Trends in medical education: integrating medical humanities in all curricula——A new curriculum evaluation index system

Abstract

Background: Classrooms are the central front for education. In China's fight against COVID-19, doctors have saved lives with their exquisite medical skills and humane professional spirit and won widespread praise from the people. This is related to China's long-standing insistence on strengthening ideological and political education in the classroom and integrating medical humanistic elements into the medical curriculum. To consolidate the education’s effect, the Chinese government calls for integrating the content of ideological and political education into professional courses and puts forward the concept of ‘curriculum ideology and politics’, which coincides with the idea of strengthening medical humanistic education in medical courses. Therefore, curriculum ideology and politics have effectively integrated medical humanities into medical curriculum education. This study aimed to create an ‘Ideological and Political Teaching Evaluation Index System for Medical Courses’ to evaluate the effect of ideological and political education in medical courses.

Methods: This study organically combined ideological and political education, medical humanities, and medical professional curriculum education to construct an ‘Ideological and Political Teaching Evaluation System for Medical Courses’. This study used the Delphi method and recruited 13 Chinese medical education experts with senior professional titles to revise and assess the teaching evaluation index system and use the analytic hierarchy process to analyse the index system. The constructed ‘Ideological and Political Teaching Evaluation System for Medical Courses’ contained three first-level, nine second-level, and 27 third-level indicators.

Results: The index evaluation matrix satisfied the consistency test at all levels, with a consistency ratio of less than 0.1. Among them, the weight coefficients of the three first-level indicators such as value leading, knowledge teaching and quality training, are 36.782%, 30.460% and 32.759%, respectively. The weight distribution of each indicator is relatively balanced, and the second-level and third-level indicators’ setting is relatively reasonable.

Conclusions: This index system can guide medical courses’ ideological and political construction. At the end of the course, the teaching quality can be evaluated from the perspectives of teachers and students, which can effectively evaluate the ideological and political education and medical humanities improvement effect of this course and ensure the teaching quality.

1. Background

The classroom is the main venue for education. Teachers have long used classroom education to resolve doubts and teach students to be human, work, and research. However, in the current era of knowledge and information explosion and constantly evolving knowledge, teachers are under pressure to impart complete knowledge in limited time in the classroom; however, this conflicts with the essential attributes of classroom education. Classroom education aims to promote the overall development of people, including allowing students to acquire knowledge and cultivating students to establish an appropriate worldview, outlook on life, and values. This highlights the human beings’ important role and value in the knowledge system, particularly in medical classrooms. The kindness and persistence shown by doctors in the fight against the novel coronavirus disease (COVID-19) are related to China's long-standing adherence to ideological and political education, and are also a critical reflection of the medical humanistic value of medical education.

To fully utilize the educating function of ideological and political education and classroom education, the Ministry of Education of China issued the ‘Guidelines for Ideological and Political Construction of Colleges and Universities’ in May 2020, which noted the importance of the teaching team, curriculum construction, and classroom teaching channels. These guidelines promoted all colleges, universities, teachers, and course leaders to accept the responsibility for educating students and constructed a broad pattern of comprehension education for all staff. These guidelines also suggested combining professional characteristics and classifications to promote curriculum thinking. The guidelines particularly emphasized that medical majors should focus on strengthening the education of medical ethics and medical style in the course of teaching, cultivate the medical spirit of ‘respecting life, saving the dying and helping the wounded, willing to give, and great love without bounds’, and focus on strengthening the education of medical practitioners’ benevolence (1). Since then, courses integrating ideological and political education content have proliferated in Chinese education, including in large-scale classrooms. In September 2020, the General Office of the State Council of China issued the ‘Guiding Opinions on Accelerating the Innovative Development of Medical Education’, indicating that it was vital to expand the reform of the teaching content, curriculum system, and teaching methods of undergraduate medical education, strengthen the professional quality of medical education, and enhance the education of medical ethics and scientific research integrity. Considering these changes, teachers need to consider the ideological and political role of the curriculum and concentrate on cultivating the life-saving spirit of medical students (2). This shows that the trend of integrating medical humanistic education into all medical courses by combining ideological and political education in the curriculum is inevitable. Meanwhile, ideological and political construction of curriculum advocated by the Ministry of Education of China is also an effective carrier to strengthen the medical humanistic education.

