other developed countries have also established systematic standardized resident training systems according to local conditions. They have systematic regulations for key aspects of resident training, such as training institutions, training standards, quality control, and qualification recognition, all of which allow standardized, institutionalized, and legalized management [12-19]. Currently, the “government leading, industry participating in management, and medical institutions responsible for implementation” model is common in several countries. The government is responsible for providing training funds and designing the training system, and the industry is responsible for identifying training bases and establishing training objectives, in order to ensure training quality [20].
The standardized resident training system in China has undergone three phases: spontaneity, conscious decision-making, and national will. The first phase occurred between 1921 and 1993. The rudimentary form of the Chinese standardized resident training system can be traced back to the “24-hour responsibility system for chief residents and residents” policy implemented by Peking Union Medical College in 1921. At that time, there was no unified standard or norm of care. The second phase of conscious decision-making persisted from 1993 to 2013. In 1993, the former Ministry of Health issued the “Trial Measures for Standardized Training of Clinical Residents” and “Trial Outline for Standardized Training of Clinical Residents,” which were explored and trialed at all levels. Some regions began to explore the “3+X” model, that is, on the basis of three-year standardized resident training, 2-4 years standardized specialist training was carried out according to the training standards and requirements of each specialist. Finally, the third phase, referred to as the national will stage, commenced in 2013 and persists to date. The “Opinions of the State Council of the CPC Central Committee on Deepening the Reform of the Medical and Health System” issued by the CPC Central Committee and the State Council in 2009 clearly highlight the need for “establishing a standardized resident training system and strengthening the continuing medical education” [21]. To further reform China’s medical and health system and medical education program, in 2013, seven ministries and commissions of the State Council jointly issued the “Guidance on Establishing a Standardized Resident Training System” and emphasized the connection between professional medical education and standardized resident training [22]. This marked the formal establishment and implementation of the standardized resident training system in China, as well as the establishment of a medical personnel training system that was suited to meet national healthcare requirements.
It is expected that standardized resident training will become a key factor and breakthrough in the journey towards promoting new healthcare reforms in China. The government is trying to meet international standards through a standardized reform of resident training, to improve the level of healthcare in China’s medical institutions, narrow the gap between different medical institutions, and achieve equalization of public health services.
After the promulgation of the “Guidance on Establishing a Standardized Resident Training System,” the National Health and Family Planning Commission successively issued a series of supporting documents, such as “Methods for the Management of Standardized Resident Training (trial)” [23], “Standard for Accreditation of Standardized Resident Training Bases (Trial)” [24], “Contents and Standards of Standardized Resident Training (Trial)” [25], “Implementation Methods of Recruitment for Standardized Resident Training” [26], and the “Implementation Methods of Standardized Resident Training Assessment” [27]. Through these, the policy system for standardized resident training was first constructed. All provinces (autonomous regions and municipalities directly under the central government) were required to fully switch to standardized resident training by 2015 and completely establish the standardized resident training system by 2020. All clinicians with a bachelor’s degree or higher who took on medical practice positions for the first time were required to receive standardized resident training.
Main Features of the Standardized Resident Training Policy in China
According to the relevant policies of the standardized resident training system in China [22-27], the following were to be monitored and established: funding, recruitment, training bases, training curriculum, training assessment, and management and treatment of trainees.
Funding guarantees
The standardized resident training system in China is supported by a multi-input mode of funding, which includes government investment, self-financing, and social support. Central finance grants provide a one-time subsidy of RMB 5 million per training base for the purchase of equipment for residents at the standardized training base. Each resident receives a subsidy of RMB 30000 per year.
Recruitment
Recruitment targets include those who intend to be involved in medical practice at medical colleges and universities (including clinical medicine, stomatology, traditional Chinese medicine, and integrated traditional Chinese and western medicine). This spectrum includes graduates with a bachelor’s degree or above; personnel who have engaged in medical work, qualified to be medical practitioners, and need to receive training; and other personnel who require training.
Training bases
Standardized training for residents can be held at training bases and professional bases. Training bases are medical and health institutions where standardized training of residents is undertaken, and these are composed of qualified professional bases. Professional bases are led by qualified professional departments. At professional bases, the relevant departments coordinate and jointly complete training tasks. Training bases are required to meet a few basic criteria, including hospital accreditation, appropriate training facilities and equipment, and an established training system. The training bases are required to meet the basic requirements of teaching staff, department construction and training plan setting. There are 34 specialties in standardized resident training, such as internal medicine, pediatrics, emergency department, dermatology, etc.
Training curriculum
The core of standardized resident training is to competency cultivation. According to the guidelines of standardized resident training, training in different areas, including medical ethics, policies and regulations, clinical practice, medical theory, and interpersonal communication, is imparted. The focus is on improving the ability of clinicians to perform standardized diagnosis and treatment, while giving due consideration to medical teaching and awareness of scientific research.
Training assessment
Training assessment includes process assessment and graduation assessment. Process assessment involves daily assessment, departmental assessment, and annual assessment of medical ethics, clinical professionalism, attendance, and clinical practice skills. Graduation assessment is divided into two parts. Residents who have obtained the Doctor Qualification Certificate and passed the training process assessment can apply for the graduation assessment. Those who pass standardized resident training are issued a combined certificate of qualification for the standardized resident training.
Management and treatment of trainees
During the training period, the original personnel (staff) and salary agreements of the trainees appointed by the unit remain unchanged; the appointed unit, training base, and trainees sign a training agreement; and the difference between the salary paid by the appointed unit and the salary of residents working under the same conditions is paid out by the training base. The trainees sign training agreements with the training base, and their living allowances during the training period are paid by the training base. The allowance standards are determined based on the salary received by residents working under the same conditions at the training base. The trainees who are postgraduates are required to meet the relevant state provisions on postgraduate education, and the training base may grant them appropriate living allowances according to the training assessment.