중국 의과대학의 교육과정 개혁: 무엇을 배웠나? (Medical Teacher, 2014)

중국 의과대학의 교육과정 개혁: 무엇을 배웠나? (Medical Teacher, 2014)

Curriculum reform at Chinese medical schools: What have we learned?

LEI HUANG1, LIMING CHENG1, QIAOLING CAI2, RUSSELL OLIVE KOSIK3, YUN HUANG2, XUDONG ZHAO2, GUO-TONG XU2, TUNG-PING SU4, ALLEN WEN-HSIANG CHIU4 & ANGELA PEI-CHEN FAN4

1Tongji Hospital, Tongji University School of Medicine, China, 2Tongji University School of Medicine, China, 3Santa Clara Valley Medical Center, USA, 4National Yang-Ming University, Taiwan

Introduction: 

중국 의과대학의 교육과정 개혁은 최근 상당한 관심을 끌고 있다. 몇몇 상위권 대학이 교육과정 개혁이라는 탐사에 앞장서면서 상당한 경험의 축적과 진전을 보이고 있다.

Curriculum reform at Chinese medical schools has attracted a lot of attention recently. Several leading medical schools in China have undergone exploratory reforms and in so doing, have accumulated significant experience and have made considerable progress.

Methods: 

중국 내 38개 의과대학에 대하여 교육과정개혁에 대한 분석을 진행하였다. 국내외 문헌을 통해서 어떤 종류의 교육과정 개혁이 진행되었으며, 어떻게 도입되었는지에 대한 설문을 개발하였다. 대부분의 문항은 교육과정 개혁의 목적, 교육과정의 형태, 개혁 이후 교수법 향상, 개혁 이후의 평가법 변화, 내학 내부의 개혁에 대한 평가, 개혁 과정의 어려움 등에 대하여 묻는 문항이었으며, 설문 외에 관계자들을 면담하여 추가적인 질적 자료를 수집하였다.

An analysis of the reforms conducted by 38 Chinese medical colleges that were targeted by the government for upgrade was performed. Drawing from both domestic and international literature, we designed a questionnaire to determine what types of curricular reforms have occurred at these institutions and how they were implemented. Major questions touched upon the purpose of the reforms, curricular patterns, improvements in teaching methods post-reform, changes made to evaluation systems postreform, intra-university reform assessment, and what difficulties the schools faced when instituting the reforms. Besides the questionnaire, relevant administrators from each medical school were also interviewed to obtain more qualitative data.

Results: 

분석에 포함된 38개의 대학 중 25개 대학이 주요 교육과정 개혁을 진행한 바 있었다. 그 중 60%는 계통(기관)중심 교육과정을, 32%는 PBL 기반 교육과정을, 8%는 하이브리드 형태를 도입하였다. 60%의 학교는 전임상실습과 임상실습 교육과정 모두에 대하여 개혁을 진행하였으며 32%는 전임상실습 교육과정에, 8%는 임상실습 교육과정에만 변화를 꾀하였다. 교육과정 개혁 이후 60%의 의과대학에서 전체적으로 강의시간이 감소하였다고 응답하였고, 76%에서 학생들의 임상술기가 향상되었다고 하였으며, 60%에서 연구능력이 향상되었다고 하였다.

Out of the 38 included universities, twenty-five have undergone major curricular reforms. Among them, 60.0% adopted an organ system-based curriculum model, 32.0% adopted a problem-based curriculum model, and 8.0% adopted a hybrid curriculum model. About 60.0% of the schools’ reforms involved both the ‘‘pre-clinical’’ and the ‘‘clinical’’ curricula, 32.0% of the schools’ reforms were limited to the ‘‘pre-clinical’’ curricula, and 8.0% of the schools’ reforms only involved the ‘‘clinical’’ curricula. Following curricular reform, 60.0% of medical schools experienced an overall reduction in teaching hours, 76.0% reported an increase in their students’ clinical skills, and 60.0% reported an increase in their students’ research skills.

Discussion: 

중국에서 교육과정개혁은 여전히 걸음마단계이다. 중국의 상위권 의과대학은 혁신적 교육법을 도입하기 위하여 다양한 노력을 하고 있다. 그러나 제한된 자원과 전통적 교육관에 발목을 잡혀 쉽사리 진전을 이루지 못하고 있었다. 이러한 문제에도 불구하고 의과대학들은 긍정적인 초기결과를 보고하고 있다. 장기적 효과는 두고보아야 할 것이다.

Medical curricular reform is still in its infancy in China. The republic’s leading medical schools have engaged in various approaches to bring innovative teaching methods to their respective institutions. However, due to limited resources and the shackle of traditional pedagogical beliefs among many faculty and administrators, progress has been significantly hindered. Despite these and other challenges, many medical schools report positive initial results from the reforms that they have enacted. Although the long term effects of such reforms remain unclear, curricular reform appears to be the inevitable solution to China’s growing need for high-quality medical doctors.

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중국 의과대학 대부분은 discipline-based curriculum

Currently, the majority of medical schools in China employ a discipline-based curricular model, where theory, clerkship, and internship are completed in three isolated phases and the GMER competencies are largely neglected. Compared to medical students who are taught via the GMER, medical students who are educated under traditional curricula underachieve.

