CME in China

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CME in China

• Zeng Zhechun MD., MPH.
• Beijing Association of Medical Education
• Beijing Institute of Heart Lung Blood Vessel
  Disease

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Outlines

• Basic Information of China
• Chinese Health Care and CME System
• Major Challenges of Current CME System
• Future Development

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Basic Information of China
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• 34 Provinces
• Autonomous Regions
• Administrative Municipalities
• 2 Special Administrative Regions

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Basic Information of China

• ? Total area 9.6 million square kilometers
• ? Total population 13 21.26 millions
• ?Urban population 5 93.79
  millions ( 44.9)
• ? Rural population 7 27.47
  millions (55.1)
• ? Age distribution
• 0-14 256.60 millions (19.4)
• 15-59 911.26 millions (69.0)
• 60 153.40 millions (11.6)
• ? GDP(2010) RMB3979.8 billions, about
  568billions
• ? Life expectency(2006) 70.9 male/ 74.5 female

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Thirty Year Economic Development
in China
GDP (Billions)
RMB 3979.8 billions
RMB 365 billions
(Years)

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Double Burdens of Diseases

• Increasingly serious threats from
• Communicable diseases
• Re-emerging TB, STD, plague, cholera
• Emerging AIDS, SARS
• Non-communicable diseases (NCD)
• Stroke, cancer, CHD, diabetes, chronic
  obstructive pulmonary diseases (COPD), mental
  diseases

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Trend of Population and Aging
(0.1 Billion)
18
16
14
12
10
8
6
4
2
0
1953
1964
1982
1990
1995
2000
2015
2050
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Tendency of Death Pattern, China, 1954-1998
Injuries poisoning
Others
Non-communicable diseases
Communicable, maternal and child diseases
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Mortality rate of Leading Causes of Death in
China(2003)
Non-communicable diseases
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Chinese Health Care and CME System
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(No Transcript)
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College Medical Education in China
2-3yrs 1-4yrs 4-5yrs 2-8yrs Lifelong
High school Preparatory Medical College Postgraduate CME
Starting point
Associate degree 3yrs
Bachelor 1yrs 4yrs

3yrs MD
2-3yrs Master
Bachelor Master
1yrs 4yrs
5yrs MD
Master 1yrs 4yrs 2yrs Master 3yrs MD
Doctor 8yrs MD
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History of Chinese CME
1949-1978 No CME, barefoot doctor, the Cultural Revolution, disorganized training
1978-1990 Reform and Open Policy, remedy, accept the idea of CME, pilot CME program
1990-1999 Found of CME organization structure, education bases and regulations
2000-- Rapid development, high coverage, credit management, regulation reform, distance learning, evaluation and monitoring
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The organization structure of Chinese CME system

• Overall Planning Policy making
• Approving State Level CME Courses
• Organizing the Development of Teaching
  Materials
• Managing Distance Learning System
• Evaluating Instructing Subordinates

Steering Committee of CME(1996)
The Ministry of Health
Academic Subgroups
Chinese Medical Association

• Local Planning
• Approving Provinical Level CME Courses
• Managing CME Bases
• Evaluating Instructing

The Bureau of Health(Provincial)
Department of CME
Academic Subgroups
CME Bases

• Implementing CME Programs
• Running the CME Base
• Courses Arrangement
• Managing Credit

The Board of Health(Regional)
Office of CME

• Organizing Hospital Level CME Courses
• Running the CME Base
• Services

Office of CME (Hospital)
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Classroom in a CME Base
Internship program
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Who pay for CME ?

• Government
• Hospital
• Individual

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Types of Credit

• Type I
• Attending state level CME courses
• 1 credit/3hours for students
• 2 credits/hour for teacher
• 10 credits/person at most
• Attending provincial level CME courses
• 1 credit/6hours for student
• 1 credits/hour for teacher
• 10 credits/person at most
• Attending state level distance learning courses
• 1 credit/3hours for student
• 5 credits/person at most

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Types of Credit

• Type II
• Scientific publications
• Got research grant
• Organizing academic activities
• Oral presentiation or poster in academic
  conference
• Self-study

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Credit Management

• The minimum credits required for one person in a
  year is 25
• 5-10 type I credit
• 15-20 type II credit
• lt10 for distance learning
• TypeI and II should not substitute
• Credit related with individuals promation
• IC Card

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Credit Management IC Card
Credit Certificate of State Level CME Course
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Distance Learning in CME

• Website
• Satellite transmission

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Process to Apply a State Level CME Course
Filling Application Form
Reviewed by ProvincialCME Academic Subgroup
Distance Learning Application Form
Reviewed by theState CME Academic Subgroup
Approved Announced by the State Steering CME
Commitee
The Web based CME Course Application System
Implementation
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Samples of State Level CME Courses in 2010 (CVD)
Name of Course Credits
New images technology guided complex coronary artery PCI 8
ECG technology and arrhythmia diagnosis 6
Applying the heart failure guideline 5
New progress in hypertension treatment (Network learning) 5
Modern diagnosis and treatment strategies of Coronary heart disease(Network learning) 5
Prevention and treatment of thrombus related disease current status and prospect (Network learning) 5
Modern treatment of atrial fibrillation(Network learning) 5
Using ACEI from guideline to practice 2
Treatment of non-ST segment elevation ACS 5
Treatment of CHD combine with tradition Chinese medicine 5
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Rapid Development of CME
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Major Challenges of Current CME System
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Imbalance Development Among Different Provinces
Geography Distribution of CME Courses,2009
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Geography Distribution of CME Courses,2009
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Quality of Courses Unevenness

• Monotonous content
• Few consideration of different persons
  qualifications
• Outdated teaching methods and
• Outdated knowledge
• Few apply of educational theories

Major complains to CME course among 700
physicians in Beijing
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Insufficient of Patient Centered Related Courses
Subjects of CME Courses,2009
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Subjects Constituent Ratio of CME Courses in 2009
Subject Num. Of Courses
Clinical 3789 73.2
Nursing 426 8.2
Public health 343 6.7
Pharmacy 224 4.3
Health Care Management 206 4.0
Basic Medical 186 3.6
Total 5174 100
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Other Problems

• Lack of evaluation monitoring
• Insufficient recourses (Teacher, bases funds)
• Challenges in Rural Area
• Staff aging
• Transform from barefoot doctors
• Lack of staff recruiting
• Low academic level
• Geographically dispersed

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Future Development

• More government investment
• Optimize regulation and organization structure
• Improve teaching quality by
• Design courses base on physicians demand (Real
  Practice)
• More patient-centered training
• Follow the frontier of medical science
• Multi-level courses facing different levels of
  person
• Diversify teaching pattern
• Apply educational theories and research outcomes
• Further informationize
• Enhance international collaboration

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Thanks for Your Attention !