Updated: Oct 23, 2018
I. MEDICAL EDUCATION: THE CURRENT STATE OF AFFAIRS
i. CME programs in China first started in 1986 and became systematic in 1991. Now Chinese CME programs are controlled by CME commissionsat national, provincial and city levels. The National CME Commission has an oversight on the programs. The roles of the National CME Commission are:
a. Provide recommendations towards CME policy making;
b. Provide recommendations towards CME strategies and development;
c. Draft regulatory documents regarding program application and accreditation;
d. Review the national level CME program applications;
e. Organize and coordinate relevant publications for national level CME programs;
f. Promote on-line/distance CME programs;
g. Oversee provincial CME commissions and other CME entities. Conduct reviews and evaluations;
h. Review the applications for national CME providers.
ii. There are no centralized platforms that contain all information of CME activities in China.The Chinese Medical Doctor Association, one of the six accredited CME medical societies, for instance will initiate about 340 national CME programs.
iii. CME programs in China vary a lot in format, including one to several-day live courses, academic conferences, on-line courses, self-study, research projects and publications. Online CME courses have increased rapidly in recent years. Because of the heavy clinical works, more and more Chinese healthcare professionals have begun to participate in online CME programs.
iv. In China, the quantity and quality of CME programs vary by geographical areas, medical disciplines, and medical facilities due to the inequality of health care resource distribution. There is tremendous need for CME in the underdeveloped areasand in primary healthcare facilities, especially middle-west rural Chinaand urban communities. This is especially truein some medical disciplines such as pediatrics, psychiatry, obstetrics and gynecology, general practice and nursing.In order to eliminate these gaps, the National Health and Family Planning Commission (former Ministry of Health) has put significant effort on developing on-line/distance education programs.
v. Under the most recent “ThirteenFive-year Plan” of Training of Chinese Healthcare professionals, the government set up the goal of training 150,000 general practitioners by 2020. Investment in CME is projected to increaseand more CME resources will be put on middle-west Chinaand urban communities. http://www.nhfpc.gov.cn/qjjys/s3593/201705/64deeb7370b74f7180221964e68fe5a7.shtml.But there is not a disclosed amount of money to do this.
B. ACCREDITATION REQUIREMENTS
i. Both providersand programs needto be accredited by the CME commission. Every program of every provider must be reviewed and accredited.
ii. Providers can be public institutions, universities, hospitals, accredited medicalsocieties and medical education companies.
iii. Accredited medical societies include the Chinese Medical Association, Chinese Stomatological Association, Chinese Preventive Medicine Association; Chinese Nursing Association, Chinese Hospital Association and Chinese Medical Doctor’s Association and their affiliates.
iv. Both providers and programs are categorized into national, provincial, and municipallevel, and accredited by corresponding CME commissions respectively.
v. The National CME Commission reviews the applications for national CME providers and national CME programs. The National Health and Family Planning Commissiongrants approvals for national CME providers and programs once receiving recommendations from the National CME Commission. Provincial and city health bureaus work collaboratively with local CME Commissions to grant provincial and city level;
vi. The municipal CME commissions report all the CME work to higher level commissions, so do provincial commissions.
vii. Pharmaceutical companies cannot develop or get their own programs accredited. They can support courses (live, on-line or journals) through grants made directly to the provider;
viii. The Chinesesystem does not differentiate CME requirements or accreditation between physician generalists or specialists, nor between physicians and nurses and pharmacists. There are 3.04 million physicians, 3.24 million nursesand more than 600 thousand pharmacists and laboratories that need to participant inCME and receive credits each year.
ix. In 2013, the National CME Commission issued a request for comments on several revised CME regulations. The Distant Medical Education Center is a new institution to develop CME programs and help move online CME into a more standard direction. It is a subsidiary of the National Health and Family Commission.
x. Every physician has an exclusive CME credit card. The credits are to be recorded on the card after the physician finishes a CME program.
II. CURRENT REQUIREMENTS FOR MEDICAL EDUCATION
i. MANDATORY – CME is mandatory for all physicians.
a. METHODS OF DELIVERY – live meetings, online/distance learning, journals, research projects;
b. CREDIT MANAGEMENT – CME Credits in China are categorized into two types: category I and category II. Category I credits can be obtained in national and provincial CME programs along with CME programs hosted by medical societies. Special granted programs satisfying pre-defined needs (such as emergency planning) also fit into this category. Category II credits can be obtained inself-study, publication and research projects. The hours required to earn one CME credit varies across different types of CME programs, for details, refer to: http://www.nhfpc.gov.cn/qjjys/s3594/201309/ee11daf7f6ba4d369772bb6a01d637c8.shtml.