중국의 교육부는 의과대학을 몇 가지로 분류하는데, 본 연구 대상으로 한 38개 의과대학은 모두 first class로 분류되어 있다.

Chinese medical schools are categorized into several classes by the Ministry of Education. The 38 schools for which data were collected are all categorized as ‘‘first class’’ medical schools (Table 1), and most have received the ‘‘Aiming for Excellence’’, ‘‘985’’, and ‘‘211’’ grants.

현재 중국에는 152개의 (서양의학을 가르치는) 의과대학이 있다. 그 중 128개가 first class이다.

Currently in China, there are 152 medical schools that teach Western Medicine. Of the 152 medical schools that teach Western Medicine, 128 are classified as first class medical schools, the other 24 medical schools belong to the second class or the third class.

1999년 Frank J. Papa와 Peter H. Harasym은 교육과정을 다섯 가지로 분류한 바 있다.

In 1999, Professor Frank J. Papa of the University of North Texas School of Medicine and Professor Peter H. Harasym of the Calgary University School of Medicine systematically reviewed both past and current medical curriculum models. They grouped each model into one of five types: 

• (1) the apprenticeship-based curriculum model, ABCM, 
• (2) the discipline-based curriculum model, DBCM, 
• (3) the organ system-based curriculum model, OSBCM, 
• (4) the problem-based curriculum model, PBCM and 
• (5) the clinical presentation-based curriculum model, CPBCM (Papa & Harasym 1999; Kong et al. 2009).

학문중심교육과정은 다음과 같은 문제 때문에 더 이상 중국에서 필요한 의사를 양성할 수 없다.

The ‘‘discipline-based curriculum model’’ no longer meets the needs of physicians training in China because it causes a number of significant problems:

• (1) each discipline covers material that widely overlaps with other disciplines and thus topics of study can become redundant, resulting in an unnecessary increase in teaching hours for professors and learning burden for students;
• (2) a lack of elective courses prevents students from exploring their individual interests; 
• (3) students do not receive sufficient clinical, research, and professional skills training and
• (4) assessment is limited to standardized means such as written examinations and lacks a formative component

매우 극소수의 의과대학만이 전임상실습과 임상실습, 예방의학, 인문의학의 경계를 허물고 통합하는데 성공하였다.

Very few schools completely dissolved all interdisciplinary boundaries by integrating pre-clinical coursework, clinical coursework, preventive medical courses, and the humanities in creating a new curriculum.

연구 대상 의과대학 

연구 대상 의과대학의 지역적 분포

교육과정 개혁의 목표

강의시간의 변화

교육방법의 변화

어려웠던 점

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Med Teach. 2014 Dec;36(12):1043-50. doi: 10.3109/0142159X.2014.918253. Epub 2014 Jun 4.

Curriculum reform at Chinese medical schools: what have we learned?

Huang L1, Cheng L, Cai Q, Kosik RO, Huang Y, Zhao X, Xu GT, Su TP, Chiu AW, Fan AP.

Author information

• 1Tongji Hospital, Tongji University School of Medicine , China .

Abstract

INTRODUCTION:

Curriculum reform at Chinese medical schools has attracted a lot of attention recently. Several leading medical schools in China have undergone exploratory reforms and in so doing, have accumulated significant experience and have made considerable progress.

METHODS:

An analysis of the reforms conducted by 38 Chinese medical colleges that were targeted by the government for upgrade was performed. Drawing from both domestic and international literature, we designed a questionnaire to determine what types of curricular reforms have occurred at these institutions and how they were implemented. Major questions touched upon the purpose of the reforms, curricular patterns, improvements in teaching methods post-reform, changes made to evaluation systems post-reform, intra-university reform assessment, and what difficulties the schools faced when instituting the reforms. Besides the questionnaire, relevant administrators from each medical school were also interviewed to obtain more qualitative data.

RESULTS:

Out of the 38 included universities, twenty-five have undergone major curricular reforms. Among them, 60.0% adopted an organ system-based curriculum model, 32.0% adopted a problem-based curriculum model, and 8.0% adopted a hybrid curriculum model. About 60.0% of the schools' reforms involved both the "pre-clinical" and the "clinical" curricula, 32.0% of the schools' reforms were limited to the "pre-clinical" curricula, and 8.0% of the schools' reforms only involved the "clinical" curricula. Following curricular reform, 60.0% of medical schools experienced an overall reduction in teaching hours, 76.0% reported an increase in their students' clinical skills, and 60.0% reported an increase in their students' research skills.

DISCUSSION:

Medical curricular reform is still in its infancy in China. The republic's leading medical schools have engaged in various approaches to bring innovative teaching methods to their respective institutions. However, due to limited resources and the shackle of traditional pedagogical beliefs among many faculty and administrators, progress has been significantly hindered. Despite these and other challenges, many medical schools report positive initial results from the reforms that they have enacted. Although the long term effects of such reforms remain unclear, curricular reform appears to be the inevitable solution to China's growing need for high-quality medical doctors.

PMID:

 

24896639

 

[PubMed - in process]