Factors bridging medical graduate students’ training and future academic achievements of dermatologists in China

Introduction

In recent decades, dermatology has increasingly attracted talented and ambitious medical students in China, emerging as a prominent field of study [1, 2]. The long-term goal of medical graduate education is to cultivate comprehensive well-rounded professionals with strong clinical skills and innovative research abilities. As a result, both applicants and medical schools are continuously working to optimize the graduate learning process and enhance students’ abilities in clinical skills, scientific research, social engagement and other areas.

Upon completing their undergraduate program in medical specialty, students in China have the option to begin their clinical career [3]. However, those aspiring to advance typically pursue a three-year master’s program, and the most outstanding students further pursuing a three-year doctoral program [4, 5]. In China, the medical master’s and doctoral degrees are categorized into two types: scientific degrees and professional degrees. The training of professional master focuses on aligning graduate education with standardized residency training, emphasizing clinical practice, and aiming to cultivate frontline clinical talents. On the other hand, scientific master’s graduate training is oriented towards academic research, emphasizing the cultivation of research skills in theoretical and experimental aspects, preparing graduates for high-level scientific research work. Due to the lengthy duration of medical education, some graduate students opt to work in clinical positions for several years before returning to pursue master’s or doctoral studies [6, 7]. Based on a nationwide research from 2002 to 2018, it is noted that Chinese clinical physicians have shown a process of quantitative growth and qualitative improvement in terms of human resources and talent training. While the supply and demand for advanced clinical medical talents are currently balanced, there is still a gap in per capita numbers and structural levels compared to middle- and high-income countries [8].

For newly enrolled medical graduate students, they quickly immerse themselves in intensive theoretical learning, clinical tasks, and research pressures. Establishing an efficient, reasonable, and scientific learning and training plan is crucial during graduate stage when time and energy is limited. However, the determining factors behind the career trajectory of successful dermatologists among medical students in Chinese society have not been clearly elucidated. We believe that identifying these factors is of paramount importance. These findings will provide crucial evidence for policy adjustments in medical schools and related institutions, leading to more rational medical education reforms that align with societal demands.

To address this gap, a retrospective study was conducted on the demographic characteristics, various learning experiences during their academic tenure, and current individual achievements in the field of dermatology for graduate students at hospital’s dermatology department over the past decade. The aim was to identify the personal factors and training characteristics during the graduate stage that are strongly associated with their success as outstanding future dermatologists.

Methods

Study design

The dermatology department of Wuhan Tongji Medical College affiliated Union Hospital is the earliest and largest training base for master’s and doctoral students in central China, accepting graduate students who have passed the national postgraduate entrance examination. Every year, the medical college allocates a designated number of enrollment quotas for master’s and doctoral students based on the qualifications of the mentor and the research projects in the department. Through a two-way selection process, each student is matched with a mentor. We conducted a retrospective study on the graduates who completed their master’s or doctoral research training in our department over the past 10 years. The entire logical structure of the study is illustrated in Figure 1, which includes the inclusion and exclusion criteria, questionnaire contents, and statistical analysis objectives. Specifically, the inclusion criteria were: (1) graduate students enrolled between 2010 and 2019, and (2) the acquirement of a master’s or doctoral degree before June 2022. Students who graduated after June 2022 for other reasons were not included as they would not have access to data on their post-graduation practices.

Figure 1:

The flowchart showing the inclusive process, survey contents and data analysis for the retrospective study.

Results

Graduate demographics and accomplishments during the graduate school period

Demographic characteristics are shown in Figure 2A and Supplementary Table 1. A total of 61 eligible electronic questionnaires were collected, of which 52 individuals (85.2 %) were female. It is worth noting that about 45.9 % of the participants had prior work experience before pursuing graduate degrees. The median age at the beginning of the graduate study was 27 years (range: 23–41 years). Among them, 21 individuals (34.4 %) obtained a doctoral degree. Both master’s and doctorate graduates exhibited a slightly higher proportion of professional-oriented students than academic-oriented students. The median age of the respondents was 35 years (range: 23–41 years). All dermatology graduates transitioned clinical positions, with 35 individuals (57.4 %) having over five years of clinical experience.

