Two senior officers from SATCM, Beijing, acknowledge that under the Law, all the universities in China come directly under the education department of the respective people’s government (the respective municipalities, provinces and autonomous regions) (C-M5 & 6). The SATCM is not responsible for the affairs of any university (C-M6). However, it is indirectly involved in the supervision of TCM education and in the development of the Beijing University of Chinese Medicine (BUCM). There are approximately 47 TCM colleges and universities in China, and many other universities which have a Chinese Medicine department and conduct TCM courses.291
In China, integrated TCM education was introduced and implemented in the 1950s. This was confirmed by the senior officer from the GDPH (C-M4). At this point in time, integrated medicine system of education is more popular than pure TCM education, which is almost extinct. A professor from the BUCM explains that the integrated healthcare system is officially recognised in China (C-A3). In all the hospitals including TCM hospitals, integrated medicine is being practised. TCM practitioners who possess knowledge of modern medicine are in higher demand compared to pure TCM practitioners, especially in tertiary hospitals. Hence, almost all the universities adopt the integrated medicine system and emphasise modern medicine in order to ensure employment in any hospital upon graduation. A TCM practitioner states that these days pure TCM practitioners either serve in rural areas or practise in old medicine shops (C-P5). Four academics mention that
291
There are 89 modern medicine colleges and universities with TCM courses, and 138 non- medical colleges and universities or research institutes with TCM courses. See China Health
Statistics Yearbook 2009,
http://www.moh.gov.cn/publicfiles/business/htmlfiles/zwgkzt/ptjnj/200908/42635.htm (accessed March 28, 2010).
integrated medicine also allows TCM practitioners to earn their living abroad in countries where modern medicine is the mainstream practice of medicine (C-A6, 10, 11 & 12). This strongly suggests that TCM students have better future career prospects if they possess knowledge of modern medicine and good clinical skills. Therefore, 50% of the academics surveyed agree to the incorporation of modern medicine subjects into the undergraduate curriculum of TCM students and vice- versa. The bachelor’s degree for the integrated TCM study is a five-year course while the postgraduate course is a seven-year combined bachelor and masters’ degree programme.
Finally, a basic knowledge of modern medicine allows TCM graduates to take part in national and international activities. This is the opinion of an academic who says that in the Sichuan Earthquake on May 12, 2008, TCM practitioners, with their knowledge of integrated medicine, participated in the rescue activities (C-A12). TCM emphasises treatment to stabilise fractures and minimise the risk of post- fracture complications, the prevention of infectious diseases, and rehabilitation such as acupuncture and massage to improve the mobility of the limbs and quality of life, together with counselling with psychological support.292 However, she stresses, this does not mean that integrated medicine discourages TCM practitioners from practising TCM. In the near future, with the high demand for TCM specialities, pure TCM education may be re-emphasised. Moreover, with the availability of a multi-disciplinary and cross-referral system, a practitioner may not be required to possess knowledge of various systems of medicine. Subsequently, the professor from the GUCM remarks that “full attention on TCM from every TCM practitioner could enhance the development of TCM” (C-A1).
In order to develop TCM, the SATCM requests all foreign students who wish to study TCM in China to have a good command of Mandarin, both written and oral. The former Director of the Examinations Department of China’s National TCM
292 Zhang, X.P. et al., “The Benefits and Clinical Applications of Chinese Medicine on Rescuing Victims in the Sichuan Earthquake,” Beijing Journal of Traditional Chinese Medicine 28(1) (2009): 6-7.
states that the Chinese Education Department has upheld the value of the Chinese language (汉语) in TCM education and used Mandarin as the medium of instruction for integrated medicine (C-A13). The basic theory of TCM such as the Classics is based on ancient Chinese language and culture.293 He stresses that it is possible to teach basic science, statistics and pharmacology in English or other languages, but not the Classics. The major problem is the absence of the corresponding ‘Siamese twins phrases’294 and ‘imaginary numbers’295
in other languages. A TCM practitioner emphasises that if improperly and inaccurately translated, the TCM terminologies may alter the original context of the texts (C-P9). Without understanding the message in the Classics, the TCM students are not able to appreciate the origin and nature of TCM. Therefore, the medium of instruction for TCM has to be the Chinese language. For example, Yan-bian Medical University in Jilin recruits mainly students from Korea. In this university, lecturers are able to teach and communicate in the Korean language. In the first year, the medium of instruction is Korean, in the second year it is a mixture of Korean and Chinese, and in the third year, it is purely Chinese.
