MD Degree Program in China- A New Reality                                                                      By: Najam Hasan

A Chinese Dream

President  Xi Jinping  said in his address to the nation that he wants to rejuvenate the Chinese nation to allow it to take its rightful place in the world by improvements of his people’s livelihoods through better education and healthcare services, more stable employment, a cleaner environment, the elimination of corruption and a stronger military.

A reality

Six hundred thousand (600,000) medical students are trained each year in Chinese medical universities but only one hundred thousand (100,000) actually become doctors, according to Professor Li Ling of the National Development Research Institute at Beijing University. In 49 listed medical universities in China more than 10,000 international students got admission to become medical doctors last year, the majority of them from South East and Central Asia. The financial contribution of these students is not significant to the Chinese economy, as these students are rather unprofitable when compared to what EU or North American students are prepared to pay for medical education. The other reason is, most Chinese universities are offering MBBS undergraduate degrees which is in line with the European medical education standards but not that of North America.

American medical education, on the other hand, is divided into two parts; 4 years of pre-med education with an undergraduate degree in human biology and 4 years of clinical training resulting in a graduate degree of Doctor of Medicine , MD. The United States Medical Licensing Exam (USMLE) is a pre-requisite to enter into an American residency for both domestic and foreign trained doctors planning to work in the United States. USMLE has also become a benchmark in other regions of the world as a medical doctor's professional qualification for employment. The USA faces a probable shortage of 90,000 medical doctor in this decade, cited by Dr. Darrell G. Kirch MD, president of the Association of American Medical Colleges (AAMC). American healthcare providers prefer graduates with an MD degree and a US medical license for residency. This presents a unique opportunity to a nation that has had a message from its leader to lead in educational fields as a national pride and priority.

Number of applications in USA for 10 desired med school for 2014

Medical school (state)	Applicants (fall 2014)
Drexel University (PA)	14,648
Lake Erie College of Osteopathic Medicine (PA)	13,536
Georgetown University (DC)	13,016
Temple University (PA)	11,286
George Washington University (DC)	10,981
Thomas Jefferson University (Kimmel) (PA)	10,204
Tufts University (MA)	9,882
Boston University	9,713
New York Medical College	9,412
Western University of Health Sciences (CA)	8,656

*An average of 11,133 students applied at each above mentioned university. Available seats for enrollment in all cases were less than 10% of the applications received.

An average of 290 students were enrolled in 165 medical schools in 2014 but an average of 109 students graduated, totaling 18,078 for the year 2014.

*Source: Association of American Medical Colleges

Statistical data of Medical school enrollment vs. graduation

Year	2010	2011	2012	2013	2014
Enrollment	42,721	43,919	45,266	45,224	48,014
Graduated	16,836	17,362	17,344	18,154	18,078

The following is a glance at the top 25 American medical schools, their tuition fees and enrollment per year.