Medicine confronts human science. Against the background of tense doctor-patient relationships and unpredictable medical diseases, many scholars have argued that implementing curriculum ideology and politics will cultivate medical students’ humanistic spirit and improve their understanding of medical and disease ethics. Research on ideological and political courses in medical courses has mainly centred on two aspects. The first is research on the evaluation approaches of ideological and political courses in medical education. For instance, Li et al. (3) demonstrated that questionnaire surveys were the most commonly used method for evaluating the effect of ideological and political teaching; however, there was no specific design for questionnaire content. The second type of research examines specific medical courses. For instance, Chen and Weng (4) evaluated a psychiatry course and revealed that implementing ideological and political courses neither affected teaching satisfaction and effectiveness nor enhanced students’ subject interest. Ideological and political courses do not appear outside of China; medical courses mainly emphasize moral and humanistic education in other countries. Hegazi and Wilson (5) suggested that the phenomenon of moral separation occurred in the medical students’ education process and that courses should be developed to strengthen their moral education. Wald et al. (6) identified integration and evaluation methods of humanistic knowledge in medical education and practice through a literature review. They argued that it was necessary to further integrate medical humanities and medical courses to cultivate competent and compassionate doctors. The existing research has also indicated that strengthening ideological and political education and the concept of the humanistic spirit in medical courses can improve the training of medical talents. As evaluation tools guide teachers to develop curriculums based on classroom standards and can be used to evaluate the effects of classroom teaching, evaluation tools for ideological and political teaching in medical courses are urgently needed.

2. Methods

2.1 Study design and process

This study aimed to create an ‘Ideological and Political Teaching Evaluation Index System for Medical Courses’ to evaluate the effect of ideological and political education in medical courses. The evaluation objects were mainly teachers and students, and the contents of the evaluation index system were preliminarily determined using a policy and literature review. The Delphi method and recruited experts in medical education were used to revise and assess the initially established curriculum evaluation index system and form the ‘Evaluation Index System of Ideological and Political Teaching in Medical Courses’. 

2.2 The source of the evaluation index system

The contents of the index system were mainly based on the Chinese government’s relevant policy requirements for ideological and political curriculum in medical training and literature on the core elements of the ideological and political construction of medical courses. 

2.2.1 Government policy documents on the ideological and political curriculum in medical training

The Chinese government created various educational and teaching guidelines to strengthen the ideological and political construction of the curriculum for training medical students. Specific results are shown in Table 1 (1, 7-11) and Table 2 (2, 12, 13).

[Table 1 here]

Table 1. Documents related to curriculum ideology and politics

[Table 2 here]

Table 2. Curriculum ideological and political requirements in documents related to medical personnel training

The requirements of government policies on education and teaching reform and medical personnel training focus primarily on the following three points. First, they underline the design of courses and integrate the contents of ideological and political education into all courses. Medical courses, including basic public courses, professional core courses, and practical education courses, are required to adhere to the characteristics of medicine, while the nature of the courses must include ideological and political goals to strengthen them and thereby meet professional requirements. Second, they highlight the teaching process and require teachers to implement curriculum ideology and politics into core teaching elements, such as training plans, syllabuses, teaching methods, and textbooks. Third, they emphasize the effects of teaching and education. For medical students, this mainly focuses on the cultivation of the medical humanistic spirit and investigates the improvement of medical humanistic literacy and cultivation of the medical spirit of students after receiving the course ideological and political education. 

2.2.2 The core elements of scholars’ ideological and political research regarding medical courses

In 1959, Bloom, an American psychologist, divided the education goals into three categories: the cognitive, affective, and operational domains. In China, Xie et al. (13) proposed a three-dimensional teaching model based on the tangible situation in the country, emphasizing that classroom teaching should be conducted closely around three dimensions; that it should not only focus on knowledge, skills, processes, and methods, but also on emotional attitudes and values. Combined with the government’s documented requirements related to the ideological and political construction of China’s curriculum and the goal of education for medical students, the value guidance in morality education corresponds to the emotional field in Bloom’s educational goal taxonomy. This encourages teachers to enhance the education and guidance related to values in the curriculum. Moreover, this aligned the classroom teaching with the cognitive domain in Bloom’s taxonomy of educational goals and further strengthened teachers’ main position in classroom teaching. In addition, aligning ability development in practical teaching with operational areas in Bloom’s taxonomy of educational goals should strengthen students’ gains and growth in the educational process. This is in line with the reality of Chinese education. This study considered these three goals as the first-level indicators of the Chinese ideological and political curriculum and teaching evaluation system (Figure 1), which can be used to construct other sub-indicators.

