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Junior Fellow shares lessons learned from rotation in China

Dr. Flora F. TengFlora F. Teng, MD, University of British Columbia resident

I was recently welcomed for a one-month rotation by the incredible staff of the Women’s Hospital School of Medicine at Zhejiang University in Hangzhou, China. These are five important lessons I learned.

There is power in numbers.
In China, I observed some of the most skilled laparoscopic surgeons in the world. With tens of thousands of gynecologic surgeries per year, 19 dedicated gynecology operating theaters running five days a week, 91,900 outpatients, and 11,000 deliveries, Chinese physicians have finely honed skills from attention to detail and immense surgical volume.

Jade is not polished without rubbing, nor is a man perfected without trials.
This Chinese proverb is exemplified day in and day out as Chinese physicians painstakingly shape and mold their residents into perfection. As parents teach their children, Chinese physicians coach residents through each surgery. The instruction may be harsh at times, but the residents accept criticism, remembering they need to be polished in order to shine.

Competency-based education may take longer, but it allows for greater mentorship.
Residents in China undergo a competency-based approach to surgical education, which is starting to take shape in the US and Canada. Opportunity in the operating room is commensurate with experience. If you assist in a particular procedure 50 times and perform the procedure 50 times with direct supervision, you take a test. (The exact number varies with each procedure.) After passing, you are allowed to perform the procedure independently.

If you are planning for a year, sow rice. If you are planning for a decade, plant trees. If you are planning for a lifetime, educate people.
I had the privilege to be in China during Teachers’ Day, a day of honoring teachers for the invaluable gifts they give us. From allowing multiple observers in the operating room to taking an extra hour on rounds for the foreign observer, I could see people have a great respect for education in China and an understanding that everyone can be your teacher.

Practice cultural humility, not cultural competency.
I witnessed so many differences in practice while I was in China, and I wasn’t sure how to interpret them relative to what I know from my home institution. Healthy patients remained in hospitals for days without discharge, asymptomatic fibroids were removed, and hormonal treatment for gynecologic complaints was rarely offered.

Were they right? Were they wrong? I soon realized that they were neither. These differences were born out of a specific cultural and political context, not a difference in medical evidence. It was only through humility and understanding cultural context that I was truly able to appreciate the care I observed during my rotation.