Enrollment in the schools of medicine with the number of seats and tuition fee  

Ranking	Medical School	Tuition fee	Enrollment
#1	Harvard University  Boston, MA	$54,200 (full-time)	726
#2	Stanford University  Stanford, CA	$50,715 (full-time)	473
#3Tie	Johns Hopkins University  Baltimore, MD	$47,250 (full-time)	461
#3Tie	University of California— San Francisco  San Francisco, CA	$32,106 (in-state, full-time); $44,351 (out-of-state, full-time)	664
#5	University of Pennsylvania (Perelman)  Philadelphia, PA	$50,444 (full-time)	655
#6	Washington University in St. Louis  St. Louis, MO	$56,212 (full-time)	474
#7	Yale University  New Haven, CT	$53,540 (full-time)	415
#8Tie	Columbia University  New York, NY	$53,544 (full-time)	648
#8Tie	Duke University  Durham, NC	$51,888 (full-time)	430
#10Tie	University of Chicago (Pritzker)  Chicago, IL	$47,673 (full-time)	356
#10Tie	University of Michigan— Ann Arbor  Ann Arbor, MI	$31,154 (in-state, full-time); $48,862 (out-of-state, full-time)	727
#10Tie	University of Washington  Seattle, WA	$31,992 (in-state, full-time); $60,978 (out-of-state, full-time)	938
#13	University of California— Los Angeles (Geffen)  Los Angeles, CA	$31,134 (in-state, full-time); $43,379 (out-of-state, full-time)	749
#14Tie	New York University  New York, NY	$47,650 (full-time)	650
#14Tie	Vanderbilt University  Nashville, TN	$45,350 (full-time)	429
#16	University of Pittsburgh  Pittsburgh, PA	$48,792 (in-state, full-time); $50,014 (out-of-state, full-time)	601
#17	University of California— San Diego  La Jolla, CA	$31,134 (in-state, full-time); $43,379 (out-of-state, full-time)	502
#18	Cornell University (Weill)  New York, NY	$49,500 (full-time)	406
#19	Northwestern University (Feinberg)  Chicago, IL	$51,882 (full-time)	687
#20	Icahn School of Medicine at Mount Sinai  New York, NY	$44,604 (full-time)	556
#21	Baylor College of Medicine  Houston, TX	$19,650 (full-time)	738
#22	University of North Carolina— Chapel Hill  Chapel Hill, NC	$18,887 (in-state, full-time); $45,766 (out-of-state, full-time)	827
#23	Emory University  Atlanta, GA	$49,500 (full-time)	560
#24	Case Western Reserve University  Cleveland, OH	$55,370 (full-time)	864
#25	University of Texas Southwestern Medical Center  Dallas, TX	$17,163 (in-state, full-time); $30,263 (out-of-state, full-time)	953
	Source: US NEWS Medical school rankings.

An American Dilemma 

After earning a 4 years Bachelor's of Science in human biology, some students do not pass the MCAT exam, a prerequisite for admission into med-school. Even with passing the MCAT exam, most aspiring pre-med undergraduates do not get admission to med- school due  to very tough competition for a limited number of seats, as shown above. These students end up changing their career path, while a very small number seeks to study in the Caribbean Islands. The Caribbean Islands have very limited resources, few teaching hospitals, and have acquired a reputation of low academic training standards. This gives an opportunity to reputable Chinese medical schools to step up and seize the opportunity.

Doctor of Medicine (MD) Program in China   

China is a power to be reckoned with. A journey that started with the manufacturing of low end consumer goods has now embarked on missions in space and the development of important innovations. Xi Jinping's Top 5 priorities for the country include, "better education and healthcare services ". This is Chinese reality, not a dream. A graduate degree in medicine in clinical science is an inevitable response to this calling to compete in the healthcare field, so China can improve its own health care sector and play its role of an emerging superpower. An MD degree program coupled with USMLE training has the potential of thousands of American medical students being recruited each year. For all we know, this could be the next best thing China has to offer the world since green tea.

Program Development

The transfer of technology is what has made it possible for China to build the infrastructure for the largest network of bullet trains in the world. Duplicating and implementing an American MD degree curriculum is essential in setting a benchmark for excellence in health care education. Universities like MIT, Harvard and Yale are already hosting cohort programs with Chinese universities in business and technology. Collaboration in the medical field will be a natural fit and will help America and China to set the standards of education on an equal footing. This cooperation is essential and desperately needed by both countries. Matching a Chinese MD program with the American counterparts will make Chinese medical doctors more marketable to the US health care sector and will attract many American students to study in China. It is a win-win scenario. The American students are capable of paying higher tuition fees compared to other foreign students  while incurring a lower financial cost than at home.