Figure 2:

Overview of graduate demographics and achievements. (A) Graduate demographics and (B) accomplishments during the graduate school period, and (C) achievements in position as dermatologists. Abbreviations: SCI, science citation index; IF, impact factor.

The achievements of their graduate studies are shown in Figure 2B and Supplementary Table 2, focusing on research output, student leadership experience, and overall awards. The results revealed that over half (54.1 %) of the participants published one or two research papers in Chinese journals during their academic period, while 12 students (19.7 %) published three or more. Regarding science citation index (SCI) papers, nearly half (47.5 %) of the students had publications as first author. The majority (83.6 %) had a cumulative impact factor (IF) below five for their SCI papers. Approximately half of the students (50.8 %) were involved in national-level research projects (Figure 2B), and a similar proportion (50.8 %) participated in three or more academic conferences (Supplementary Table 2). Additionally, seven dermatology graduate students (11.5 %) held student leadership positions, while 17 individuals (27.8 %) received various honors and awards of various levels during their graduate period.

Discussion

Although the entry requirements for medical practice in China are not high, completing a 5-year undergraduate clinical medical program is sufficient for independent medical work. For medical students with ambitious career aspirations, continuing their studies in a 3-year master’s program or even a 6-year combined master’s and doctoral program remains a necessary path to future professional success. Moreover, as national requirements for graduate education including dermatology specialty continue to rise, the competition pressure for dermatology graduate students has been increasing. On the other hand, high-level medical schools that offer graduate programs also need to recognize the important demand for nurturing future leaders in the field, leading to continuous analysis and reform of teaching objectives and plans [9]. Therefore, we conducted in-depth analysis of associations between several important individual variables of graduates and their career development in the workplace.

Individuals who got promotion successfully tend to be over the age of 35, have more than five years of work experience, and complete an extra three- or six-year doctoral training. Dermatologists who achieved a doctoral degree also tend to work longer hours per week in their position. This suggests that sustained long-term efforts appear to be most crucial factors in achieving professional success as a dermatologist. Additionally, obtaining a Doctor of Medicine degree in graduate studies is crucial for becoming a successful dermatologist in Chinese society. Whether pursuing a professional or research-oriented doctoral degree, obtaining a doctoral qualification signifies the completion of rigorous training in research thinking during the graduate stage and the achievement of corresponding outcomes, such as publication of articles. This not only facilitates entry into top-tier hospital platforms but also benefits career development after graduation. It is worth noting that we found that nearly half (45.9 %) of dermatology graduates had prior work experience before entering graduate school, and 44.3 % of the individuals began their graduate studies at or after the age of 28 (Supplementary Table 1). However, this experience did not have an adverse impact on their future achievements as an outstanding dermatologist (Table 2). When targeting older students, it is imperative to adopt differentiated teaching and training methodologies tailored to each individual. Furthermore, heightened consideration must be given to their personal and emotional needs. Additionally, the training programs should be flexibly adjusted to assist them in effectively managing the potential challenges they may face. This holistic approach ensures that the learning experience is both effective and supportive of their unique requirements.

Unlike dermatology graduates in developed countries who may choose private practice, the most outstanding graduates in China predominantly consider large general hospital systems as their preferred career option due to various factors 10], [11], [12], [13. Doctors in China’s top general hospitals often undertake the task of scientific research and innovation, and the cultivation of dermatologists with research capabilities is an important component of graduate medical education [14, 15]. Our research findings also support that in-depth training of medical research during doctorate study with more than one SCI paper and total IFs higher than five is the key factor for entering top-tier general hospitals (Table 3). Interestingly, in the study by Stephens MR, it was also found that only first-authored and high-quality academic research conducted by dermatology medical students during their schooling was positively correlated with their future academic achievements, while merely publishing case reports was negatively correlated [16]. The training of research critical thinking and methods for clinical doctors have been overlooked in current education management. Actually, they provide useful tools not only for research need but also for solving clinical problems at work. Furthermore, a considerable proportion of graduates express the desire to improve their research abilities in their work, particularly among those who had relatively limited research accomplishments during their graduate studies. These findings emphasize the importance of providing research training for dermatology graduates in the current professional landscape for doctors.

