On Taiwan Chinese Medicine Doctor Practice Qualification And Specialty Education

Aim:This thesis carries three purposes which are to introduce the historical development and current situation of Taiwan Chinese Medicine(CM) doctors' medical education,explore the history and present condition of Taiwan CM doctors' practice qualifications and discuss the feasibility of establishing the Taiwan CM specialist system.Based on research results, suggestions will be proposed as reference for related departments and staff to improve and develop CM.Methods:Under the frame of history research methodologies,literature review,document analysis,comparative research,semi-structured interviews, Delphi Technique expert consultancy questionnaire,etc.are adopted as data collection and pooling methods whicharemostly qualitative in nature and at the same time carry out the quantitative analysis of experts' opinions.Result:1.Taiwan CM Doctors' Professional Status Rises with History DevelopmentUp to now,Taiwan CM has taken the road of independent development. Practitioners have transformed from the early-stage witches,Confucian doctors,master-followers or self-learners to CM doctors who have passed the examinations according to the legislation of Taiwan and are recognized by the society.CM education also develops from traditional family inheritance, masters' instruction,self-study or home learning,etc.to modern school education.During the development period,CM once was nearly ruined by the impact of the introduction of Western Medicine and the Japanese invasion.Taiwan CM ancestors tried their best to establish the CM colleges,educated CM staff through various CM practice qualification exams,demanded CM doctors to attend the CM Doctors' Society and register relying on government legislation,and provided CM doctors' advanced education through CM Doctors' Society and various CM associations.The dynamic process of Taiwan CM doctors' professionalization and specialization can be taken into constructive analysis from the angle of historical development.Taiwan CM doctors have the professional features in specialized knowledge,qualifications, organizations,professional development and ethics,etc.What they need to seek at present is the irreplaceable professional authority.2.CM Doctor Practice Qualification Examination and Specialty Colleges Bring About Taiwan CM PersonnelFor historical background,social requirement,education and medical care level and other factors,Taiwan CM doctors' examinations fall into two categories:regular medical education and irregular medical education. Examinations can evaluate and select various CM personnet learning from school or masters which impel the development of CM.Law of Doctors issued in 1943 prescribes clearly that CM and Western Medicine doctors enjoys equal status and the two kinds of medicine are regulated by the same law.The third item of this law concerning CM doctors' Qualification Examination states one qualification is to graduate from CM specialty school or above.However,medical administration and education were mostly about Western Medicine at that time.CM personnel asked the government to set up CM schools or allow setting up private CM schools but failed. Therefore no one in Taiwan met this requirement.The law existed in name only. In 1945,Taiwan severed the colonial reign of Japan and returned to Republic of China(R.O.C.).In the early period,there' s only one way of educating CM doctors,the CM doctor examination given by the Examination Board.Since lack of CM schools and considering the social demand,the Examination Board offered the Special Examinations of CM Doctors for the first time and the qualification requirement is loosened.In that year,2 people passed the exams in Taipei.Doctor practice qualification identification system is the demonstration of the legal administration of the country and the examination qualification should meet with the personnel education system closely,therefore teaching, examination and application can be integrated.In 1949 when R.O.C.withdrew to Taiwan,the struggle and interaction between CM and Western Medicine in Mainland China also expanded to Taiwan.After twists and turns,China Medical College,later named China Medical University was founded in 1958.The founders proposed that the legal status and education of CM and Western Medicine doctors and held the following as the education principles:recovering CM,absorbing new knowledge of Western Medicine,and building new medical system by assimilating the two medicine systems.Before 1966,only Integrated CM and Western Medicine Department was offered.In 1966,CM Specialty was established with the permission of the Ministry of Education and later it changed to CM Department to educate the CM specialists.It' s the beginning of CM doctors' regular specialist education in Taiwan.In 1972,among those taking the Qualification Examination for CM Practitioner Examination,most are the first session of CM Department graduates.However,the regular specialist education was not popular at that time(only 43 graduates of the first session in 1972). Many experienced specialists having learned by themselves or from masters in the society didn't have the equivalent education background and couldn't take the examinations to get the practice qualifications.One qualification for Special Examination of CM Doctors was to take the medical care position in public schools,town administrations or above.This might offer chances to those false doctors:therefore people from different fields suggested correcting this qualification condition.With the urgent need for CM doctors, the Examination Board invited related personnel to discuss several times.All the attendants suggested it necessary to hold Qualification Examination for CM Practitioner Examination which would educate more CM personnel and meet the social requirement for CMcare.Therefore,on April 2^nd,1968,the amended Regulations of Special Examination of CM Doctors was issued.It deleted the qualification requirement of working as CM doctors for three years or above in government or institutes and holding the related proof.It included those passing the Qualification Examination for CM Practitioner Examination, offering opportunities for those learning by themselves.Considering those passing the Special Examination of CM Doctors mainly learned by themselves and didn't have enough clinical training,the Examination prescribed in 1988 in Training for Passers of the Special Examination of CM Doctors that since 1989,all those who have passed the Special Examination of CM Doctors with the qualification of Qualification Examination for CM Practitioner Examination must receive basic medical and clinical diagnosis and treatment training which lasts from 6 months to 1 year.When they pass at the end of the training period,the examination procedure finishes and certificates will be issued.Examination Law Enforcement Regulations issued earlier has stated that CM doctors are professional and technical staff.No.453 judicial interpretation of the Justice of the Constitutional Court of Taiwan says that all kinds of professionals' and technicians' practice concerns people's life, health and property safety.The conferment of the practice qualification should take into consideration the nature