Lead My World's role in the development of this academic program 

It is an undertaking for sure and a lot needs to be done to overhaul Chinese higher education system with fundamental changes in the culture of Chinese academia. Lead My World's educators and executives have  been actively engaged in Chinese education sector for over a decade. Lead My World (LMW) is a higher education pathway organization managing Medical Education and coaching programs at the International School of Capital Medical University, .Beijing, China and other institutions.  LMW management has developed academic curriculum in English language for Chinese schools, authored and contributes in MBBS coaching , USMLE training and the development of an MD degree program for Chinese medical universities. Lead My World has the necessary relations and partners both in the USA and Peoples Republic of China to launch and execute Public Health Degree programs with medical schools and HC training institutes . For information or comments  please contact the author, Najam Hasan.

 najam@leadmyworld.com or Najam@ccmu.edu.cn  

Sexual harassment and rape on campus

When I started thinking about writing on the topic of hazing on campuses and its psychological implications, I had to stop and think of something more severe and tragic that impacts the life of a victim. No its not bullying, although it is an important issue but not so common at the college campuses. As I was doing my research on the subject matter, too many stories unfolded and too many people did not want to talk about it. After all, sexual harassment and rape are uncomfortable topics and it becomes even more daunting when it’s about “at college campuses”.

I want to take up a reported case of a University of Virginia’s incident. I am omitting names of the people involved, bullying was not the first step, it was the subtle deception enveloped in an intimidating invitation to the party at the fraternity house- a powerhouse of testosterone. It involved consumption of alcohol and possibly sedatives, deceiving a female student who was gang raped after given the drink. The school ignored the complaint as it seems like a pattern with some schools to ignore such things or their inability to deal with the issues. Take the case of a school that has some stories buried under the historic cathedral like buildings; Yes I am talking about Yale, which on a first look gives a sense of piety, wisdom and sanctuary. In both cases of UV and Yale, it is reported that complaints, protests and repeated pleas for justice were ignored and rather frowned upon.   

  

The irony of the issue is that sometime campus rape is classified as “date rape”, as if somehow the rapist is not a criminal but out of heat of the passion committed the crime against his “date”, presumably who may have had consensual sex anyway? So the “date” rapist gets his image softened up and we talk about it with less disgust and outrage. This is particularly true when it comes to the fraternities of collages. Why-we should ask ourselves? Why is rape not a crime of constitutional violation of the right to be safe and live in dignity as a free person and pursue happiness, why isn't it considered terrorism against an individual and torture along with sexual battery? Why isn't the book thrown on the rapist for the violation of basic human rights? Why are those laws reserved for political issues and not the crimes inflicted on individuals?  

There is a short distance between date rape and sexual harassment. Date rape is defined as physical sexual violation and battery against a victim and sexual harassment is interpreted as a psychological intimidation.  In the gang rape incident that involved Phi Kappa Psi on September 28, 2012 the fraternity shamelessly denied the charges and the Burden of shame was put upon the victim who is generally reluctant to come forward to begin with. It was swept under the blankets as fast as it appeared but a sexual harassment scandal unfolded at Yale. This is not the first one but who wants to talk about “Yale” in a negative manner, a university that produces presidents and executive management of the Government, powerful corporate Moguls and world leaders. So the sexual harassment complaints were also swept under the rugs or filed away in at least one case for decades according to a report. Different entities classify sexual harassment differently. It is wrongfully classified as sex discrimination in my opinion, which again softens the impact of the crime on a victim who generally in a subordinate position of need. Following is a definition of sexual harassment by EEOC;

Sexual harassment is a form of sex discrimination that violates Title VII of the Civil Rights Act of 1964. Title VII applies to employers with 15 or more employees, including state and local governments. It also applies to employment agencies and to labor organizations, as well as to the federal government.

Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when this conduct explicitly or implicitly affects an individual's employment, unreasonably interferes with an individual's work performance, or creates an intimidating, hostile, or offensive work environment.

Sexual harassment can occur in a variety of circumstances, including but not limited to the following:

·         The victim as well as the harasser may be a woman or a man. The victim does not have to be of the opposite sex.

·         The harasser can be the victim's supervisor, an agent of the employer, a supervisor in another area, a co-worker, or a non-employee.

·         The victim does not have to be the person harassed but could be anyone affected by the offensive conduct.

·         Unlawful sexual harassment may occur without economic injury to or discharge of the victim.