The second- and third-level indicators mainly corresponded to the educational connotation of the first-level indicators. Keywords were used to search domestic and foreign literature, and evaluation index elements were extracted from the literature. This study cultivated three keywords: the value lead, knowledge teaching, and ability development. These were combined with curriculum ideology and politics, and medicine for the literature retrieval. As there is no such thing as an ideology and politics course outside of China, these words were replaced by words, such as citizenship curriculum, medical humanities, and moral education, thereby identifying value-led secondary metrics. The key to the ideological and political construction of the curriculum is the teachers, the foundation is the curriculum, and the results come from the students. Therefore, the two first-level indicators of value guidance and knowledge transfer were the two first-level evaluation targets, which focused on teachers. The results mainly reflected ability development, and the evaluation focused on students (14). Value guidance should first consider teachers’ ideological understanding and then teachers’ own theoretical level of understanding and implementation ability (14).

Regarding knowledge transfer, professional and humanistic knowledge should be an important part of medical courses (15). Furthermore, teaching methods involve selecting and applying teaching forms and the effect of knowledge transfer (16, 17). Ability training mainly reflects the effect of education. In medical classrooms, ideological and political education is an important carrier of medical humanities education (18). Moreover, the implementation effect of the ideological and political curriculum reflects the cultivation of students’ humanistic spirit (19) and the development of their professional and scientific spirit (20). Therefore, the evaluation index system was initially divided into three first-level indicators, nine second-level indicators, and 27 third-level indicators, and expert consultations were conducted.

2.3 Establishment of evaluation index system

To verify the scientific value of the constructed index system, 13 medical education experts from Zhejiang University, Wuhan University, Anhui Medical University, Xuzhou Medical University, Wenzhou Medical University, and other universities were randomly selected, and the Delphi method was used to organize the expert consultations. Of the 13 experts, all had senior technical qualifications, 53.85% were very familiar with ideological and political teaching reform, while 46.15% were relatively familiar; further, 38.46% were very familiar with medical humanities education, while 61.54% were relatively familiar, representing the level of medical education in the country. 

Questionnaires were distributed, and 13 valid responses were obtained for a 100% recovery rate. Answers were rated on a five-point Likert scale (5 = very important, 1 = unimportant). Each indicator required feedback; therefore, 13 experts gave feedback on the first-level indicators 39 times, second-level indicators 117 times, and third-level indicators 351 times. The specific statistical results are illustrated in Table 3.

Table 3. Feedback from experts on the evaluation index system

Among the first-level indicators, the generally important and unimportant indicators selected by experts mainly focused on evaluating knowledge transfer. Among the second-level indicators, the generally important and unimportant indicators selected by experts mainly focused on theoretical literacy, implementation ability, professional knowledge, teaching method, job awareness, scientific pursuit, and other evaluation points. Among the third-level indicators, the experts’ selection of generally important and unimportant indicators mainly corresponded to the selection of second-level indicators. For the unimportant indicators, the experts gave suggestions for revision, such as changing ability training from the first-level indicators to quality training, implementation ability from the second-level indicators to value judgment or personality building, post awareness from the secondary indicators to professional quality or post competency, and discussion teaching method from the third-level indicators to the experiential teaching method. The experts’ advice and analysis results produced the ‘Ideological and Political Teaching Evaluation Index System for Medical Courses’, as illustrated in Table 4.