and required expertise of different subjects.Regular professional education and internship are demanded to ensure the life and property safety of people.With the ever-changing medical techniques,the medical ethics relies more on education.CM doctor education in Taiwan is more standard and academic.In 1998,Department of Chinese Medicine was set up in the Medical College of Chang Gung University under the guidance of its founder,Mr.Wang Yung-ching,to study CM to make up for the defects of Western Medicine.50 students are recruited each year and the dual major of CM and Western Medicine Program lasts for 8 years.27 items of Professionals and Technologists Examination Act were amended and announced on December 29th 1999 and enacted since January 1st 2001.This law deletes the qualification review system and integrates its spirit into examinations. Professionals and Technologists Examination Act amended on June 14th 2000 also make sunset clause for CMdoctor qualification examinations.Therefore no CM doctor qualification review is accepted after January 1st 2001.Those who applied for the qualification review and were allowed to take the written examinations before December 31st 2000 would continue taking the examinations from 2001 to 2005.The qualification examination was deleted since 2006.The CM doctor qualification examination regulations prescribe that the accepted new applications in 2005 are the last ones and the make-up examinations for old cases stop in 2008 and the examination ends in 2009.On December 30th 2000, the Examination Board issued Regulations for Senior Qualification Examination for Professional and Technical Personnel in the category of Chinese Medicine Practitioner which prescribes the qualification is receiving regular medical specialty education.On January 16th 2002,43 items of Law of Doctors were amended and announced.The third regulation of Item 3 prescribes that the Special Examination for CM Doctors in 2011 is the last one.After 2012,the only way to get the CM practitioner qualification is to attend the Senior Qualification Examination for CM doctors.That is to say only attending regular medical education and internship can one become registered CM doctor.At the same time,the No.1 and No.2 regulations of Item 8 of Law of Doctors prescribes that doctors should apply to the city or country they belong to for registration of practice.Only after getting the license can one practice medicine.Those medical practitioners need to receive advanced educationand renew licenses by providing the advanced education proof every 6 years.Before April 22nd 2009,those CM doctors who practiced more than 6 years should provide proof of 180 credits' advanced education to renew the license;otherwise they can't practice any more.By legislation,Taiwan realizes the combination of CM doctors' advanced education and the renewal of practice licenses.3.Tendency of Betterness Education in Taiwan CM Doctor Specialist EducationIn course design,teaching material and methodologies,the advancement of teaching staff and evaluation,Taiwan CM educational reform seeks for the excellent and high quality output.The passing rate of CMdoctor qualification examination rises year by year.Computer Aided Instruction and multimedia are introduced to improve the teaching quality.New courses are designed by initiatively integrating the CM classic works into modern medical concepts. New teaching methodologies are adopted to enhance the learning motives like question-oriented teaching and clinical skill teaching.Betterness Education has four major features:excellence,efficiency,scientific and innovativeness which reflects the current development of Taiwan CM doctor specialist education.4.The Feasibility ofEstablishingCMSpecialist System in Taiwan under the Planning of CM Professional Societies and Health Administrations(1) System Designing Principles:the specialist practice of CM doctors is recognized by experts;the quality control of specialist education should be undertaken by CM professional societiesand health administrations together which should be open for inspection.(2) Specialist Training System:the classification of specialist departments should focus on exerting the advantages and features of CM.The training can take two-tier system and the training model of 2+X. (3) Specialist Access System:the screening and examination of Taiwan CM specialist should be undertaken at least once a year and it shouldn't restrict the practitioner to only one specialist department.Ministry of Health shouldn't add or deduct the number according to the demand and supply of specialist doctors' manpower situation.Each specialist department society should draft the examination ways and hand in to the Ministry of Health to announce and enact,which include the application qualification,the examination procedure,examination ways,subjects,limit,time,grading and passing standard,etc.Examination is carried out in written and oral tests, quizzes,or field examination.If the examination of the qualification of foreign CM specialists shows that their specialist system and training process are equivalent to those of Taiwan,they still need to take the written and oral examinations,quizzes or filed examination.(4) Specialist Administration System:Seed doctor system should be established prior to Specialist CM System.Those who have obtained the specialist certificates from specialist societies and passed the examination of the Ministry of Health still need to receive 2+X years' training in teaching hospitals.Written and oral examinations,quizzes or field examinations can be exempted if applying for the specialist examination within 3 years.The training hospitals' evaluation should be undertaken by CM Committee of the Ministry of Health.About the training expenses,it should be shared by the government,the training CM hospitals and individuals.5.Taiwan CM doctor specialist education,specialists' training and advanced education should form a continuous and complete medical education system.Suggestions:Based on research results,literature discussion and expert interviews, suggestions are proposed for Taiwan CM doctor specialist education,practice qualification and specialist doctor system. 1.CM Doctor Specialist Education:Conduct the authentification of CM specialty;innovatively combine master inheritance into school education and carry out the advanced study and post-graduation medical education so as to form continuous and complete CM education and educate senior CMclinical staff; emphasize the clinical learning experience and seek for the CM residence system.2.CM Doctor Practice Qualification:Emphasize the clinical skills and take the 3-phase national CM doctor license examination;optimize the examination content,considering the CM education reform.3.CM Specialist System:Before enactment,publicity and amendment of related orders are needed;the evaluation of teaching hospitals should be carried out which are recognized by the Ministry of Education;CM professional societies should also be evaluated.4.Thoughts for Follow-up Researches:the questionnaire of CM specialists can extend to patients;related topics like integrated CM and Western Medicine education,course rate of Program of CM,general doctor or specialty differentiation may be further explored.