Short Communication
Investigation of Chinese Neurosurgeon Creativity - What can be drawn from the US Neurosurgeon Education System
Jun Ma1,2, Guijun Jia1,2 and Wang Jia1,2*
1Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, China
2National Clinical Research Center for Neurological Diseases, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brian Tumor, China
*Corresponding author: Wang Jia, Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Dongcheng District Beijing, China
Published: 27 Aug, 2018
Cite this article as: Ma J, Jia G, Jia W. Investigation of
Chinese Neurosurgeon Creativity
- What can be drawn from the US
Neurosurgeon Education System.
World J Surg Surgical Res. 2018; 1:
1047.
Abstract
The creativity of Chinese young neurosurgeon is a weakness comparing to that of the counterparts
in US. The professional education system of Chinese young neurosurgeon is yet to be improved.
This study compares the neurosurgery training system between China and US, especially the
neurosurgeon residency training program, to draw experience from US neurosurgeon education
system for enhancing the creativity of young neurosurgeon in China. The creativity improvement
of young neurosurgeon requires mature professional training system, nice sense of humanism, high
quality of personality, and powerful support of the nation.
Keywords: Neurosurgery; Chung-Cheng Wang; Surgery
Introduction
The neurosurgery in China experienced great development for the last few decades. The population
neurosurgeon ratio (PNR) had already reached the similar level with that of the developed country
in 2009, with one neurosurgeon per 100 thousands population and 13 thousands in all (data by
Chinese Congress of Neurological Surgeons) [1] (Table 1). Generations of neurosurgeons in China
had made impressive contributions to skull base tumor, brain stem tumor, and intramedullary tumor
surgeries. At the mean time, young neurosurgeon in China weren’t among the most outstanding
on the international stage. The Young Neurosurgeon Awards was set up by World Federation of
Neurosurgical Sciences (WFNS) in 1979. Since 1981 it started to offer five awards every four years
for the best original unpublished papers whose first authors were neurosurgeons younger than 35
years old. The papers were evaluated according to the academic value and the creativity. Only three
Chinese young neurosurgeons won the awards ever [2]. At a glance of those medical words named
after a person most of the eponymous doctors were from western world or Japan, and they generally
had already shown impressive creativity when they were still young neurosurgeon. Creativity
development requires broad medical knowledge, profound culture, mature personality, and strong
mind [3]. Creativity is essential to advancement and superior.
The young neurosurgeon development is not only a personal affair but reflecting the whole
medical system and the medical education system of the country. Fully development of the
professional training system is necessary and should be based on specific characteristics of the
Nation while drawing experience from other advanced cultures.
The professional training system of young neurosurgeon
The residency training is a critical process for creativity development of young neurosurgeon.
The Chinese neurosurgeon residency training program is still under revising. The latest policy,
The Details of Chinese Neurosurgeon Training Program, was released by Chinese Congress of
Neurological Surgeons in 2012. Medical students who choose surgery as their major enter the surgery
residency training system after they received the medical doctoral degree. The first year is General
Surgery training. The resident can take the medical license examination before or during this first
year training. If passed the resident can go on entering the next stage of five years of neurosurgery
training. During this stage, the resident will rotate in all groups of Neurosurgery department,
Neurology Department, and Neuro-radiology/imaging department, and participate in research
projects. The training methods include taking responsibilities in patient management, joining
selective operations regularly, shifting on call and dealing with emergencies, attending classes and
lectures, joining researching projects and publishing papers. The destination is to mentor a medical
student into a junior clinical surgeon, being able to applying medical
knowledge into real clinical world, dealing with common diseases of
neurosurgery, finishing selected operations, and to communicating
with patients under every circumstance. At the end of the whole
training there will be a written test and in interview for Certification
of Chinese Neurosurgeon.