·         The harasser's conduct must be unwelcome.

It is helpful for the victim to inform the harasser directly that the conduct is unwelcome and must stop. The victim should use any employer complaint mechanism or grievance system available.

When investigating allegations of sexual harassment, EEOC looks at the whole record: the circumstances, such as the nature of the sexual advances, and the context in which the alleged incidents occurred. A determination on the allegations is made from the facts on a case-by-case basis.

Prevention is the best tool to eliminate sexual harassment in the workplace. Employers are encouraged to take steps necessary to prevent sexual harassment from occurring. They should clearly communicate to employees that sexual harassment will not be tolerated. They can do so by providing sexual harassment training to their employees and by establishing an effective complaint or grievance process and taking immediate and appropriate action when an employee files a complaint.

It is also unlawful to retaliate against an individual for opposing employment practices that discriminate based on sex or for filing a discrimination charge, testifying, or participating in any way in an investigation, proceeding, or litigation under Title VII.

United States Department of State has instituted the following policy;

The Department of State is committed to providing a workplace that is free from sexual harassment. Sexual harassment in the workplace is against the law and will not be tolerated. When the Department determines that an allegation of sexual harassment is credible, it will take prompt and appropriate corrective action.

What Is Sexual Harassment?

Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when:

1)  An employment decision affecting that individual is made because the individual submitted to or rejected the unwelcome conduct; or

2)  The unwelcome conduct unreasonably interferes with an individual's work performance or creates an intimidating, hostile, or abusive work environment.

Certain behaviors, such as conditioning promotions, awards, training or other job benefits upon acceptance of unwelcome actions of a sexual nature, are always wrong.

Unwelcome actions such as the following are inappropriate and, depending on the circumstances, may in and of themselves meet the definition of sexual harassment or contribute to a hostile work environment:

·         Sexual pranks, or repeated sexual teasing, jokes, or innuendo, in person or via e-mail;

·         Verbal abuse of a sexual nature;

·         Touching or grabbing of a sexual nature;

·         Repeatedly standing too close to or brushing up against a person;

·         Repeatedly asking a person to socialize during off-duty hours when the person has said no or has indicated he or she is not interested (supervisors in particular should be careful not to pressure their employees to socialize);

·         Giving gifts or leaving objects that are sexually suggestive;

·         Repeatedly making sexually suggestive gestures;

·         Making or posting sexually demeaning or offensive pictures, cartoons or other materials in the workplace;

·         Off-duty, unwelcome conducts of a sexual nature that affects the work environment.

How to safeguard yourself from Sexual harassment & Sexual misconduct of any degree at the campus or work place?

1.      Set the limits: It has become fashionable for girls to act cool by using profanity and acting tough, this gives an opening for the boys to sometime cross the limits and begin the process. There are cases that a victim does not even know the subtle harassment until it becomes an obvious issue of disturbance. Be who you are but do not try to fit in by giving your standards.

2.      Admonish the perpetrator: Make sure that you communicate your displeasure clearly and what is not welcomed by you and for him/her to stop that behavior. Try to do that in public and in the presence of the witnesses.

3.      Do not participate: Do not respond to the pranks, jokes and comments which seem  inappropriate and unacceptable to you

4.      Protect yourself: meet friends in public and stay in groups. Do not be a superwoman. Use caution and always be on a look out for stalkers and unfamiliar faces around campuses. Report to campus security and police for any person or activities. The worst thing that could happen as a result of your over reaction is a false alarm but the best thing is that you could save your and others lives.

5.      Information of your whereabouts: Inform your friends and family members of your whereabouts and approximate time of your activities so they worry about an unusual delay and try to contact you.

6.      Know your rights:  It is important to know your basic legal rights and do not get intimidated by the power of the perpetrator, every pharaoh eventually drowns so do not put yourself in a compromising position and do not compromise your principles. Sexual harassment is not a normal behavior of any culture and it is not acceptable. Why did I talk about sexual assault and harassment in the same articles? Because they are close relatives and they both can leave the same psychological impact on a victim. Stay safe!         

