Fall 2018 (Volume 28, Number 3)

China Teachings: British Columbia Rheumatologists in China

By Simon Huang, MD, FRCPC; Ian Tsang, MB, FRCPC; and Barry Koehler, MD, FRCPC

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How it all began
This program began after a chance meeting with Professor Zhongdao Wu, then Dean of Undergraduate Study at Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou. He invited the three of us to teach a two-week elective to medical students at the beginning of their fifth year of an eight-year program. Professor Wu particularly wished that the students would have exposure to “Western-style” teaching.

It was restricted to students who had a working knowledge of English. Attendees averaged 80, out of a total class size of 100. The invitation was renewed for the next six years. For the last two years it has become part of the formal curriculum for the entire class, due to the efforts of Professors Wu and Dean Guoquan Gao.

What did we do?
We had planned a rheumatology course for medical students who were early in their clinical training, but soon realized that we needed to use this framework to teach a sound approach to history-taking, physical examination and differential diagnosis. Dr. Simon Huang’s expertise in teaching methods formed the foundation.

Mornings are devoted to review of the previous day’s topics, followed by two to three lectures. Afternoons are spent at various hospitals, with one of the faculty and ten to twelve medical students reviewing a patient. The students collaborate to obtain the history, followed by the faculty member leading them through relevant physical findings, and a subsequent exploration of the possible diagnoses.

Our faculty has been augmented in recent years by Dr. Antonio Avina-Zubieta and Dr. Mercedes Chan. For the past two years students also were offered a workshop on evidence-based medicine, under the guidance of Dr. Charles Goldsmith.

The medical school supplies translators for those of the faculty who did not speak Mandarin (for the afternoon bedside teaching), prepares a printed course syllabus, and arranges teaching rooms for the afternoon clinical sessions – and also room and board.

What did we achieve?

• ● Students
  
  • Students were initially inhibited to be involved in a Socratic learning environment but quickly became enthusiastic participants.
  • They learned our approach to practice: Medicine is organized, consistent detective work, beginning and ending with the patient.
  • Zhongshan Medical School has achieved first place in the national competition for clinical skills in recent years, a competition previously dominated by the Beijing medical schools.


• ● Fellows
  
  • With the support of the University of British Columbia (UBC) Division of Rheumatology 17 fellows have had the opportunity of teaching learners from a different culture but, perhaps more importantly, to spend time immersed in a different culture.


• ● Faculty
  
  • We were reinforced in our belief that, while medical students are always bright and always learn, the learning is enhanced by the right learning environment.
  • Lectures were all done in English. This led to the recognition that the students found that those with English as a second language (Tsang, Huang) were easier to follow than someone for whom English is their mother tongue (Koehler), whose speech tends to be larded with ‘strange’ colloquialisms.
  • Take into consideration the customs of another country. We learned that a two-hour break at midday is a necessity for medical students in China; it’s not just lunch but also nap-time!

Barry Koehler, MD, FRCPC
Clinical Professor Emeritus, Department of Medicine,
University of British Columbia, Richmond, British Columbia

Simon Huang, MD, FRCPC
Clinical Associate Professor, Department of Medicine,
University of British Columbia,
Vancouver, British Columbia

Ian K. Tsang, MB, FRCPC
Clinical Professor Emeritus, Department of Medicine,
University of British Columbia
Vancouver, British Columbia