Does medical education reform change who is selected? A national cross-sectional survey from China

OBJECTIVES: Approximately 10 years ago, China introduced an education plan to improve the overall quality of medical education and to better serve the population’s health needs. Many medical schools were then recognised and financed by China’s Ministry of Education to develop and operationalise new pilot programmes (PPs) aligned with this plan. These ran in parallel with the traditional programmes (TPs). One way to achieve the plan’s first aim, improving the quality of medical education, is to select academically stronger candidates. We, thus, examined and compared who were selected into PPs and TPs. DESIGN: Cross-sectional study. SETTING: Data were collected from 123 medical schools across China via the 2021 China Medical Student Survey. PARTICIPANTS: Participants were undergraduate clinical medicine students across all year groups. PRIMARY AND SECONDARY OUTCOME MEASURES: Medical school selection was via the National College Entrance Examination (NCEE). Medical students’ NCEE performance and their sociodemographics were used as the primary and secondary outcome measures. Mann-Whitney or χ(2) tests were used to compare the means between educational programmes (PPs vs TPs) and various selection outcomes. Multilevel mixed-effects regressions were employed to account for school idiosyncratic selection results. RESULTS: Of the 204 817 respondents, 194 163 (94.8%) were in a TP and 10 654 (5.2%) a PP. PP respondents (median=75.2, IQR=69.5–78.8) had significantly higher NCEE scores than their TP counterparts (median=73.9, IQR=68.5–78.7). Holding constant their NCEE score, PP respondents were significantly more likely to come from urban areas, not be first-generation college students, and have parents with higher occupational status and income. CONCLUSIONS: Assuming quality can be indicated by prior academic achievement at the point of selection, PPs achieved this mission. However, doing so limited medical students’ diversity. This may be unhelpful in achieving the Education Plan’s goal to better serve China’s health needs.