With regard to challenges in integrated medicine education, an academic from the GUCM realises the difficulties in ensuring that the fundamental theories of TCM be taught and understood by TCM students (C-A1). This challenge in integrated medicine education is secondary to the fact that TCM students fail to appreciate the philosophical thinking of TCM that is immeasurable.296 On the other hand, students easily accept the parameters of measurable scientific theory of modern medicine. In responding to this, two academics explain that these days, the younger generation rarely expose themselves to traditional Chinese culture and philosophy since childhood (C-A7 & 14). Childhood exposure to traditional
293 The ‘Classics’ will be used to replace the ‘Four Chinese Classics of Medicine’.
294 Li, P., and Y.Z. Shi, “English Translation of Antithetical Words in Huang Di Nei Jing,” Journal of
Chinese Integrative Medicine 7(1) (2009): 85-88.
295 Fu, L.Y. and Y.Z. Shi, “English Translation of Imaginary Numbers in Yellow Emperor’s Classic of Medicine,” Journal of Chinese Integrative Medicine 6(12) (2009): 1318-1320.
296
In TCM, there are different schools of thought. Some are based on Confucian and Taoist philosophical thinking.
Chinese culture establishes a good foundation in TCM culture. This is the determining factor for the future success of being a well-known TCM practitioner, for example, Wang Hong Shi.297 Without early exposure a majority of them find it difficult to understand the classical literature of Chinese medicine and accept the fundamental theories of TCM. They even doubt the healing properties of TCM due to the existence of the numerous schools of thought. A suggestion from one of the academics is that the authorities concerned may consider teaching TCM and planting the TCM philosophical theory in the students’ minds prior to introducing knowledge in modern medicine since students are able to accept modern medicine easily (C-A14). Moreover, TCM students may be tempted to compare both TCM and modern medicine in integrated medicine education. This could cause some confusion while studying the two systems of medicine simultaneously because of the conflict between the philosophical theory of modern medicine and that of the traditional system of medicine. The alternative is to establish courses on ‘traditional Chinese culture and TCM’ to enhance TCM students’ confidence and a feeling of pride in their profession. For example, Shanghai University of Chinese Medicine (SUCM) has conducted the ‘traditional Chinese culture and TCM’ since 2002, and a 2007 report demonstrated that more than 80% of the students were enthusiastic about learning traditional Chinese culture.298
Nevertheless, the integrated medicine education system in most TCM Universities is purely on the natural sciences, and does not educate students on Asian Chinese Medicine or the Classics. This is highlighted by an academic from the BUCM (C-A3). In fact, this traditional theoretical education on TCM can be maintained if the authorities concerned consider retaining more ‘credit hours’ for TCM subjects.299 Initially, the credit hours for modern medicine (basic medical sciences and clinical modern medicine) are 30-40% of the total credit hours for the
297 Liu, N., et al., “Understanding the Current Chinese Medicine Education based on the success of Beijing’s well-known physician, Wang Hong-Shi,” Beijing Journal of Traditional Chinese Medicine 27(3) (2008): 235-237.
298 Ye, G.H., et al., “Analysing the Study on Traditional Chinese Culture Education in the University of Chinese Medicine,” Beijing Journal of Traditional Chinese Medicine 27(7) (2008): 574-575,575. 299
whole TCM degree course, and some TCM universities have even increased this to 50%. In comparison, in the modern medicine universities, the credit hours for TCM make only 5% of the total credit hours.300 He remarks, “….in TCM universities, there is a problem in balancing the ratio of credit hours between TCM and modern medicine since the incorporation of modern medicine subjects into the undergraduate degree course has decreased the credit hours for TCM subjects.” The former leader of SATCM holds a similar view. After the Cultural Revolution, the ratio of credit hours between TCM and modern medicine was not maintained at 7:3 (C-M1). It has become 1:1 (50%). This is secondary to the increase in the modern medicine subjects without extending the credit hours for the entire course in a TCM university.
