Current status and future perspectives on standardized training for laboratory medicine resident physicians in China

Training objectives

Rooted in the national standards for residency education and shaped by six core competencies. The six core competencies required in specialist physician standardized training include: professionalism; medical knowledge and skills; patient care; communication and collaboration; teaching ability; lifelong learning and self-improvement. The program aims to produce laboratory physicians who can independently and proficiently manage clinical responsibilities. Residents are expected to master both clinical and laboratory medical knowledge, perform key laboratory procedures, interpret test results with precision, and provide expert diagnostic and therapeutic consultations. Additionally, ethical conduct, humanistic values, research literacy, and teaching capabilities are emphasized as integral components of professional development.

Basic conditions of the training base

The hospital must have at least 1,500 beds in total and an annual outpatient volume of no less than 1,000,000 visits. The average daily number of specimens tested should be no less than 2,000. The Department of Laboratory Medicine should include the following subspecialties: Clinical Hematology and Body Fluids, Clinical Biochemistry, Clinical Immunology, Clinical Microbiology, and Clinical Cytology and Molecular Genetics.

The types of diseases covered by the clinical departments for rotation must comply with the requirements specified in the Standards for Standardized Residency Training Bases and the Standards and Requirements for the Content of Standardized Residency Training in Laboratory Medicine. The variety and volume of laboratory tests performed, as well as the corresponding instruments and equipment, must meet the detailed requirements for Laboratory Medicine outlined in the Standards for Standardized Residency Training Bases.

The training base must be equipped with demonstration classrooms, digital projection equipment, and full-text databases and retrieval platforms for Chinese and English electronic journals.

Training methods

The training spans 36 months and adopts a rotation-based structure covering both clinical and laboratory disciplines (Figure 1):

Figure 1:

Clinical laboratory physician training program rotation schedule.

Clinical Rotations (12 months): Residents rotate through internal medicine subspecialties, such as cardiology, nephrology, respiratory medicine, gastroenterology, endocrinology, and hematology, to build foundational clinical skills.

Laboratory Rotations (21 months): Training encompasses clinical hematology and body fluids, biochemistry, immunology, microbiology, and molecular genetics, with residents gaining practical experience in core laboratory techniques and quality assurance.

Flexible Rotations (3 months): These are tailored for specialized learning or supplementation.

Throughout the program, residents engage in diverse activities – patient care, laboratory practice, theoretical sessions, case discussions, and teaching rounds. Junior residents guide interns, while senior residents mentor juniors, creating a collaborative and hierarchical learning environment.

Training content and progression

Year 1: Focuses on developing clinical proficiency in internal medicine. Residents are trained to understand the diagnostic and therapeutic workflows of prevalent diseases, including related laboratory investigations.

Year 2: Residents begin formal training in laboratory medicine, acquiring basic laboratory techniques under the supervision of experienced mentors. Rotations span key laboratory subspecialties.

Year 3: Emphasizes integration of clinical and laboratory knowledge. Residents take part in ward rounds, case reviews, and multidisciplinary consultations. Rotations include advanced topics such as cytogenetics and molecular diagnostics.

Training courses

According to the guidelines for standardized residency training teaching activities, specific requirements are set for the frequency and format of training courses. The training includes departmental orientation and rotation induction, image reading sessions, case discussions, laboratory report interpretation, and mini-lectures.

Training trainer

Supervising instructors must hold a medical undergraduate degree or above and possess at least three years of experience as an attending physician (or senior laboratory technician) with a professional technical title. They must have at least five years of working experience in the Department of Laboratory Medicine and a minimum period of practice in the relevant subspecialty they supervise, such as at least four years in Clinical Hematology and Body Fluids, three years in Clinical Biochemistry and Immunology, five years in Clinical Microbiology, or three years in Clinical Cytology and Molecular Genetics.

Each resident must be assigned a dedicated supervising instructor as their mentor, who is responsible for providing full-process guidance throughout the training period. Before starting their role, supervising instructors must participate in institution-level faculty training, with a 100 % training completion rate, and must hold a valid faculty certification. They are also required to continuously engage in continuing education to enhance their teaching abilities. An annual evaluation of each supervising instructor’s teaching performance must be conducted at least once every year.

