Abstract.In order to strengthen personnel training and talents squad construction of grass-roots health, the rural-oriented order free medical education is being implemented in China. Gannan Medical University has explored and practiced rural medical personnel order training mode, created a personnel training mode called "3.5+1.5" rural-oriented medical personnel training mode, improved the curriculum system of this personnel training mode, providing an important guarantee for upgrading the quality of the rural-oriented order free medical education.
Key words： rural medical personnel; personnel training mode; rural-oriented order personnel training; medical education.
In order to strengthen personnel training and talents squad construction of grass-roots health, medical universities and colleges should try to adjust to the actual needs of grass-roots health services, comply with laws of medical education, transform the educational ideas, innovate the teaching methods, promote the curriculum reform, intensify the construction of clinical practice bases, improve the ability and standard of teaching, and explore a personnel training mode that can meet the needs of grass-roots medical and health care.
1.The implementation background of rural-oriented order personnel free medical education
In the year of 2010, “Notice on the issuance of talents squad construction planning of grass-roots medical and healthcare focusing on general practitioners” (Development and Reform Society, [2010] No.561), which is issued by the joint efforts of the National Development and Reform Commission, the Ministry of Health, the SCOPSR, the Ministry of Education, the Ministry of Finance, the Human Resource Department, the Ministry of Social Security, indicated that China will cultivate 300,000 general practitioners through a variety of ways and gradually form a grass-roots healthcare contingent which has proper quantity, high quality, reasonable structure, and can meet the needs of the fundamental medical systems, in order to basically meet the human resource needs of “the least sickness cared in the grass roots” by 2020. At the same time, the National Development and Reform Commission, the Ministry of Health, the Ministry of Education, the Ministry of Finance, the Human Resource Department, the Ministry of Social Security jointly issued “Notice on the issuance of carrying out the rural-oriented order medical students free training work” (Development and Reform Society, [2010] No.1198), to formally start the rural-oriented order medical students free training plan.
In addition, to further deepen the reform of the educational system and implement the state program for medium and long term educational reform and development, the State Council issued the document “Notice on conducting the experiment of national education system reform issued by General Office of the State Council” (General Office of the State Council, [2010] No.48), which was decided to carry out the experimental work of national education system reform in some areas and schools. Gannan Medical University is among the schools that should be responsible for the pilot project of national education system reform “Exploring a ‘five-year’ medical personnel training mode oriented to villages, towns and communities” (Project No.03-114-137),to carry out the exploration and practice of the training mode of medical personnel oriented to villages, towns and communities.
2.Theory construction and practical exploration on rural medical personnel training mode
According to the specific training objectives and personnel specifications, personnel training mode refers to the sum of the implementation of the talent education process with a relatively stable course content and curriculum, management system and assessment methods, which is under the guidance of educational theories. The key issue of training mode is "what kind of talents to culture" and "how to train talents". It is the objective requirements of strengthening the construction of primary health personnel and meeting the actual needs of primary health care services to innovate rural medical personnel training mode, improve the quality of medical education, train and bring up the high-quality rural medical personnel.
Since 2006, Gannan Medical University was the first university of starting to implement rural medical personnel order training in Jiangxi Province, has been trained 300 three-year Clinical medical students for the orders of Ganzhou city, Jiangxi province within three years, and all graduates have worked in township hospitals. The successful experiment of the rural medical personnel order training mode have made a positive contribution to the local rural development, health development and health care professionals, and achieved good social responses in rural society.
Learning from the successful experience of this mode, Gannan Medical University have started to explore and practice the rural-oriented medical personnel training mode for the township and community since 2010, carrying out the work of the rural-oriented order medical students free training actively.
1)Theory construction and practical exploration on rural medical personnel order training mode
Rural medical personnel order training mode is a combination training mode of the basic medical and health which medical schools that bears the medical and health personnel training task and health sectors (local health bureaus, hospitals) as the employers sign an agreement. According to the national education policies, the job demand conditions of the health sector (local health bureaus, hospitals) and the quality of human resources requirements, medical schools and health sectors jointly develop the training plan, take advantage of intellectual, physical, performance venues for the teaching and design the medical and health personnel specially for the health sectors’ needs and graduates’ direct employment in order to improve the present situation.
Four characteristics of rural medical personnel order training mode are the following:
a. Scientific. Rural medical personnel order training mode is based on the adequate investigations and studies. After scientifically analyzing the present situation of grass-roots health care, under the premise of respect knowledge, the tripartite systems of the prefectural or municipal health bureau, training institutions and grass-roots employers formulate a scientific and feasible program to facilitate the operation of medical personnel training.
b. Normalization. The requirements for knowledge of the school teaching programs and skills training content are determined by the actual needs of grass-roots healthcare. The teaching content is no longer the mere subject teaching mode, and it closely contacts with the actual needs of grass-roots medical care and local common diseases, frequently occurring diseases and refractory diseases. At the same time, the characteristic teaching is introduced into the classroom, which fully embodies the normalization and practicality of personnel training.
c.Orientation. When the medical personnel under order training directly serve the grass-roots medical units after graduation, they are able to adapt to the needs of the job quickly, thus making a positive contribution to the development of grass-roots medical and health care and the training of medical and health care professionals. What’s more, the medical students under this mode have more stable professional thought and higher learning enthusiasm, and their learning purposes and employment destinations are very clear.
d.Efficiency. The establishment and selection of the rural medical personnel order training mode aims to improve grass-roots medical and health conditions, to strengthen the teaching ability, and to ensure the students" full employment, thus creating a "win-win-win" situation among grass-roots medical and healthcare improvement, school development and student employment, which have great economic and social benefits.