It is noteworthy that male graduate students are significantly more likely than female students to be promoted in administrative positions, teaching positions, and medical positions (Table 3). Importantly, in our study population, females actually account for as much as 85.2 % of dermatology graduates, but the absolute number of females who achieve promotion in the aforementioned fields is quite small. This suggests that female dermatologists may still face various challenges in areas such as administrative management and academic recognition, despite having received comparable educational backgrounds. This phenomenon is also observed among doctors in other medical specialties and in other countries, which reflect the difficulties commonly faced by female physicians in the workplace [17, 18]. To prevent issues caused by gender disparities, we can establish policies that promote a more equitable promotion system, provide leadership development courses specifically for female healthcare workers, and set up dedicated funds to support their research projects. Implementing these measures will aid in eliminating gender discrimination, elevating the status and influence of female medical professionals, and consequently fostering the sustained and healthy development of the entire healthcare sector. Encouragingly, in our surveyed population, female graduates showed no differences compared to male graduates in terms of hospital employment, salary, paper publications, and self-assessment of satisfaction.

Finally, based on the findings of this study, future research could further explore multicenter studies to assess the impact of different regions and hospital levels on the training and academic achievements of dermatologists. Additionally, specific interventions such as mentorship programs or targeted research training that support the career development of female dermatologists could be further investigated. Examining the importance of continuous professional development and its impact on maintaining a competitive edge in the rapidly evolving field of dermatology would also be highly beneficial. These studies could provide valuable insights to improve the quality and effectiveness of dermatology education and training programs in China and other countries.

Limitations

This study has several limitations. The primary limitation is the single-center research design, resulting in a relatively small sample size. Despite being one of the largest centers for awarding dermatology graduate degrees in the central region of China, the scale is still relatively modest. According to relevant statistics from the National Health Commission in 2012, there were approximately 25,500 registered dermatologists in China, with an average of 22.68 % having a master’s degree or above. Estimating the total number of dermatology graduates with a master’s degree or above nationwide to be around 5800, of which the participants in our study constitute only about 1.1 %. Secondly, it is essential to note the retrospective nature of this study, which may introduce certain biases in the analysis and conclusions. Specifically, limitations in obtaining accurate and available information on physicians’ training processes, career trajectories, and other relevant details from past records exist. To mitigate this limitation, various methods of data verification and cross-checking were employed, but the potential impact cannot be entirely eliminated. Besides, incorporating third-party evaluation indicators in future research, such as independent assessments of postgraduate research outputs by external experts to enhance the study’s reliability is essential. Additionally, among the participants in our study, 34.4 % held a Doctor of Medicine degree, indicating a relatively high level of education. However, this may result in an overconcentration of the sample in terms of education level and may not adequately represent the entire physician population, since the participants in this study have a relatively higher education level, compared to that of national average. Therefore, caution should be exercised when generalizing the study conclusions to the overall physician population.

Conclusions

In conclusion, the study revealed that pursuing a doctoral degree after completing master’s training was closely associated with future career achievements in dermatology, while other factors like the age of enrollment or the graduate subtype were less decisive. The research also highlighted the critical role of in-depth research training, particularly the involvement in national projects and the publication of high-quality SCI papers, in shaping professional development. Additionally, male graduates showed a distinct advantage in future promotions to administrative, teaching, and medical titles. These results indicate that in the medical field, the duration and quality of training play a more critical role in career development than factors like enrollment age. It’s crucial to emphasize the implications of these findings for educational practices and policy making. Future research should consider conducting longitudinal studies and exploring specific interventions, such as targeted research training and more equitable evaluation systems, to promote better career development for dermatologists.