For a long time, it has become a vicious trend in clinical medicine to emphasize research and neglect clinical practice. As a result, there are many strange situations: there are many clinical doctors and associate chief physicians in hospitals who have not been in the clinic for one day; many doctors who have rich clinical experience but are not good at running projects and issuing SCI papers have difficulty in getting recognition from the system. The reform of the training and promotion mechanism of clinicians has become a difficult problem that has been called for years but never been fundamentally solved. An article by a foreign doctor triggered a great discussion in the medical community “Everyone may become a patient sooner or later, who wants to lie in a high-class ward in the future, but receive poor quality medical services.” November 28, 2013 was the annual Thanksgiving Day in the West, and on this day, an article titled “What Will Save You, My Loved Ones” began to circulate in the microblogosphere. The author of the article, who claimed to be a graduate of a prestigious medical school in China and now works as a doctor at Hopkins Hospital in the United States, recounted his experience four years ago when he returned to his home country to visit the old dean, who had treated him with kindness. At the time, the old dean had just undergone major surgery and was already seriously ill. “As a physician, I noticed that he was not using prophylaxis for deep vein thrombosis and malpractice. I reflexively looked at both of his lower extremities, and it turned out that the right calf was visibly red and swollen, and Homas was evident, suggesting deep vein thrombosis.” He immediately relayed the problem to the nurse practitioner, and a second-line on-call associate professor of neurology soon appeared on the ward, but the associate professor had no idea how to treat this common neurology complication and was torn between using aspirin or favalin. He read the old dean’s medical records and used diuretics to lower IOP after surgery, but did not monitor electrolytes immediately, but ran many expensive tests, the article said. “You can hardly blame the associate professor of neurology, who perhaps spent most of his residency training in the laboratory, goddessing over how to publish SCI papers,” says the article, which is filled with the author’s indictment of his alma mater’s clinician training mechanism, arguing that the school places too much emphasis on scientific research in the training of doctors, producing only research papers that will be written by “The article is filled with the author’s complaints about the training mechanism of his alma mater’s clinicians. He argues that such a training mechanism has led to a deteriorating level of practice among current clinicians, thus making each of us a potential victim of poor quality medical care. “The teacher in the pharmacology class repeatedly stressed to us that diuretics to lower IOP should pay attention to electrolytes, and the teacher also explained the use of anticoagulants very clearly, a second-line associate professor will not understand?” The netizen “ADR” said after reading the article, he is not the first person to question the experience described in the article, many netizens believe that the author of the article is the hospital’s “senior black”, pretend high-end, the purpose is to discredit each other. I think it’s common knowledge that after diuretic treatment, the volume and electrolytes should be monitored, and that long-term bedridden patients must prevent venous thrombosis,” Yu Ying, a former doctor at the Union Hospital, also questioned the article on Weibo. Don’t neurology professors in particular know about anticoagulation?” Although many clinicians are also questioning the authenticity of this article, they are quite agreeable to the problem of low practical skills due to too much emphasis on research in the current training process of clinicians as reflected in the article. “I’ve seen clinical doctors who don’t know what albumin is.” I’ve seen clinical doctors who don’t know what albumin is,” said a friend, “Smiling and whispering 8,” who is also an attending physician at a local tertiary care hospital, and she replied to Dr. Yu Ying’s suspicions. The first hospital of Wenzhou Medical College physician Dong Fengquan also mentioned that he had listened to two of the most famous domestic hospital experts lecture, the class is very good, but once asked the actual problem, immediately messed up, obviously a very common clinical situation, but said that this situation is rare, clinical will not encounter. “It may be that they have too many social engagements, too many lectures, too many topics, too many doctors in training, and have not been on the clinic for a long time.” “This article should resonate with many clinicians and clinical medicine graduate students. You can see many clinical medicine graduates with master’s and doctoral degrees, but have you ever seen clinicians with master’s and doctoral degrees who have not been in the clinic for a day until graduation? Such masters and doctors abound in China.” “Surgeon Sun Ligang” also believes in microblogging that the degree of light clinical and scientific research in the training of domestic clinicians has reached a