China: Making significant progress, overcoming hurdles

Issue: Issue 4 2006

In the May/June issue of Orthopaedics Today, there was a lengthy article regarding the status of development of orthopaedics in the People’s Republic of China — specifically, Chinese surgeons seeking Western technology, expertise and support — and Chinese orthopaedists gaining greater international standing.

John C.Y. Leong, FRCS, MCAS [photo]
John C.Y. Leong

The article made me recall my own experiences. In 1980, I was invited, along with two colleagues, to deliver lectures and demonstrate spinal surgery at the Guangdong Provincial People’s Hospital in Guangzhou by the then-head of the department, Chen Zhi Bai, MD. There were some 200 participants, most of whom were senior orthopaedists, department heads and professorial chairs. As a result of that exposure, I have been invited to lecture and demonstrate surgery at many orthopaedic centers in mainland China over the past two and a half decades. These have given me the opportunity to have a fair appreciation of the changes in the orthopaedic scene in China.

Signs of change

My observation is that, for the first 15 years or so after 1980, their system had significant hurdles that curbed progress, even though surgeons were eager to learn new techniques and upgrade themselves. However, in the last 8 to 10 years, it has taken a significant turn for the better since three important processes have taken place.

First, increasing numbers of orthopaedic surgeons are traveling outside China to learn from the more developed orthopaedic centers. Second, many prominent foreign orthopaedists have been invited to mainland China to share academic and surgical skills. Third, China has seen an increase in orthopaedic scientific meetings, specialty seminars and skills training workshops country-wide. These have largely been mounted by specialty and subspecialty societies, with a lesser effort by hospitals and university departments. There is no doubt that technology transfer has occurred at anunprecedented pace in the past 8 to 10 years.

Increasing numbers of orthopaedic surgeons are traveling overseas from China to learn and gain experience.

All this augurs well for the future of orthopaedics in China. However, problems remain. The monitoring of training standards, surgical treatment standards, and the outcome of treatment procedures is not at the level of those in more developed countries. Training programs, the monitoring of trainee progress and the assessment of the outcome of training are all mainly hospital-based.

Without a central system of ensuring the quality of training programs and the objective and independent assessment of trainees’ outcomes, it is very likely that, in a country as big as China, there will be substantial variability in the standards across the board.

There is no doubt that the orthopaedists in the major university and provincial centers are well-trained and practice evidence-based medicine, including the use of new technology and implants. Yet, a significant number of them enthusiastically use new treatment modalities, surgical instruments and implants after having attended a scientific meeting or a skills training workshop, without undergoing a strict training program under supervision in a hospital setting.

Geographic challenges

It is, of course, difficult to institute a nationwide training and assessment process, given the large geographical separation, huge population and great heterogenicity of social, economic and physical infrastructure development in different parts of the country.

To develop a centralized system similar to the American Board of Orthopaedic Surgery, the surgical Royal Colleges of the United Kingdom, or the Hong Kong Academy of Medicine would take much political determination and muscle, as well as a lengthy period of institution. However, every effort should be mounted to start such a process. Otherwise, developing orthopaedics to a world-class standard will be significantly impeded.

John C.Y. Leong, FRCS, MCAS
Chairman, Editorial Board