2)Construction and exploration of the rural-oriented medical personnel training mode
In order to develop practical general medical personnel oriented to townships and communities who have the qualities of "effective learning, ready to serve, attractive stay, feasible usage, real application", Gannan Medical University has carried out a series of reform and practice, and constructed a training mode called "3.5+1.5" rural-oriented medical personnel training mode, which has achieved positive effects in creating rural medical personnel training mode, exploring the experience of medical education reform and enhancing the teaching quality of higher education.
(1)The overall objectives and requirements of rural-oriented medical personnel training
According to the overall objective of Chinese higher medical education and global minimum essential requirements in medical education, Gannan Medical University has determined the overall objective of the rural-oriented medical personnel training, which is to cultivate comprehensive medical personnel who develop high-quality clinical expertise with good work ethic, innovative spirit and practical ability, and life-long learning ability with a grasp of basic medicine, clinical medicine and preventive medicine development, basic knowledge, basic general theory and basic skills to adapt to the development needs of rural health work, moral, intellectual, physical, and aesthetic aspects.
To achieve the overall objective of the rural-oriented medical personnel training, Gannan Medical University has built "3.5+1.5" medical personnel training mode. That is, according to the overall objective and requirements of the rural-oriented medical personnel training mode, it emphasizes on knowledge, ability and quality of this kind of medical students, especially training prominently the common and frequently occurring basic medical skills in rural areas, and strengthen practice teaching. They should learn three and a half years in school, and practice one year and a half in the hospital, during which 50 weeks for the practice of clinical medicine, and 20 weeks for the practice of preventive medicine and community health services to ensure them can provide the combination of prevention, care, diagnosis, treatment, rehabilitation, health management for the people in the townships and communities.
a. Knowledge structure: They should master the basic knowledge of basic medicine, clinical medicine and preventive medicine, the basic theory and skills, have good subject knowledge and ability to structure, and proficiency in the general common disease diagnosis and treatment technology.
b. Ability structure: They can use biomedical, behavioral science and social science expertise and skills to provide health education to the masses of peasants, health counseling, disease prevention, community health services and general disease, primary treatment, referral for treatment of incurable diseases.
c. Quality structure: They have the quality structure of good moral character, social responsibility, codes of conduct and professional ethics, and determined spirit of rural medical and health services with good health and good mental qualities.
(2)The curriculum of "3.5 +1.5" rural-oriented personnel training mode
In order to make rural-oriented medical students assume the responsibilities of general practitioners better after graduation, in the aspect of curriculum arranging, Gannan Medical University adheres to the principles of equal knowledge, ability and quality in accordance with the general requirements and basic requirements of medical personnel training; according to the teaching philosophy of "wide caliber, solid foundation, strong practice, for innovation", it sets a course scheme of “Three modules, Five major categories”. The three modules are namely, the general education course module, the professional basic course module and the professional education course module; and the five major categories are as follows: the ideological and political category, the humanity-based quality category, the public base category, the major related base category, and the specialized subjects.
a. General education course module includes three categories namely, the ideological and political category, the humanity-based quality category and the public base category. It primarily offers general education to the rural-oriented medical students to cultivate their ideological and moral qualities, human qualities and scientific quality; it helps them broaden their professional horizons, nurture their soul and improve their culture quality and mental ability; it cultivates aesthetic, understanding, thinking and judging abilities of them and trains them to master the basic theoretical knowledge so as to cultivate their preliminary theoretical accomplishment. This module mainly includes literature, history, philosophy, art, mathematics and natural science and other courses.