very serious degree. The fault lies in the fact that SCI is the only way to judge heroes. Jiang Jinyan served in the oncology department of a well-known local teaching hospital for 16 years, but she chose to resign from the unit in 2012, like many front-line doctors who have lost their jobs, she chose to serve in a private hospital and then prepared to open her own clinic. “I am still an attending physician and it is too difficult to be promoted to associate chief physician, not only do I need to apply for the National Natural Science Foundation of China, but I also need to publish many SCI papers in foreign journals. I think I am not suitable for scientific research, and I am not good at running projects and writing papers”, Jiang Jinyan thinks she cannot adapt to the current assessment system of clinicians, which is the reason she chose to walk out of the institutional hospital. In Jiang Jinyan’s opinion, the reason why clinicians are getting farther and farther away from the clinic is the current “one-size-fits-all” evaluation mechanism for training clinical medical students and promoting doctors. “Without a certain number of papers, a master can’t graduate, a doctor can’t graduate, an associate professor can’t be evaluated, a professor can’t be evaluated, these are all rigid indicators, but on the contrary, the requirements for clinical are not so strict, the requirements may be limited to no accidents.” “Do you want to continue your studies now, or go to work right away?” In the past, whenever the department assigned interns who graduated from undergraduate or graduate school, Jiang Jinyan would ask this question first. For those who didn’t want to go to graduate school, she would require that they must complete their internship subjects; while for those who wanted to go to graduate school or take a doctoral exam, she would turn a blind eye and give them time to review. So the reality is that many clinical interns are gnawing on books for graduate school, and most doctoral students are gnawing on materials and doing experiments, while desperately trying to do research will only squeeze out clinical time. The clinical rotation after graduation is also spent in the laboratory, and most of those who are fortunate enough to stay in the hospital after graduation are also those with high SCI scores, and after the clinical rotation, they will be in time to evaluate associate professors and work as residents in the hospital, and a lot of time may be spent doing experiments and writing papers during the residency process. “With scientific research to stay in school, with scientific research to promote the grade, this is the evaluation benchmark of all teaching hospitals.” Jiang Jinyan lamented that this has led to a hospital with many clinicians with high titles but not much clinical experience. Yet patients do not know the doorways inside these titles when they see them and easily give their lives to them. So there are doctors who regretfully say that according to the current standards of doctors, national treasure doctors like Wang Loyal and Lin Qiaozhi are not rated as professors, because they have not published many papers, and if they put their minds on writing papers, I’m afraid they won’t become famous doctors. “The rest of them are tired by scientific research, and they are all focused on research, examinations, writing articles and promoting their titles, because thesis topics have become almost the only criteria for doctors’ promotion. The same doctor’s netizen “love wandering fans” also believes that scientific research is not wrong, but too much emphasis on the loss is not worth the gain, the imposition of profitability has changed the nature of scientific research and the practice of medicine is the most damaging. It is precisely for this reason that many people are at a loss. Nowadays, clinical medicine students and doctors put too much energy on how to get projects and papers, but not really on the clinic, not because they don’t have the passion to join the clinic and treat patients, but because they are pressed by one assessment standard to learn. Under such a selection and promotion mechanism, people with weak clinical thinking and ability are mixed in, while some people with strong clinical ability are suppressed. “Doctors should do scientific research by interest, not tasks, indicators, to be a doctor is the most important is to solve the clinical problems, based on SCI evaluation of doctors, the end result is light on clinical, heavy on scientific research, will only apply for project funds will not cure the disease.” Gong Xiaoming, an obstetrician and gynecologist and founder of China Obstetrics and Gynecology Network, thinks so. Clinician training and promotion mechanism calls for radical changes In the face of the current training and promotion mechanism of clinicians, doctors on the one hand lament the general environment that leads to light clinical and scientific research, which greatly frustrates the enthusiasm of those medical personnel who love the profession of doctors and clinical work; on the other hand, they are more worried about the next problem of declining medical standards. Dr. Xie Rushi of the Sixth Hospital of Sun Yat-sen University said on Weibo, “If this problem is not improved, a large number of doctors who