In US the present neurosurgeon residency training program was
the program released by Accreditation Council of Graduate Medical
Education (ACGME) in 2013. The medical students usually take the
first two steps of medical license examination before the graduation
and apply for residency training program through national medical
matching system afterwards. The matching is national-wide,
two-way match, and double blind. The whole residency training
program is seven years. The first year is rotation in General Surgery,
Emergency Department, Multi-Trauma, Neurology, and Anesthesia
Department. The next 1.5 years will be rotating in neurosurgeryrelated
departments like Neurology, Neuropathology, Neuro-ICU,
Neuro-imaging, etc. Then starts the rotation in Neurosurgery
Department for the rest years. Around year five there will be a quite
flexible choice time of one to two years of pursuing research or further
neurosurgery subspecialty training. The last one to two years are the
chief residency training. Evaluation will be given after every stage by
multi-departments and documented through ACGME registry. The
results will be fed back to the resident every half year, reviewed by
the program director together. At the end of seven years training
there will be a systemic summary based on professional standards
on clinical work, as well as on education work and personality [4-7]
(Table 2).
There are essential differences between the two training systems.
The US system possesses national-wide double-way matching
admittance criteria, counteracting the limitation of region or
institute. This promises more reasonable distribution. The individual
will result in the most interested and suitable position, which are
important internal motivation for one’s long-term development.
The training covers all aspects from the most basic to the most
advanced abilities as a neurosurgeon, while being carried out step
by step. During the process a young neurosurgeon will first cultivate
strong bases of neuroscience, and then engaged into neurosurgery,
further investigate their own orientation of professional development
during the individualized research or subspecialty training, and
lastly practice all they’ve learnt during the chief residency training.
Furthermore there’re fully developed evaluation systems from
ACGME focusing not only on resident but also on teachers and the
training system as well [8-10]. In China the medical graduates will
searching the residency training program in person due to lack of a
national-wide matching system. The bias of resident distribution does
exist and will be influenced by where the candidates come from or
from which medical school they graduate. Some regions have their
own training system which may not follow exactly the same standard.
The training stages are more interweaving. The residents rotate in all
related departments including research work without detailed stages.
The evaluation system also has bias which focuses more on residents
while lacks sufficient feedbacks of the training system itself. The
present training system requires further revising and a national-wide
standard is necessary.
The role of humanism and personality
Modern medicine is more humanistic rather than scientific.
Humanism is the center point and any science will be hollow and
banal without this. Western medicine emphasizes the basic elements,
investigating into the molecular level, revealing the most innate
mechanisms and then following the subsequences. Chinese culture
is more macroscopic, tending to view a organic body as a whole,
emphasizing the interactions of all systems, and trying to recuperate
on the basis of harmony both internally and externally. The harmony
theory is the essence of Chinese medicine. The two cultures are
viewing from two sides but into the same center point. Embracing US
experience into Chinese training system with combination of the two
cultures maybe expected to cultivate even more promising results,
and can be drawn for young neurosurgeon training. More wide
spread culture background is as important as professional knowledge
and skills for improving personality with superior integrated abilities
of understanding, admiring, expressing, and creativity. Creativity is a
synchronized ability based on encyclopedic professional knowledge
as well as profound cultures. With high level of creativity the
individual is able to pursue life-long study, cultivate sensitivity to
new information, investigate in new arena with the capability, and to
discover and invent. A young neurosurgeon full of these abilities will
thus be able to contribute on a world-wide stage [11,12].
Humanity and personality are also important as all doctors
are serving human beings [13,14]. A wonderful doctor should
be a philosopher of life, with all qualities of decency, selflessness,
modesty. A noble soul will guide a young person following the pure
route of pursuing ideal, leading to the real scientific creativity. On
the other hand the neurosurgery career requires extreme energy as
well as full intelligence. ACGME has already considered rational
rest into professional plan of a neurosurgeon. There are standards
on working hours, frequencies of on call, and reporting program.
A nice personality will promise a good health status of the young
neurosurgeon, both physically and mentally.
