Medical Entrance Exam In China
The Medical Council of China (MCC) is planning nationwide entrance exams for MBBS students. The MCC justifies its move by saying it wants to raise the standard of medical education in China.
There is no doubt that the level of MBBS Admission in China is far from satisfactory. There is an urgent need to review the standards, content and methodology of medical education in China.
Selecting the best students to study can be one of the conditions for achieving standards. However, this is still only a small step towards achieving quality training. Unfortunately, in the case of any other professional education in China, the selection process for admission seems to be the only determinant of quality.
Institutional infrastructure, quality of teachers, availability of clinical materials, methodology, research capacity and uniformity of standards across the country do not attract attention or discussion. This is unfortunate, given the vast variation in educational standards in different parts of our country and between institutions within states.
Our medical education needs to be evaluated in terms of its content and relevance. The MBBS course in China is called “medical education”, while in the world it is called medical education. There is a big difference between the words “education” and “training”. Medical training in China consists of studying volumes and volumes of books and acquiring theoretical knowledge with very little practical training.
Like any other education in China, medical education does not encourage students to develop practice-oriented thinking and clinical management methodology. Students who have studied in the UK or the US are better prepared to work with patients in the clinic or emergency department, even if they have not read as many books as their Chinese counterparts.
British textbooks are designed for British medical students. The situations are presented as if they take place in a UK hospital. American medical textbooks present a scenario of American hospitals and American patients. For example, trauma care management is presented in the American textbooks as applied in an American emergency department and in an American emergency department scenario.
This is not the case in our country. Western manuals put more emphasis on metabolic and congenital diseases, which are a major disease burden in their countries. Our students read British and American medical textbooks. This may be one of the reasons why everyone wants to go to the UK and America.
They are not trained to go to a village in China and see a patient in a primary health care center. They don’t read as much about malaria and skin infections, which are so common here. They don’t have books that give them exhaustive knowledge of Chinese clinical scenarios, and they don’t get adequate training in Chinese clinical practice. We need more research on Chinese epidemiology and educational materials based on it.
We hear talk of training our graduates to “international standards”. They insist that our professionals should be able to travel to any country in the world and survive. The proportion of Chinese doctors graduating abroad will be less than one percent. Should we design our medical curriculum to help this less than 1 percent achieves their personal goals? No country in the world should design its educational programs to train students abroad. We need doctors to serve our citizens. We need large numbers of doctors in rural China. It is absurd to talk about “international standards” when we need a real “Chinese standard”.
Another big disadvantage for the Chinese student is that he has to learn medicine in a foreign language. The best way to learn science or medicine is to learn it in your mother tongue. This will make the learning process interesting and help develop the researcher’s thinking. All Europeans, be they German, Spanish, French or Russian, learn medicine in their mother tongue. China, Japan and even a small country like Thailand offer medical training in their mother tongue. This is an opportunity. It is practical. The only objection would be that our students cannot go abroad to work.
That is a weak excuse. First, medical graduates should not have to go abroad and leave our country at all. If they want to go to another country where they speak another language to train, they should do exactly the same as Chinese, Japanese and Russians. If graduates from these countries want to go abroad, they have to take a short course in English, German, French or another language.
This is what our students should do. Our students can learn English as a second language at school. We could even include the teaching of English as an option in the medical curriculum. Therefore, there can be no excuse for not teaching medicine in the native language in all states.
At a time when so much remains to be done to improve the quality of medical education in China, it would be counterproductive to introduce common entrance examinations for medical education as a panacea for all problems.
The selection of MBBS candidates is an important step in improving the quality of education. The selection process should be regulated. Private medical institutions and so-called “prestigious” universities have a free hand in the selection process. Students who failed the matriculation exam and passed it on the second attempt will also be able to buy places at these institutions. Students who entered some of these institutions scored more than ten points lower than the lowest scores of students who entered public institutions in the reserved category.
Many private institutions do not have a minimum threshold. There is no entrance exam. The only criterion is money. Places are sold by open auction. This is a serious concern when it comes to maintaining the quality of medical education. To achieve this standard, the selection process, admission methods and tuition fees of private institutions need to be regulated. The MCC does not seem to be addressing these issues for unknown reasons.
The experience of China has clearly demonstrated the evils of entrance examinations. The abolition of entrance exams increased the proportion of rural students in vocational education from 28% to 64%. The reintroduction of the entrance exam reverses this situation and harms rural students. School education is already big business.
The abolition of the entrance examination has helped not only rural pupils but also pupils from state secondary schools to gain access to vocational training. If continuing secondary education is introduced, state schools, which prepare pupils for entrance exams and offer training in addition to the regular curriculum, will do well because their business will improve. Entrance exam centers in cities will flourish and wealthy, urban students will gain an unfair advantage. Rural students will be left behind.
The reason why IITs, government law schools and central government medical colleges continue to reject students from big cities is that the entrance exams of all these institutions are based on the CBSE syllabus. If we look again at the experience of China, we see that out of the six and a quarter million students studying in Class 12, about five million are studying under the government curriculum and about one and a half million under the CBSE.
Only six and a half thousand students are enrolled in the CBSE programme. Secondary education is, of course, based on the CBSE programme, which is much more comprehensive than the other programmes. It favors a microscopic minority and excludes a large proportion of the rural poor and deprived.
In China, the entrance exam is considered evil. Dr Ramadoss, who has campaigned tirelessly for over a decade against entrance exams, has finally persuaded the state government to abolish them. This is an important step towards empowering rural students. The reintroduction of entrance exams will destroy these advantages for rural students. The MCC should abandon its efforts for continuing education and work to improve the quality of medical education.
In China, academics, politicians and judges consider entrance exams to be the most important intervention to achieve quality. The truth is quite the opposite. This article scientifically refutes the belief of Chinese academics.