Medical Tourism- A Health Journey

We define Medical Tourism as “Health Journey”. After all, people suffering from medical conditions are traditionally discouraged to travel as it involves discomfort and many risks but sometime patient’s conditions are so acute that patient or the caretakers decide to take this leap for survival or better health conditions than status quo.

Lead My World’s Health Management Model

LMW is positioned on higher grounds of this profession. We develop medical coaching and certification programs for universities, we train doctors and collaborate with teaching hospitals and healthcare facilities. Our executive management is comprised of medical doctors. We have established collaborative relations with the hospitals of specialization in critical disciplines. We have instituted a strong patient referral program for those patients seeking alternative treatments and with the progressive hospitals to treat such patients. Our medical professional expertise and working at the grassroots level gives us leverage over people who use Medical Tourism strictly as a business. To us it’s about the value of life and a relentless pursuit of wellness.

HEALTH JOURNEY- MT BACKGROUND

Medical tourism is as old a phenomenon as human being started travelling out of their enclaves to discover certain tree roots and herbs for treatment and traveled across continents for it. Their journey was not necessitated by economics but the unavailability of medicine and the healers. Medical Tourism- while introduced as an alternative is becoming a mainstream Healthcare management field. According to Dr. J. Bhagwati of Columbia University, Americans have saved up to 75 Billion dollars in one year by taking advantage of MT Healthcare. Revenue attributed to MT for the year 2014 is at 65 Billion dollars according to a report published by “Frost & Sullivan Research”, and growing at the rate of 20%. Johns Hopkins and Mayo Clinics have now setup their offshoots overseas for the purpose of savings of HC cost. We believe that China is one of the most advanced countries in the world, both technologically and in physician care with an added benefit of new innovations and holistic approach to Medical Tourism.            

WHY PEOPLE TRAVEL FOR MEDICAL TREATMENT

It is not easy to leave the comfort of your home and familiar environment in a situation when you do not even feel good but it’s a journey some of us must take- Leaving home involves financial, physical and psychological hardships but none of them are greater than the risk of not getting well. While information is readily available on our fingertips the renowned hospitals have also gotten closer in distance with global travelling trends. Travelling for wellness and health are no different from travelling for leisure. As a matter of fact it has now become “business as usual” for some. Following are a few reasons attributed to Medical Tourism;

Advanced medical technology (AMT): Hospitals in developed countries are generally equipped with state of the art technology which is not readily available in developing country’s hospitals. The technological know-how also gives an edge to the hospitals in the industrialized nations.

Advanced medical research and inventions: Industrialized nations invest into research and development, inventions and experiments to improve on healthcare experience. As a result they are far ahead of other countries in implementing such procedures. Cost effective Stem Cell research and organ implants are some of the prime example of such privileges which attract patients from other parts of the world developing and industrialized alike, to countries like China.
Legalities of medical procedures: An American interventional radiologist Dr. Charles Dotter experimented with a procedure to deliver a stent through a catheter to treat peripheral arterial disease in 1964. The experiment was successful Dr. Charles Dotter and Dr. Andreas Gruentzig experimented with the same procedure and found it not only successful but also a better option for reconditioning of body after surgical procedure. The procedures were not legalized yet and the medical doctors had to be creative about their practices in the beginning. Dr. Peter Dr. Richard Myler of Emory University Hospital mentioned once that he had to travel to Latin America to perform angioplasty procedure which after getting a legal approval revolutionized cardiac care. Not all countries allow some medical procedures because of lack of scientific data, bureaucracy or cultural taboos; as a result patients end up travelling to the countries not restricting healthcare procedures most suitable for the patients from abroad.
Economics of Healthcare: Some countries like China have lower healthcare cost than the others. China is a prime example of it. This makes destinations like China attractive and financially viable for the insurance companies. Patient and the family is rewarded with expenses paid residence and other allowances to get the treatment done abroad rather than in the USA or some European countries.
Patient & caretaker’s choice: It does not come as a surprise that the elite class of developing countries have the option to travel to the developed countries for medical treatment. This gives them the sense of empowerment that their wealth is working for them and that they can exercise the right to choose whatever they like. This market segment is small but with a bigger spending budge on their wellness. According to a report issued by Center for Disease Control and Prevention, Atlanta CDC approximately 1.2 Million Americans travel overseas for medical treatment each year. Some of the obvious reasons are;