The characteristics respecting young neurosurgeon
training in China
China is a large country. The levels of development are quite
various for different regions, so is for medicine or medical education
system. Neurosurgery as a subspecialty in surgery has significant
imbalance in development [15] (Figure 1). All advanced neurosurgery
sources gather around first line cities like Beijing, Shanghai, etc. Beijing
Tiantan Hospital is one of the largest neurosurgery centers in China,
with annual operations around 8,000 to 9,000. 75% of the patients
are from all around China other than Beijing. Each neurosurgeon
is in charging of approximately one 2.4 inpatient beds, taking care
of 903 clinics admission, 67 inpatients, and 61 operations per year
[7]. The main sources of neurosurgeon residents are new graduates
from medical school without much professional experience. So that
the difference in levels of medical school of different regions will also
influence the residents embraced into the residency training system.
The neurosurgeon training system in China has been greatly
improved by Dr. Chung-Cheng Wang. He is one of the most excellent
pioneers in Chinese neurosurgery and is also the first neurosurgeon
awarded by Academic Divisions of the Chinese Academy of Sciences
in China, the highest academic awards in China. He set up Beijing
Neurosurgical Institute relying on the support of Beijing Tiantan
Hospitalin 2004, dedicating to neurosurgeon training [16,17]. The
Institute is open to those being certified with medical license from
all public medical schools and hospitals in China. The Institute
adopts a five-year training system, emphasizing on both clinical
ability and academic researching ability. The participants will take
rotation in Neurosurgery, Neurology, Neuro-radiology/imaging,
Neuro-pathology, and Neuro-physiology departments, and are
qualified to apply for chief resident position, participating in large
amounts of operations. The staged evaluation was taken by Beijing
Tiantn Hospital Expert Committee. The first 20 students graduated
in 2009. Most of them returned to their original regions and became
the main force of local neurosurgery. Beijing Tiantan Hospital also
has a lot of further study programs of different terms, accepting
neurosurgeon of all levels. Dr. Chung-Cheng Wang also built a
wide-range of collaboration between Beijing Tiantan Hospital and
Other hospitals from those regions of less advanced neurosurgery,
while offering training opportunities for young neurosurgeon of
these institutes as well. The limitation of these training systems is
lacking of official supports from the government. During the five
years of training in Beijing Neurosurgical Institute, the participants
have no opportunities of specialty certification or promotion, nor
additional salary or imbursement. During collaboration with other
hospitals, imbalanced development of different hospitals will appear
according to the subspecialties of the experts that supporting the
institute. This will be a special limitation for the training of young
neurosurgeon, who needs balanced development of all aspects. There
are a lot of public and private institutes in US offering finical and
politic supports for residency training. The comprehensive national
strength and policy will always be a major determining factor for
young neurosurgeon development.
The present world is an everyday-changing world. As a
representative of the most interdisciplinaryscience medicine is
experiencing faster and faster development, combing the most
advanced science and technique to serving life. Only the highly
talented and fully trained person can be qualified to master this
honorable profession. Neurosurgery is among the peaks. Young
neurosurgeon is the future. Let’s hold the respects for neurosurgery,
cherish the young talents, and fulfill the ultimate summit what has
been pursued by every Chinese neurosurgery pioneer. That is to
advance neurosurgery in China, and to advance neurosurgery in the
world.
Table 1
Figure 1
Figure 1
Schematic diagram for training of neurosurgeons in mainland
China. Currently, training for neurosurgical residents lasts 6 to 7 years. After
completing residency training, a neurosurgeon must complete continuing
medical education training courses to be promoted to higher positions [15].
Table 2
Table 2
The neurosurgery resident training program of the Massachusetts
General Hospital (MGH) of USA.
Finicial Support
Jun Ma is supported by the Funding Project for Development
Program for Beijing Superior Talent. Granting organization:
Organization Department of Beijng Municipal Committee. Program
No. 2015000021469G223.
Wang Jia is supported by National Natural Science Funding.
Granting organization: National Natural Science Foundation of
China. Program No. 81471229.
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