To the Editor:
Competency-based medical education has emerged as a core strategy to educate and assess the next generation of physicians. To advocate the advanced educational philosophy and methodology and to guide and promote the development of clinical medical education reform in China, the Research Center of Clinical Medical Education of the Ministry of Education (RCCME), People’ Republic of China, has held a national clinical skills competition for medical students (hereafter referred to as the competition) for 6 consecutive years since 2010. We summarize the competitions and provide the referential experiences for medical education in other countries.
The competitions were sponsored by the RCCME and hosted by different colleges. Use of human patient simulation and validation of the Team Situation Awareness Global Assessment Technique: a multidisciplinary team assessment tool in trauma education. Because it is a college level competition, each college selected four students (448–468 students in total) at the stage of clinical practice to represent their college. The competition was divided into divisional matches and the national final. All colleges participated in the divisional matches held in April each year. The top 29% to 37% of colleges in each divisional match (32–42 colleges with 128–168 students) were selected to enter the national final held in May each year. The college rankings were determined in the final.1
The competition involved simulation-based assessment. It consisted of two forms: Objective Structured Clinical Examination and the “Track Contest.” The Track Contest was similar to a 100-m race, with three to six tracks in parallel and four to six test stations on each track. Each track accommodated one team with four players, who would pass through all the stations sequentially in accordance with the requirements within a specified time. The divisional matches mainly used Objective Structured Clinical Examination with approximately 20 to 30 stations, which might take 1 day to finish all the tests.2 The finals always used the Track Contest with approximately 25 to 36 stations, which might take 2 days to finish all the tests. Each station simulated the clinical scenario through task trainers, high-fidelity simulators, or standardized patients.1
The scope of the competition covered approximately 100 clinical skills from internal medicine, surgery, gynecology and obstetrics, and pediatrics. The RCCME and the hosts asked the experts to design the competition questions and the scoring criteria. Both technical skills (such as history taking, physical examination, thoracocentesis, peritoneocentesis, lumber puncture, bone marrow puncture, incision, sutures, knotting, removal of stitches, changing dressings, basic life support, pelvic examination, and neonatal nursing), nontechnical skills (such as clinical reasoning, communication, and teamwork), and professionalism were evaluated.1 Most of the tests were scenario based. The competition highlighted the evaluation of knowledge, skills, and attitudes. The questions in the finals were more difficult than those in the divisional matches with more comprehensive scenarios. The mean score of the stations varied greatly from 4% to 98% in the finals, with a mean (SD) of 57% (18%). The score was usually high in questions evaluating technical skills only but low in questions evaluating both technical skills and nontechnical skills.
The competition has been well accepted in China.3 It has been organized annually since 2010. To summarize and improve the competition, we conducted a nationwide survey in 2015 to evaluate the effects and difficulties of hosting the competition. Eight hundred eighty questionnaires were distributed to 110 participating colleges. The interviewees included teachers, administrative staff, and students. In total, 752 valid responses were received from 95 colleges. Most interviewees agreed that the competition had a positive role in the adoption of advanced educational principles, promoting faculty development and improving educational resources. The interviewees agreed that the difficulties in organizing the competition included question designation (53.9%), funds, competition venues, and equipment (22.9%), referee training (10.6%), and organization and management (8.5%). The respondents agreed that the competition questions should emphasize technical skills (94.3%), nontechnical skills (80.2%), knowledge (71.4%), professionalism, ethical questions and laws (70.0%), and English proficiency (32.0%). In addition, 75.3% of the respondents thought that the divisional matches should be based on technical skills, whereas the finals should be based on the evaluation of comprehensive abilities. Approximately 63.7% of the respondents recommended that we should reduce the number and difficulty of the questions, so that the students could have more time for practice tests to show their proficiency, which may be more important for medical students.
Assessment can improve the learning outcome. The competition is currently widely recognized as an effective method of driving the development of simulation-based clinical medical education in China.4 There is the potential to apply this competition in other countries. As mentioned previously, for such a large-scale competition, question designation is the key element in a successful competition. Assessment is the best way to drive learning. The questions need to reflect the development of the new philosophy and methodology of teaching. In addition, an authoritative sponsoring organization to hold the competition is desirable. The influence of the competition also requires several years to gain recognition and attract participants. It is suggested that the competition be held by an authoritative organization on a regional scale and then gradually develop into a national competition.
Jing Liu, MD
Guanchao Jiang, MD
Peking University People’s Hospital
Hong Chen, MD
Shan Wang, MD
Peking University People’s Hospital
Qiming Wang, MD
Department of Higher Education
Ministry of Education
the People’s Republic of China
Baorong Chi, MD
Norman Bethune Health Science Center
Qingnan He, MD
Xiangya School of Medicine
Central South University
Haipeng Xiao, MD
Zhongshan School of Medicine
Sun Yat-Sen University
1. Guanchao J, Hong C, Qiming W, et al. National Clinical Skills Competition: an effective simulation-based method to improve undergraduate medical education in China. Med Educ Online
2. Wang Y. Analysis and assessment of clinical skills competition (Huabei division) for medical students in medical colleges and universities. China Higher Med Educ
3. Li M, Fang H, Hu J. Discussions regarding the promoting effects of national competition of clinical skills on the teaching of clinical practice in medical colleges and universities. Northwest Med Educ
4. Liu D, Meng X, Su H, Wang S. Promoting effect of national clinical skills competition for medical students on their cultivation. China Higher Med Educ