Medical humanities education in China: an exploratory cross-sectional study

Abstract

BackgroundGovernmental policies in China have strengthened education in the medical humanities. Previous publications have highlighted the inadequacy of medical humanities education in China and have promoted their advancement and evaluation. Medical disputes and mistrust between doctors and patients in China have been ascribed to a paucity of proper medical humanities education at the medical student level. However, no studies to date have specifically examined the frequency, structure, and characteristics of the medical humanities curricula at all Chinese medical schools, making it difficult to draw a comprehensive understanding of its current state. We therefore aim to provide such an understanding of the current role of the medical humanities at Chinese medical schools. MethodsWe did an exploratory cross-sectional study of medical humanities education in China. We did a comprehensive web-based search of records and curricula to identify all medical humanities courses at all tier-one western medicine Chinese medical schools. In China, only tier-one colleges can offer an education in clinical medicine. All medical schools' compulsory public curricula and the schools' medical humanities curricula were included in our analyses. The primary outcome was to categorise both quantitatively and qualitatively the role of the humanities at Chinese medical schools. We categorised all course data and analysed it using SPSS (version 20). Ethical approval was obtained by the Institutional Review Board of the National Yang-Ming University. FindingsBetween July 1, 2017, and April 30, 2018, we identified 138 tier-one Chinese medical schools with compulsory public curricula, of which 93 (67%) had a medical humanities curricula. Eight medical humanities course types were identified. On average, each school offers 3·84 types of different medical humanities courses. The types of courses that are offered the most are medical psychology or clinical psychology (72 [77%] of 94), medical ethics (68 [72%]), hygienic or medical jurisprudence (56 [60%]), and doctor–patient communication (46 [49%]). Medical humanities courses account for 3–10% of the total credits medical students are required to obtain to graduate in China. The compulsory Ideological and Political Theory curriculum accounts for 6–8% of credits required to graduate. This curriculum includes Mao Zedong Thought, Modern Chinese History, Marxism, Socialism with Chinese Characteristics, and Moral Education and Law, and is required of all students, not solely medical students. InterpretationMedical humanities courses at western medical schools such as the University of Oxford and Harvard Medical School account for 15% and 25% of the total credits required to graduate, respectively. In China, medical humanities education accounts for a substantially smaller portion of the curriculum. Despite ongoing medical disputes and doctor–patient tension, only half of medical schools offer doctor–patient communication type courses. However, China's Ideological and Political Theory curriculum also has a humanistic intent, and when added with medical humanities courses, the two together account for 9–18% of the total credits required to graduate. These unique curricular components serve to support governmental priorities, including developing leaders who follow the so-called rule of law and the rule of virtue. These traits of China's medical humanities curricula match China's national political ideology. However, a more coherent longitudinal medical humanities framework specifically aimed at strengthening the patient–doctor relationship would be useful. China's endeavours to foster medical humanities education reform should be actively promoted at the research, policy, and practice level. FundingThe Republic of China Ministry of Science and Technology (grant MOST 105-2511-S-010 -002 -MY2).