[Table 4 here] 

Table 4. The evaluation index system of ideological and political teaching in medical courses

2.4 Weight analysis of the evaluation index system

The weights indicated a quantitative distribution of the importance of different aspects of the objects evaluated in the evaluation process, and the role of each evaluation factor in the overall evaluation was treated differently. In the early 1970s, American operations researcher Saaty TL proposed the analytic hierarchy process (AHP), a decision-making method combining quantitative and qualitative methods. The AHP provides a quantitative basis for analyzing, making decisions, predicting, or controlling development by comparing multiple related factors, layer by layer. Through the AHP, the content of the developed index system was evaluated and scored, and the weight coefficient of each index was confirmed; finally, the ‘Evaluation Index System of Ideological and Political Teaching in Medical Courses’ was formed. This was a multi-level complex data system composed of many interrelated and mutually restrictive factors, which not only required in-depth analyses of the experts’ hierarchical evaluation but also aided in decision-making based on the opinions of each expert. The AHP is an effective method to solve this problem. The following steps were implemented:

1. The relationship between various factors in the system was analyse, and the hierarchical structure of the system was established. The structure was divided into three layers: target, criterion, and program. The criterion layer could have multiple sub-layers.
2. A pairwise comparison matrix was constructed, the importance of factors at the same level based on a criterion in the previous layer were compared, and a pairwise comparison judgment matrix was constructed.
3. The relative weight of the compared factors to each criterion was calculated based on the comparison matrix, and a consistency test for the matrix was conducted.
4. A combined weight and consistency check of the scheme layer in relation to the target layer was performed.
5. Based on the evaluation results of each expert, the comprehensive weight of each indicator in the scheme layer—relative to the target layer—was calculated.

2.4.1 Model building

The hierarchical structure of the evaluation index system was divided into four layers. The first layer was the target layer (O); that is, the quantitative ranking of the evaluation indicators of ideological and political teaching in medical courses. The second layer was the criterion layer I (A); that is, the primary evaluation index factors of ideological and political teaching in medical courses, which were value guidance (A1), knowledge transfer (A2), and quality training (A3). The third layer was criterion layer II (B), which was nine evaluation index factors further decomposed from the primary evaluation index factors; these were recorded as Bi (i = 1, 2, 9). The fourth layer was the program layer (C), which was the 27 evaluation index factors Cj (j = 1, 2, 37).

2.4.2 Constructing the evaluation matrix

Based on the actual indicators of ideological and political teaching evaluation for medical courses, this study considered the role of various criteria- and program-level indicators in evaluating ideological and political teaching of courses. An evaluation matrix was constructed by comparing the influence of each factor at the same level on the relevant factors in the previous level—that is, comparing the factors at the same level in pairs. The construction of the evaluation matrix used the AHP for the expert scoring and weighting method, meaning that the relative importance was described by expert scoring, after which the weight was calculated. The average value of the analysis items was calculated. The relative importance was obtained using the average value information, and the judgment matrix—required by the AHP—was constructed. The AHP hierarchy analysis judgment matrix of the first-level index is shown in Table 5.

Table 5. AHP evaluation matrix for first-level indicators

Note: The mean was the average of 13 experts who rated the importance of this indicator. The judgment matrix was calculated using the ratio of the averages. For example, 0.828 indicates the importance of knowledge transfer relative to value guidance. This value = the average value of knowledge transfer/average value of knowledge transfer; that is, 0.828 = 4.077/4.923.

2.4.3 Weight determination and consistency check

For the third-order evaluation matrix, which was constructed using value guidance, knowledge transfer, and quality training, the AHP hierarchy method was used. Further, the sum-product method was used to calculate the weight and maximum eigenvalue. The basic steps were as follows.

Table 6. The first-level indicator AHP analysis hierarchy process results

CI: Confidence Interval 

The average random consistency index (RI) was obtained by repeatedly calculating the eigenvalues of the random evaluation matrix and taking the arithmetic average. Generally, the average RI of the evaluation matrix repeated 1000 times was used, as illustrated in Table 7. The consistency ratio (CR) was calculated as follows: 

In this study, a third-order evaluation matrix was constructed, corresponding to Table 7. The RI value was obtained by querying to 0.52, and the CR value was calculated. In general, smaller CR values indicated better consistency of the evaluation matrix. A CR value below 0.1 indicated that the evaluation matrix satisfied the consistency test. A CR value above 0.1 would indicate a lack of consistency, and the evaluation matrix would need to be appropriately adjusted and analysed again. The confidence interval (CI) value calculated for the third-order evaluation matrix was 0.000, and the RI value was 0.520. Therefore, the calculated CR value was 0.000 < 0.1 (Table 8), indicating that the evaluation matrix in this study satisfied the consistency test, and the calculated weights were consistent. This process was repeated for the secondary and tertiary indicators, and the results are detailed in the appendix.