Physicians carry CME ID cards. CME credits are granted by providers or applicable grantors (i.e. the hosting institution for a research project or publication) through CME credit certificates which CME management staff later loads into an applicable system. Sometimes CME providers carry ID card readers which directly grant credit upon completion of the program.
c. HOURS / CREDITS NEEDED – 25 credits are required each year for all GPs and specialists, of which 5 – 10 credits should be category I, 15 – 20 credits should be category II. Take the Annual Congressof the Chinese Society ofEmergency Medicineas an example, a four-day conference being held in 2017in the Shandongprovince. Participants could earn up to 5 category I CME credits upon completion.http://csem2017.medmeeting.org/4645?lang=cn
d. PENALTIES / REWARDS FOR COMPLETION – Completion of CME requirements serves as evidence for annual performance review and prerequisite for credentialing and promotions.
e. RECERTIFICATION – There is no recertification required. A medical degree and specialization are awarded by universities and are good for life.
f. EVALUATION – National providers are evaluated and reaccredited every three years. Each Provincial Department of Health and CME Commission can determine its own policy in terms of provider performance review. There is no formal CME program evaluation. Except for medical societies, only accredited CME providers can deliver CME programs.
g. RECIPROCITY OF CREDITS – Visiting clinical training (including domestic and abroad) longer than 6 months can be counted as 25 CME credits upon approval.
i. MANDATORY – CME is mandatory for all pharmacists. Management and policies are the same with physicians except for the annual requirement is only 15 credits for pharmacists.
i. MANDATORY – CME is mandatory for all nurses and like physicians they must get 25 credits. Management and policies are also the same as forphysicians.
D. OUTCOMES ASSESSMENT
i. The outcomes assessment of CME activities in China is based on the knowledge and clinical skills tested by written questionnaires or online surveys. There is no method to assess behavioral changes.
III. FUNDING OF MEDICAL EDUCATION – POLICIES, REQUIREMENTS & REGULATIONS
i. According to the “Recommendations towards Enhancing Continuing Medical Education” released by the Ministry of Health, the funding of CME programs should be a combination of provider budgeting, program registration and other appropriate sponsorships.
B. ACCREDITATION FEES
Available regulatory documents don’t specify how much registration/renewal fee a provider needs to pay to maintain active status. Since the CME provider system is administered under a decentralized basis, there is no single portal for application. Policies and procedures vary across provinces.
C. INDUSTRY SPONSORSHIP
i. According to a survey WMGS did with the Chinese CCME Magazine, 60% of the CME program funding comesfrom industry sponsorship. Currently there is no regulation that describes in detail what pharmaceutical or medical device companies can or can not do in terms of sponsoring CME programs. The general rule is that sponsorship may not bias the education. Physicians used to get rebates from industry for prescribing which is no longer the case. Now a big proportion of individual registration fees for CME programs comes from the industry
IV. GAME MEMBERS CURRENTLY ACTIVE IN PRODUCING / SPONSORING MEDICAL EDUCATION ACTIVITIES IN CHINA
A. Medical MOOC–an online CME course provider in China.
V. MEDICAL EDUCATION RESOURCES
A. NATIONAL AUTHORITIES
i. The National Health and Family Planning Commission (former Ministry of Health)– Division of Science and Education: Oversight of all research and educational effort related to health care system.
Email: not available
ii. CMA - Chinese Medical Association Division of Continuing Medical Education: the national level medical association in China.
Email: not available
iii. Chinese Stomatological Association: The national level association for dentists.
iv. CPMA – Chinese Preventive Medicine Association: the national level association for preventive medicine.
v. CNA – Chinese Nursing Association: the national level association for nurses.
Email: not available
vi. CHA – Chinese Hospital Association: the national level association for hospital management.
vii. CMDA – Chinese Medical Doctor Association: the non-government association for medical doctors.
B. REGULATORY & ACCREDITATION BODIES
i. The National Health and Family Planning Commission (formerly the Ministry of Health)– Division of Science and Education: Oversight of all research and educational effort related to health care system.
Email: not available
ii. The National CME Commission – there is no website available
iii. Provincial and city level health bureaus and CME commissions;
C. RELEVANT COUNTRY SPECIFIC ARTICLES & STUDIES
i. ThirteenFive-year Plan” of Training of Chinese Healthcare professionals http://www.nhfpc.gov.cn/qjjys/s3593/201705/64deeb7370b74f7180221964e68fe5a7.shtml
a. This report reviewedthe past development and achievements of the Chinese health care systemand CME, and analyzed the current challenges with the health care reformand medical staff training. It also lists the priorities for the upcoming five years;
b. Building up comprehensive and qualifiedmedical professional team is listed as one of the top priorities in the report in which continuing medical education is extensively mentioned;
c. Priorities in terms of CME include expansion of education coverage to the underserved areaand some medical disciplines, training specialist, extensive effort in development of primary care, standardization of medical education and development of distance/online learning programs.
ii. Chinese Health and Family Planning StatisticsAnnals– 2016
a. This report offers both overview and detailed breakdown about Chinese health care system in the year 2014, including medical and funding resource allocation;
b. It also identifies the gap of care and education.
ii. Chinese Continuing Medical Education www.zgzzsgw.com
b. The official magazine of the Ntional CME Commission
D. KEY MEDICAL SOCIETIES / SPECIALTY BOARDS
i. Chinese Society of Cardiology(CSC) – cardiology
ii. Chinese Society of Oncology(CSO) – oncology
iii. Chinese DiabetesSociety (CDS) – diabetes
iv. Chinese Society of Respiratory Diseases(CSRD) – respiratory disease including asthma
v. Chinese Society of Neurology(CSN) – neuroscience
Email: not available
vi. Society of Infections Diseases– Infectious Disease
vii. Chinese Society of Hepatology(CSH)——Hepatology
Email: not available
viii. Chinese Medical Education Association(CMEA)——medical education
ix. China Association of Health Promotion and Education(CAHPE)——medical education
x. Chinese Anti-Cancer Association(CACA)——cancer
xi. Maternal and Child Health Care of China Association(MCHCCA)——Womenand Child Health
Email: not available
xii. Chinese Continuing Medical Education(CCME)- Official magazine of the National CME Commission