Training evaluation

A comprehensive evaluation system is employed, including daily assessments, periodic reviews, and annual examinations. Routine assessments include evaluation of medical ethics and professionalism, clinical professional conduct, attendance, clinical practice competence, completion of training indicators, participation in academic learning activities, as well as the implementation of formative evaluations. Relevant records and original documentation must be complete, authentic, and properly maintained. Rotation assessments must have detailed implementation guidelines. The assessment content should cover both theoretical knowledge and practical skills, reflect the specialty’s characteristics and competency requirements for the position, and align with the concept of progressive training by levels. The assessment format must be standardized, with complete original documentation, and must be reviewed and signed by the teaching group and the group leader of the specialty base. Annual assessments must have implementation guidelines that align with the specialty. The content should include personal summaries, theoretical knowledge, practical skills, and comprehensive evaluations, providing an accurate and thorough reflection of the resident’s annual training performance, while highlighting the specialty’s characteristics and the progressive training requirements by level.

The assessment matrix covers theoretical knowledge, clinical competencies, and case-based performance. Upon successful completion of all required training rotations and assessments during the standardized residency program, residents must pass the National Medical Licensing Examination, which evaluates their comprehensive medical knowledge and clinical competence. In addition, they must pass the final exit examination organized by nation, which typically includes a theoretical exam and a practical clinical skills assessment, ensuring that trainees meet the required standards of independent practice in their specialty.

After passing both the national licensing exam and the program’s final certification assessment, residents are awarded a nationally recognized Residency Completion Certificate and the National Medical Practitioner Qualification Certificate (medical license). Holding this license is mandatory for registration on the national medical practitioner registry, which is a legal prerequisite for practicing medicine independently in China. Only registered physicians listed in the national database are authorized to provide medical services, and assume full responsibility for patient care (Figure 2).

Figure 2:

Assessment and certification process for clinical laboratory physician training program.

Standardized framework

Since 2014, a unified structure for training objectives, curricula, and evaluation methods has promoted consistent national standards. This has helped ensure equitable development across institutions and improved the overall quality of training nationwide.

Workforce development

Thousands of residents trained through this program now serve in diverse healthcare settings, contributing to improved diagnostic accuracy, enhanced patient care, and better treatment outcomes.

Academic and research contributions

The training program encourages active participation in research, publications, and academic activities. These initiatives foster innovation and elevate China’s global presence in the field of laboratory medicine.

Disparities across training bases

Training quality varies significantly due to unequal resource distribution. Grassroots institutions often lack advanced equipment, experienced faculty, and complex case exposure, which can hinder training effectiveness.

Outdated curriculum and clinical relevance

Rapid innovations in diagnostics often outpace curriculum updates. Moreover, current training may insufficiently address interdisciplinary collaboration or critical thinking – both essential in the era of precision medicine.

Faculty shortages

There is a lack of well-trained educators proficient in both clinical practice and teaching methodologies. Many instructors focus primarily on clinical responsibilities and lack formal pedagogical training.

Inconsistent evaluation standards

Although a multi-level assessment system is in place, the emphasis often skews toward theoretical knowledge, with less focus on clinical reasoning or decision-making. Regional inconsistencies in evaluation practices further impact fairness and reliability.

Strengthening training bases

Invest in infrastructure and faculty at grassroots institutions.

Foster partnerships between tertiary hospitals and community facilities.

Implement regular audits and dynamic evaluation systems to maintain training quality.

Curriculum modernization

Regularly update content to reflect cutting-edge technologies and clinical practices.

Integrate multidisciplinary learning to encourage broader clinical thinking and collaboration.

Faculty development

Establish structured faculty development programs focused on teaching methodologies.

Promote innovation in education through pedagogical research and problem-based learning.

Assessment reform

Align assessments with practical decision-making and clinical integration.

Standardize evaluation criteria and ensure fair implementation nationwide.

Technology integration

Develop digital platforms for training, assessment, and resource sharing.

Leverage telemedicine and e-learning to enhance flexibility and accessibility.