Table 7. Random consistency RI table

Table 8. Summary of the consistency test results of the first-level indicators

3. Results

Based on the above calculation results, each level and its corresponding and total weight coefficient were obtained, and the evaluation matrix of the three-level indicators satisfied the consistency test, forming the ‘Evaluation Index System of Ideological and Political Teaching in Medical Courses’. This is illustrated in Table 9.

[Table 9 here]

Table 9. The evaluation index level and weight of ideological and political teaching in medical courses

Note: The weight coefficient is the weight coefficient of various factors (low-level) for the target (high-level) obtained by the AHP, and the total weight coefficient is the total weight coefficient of the third-level indicators for the evaluation of ideological and political teaching in medical courses.

4. Discussion

4.1 The index system reflects the policy requirements of the country

The ‘Ideological and Political Teaching Evaluation Index System for Medical Courses’ construction was in line with the national policy orientation and was an effective effort within educational reform in China, which has specific national conditions. The index system not only integrated the elements of Chinese ideological and political education but also combined the urgent demands of the current COVID-19 pandemic and the rapid development of medicine and healthcare for medical humanistic knowledge. The index system accurately combined ideological education and medical humanistic elements and fully utilized the curriculum, using the main channel of educating people in the classroom to achieve educational purposes. The content source of the index system is, firstly, documents and policies issued by the national government. Secondly, the content closely related to the index system is selected based on the domestic and foreign research on medical humanities, moral education, and citizenship curriculum. Such a setup can effectively combine the educational needs of the country because no matter which country it is, national needs come first. For example, Ethiopia will formulate relevant policies to construct a national high-quality science education system (21). Another example is the United States, which aims to integrate the social factors affecting education into the education system so that the goal of cultivating talents for the country and society through various associations is achieved (22). Simultaneously, ideological and political education is China’s feature, which integrates the contents of medical humanities, moral education, and citizenship curriculum. However, it also reflects the educational requirements of other countries and meets the needs of the current global medical talent training. 

4.2 The index system embodies the characteristics of medical humanities

Medicine is both a science and a human science. For a long time, there has been a focus on establishing medical humanities courses (23). For instance, the China Medical University offers medical humanities education courses, such as medical ethics, medical history, introduction to medical humanities, health law, and medical sociology, strengthening medical humanities education for medical students. By studying medical humanities, medical students are expected to move from merely dealing with the disease to seeing the whole patient; however, educators must employ teaching strategies to increase students’ depth of learning (24). A medical school in the United States integrates the theory and practice of medicine, war and art into the curriculum, and analyses students' responses to oral, literary, and visual stories of war and trauma in the curriculum. Then it triggers students to think about the doctor-patient relationship (25), which can cultivate empathy in medical humanities courses to reduce hidden biases and compassionate behaviour (26). In China, we also integrate typical cases of medical rescue into medical courses. This is precisely the course of ideological and political education advocated by the Chinese government. We aim to integrate Chinese traditional culture and medical rescue deeds into all medical courses with a subtle ideological education effect in the course teaching. This is similar to the effect of the current global promotion of narrative medical education. The humanistic spirit, professional quality, and scientific pursuit in the index system all enhance the teaching effect of medical humanities in medical ideological and political courses. 

4.3 The index system can be effectively used to evaluate teaching quality 

Scholars believe that teaching evaluation can guide the teaching design process, including learning objectives, learning experience, and evaluation techniques (27); this was also the original aim of this study in designing the ‘Ideological and Political Teaching Evaluation Index System for Medical Courses’. To ensure the effectiveness of public and population health (PPH) education in medical education programs, the Association of American Medical Colleges has developed a PPH evaluation framework (28). The evaluation method was used to verify the teaching level of dental schools in Spain, and it was believed that the undergraduate dental pulp teaching followed the main recommendations of the ESE undergraduate curriculum guide (Int Endod J 46, 2013, 1105), which was comparable to the teaching in the UK in most aspects (29). To test the teaching quality, the index system designed in this study can allow teachers and students to give two-way scoring on the teaching effect of the course at the end of the course. For example, it can be in the form of a percentage system. Teachers and students will score each item according to the learning experience gained and lessons learned in the course process, and the scoring results will be substituted into the index system to calculate the overall evaluation of the course. The total evaluation is calculated according to the total weight coefficient of the three-level indicators in Table 9. The specific formula is as follows : = 4.71%A11+4.55%A12+3.94%A13+4.27%A21+3.85%A22+3.57%A23+3.87%A31+4.01%A32+4.01%A33+4.93%B11+5.2
9%B12+5.57%B21+5.38%B22+4.72%B31+4.56%B32+2.87%C11+2.96%C12+2.87%C13+2.87%C14+2.54%C21+2.59%
C22+2.59%C23+2.68%C24+2.80%C31+2.80%C32+2.89%C33+2.31%C34.