In responding to the above issue, an academic expresses her frustration by saying that reducing the credit hours for TCM creates difficulties in the TCM syllabus arrangement and teaching materials preparation and ultimately compromises certain TCM subjects (C-A12). For example, TCM History and Philosophy that would prove useful in disease management as attested to by 50% of the academics. She strongly recommends maintaining the proportion of the credit hours for TCM subjects and removing irrelevant compulsory subjects such as English language. Politicians and academics comment that English should be an optional subject in the integrated TCM curriculum.301 An academic from the GUCM Suggests that TCM practitioners can attend part-time or short courses in modern medicine after their graduation (C-A2). In this way many credit hours can be saved for TCM instead of for modern medicine. A policy maker emphasises that the addition of modern medicine subjects should not compromise the credit hours for TCM (C-M4). The former Director of the Examinations Department of China’s National TCM points out that, “No matter what, TCM and modern medicine universities should not be combined. Otherwise, TCM would be overshadowed by
300
Students of modern medicine have to study only one subject on TCM. Moreover, it is not an important subject in their syllabus since a compulsory pass is not required for them to qualify as allopathic physicians.
301 Jia, Y.L., “The Necessary in Excluding the Examination of English Subject in the Universities of Chinese Medicine,” Guangming Journal of Chinese Medicine 24(2) (2009): 364-365, 365.
modern medicine and lose its nature and origin. This is because if these courses are combined in a university, TCM will just become a single discipline / subject” (C-A13).
Two professors highlight the fact that given the time constraints and capacity limitation, TCM students who study integrated medicine spend most of their time on modern medicine subjects and neglect TCM subjects (C-A4 & 12). It is very difficult for students to be engaged in both systems. They would therefore like to opt for the system which is the easiest to cope with and is acceptable. However, a lecturer points out that students do not receive proper guidance for their optional biomedical subjects either, especially statistics and clinical epidemiology (C-A8). It can be said that many academics are uncertain about the methodology for educating and guiding the TCM students to ensure that they understand and appreciate integrated medicine. Additionally, it is felt that studying modern medicine has negatively affected the ability of TCM students to analyse and understand TCM. Another lecturer notes, “TCM has a variety of schools of thought with a complicated philosophical theory behind it” (C-A7). A professor from the CBIATC agrees, “TCM is a very specific system of medicine which is related to nature, culture and science; every TCM student must have an interest in it in order to understand and be a successful TCM practitioner or researcher” (C-A10). She therefore suggests that all TCM academics should know about the interests of their students who enrol for integrated medicine or TCM degree courses. Some students do not show any interest but enrol because of family coercion.302 She even suggests that after high school, students should be exposed to a variety of disciplines prior to pursuing higher education. She refers to the principle of the American system whereby all students have to undergo a four-year fundamental training in all the science disciplines prior to taking up a medical course. She believes that after four years students would be mature enough to opt for a
302
A report from the Shanghai University of Chinese Medicine showed that 46.2% of students were under coercion to opt for professional courses. See Yan, X.T., et al., “Discussion on PBL Teaching Policy Based on Our National University Students’ Learning Attitude,” Beijing Journal of Traditional
suitable course. The evidence above shows that increasing student interest in TCM is surely a challenge for all the TCM academics.