Among them, the ideological and political courses mainly require the rural-oriented medical students to master the basic theoretical knowledge of Marxism-Leninism, Mao Zedong Thought, Deng Xiaoping Theory, the important thought of Three Represents and the scientific concept of development, and to properly treat nature, society and life development applying the ideas and methods of dialectical materialism and historical materialism. The humanity-based quality courses can offer them broad humanistic and social scientific knowledge, behavior and ethical knowledge, and also develop their healthy professional values and scientific attitude, and improve the collaboration and communication skills. The public base courses are designed to help the rural-oriented medical students to lay a solid natural science foundation and to master the basic theory, knowledge and skills of foreign languages, mathematics, physics, chemistry, computer and other disciplines.
b. Basic curriculum module: In order to achieve the personnel training target of thick foundation and strong ability. This module mainly aims to develop a solid foundation of basic medical knowledge and capacity of the rural-oriented medical students. Choose teaching contents, pay attention to the modern medical science and technology from the new achievements. To reflect a new level of medical and scientific development, to rise their horizon, and to help them a properly handle the convergence and division of basis for medical, clinical course and related course content to realize the optimization of the course structure.
c. Professional education course module: Its content is grasping the medical, surgical and specialist clinical knowledge and clinic skills. And the goal is to strengthen the clinical thinking of the rural-oriented medical students. This module develops their strong clinical analysis and thinking abilities of Chinese Medicine combining Western Medicine, strong practical abilities and the ability of classification and identification of human diseases causes and pathogenesis; it helps them to grasp the diagnosis and treatment of common diseases and frequently-occurring diseases and handling approaches to urgent, difficult, severe cases; it puts great emphasis on clinical skill training and guides them to use the principle of evidence-based medicine and critical thinking for medical practice. As to the teaching methods, the module adheres to the combination of theory and practice in order to better cultivate practical high-quality general clinical professionals with “effective learning, ready to serve, attractive stay, feasible usage, real application”.
In order to expand the horizons of the rural-oriented medical students, broaden their knowledge, cultivate the creative spirit, adapt to the development of medical science and changes in the medical pattern, and to fully strengthen the training of comprehensive quality, Gannan Medical University also offers optional courses in the rural-oriented medical students training curriculum. In addition, traditional class teaching and extra curricular are expanded into practice teaching of curriculum system, formed a theory teaching and practice teaching, including reasonable a more reasonable teaching contents.
3.The reflections on rural-oriented medical personnel training mode
Medical schools should further elaborate the personnel training and advantages and functions of the service to the community, strengthen the teaching staff, reform the curriculum system and the personnel evaluation system, and at the same time they should also strive for policy support and full participation of government and health administration departments, just in order to implement rural-oriented order personnel free education, explore the rural-oriented medical personnel training mode and improve the quality of medical personnel training.
1)To take the advantages and functions of the medical education training personnel and serve the society. Medical universities and colleges should actively develop the school characteristics, rationally utilize current curriculums, bring the pathogenesis mechanism, clinics technology of common disease, difficult disease, frequently-occurring disease in rural areas, into the curriculum system. They also should fully exploit the advantages of resources and teaching advantages, develop curriculum and school-based curriculum, optimize the curriculum system, strengthen the general medical education, strengthen practice teaching, and implement the teaching requirements of “early clinic, more clinic, repeated clinic”, so as to develop the medical students’ clinical competence. Medical schools still should enrich the teaching contents with the knowledge, theory and skills really needed in rural health services, fully elaborating the advantages and features of the higher medical education personnel training and service to the villages, towns and communities.
2)To build the faculty adapting to the rural-oriented medical personnel training mode. To ensure the quality of the rural-oriented medical order personnel free education, medical universities and colleges need to cultivate a group of teachers with solid basic medical knowledge and strong clinical practice competence, and with certain diagnosis, treatment and research to the rural frequently-occurring diseases, common diseases and refractory diseases. As to the curriculums which involved with these diseases, medical universities and colleges may also employ experts from grass-root health care units, combined with the lectures and guidance to medical students" practice.
3)To get the policy support and involvement of government and the public health administration department in the process. To carry out this rural-oriented medical personnel free education, government’s support is the key. During the process of it, the government should effectively increase capital investment and strengthen constructions of clinical practice bases. After students’ schooling education, government and health authorities must strictly abide by the agreement, implementing the students" employment, to arrange qualified students to grass-roots’ hospitals. Strengthening their follow-up training, continuing education, etc, and solving their concerns to ensure they can truly long-term serve in grassroots’ healthcare.
Personnel Training Mode is a complex systematic project which involves a broad content. Rural-orieted medical personnel training mode is still at the exploratory stage. Practice and exploration need to be constantly improved in the education system reform.
4. Fund
A phased result of Chinese pilot project of national education system reform, “Exploring a ‘five-year’ medical personnel training mode oriented to villages, towns and communities” (Project No.03-114-137).
5. References
[1]Huang linbang, Liu Min, Xiao Chensheng. The feasibility study of rural medical personnel "order form" training mode. Education and Vocational,2009(29).
[2]Liu Min, Gan Yafeng, Xie Qingping. Curriculum exploration on rural medical personnel “order form” training. Education and Vocational, 2010(11).
[3]Huang linbang. Theory and practice on rural medical personnel "order form" training mode. Nanchang: Jiangxi Colleges Publishing House, 2011.
[4]Liu Zhenyou, Xu Ping. Reflections on the scheme for the rural-orieted training of rural medical talents. The Science Education Article Collects, 2011(09).
[5]Liu Min, Xie Qingping, Wang Xingzhou. Research and practice on rural-oriented training medical personnel, World Education Information, 2011(12).