SHANGHAI“5+3”MODEL
To unify the postgraduate medical education and train more professional doctors，an innovative combination of residency and postgraduate training was conducted in Shanghai starting from 2010.
This project was also part of our collaboration with the China Medical Board to systematically study successful experience in medical education and doctor training in the United States and apply those helpful lessons in China with proper adjustment for differences in backgrounds.By implementing advanced medical education theories in accordance with China's circumstances as well as performing multiple empirical studies and field work，trials，and experiments，Shanghai Medical College of Fudan University has gradually established this innovative“5+3”Medical Education Model focused on the enhancement of practical skills in clinical diagnoses and treatment.This model describes a training programme combining 5 years of undergraduate study in clinical medicine in college with 3 years of postgraduate apprentice training as a resident doctor.This project has been recognized as a successful example of connecting medical education innovations with health reform to meet the growing demand in health care in China.
Because of the following 3 novel combinations，the clinical skills of the“5+3”trainee can meet the practical requirements and avoid repeated residency training.
The first is the combination of the National Graduate Admission Examination with SRT recruitment.In accordance with the demand-oriented principle，the“5+3”quota depends on the total number of SRT trainees，ie，the clinical needs and capacity of accredited hospitals.
The second refers to the integration of the graduate medical education with the SRT programme.For the curriculum system，the“5+3”model introduces online courses to facilitate at least 33 months of clinical rotation，as mandated by SRT.Furthermore，the rotation requirement is strictly accomplished in accordance with the SRT policies pertaining to 18 specialties.To distinguish the professional master's degree from an academic science degree，the“5+3”model clearly requires that the professional master's degree thesis be a case report literature review that is closely related to the clinical practice and experience.(https://www.daowen.com)
The third is the integration of the professional master's degree with the practitioner registration.In the“5+3”model，those who fulfill the requirements of the compulsory courses and clinical rotations of SRT pass the examination of qualified medical practitioners and assessment of clinical capacity.They complete a thesis defence and can be awarded certification of SRT with a diploma and MM degree.Additionally，those who fail to pass the examination of qualified medical practitioners twice will have their SRT terminated and will be dismissed from graduate training.
During the implementation process，the specialized quality assurance system has been developed to guarantee successful practice of the“5+3”model with the help of local health care departments，universities and hospitals.Specifically，the system consists of the management，expert，and working committees for managing the model.The management committee includes the relevant functionaries of Shanghai Municipal Education Commission and Shanghai Municipal Commission of Health and Family Planning as well as the deans of the medical schools in Shanghai.The expert committee includes experts in graduate education and SRT，who are responsible for the relevant policies in that area.The working committee consists of staff members from the Department of Degree Management under the Shanghai Municipal Education Commission，the Department of Research and Education under the Shanghai Municipal Commission of Health and Family Planning，Graduate Schools，and the Department of Hospital Management in the concerned universities.Regular meetings are held to coordinate the various system components.
Headed by Shanghai Medical College of Fudan University，4 research projects have been conducted since 2010，which are summarized as follows：the blueprint of reform in professional degrees in Shanghai，as indicated by defining professional master's degree candidates as both a graduate student and resident；the working plan of the professional master degree in Shanghai，as indicated by a series of regulations and policies，such as the admissions policies of the professional master's degree and of detailed training programmes of the professional master degree，the signing of professional master's degree agreements，the detailed guidelines of mentor and student management，and the relevant policies of degree awarding for the professional master's degree；the quality control system for the professional master's degree in Shanghai in terms of admission，training，skills and thesis；and the evaluation system and thesis criteria for the professional master's degree in Shanghai.
We have accepted the dual roles of“graduate student”and“resident doctor”for each graduate students majoring in clinical medicine and combined the following procedures over 3 different stages.First，we integrated the recruitment of graduate students and resident doctors.Second，we have incorporated medical education for graduate students and the professional training of resident doctors.Third，we coordinated the standards for medical diploma awarding and professional clinical doctor certification.Upon graduation，our clinical students could simultaneously receive the following 4 certificates：a doctor's qualification for medical practices，a certificate for completing resident doctor training，a graduate student diploma and a clinical master's degree.
In this pilot reform，we enrolled 1112 first-year residents into the postgraduate training system of 3 medical colleges（Fudan University，Shanghai Jiaotong University，and Tongji University）from 2010 to 2012 in Shanghai.They had dual identities，receiving both residency and postgraduate training in 3 years.The postgraduate course was substituted by a residency competency-based course and was mostly taught online.Additionally，the training programme focused on clinical competency.Furthermore，the participants were asked to submit a scientific dissertation at the end of programme.These residents will receive their national medical license，residency certificate，master diploma，and academic certificate when they finish 3 years of training and pass all examinations.As a result，they only spent 8 years（5 years entry-level training plus 3 years of postgraduate training）to complete postgraduate medical education and could choose to enter a specialist training programme.