School education administrators or teachers may evaluate the teaching quality of courses according to the evaluation score. However, in the evaluation process, attention should be paid to the issue of fairness to avoid the interference of subjective factors of teachers and students (30).

5. Conclusions

Among the three first-level indicators constructed in the ‘Ideological and Political Teaching Evaluation Index System for Medical Courses,’ the weight of each level was relatively balanced, and the content distribution of the three levels of evaluation indicators was reasonable. This is a relatively scientific teaching evaluation index system, which was evaluated and revised by experts, including weighting by experts. The contents combined professional courses with ideological and political education and medical humanities education. This system not only meets the ideological and political requirements of the curriculum, as emphasized by the Chinese government, but it also strengthens the humanistic education of medical students, which addresses the requirements of current global medical and health development.

Declarations

Ethics Approval and consent to participate

The study was approved by Ethics Committee of Wenzhou Medical University. Informed consent was obtained from all study participants and the study was carried out in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Availability of data and materials

Data and materials can be obtained from the corresponding author upon request.

Competing interests

The authors declare that they have no competing interests.

Authors Contributions

WJ and YL conceptualized the research design and analysed the data. WJ and YF carried out the study and collected the data. YL instructed WJ to write the manuscript.

Funding

This study received support as part of the first batch of provincial-level ideological and political teaching curriculum design project of the Zhejiang Provincial Department of Education, titled ‘Research on the Construction of an Evaluation Index System for Ideological and Political Teaching in Colleges and Universities’.

Acknowledgments

The authors gratefully acknowledge the financial support of the Zhejiang Provincial Department of Education.