Another challenge of the current integrated education system is the lack of clinical training which leads to poor academic performance by TCM students. A professor from the CBIATC says, “Nowadays, TCM universities have recruited too many students and yet they do not have enough facilities to train them clinically” (C-A10). Although certain universities, such as the Peking Union Medical College, have set up their own hospital to provide both theoretical and clinical teaching, there are insufficient opportunities for students to correlate theory and the practice and share ideas. This problem was highlighted by eight out of fourteen respondents from the academic group. One of them explains that in the early days TCM students were exposed to clinical cases from the initial stage under the Apprenticeship System (C-A2). A TCM practitioner disclosed that collaboration between institutional and apprenticeship education was re-implemented and encouraged by the authorities concerned after realising the importance of simultaneously conducting theoretical teaching and clinical training (C-P6). The institutional education has a systematic promoting and monitoring mechanism.303 This is reaffirmed by a senior officer from the SATCM, Beijing, who says that clinical training is dependent on the experiences of masters, whereas the philosophical theory of TCM is based on reading and understanding the texts (C- M5). In particular, an academic says that the Guangxi TCM College started apprenticeship form of education since 2007 (C-A3). Students are asked to follow well-known senior TCM practitioners so as to increase exposure to clinical cases and learn special clinical skills. In this way students appreciate and understand the holistic principles of TCM better and are able to correlate it with the study of clinical cases from the beginning of the academic year. Unfortunately, according to a colleague, many retired TCM practitioners with 15-25 years of clinical experience do not wish to accept students nor pass down their expertise (C-A14). This
303
Xue, G., et al., “Follow and Learn the Experiences of the Well-known TCM Masters,” World
indicates that incorporation of clinical and theoretical teaching is highly recommended for the success of integrated TCM education.
In TCM universities such as BUCM, a younger generation of well-known TCM practitioners is recruited (名医子弟班). According to an academic, these students have been under the influence and training of their elders or masters since childhood (C-A12). They have to sit for a special entrance examination upon registration for this class. Once they are accepted they have to undergo five years of institutional training that focuses on TCM clinical training. They are also given a certain amount of time to follow the elders or masters and learn from their experience. The main objective is to allow students to develop a deep understanding in the approach of clinical cases and eventually establish their own specialisation.
With regard to the Apprenticeship System for graduates which began ten years ago, the former leader of the SATCM, Beijing, stresses that only selected qualified TCM practitioners with at least five years of experience (attending doctors)304 and below 35 years old, are allowed to follow these masters or senior physicians to acquire knowledge as well as experience (C-M1). There are about 500 masters in China. Each master teaches and guides two qualified practitioners at a time. After completing their training, the practitioners are evaluated on how both the master and the student examine the same patient and write their treatment/prescription separately. This mainly comprises clinical assessment. Then, a comparison is made to analyse whether the student has acquired the master’s speciality. If the performance is good, the student is awarded the title of associate professor without going through the routine process (promotion based on years of experience). He further elaborates that the first class of apprenticeship education was conducted in 1991, the second class in 1994, the third in 1997 and the fourth
304
In China, the clinical posts for doctors in hospitals have the following sequence, from the lower to the higher levels: Intern, residential doctor, attending doctor, vice-chief doctor, chief doctor (The residential doctor is equivalent to a medical officer, the attending doctor is a specialist and the chief doctor is a consultant).
class in 2008. After the completion of the training of the second and third classes, the authorities concerned became aware of the challenges in the apprenticeship education. In particular, the masters were biased and selected only their favourite students. The other challenge was the fact that selected practitioners failed to allocate adequate time to follow their masters because they still had to continue their normal clinical work in order to earn a living. This affected their learning processes. This indicates that the authorities concerned realise the importance of apprenticeship education and its challenges.
Understandably, graduates including Master's and PhD scholars lack TCM clinical experience and end up in deterring the development of TCM. A professor from the BUCM mentions that in the last two years, apart from the Apprenticeship System, the authorities concerned have proposed a temporary measure emphasising clinical training whereby graduates have to go back to hospitals to undergo clinical training again known as ‘Hui Lu’ (回炉) (C-A11).
Apart from academic performance, the authorities concerned notice the poor performance in the TCM practices and subsequently many of the qualified TCM practitioners practise modern medicine instead of developing TCM.305 As a professor stresses, due to public demand and limited TCM knowledge, the majority of TCM graduates have the tendency to practise modern medicine after graduation especially when dealing with complicated cases (C-A5). As another senior academic argues, “I agree with integrated medicine education, as long as we are sure of its objective which is training and producing high quality TCM practitioners and not allopathic practitioners. Modern medicine is used to support TCM during the process of patient management” (C-A4). The TCM academics wonder if the authorities concerned wish to educate and produce good TCM practitioners or TCM practitioners who merely emphasise modern medicine. In order to improve TCM education, the authorities concerned should have a proper
305 See Kong, F.H., “The Present Chinese Medicine Practitioners Should Enhance the