Exporting our medical model
By Mike Foster
The White Coat Ceremony is a rite of passage for future doctors, signalling their commitment to the Hippocratic Oath and the values of altruism and honour at the very start of their education. For more than a century, the white coat has symbolized science, purity and integrity.
So it was a special moment when the first cohort of 56 Chinese students donned their white coats in front of proud family members at the Ottawa-Shanghai Joint School of Medicine (OSJSM) in Shanghai on October 17.
Equally proud were Jacques Bradwejn, University of Ottawa dean of the Faculty of Medicine, and uOttawa president Allan Rock: The ceremony marked the one-year anniversary of a pioneering partnership between uOttawa and the Shanghai Jiao Tong University to establish the OSJSM — the first school to offer a North American medical education program in China. The ceremony means the OSJSM is now up and running.
The students will also be among the first in China to receive training in Canadian-style family medicine. To make this happen, the OSJSM has established the OSJSM Academic Family Health Team at the International Family Medicine Clinic, a demonstration project that was inaugurated on the same day as the White Coat Ceremony.
“The family medicine discipline currently does not exist in China, but Chinese health care leaders are pursuing the introduction of the primary care model with the creation of the Academic Family Health Team. Located at Renji Hospital in Shanghai, the family medicine clinic will act as a pilot project in China for the eventual development of a broader family medicine sector of primary care,” said Dr. Jacques Bradwejn.
At this time next year, around 30 students out of the 56 will be selected for the four-year medical program, according to uOttawa’s criteria. They will complete two years in pre-clerkship and two years in core rotations in specialities such as internal medicine, obstetrics and gynecology, surgery and psychiatry.
Dr. Dianne Delva, chair of the Faculty of Medicine’s Department of Family Medicine, says that the University’s partners went “beyond expectations,” building the clinic, which has several examining rooms, in three months.
The next step is to recruit family physicians and build a family health team, which could include nurses, psychologists, social workers and pharmacists. Dr. Delva will travel to Shanghai next month with Dr. Barbara Power, Department of Medicine vice-chair, education, to run a conference on family medicine and work out clinic logistics.
China’s health system is super-specialized. Patients with headaches can go directly to highly trained neurologists. However, given the high costs involved, China’s National Health and Family Planning Commission wants 90% of the general population to have a family physician by 2020. And in Shanghai, the municipal government has set a target for half of the general population to see a family physician as a first step within the next three years.
“Comprehensive primary care over a period of time is not well developed in China at the moment,” says Dr. Delva. Although there are general practitioners, they tend to be geriatricians, or focused on looking after acute problems, she says.
“Countries with strong primary care have lower costs and better health outcomes,” Dr. Delva adds.
The clinic will showcase Canadian primary care, building up a roster of patients and eventually becoming a space for training in family medicine, according to Yuwei Wang (PhD ’00, Biochemistry), University of Ottawa Faculty of Medicine assistant dean, internationalization. As uOttawa exports its undergraduate medical education program, Wang says that including training in family medicine was crucial.
“In China, they do not have a family medicine curriculum in medicine as a core rotation because they do not have a clinic. Students are not exposed. Therefore, students don’t choose family medicine when they graduate,” says Wang. “I think this has the potential to be huge.”
The University of Ottawa’s Faculty of Medicine leads the country in terms of the number of graduates who choose family medicine. Last year, more than half of its 160 graduates did so, Dr. Delva says.
“Our students go out to family medicine right from first year to learn clinical skills in that setting. They also do clerkship placements in their third year where they are actually working in a family physician’s office. The model of care they are exposed to in medical school is a good way of informing them what primary care offers. We hope to do the same at the OSJSM. You get a very skewed view of health care if your training is only hospital-based.”
The curriculum has been designed and developed through faculty and student exchanges, with uOttawa professors visiting Shanghai to conduct workshops and teach trial courses. Teachers from the Shanghai Jiao Tong University School of Medicine (SJTUSM) have visited uOttawa to shadow students and see how courses are delivered.
The OSJSM Academic Family Health Team is just one more example of benefits to emerge from the ground-breaking joint medical school. Last month, another MOU was signed to create a joint clinical research centre at Xinhua Hospital, building upon work to improve research on diseases that affect babies and moms, based on Ontario’s BORN (Better Outcomes Registry & Network). The research centre will open the door to new findings in obstetrics, maternal-newborn care, neonatology and care quality improvement.
As for the clinic, Dr. Delva says there are a few details to work out. One idea for medical staffing is to recruit clinicians in Shanghai while having uOttawa Faculty of Medicine professors provide guidance and work at the OSJSM clinic for periods of time.
“One of the big challenges is building bridges: we are introducing something that we understand here into a country that doesn’t understand our system,” says Dr. Delva. “We have to be respectful of the environment. We have some big challenges: language, electronic medical records and understanding the (Chinese) system.”