·         Medical treatments are far less expensive overseas than in the USA

·         Insurance companies have started giving incentives to the families and caretakers of the patients where as they feel like they on vacation rather than being stuck with no options.

·         Some experimental drugs and procedures prohibited in the USA are already administered and institutionalized abroad. Medical professionals are not gun-shy of taking the risk and the societies are not litigation oriented as much as the Americans are. Most common procedures that people are coming to China for are;

o    Stem cell therapy

o    Organ implantation

o    Cosmetic surgery

o    Dental work

o    Heart surgery

o    Alternative cancer treatment

o    Orthopedic and sports medicine

o    Holistic and traditional medicine treatment for chronic diseases

RISKS OF MEDICAL TOURISM & RISK MANAGEMENT BY LMW

Anytime we come out of our comfort zone we involve risk due to our activities. Following a list of MT risks and how Lead My World addresses them:

·         Linguistic and cultural difference: It is a major risk to take especially when you are dealing with a life situation. LMW’s doctors and MT staff are all bilingual and professionally trained on cross cultural sensitivity.

·         General and Medical hygiene standards: Western countries practice high standards of hygiene & preventative care, developing nations are not as sensitive about it in some cases. LMW only uses hospitals which are government approved and practice, WHO, CDC, HEPA, OSHA and other global standards of operations. We thoroughly examine and inspect facilities before putting them on our recommendation list.

·         Counterfeit medications: It is not uncommon to find counterfeit medications in developing countries like India but Chinese laws are very strict in this regards. Our association with the Health Ministry approved facilities guarantees the authenticity and safety of drugs.

·         Proper recovery time after surgery: some people like to go home right after a successful procedure is completed. We recommend that proper time is allotted for rest and leisure to avoid potential risks such as blood clot due to flying. We believe that post-operative care is as important as the procedure itself.

CENTER FOR DISEASE CONTROL AND PREVENTION (CDC) GUIDELINE FOR MEDICAL TOURISM

What You Can Do

·         If you are planning to travel to another country for medical care, see a travel medicine practitioner at least 4–6 weeks before the trip to discuss general information for healthy travel and specific risks related to the procedure and travel before and after the procedure.

·         Check for the qualifications of the health care providers who will be doing the procedure and the credentials of the facility where the procedure will be done. The Joint Commission International (US-based) certifies health care facilities according to specific standards.

·         Make sure that you have a written agreement with the health care facility or the group arranging the trip, defining what treatments, supplies, and care are covered by the costs of the trip.

·         Determine what legal actions you can take if anything goes wrong with the procedure.

·         If you go to a country where you do not speak the language, determine ahead of time how you will communicate with your doctor and other people who are caring for you.

·         Obtain copies of your medical records that includes the lab and other studies done related to the condition for which you are obtaining the care and any allergies you may have.

·         Prepare copies of all your prescriptions and a list of all the medicines you take, including their brand names, their generic names, manufacturers, and dosages. Arrange for follow-up care with your local health care provider before you leave.

·         Before planning “vacation” activities, such as sunbathing, drinking alcohol, swimming, or taking long tours, find out if those activities are permitted after surgery.

·         Get copies of all your medical records before you return home.

Lead My World has stringent rules to enlist a hospital offering Medical Tourism. In China we not only assist clients to locate and qualify a healthcare facility but our medical staff monitors the hospitals as it relates to services. Dr. Ahmed Fiaz, Dr. Anwar Jamil and Dr. Khayyam Masood are heading this division of LMW. For any questions, please contact me: Najam@Leadmyworld.com