References

1. Notice of the Ministry of Education on Printing and Distributing the "Guidelines for the Ideological and Political Construction of Colleges and Universities" 2020 [Available from: http://www.moe.gov.cn/srcsite/A08/s7056/202006/t20200603_462437.html.
2. Guiding Opinions of the General Office of the State Council on Accelerating the Innovative Development of Medical Education 2020 [Available from: http://www.gov.cn/zhengce/content/2020-09/23/content_5546373.htm.
3. Li Y, Zhao L, Chen J, Zhang Z, Xing L, Tian J. Summary and analysis of teaching effect evaluation of ideological and political education in the courses in medicine and health field. China Medicine Guide. 2021;23(06):477-80.
4. Chen Y, Weng S, editors. Evaluation of teaching effect of ideological and political reform of "psychiatry" course in medical colleges. The 2nd Symposium on "Exploration of New Curriculum Reform Education Theory"; 2020; Wuhan, Hubei, China.
5. Hegazi I, Wilson I. Medical education and moral segmentation in medical students. Medical Education. 2013;47(10):1022-8.
6. Wald HS, McFarland J, Markovina I. Medical humanities in medical education and practice. Medical Teacher. 2019;41(5):492-6.
7. Notice of the Party Group of the Ministry of Education of the Communist Party of China on Printing and Distributing the "Ideological and Political Work Quality Improvement Project Implementation Outline in Colleges and Universities" 2017 [Available from: http://www.moe.gov.cn/srcsite/A12/s7060/201712/t20171206_320698.html.
8. Notice of the Three Departments Printing and Distributing the “Guiding Opinions on Accelerating the Construction of ‘Double First-Class’ in Colleges and Universities” 2018 [Available from: http://www.gov.cn/xinwen/2018-08/27/content_5316809.htm.
9. Opinions of the Ministry of Education on Accelerating the Construction of High-level Undergraduate Education and Comprehensively Improving Talent Cultivation Ability 2018 [Available from: http://www.moe.gov.cn/srcsite/A08/s7056/201810/t20181017_351887.html.
10. The General Office of the Central Committee of the Communist Party of China and the General Office of the State Council issued "Several Opinions on Deepening the Reform and Innovation of Ideological and Political Theory Courses in Schools in the New Era" 2019 [Available from: http://www.gov.cn/zhengce/2019-08/14/content_5421252.htm.
11. Opinions of the Ministry of Education on Deepening the Reform of Undergraduate Education and Teaching to Comprehensively Improve the Quality of Talent Training 2019 [Available from: http://www.gov.cn/xinwen/2019-10/12/content_5438706.htm.
12. Opinions of the General Office of the State Council on Deepening the Collaboration of Medical Education and Further Promoting the Reform and Development of Medical Education 2017 [Available from: http://www.gov.cn/zhengce/content/2017-07/11/content_5209661.htm.
13. Xie W, Zhang J, Fan X, Yu F. Analysis on the effective integration of medical students' moral education and three-dimensional objectives. Chinese Health Industry. 2019;16(28):18-9.
14. Xu C. The value guide and action plan for ideological and political education in medical curriculum. Journal of Southeast University (Philosophy and Social Sciences Edition). 2021;23(S1):154-7.
15. Cao S, Yang Y, Lu X, Shi W, Yan W, Ni C. Instructional evaluation of ideological and political course in practice skills training of public health. Medical Education Research and Practice. 2020;28(05):852-4.
16. Goldman EF, Swayze SS, Swinehart SE, Schroth WS. Effecting curricular change through comprehensive course assessment: using structure and process to change outcomes. Academic Medicine. 2012;87(3):300-7.
17. Liu J, Huo D, Xue H, Liu Y. Exploration of Ideological and political education of immune system under background of COVID-19 epidemic. Chinese Journal of Immunology. 2021;37(11):1383-5.
18. Hu J, Lei L, Wang Y, Zhang M. Exploration and on the path of integrating ideological and political education into medical courses. Chinese Medical Ethics. 2020;33(12):1535-9.
19. Bifulco MA-O, Pisanti SA-O. Integrating medical humanities into medical school training. EMBO Reports. 2019;20(12):e48830.
20. Li Y. Research on the developmental evaluation system of humanistic quality for medical students [PhD]: Third Military Medical University; 2011.
21. Sbhatu DB. Challenges of 20th century Ethiopian Science education. Heliyon. 2021;7(6):e07157.
22. Trilk J, Nelson L, Briggs A, Muscato D. Including lifestyle medicine in medical education: Rationale for American College of Preventive Medicine/American Medical Association Resolution 959. American Journal of Preventive Medicine. 2019;56(5):e169-e75.
23. Tambone V, Lauri G, Guarino MPL, Campanozzi LL, Ciccozzi M. Leonardo's folio 730 recto: Lessons for the medical humanities. Lancet. 2019;393(10179):1411-2.
24. Chiu YC, Liang JC, Hsu HY, Chu TS, Lin KH, Chen YY, et al. To examine the associations between medical students' conceptions of learning, strategies to learning, and learning outcome in a medical humanities course. BMC Medical Education. 2019;19(1):410.
25. Payne L. Who's your enemy?: Incorporating stories of trauma into a medical humanities course. Journal of Medical Humanities. 2020;41(4):481-7.
26. Schwartz BD, Horst A, Fisher JA, Michels N, Van Winkle LJ. Fostering empathy, implicit bias mitigation, and compassionate behavior in a medical humanities course. International Journal of Environmental Research and Public Health. 2020;17(7):2169.
27. LaVelle JM, Lovato C, Stephenson CL. Pedagogical considerations for the teaching of evaluation. Evaluation and Program Planning. 2020;79:101786.
28. Johnson SB, Fair MA, Howley LD, Prunuske J, Cashman SB, Carney JK, et al. Teaching public and population health in medical education: An evaluation framework. Academic Medicine. 2020;95(12):1853-63.
29. J. SJ, A. Z, C. JM, D. C, V. A, J. M. Evaluation of undergraduate Endodontic teaching in dental schools within Spain. International endodontic journal. 2020;54(3).
30. Valencia EA-O. Gender-biased evaluation or actual differences? Fairness in the evaluation of faculty teaching. Higher Education (Dordr). 2021:1-19.