Facing rising medical costs and shortages of physicians in rural and urban areas, a government calls for health care reform. Experts warn that more primary care and family medicine physicians are needed to meet the surging demand for first-line treatment, chronic disease management, and the promotion of prevention. In response, medical schools look for ways to adjust their programs to prepare new doctors for careers in family medicine and community health.
It’s a familiar story for Americans, but the same drama is playing out half the world away in China. With their population soaring past the 1.3 billion mark, the community health crisis is on an even larger scale than the one here in the United States. But in many ways, the country is farther away from a solution, with a national medical curriculum that heavily prioritizes inpatient care and specialization. In response, the Chinese government recently issued a mandate redirecting schools to start producing more front-line doctors.
But it’s no simple matter to create a new curriculum from scratch, and the University of Chicago Medical Center is helping one Chinese medical school with that process. Wuhan University, a school in the central Chinese province of Hubei, is working with Renslow Sherer, professor of medicine, and other faculty to revise their curriculum over five years. A key part of that collaboration – the creation of a family medicine department – recently reached a landmark in October as the first six Wuhan medical students began a one-month community health rotation designed by Wuhan and Chicago doctors.
Sarah-Anne Schumann and Mari Egan, assistant professors of family medicine, have spearheaded Wuhan’s construction of a new family medicine program, visiting the country three times between them in the last year. As leaders of the family medicine and community health programs at the University of Chicago’s Pritzker School of Medicine, both are experienced in creating partnerships between a hospital and the surrounding neighborhoods. But despite Wuhan’s original plan to import their Pritzker program wholesale to China, it became quickly apparent during the visits that a custom-fitting was necessary.
“We were constantly saying ‘You can’t create a community clerkship for the South Side of Chicago in China,'” Schumann said. “You have to look at what your patients need and design the clerkship around that. They needed to take ownership and make it work for their students.”
The main challenge was connecting the Wuhan medical school with the community health centers in the city, which are actually very impressive facilities, Schumann and Egan said. Care for chronic diseases such as diabetes or asthma, rehabilitation medicine, traditional Chinese medicine, and specialized care are all available at the centers, and doctors and nurses do home visits for those who can’t make it into the clinic. Physicians use electronic medical records to keep track of patients, statistics about blood pressure and glucose levels are posted on the wall, and a “menu” of procedures is prominently displayed in the front (pictured at right).
“You walk into the health center, and it’s like McDonald’s – there’s a neon sign that’s rotating, and it has all the treatments and how much they cost,” Schumann said.
But until now, students from Wuhan University did not have an opportunity to experience medical care in this environment. Nearly all of their patient encounters took place in the hospital, and the community health education amounted to hearing lectures about the neighborhood clinics without ever visiting them. That format is similar to what was commonly seen in American medical schools until the relatively recent push for more hands-on community health experience, Egan said.
“Until about 40 years ago in the United States, most of medical education was taught in the hospital, and we needed to learn how to teach students in the outpatient community setting,” Egan said. “Now we’re starting to do the same thing in China.”
Over the course of their first two visits, Schumann and Egan helped connect the medical school faculty with the physicians in the community health centers to determine the best way to educate students. Their approaches were different – academic doctors talk about diseases, and community health doctors talk about symptoms – but a mutual teaching plan was carefully reached. It was agreed that three groups of six students would each spend a month working in the community health centers, a pilot program that would be expanded to every student if successful.
Last month, Schumann visited Wuhan while the first group spent their first day at a community health center. After that exciting day, she sat in on a roundtable discussion of what they observed and saw at the clinic.
“What they all said was that they were so impressed by the relationships that the doctors had with the patients,” Schumann said. “One said ‘it’s almost like they treat them like friends.’ They had never seen that model before, and they were really touched by the closeness between the doctors and patients.”
Establishing the community health clerkship is only the first phase of the curriculum changes in Wuhan. The University is also working to create a family medicine department – not an easy task given that there are currently no doctors trained in family medicine. But as graduates of the new program begin to practice and specialists are re-trained in general medicine, a robust department and curriculum will hopefully develop and serve as a model for the rest of China.
“I think what we’ve learned, especially in doing global health, is that in order to make meaningful change, you don’t just go in and do something and then leave,” Egan said. “Going and providing health care to them for a week is not going to solve anything. But being part of the sustainability of medical education reform where we’re actually helping them create their own family medicine doctors is probably the most meaningful thing we can do for the community.”