only write articles will soon become the teachers of all young doctors. They bring a new generation of ‘article doctors’ to treat everyone, the horror is not?” Netizen “Huaguoshan Xiaonong” also worried that clinicians are tired by the heavy research has become an indisputable fact, more terrible is that the “SCI-only theory” has seriously affected the training of medical students, students now almost regard clinical internship as a burden, think that issuing papers is more important than going to the clinic. The students now regard clinical internship as a burden, and think that publishing papers is more important than going to the clinic. “The first thing that I want to do is to think about the future of China 20 years from now, what will the doctors do and what will the patients rely on. Zhong Nanshan had also said in a previous interview that “publishing papers in high level journals is not the only criterion to measure the high and low level of doctors.” Therefore, in recent years, there have been more and more calls for changes in the training and promotion mechanism of clinicians at home and abroad. It has become the wish of many in the field to abandon the “SCI-only” evaluation criteria for clinicians and to diversify the promotion assessment criteria. Therefore, many medical professionals believe that they should learn from foreign countries. In many European and American countries, the promotion of clinicians is mainly in two ways: one is research doctors, the level of assessment is inclined to academic, promotion is required to have articles, funds, scientific research results; the other is promoted from the clinical route, through the clinical level assessment, the criteria for judging the situation of continuing education, workload, clinical diagnosis and treatment level, where the clinical diagnosis and treatment level is judged by peers. Many clinicians believe that, contrary to the evaluation system in foreign countries, the training and evaluation system of domestic clinicians is to force those who are engaged in clinical medicine through assessment to engage in scientific research at inappropriate times, detaching themselves from the reality and treating scientific research as a task to be completed, instead of studying the problems found in the clinic, which can only become paperwork. Not long ago, some places began to explore the improvement of medical personnel title promotion assessment system, some large hospitals in Shanghai to learn from foreign experience, the clinical research staff into different categories, changing the previous medical, teaching, research “one person to pick” mode, so that young doctors have time to do interested and good at work. There are many people who applaud the reform in Shanghai, but the doctors in the interview still hope that the entire clinical medical community can be completely changed, a moment, a place, a hospital reform can only be a drop in the bucket. In the domestic clinician training and promotion mechanism only on the SCI behind, is the whole clinical medicine community is generally spread “SCI-only theory”. Some doctors said in an interview that the hospital leadership clearly instilled in doctors the idea that hospitals must find ways to dominate in scientific research if they want to grab academic status in the competition and not be left behind by their peers, which is why the hospital pressed the paper index to clinicians one level at a time. “Europe and the United States do have a distinction between research doctors and clinical doctors, but whether it can work in the country or need a general environment to support.” Dr. Zhang Nan of Beijing Anzhen Hospital, who was a visiting doctor at the Danish National Hospital, believes that it is difficult to evaluate the clinical level of clinicians, and there is no good experience in quantitative evaluation at home and abroad, while in the field of scientific research, such as the number of published articles, cumulative value of impact factor, number of citations, as well as the level and amount of funds received, and even education and seniority are easier to quantify. This has led to the fact that the domestic administration evaluates hospitals and hospitals evaluate doctors only by scientific research indicators to see the gap, so hospitals and doctors pay more and more attention to scientific research than clinical. In reality, for many hospitals, scientific research can bring subject funding and research funds. In the competition for these resources, the number of SCI papers published each year is the most important and practical indicator, while the improvement of doctors’ skills and medical services, which are difficult to quantify, are put in the dark corners and ignored. In Dr. Zhang Nan’s opinion, in this environment, there are many strange situations, “hospitals do not pay attention to the training of clinicians, but only treat those who receive clinical training as cheap human resources, and who will be enthusiastic about such training? Domestic hospital evaluation of the first to promote scientific research, but the work content and heavy in the clinical, research staff funding restrictions, low treatment, so many of the hospital’s best researchers are willing to very reluctantly put on a ‘clinical expert’ hat.”