Chinese medical students’ agreement with and fulfillment of the Physician Charter

Ning Ding, Dan Yan, Honghe Li, Yuan Ma, Deliang Wen

Although it has been nearly 15 years since the Medical Professionalism in the New Millennium: A Physician Charter (the Physician Charter) was proposed to reaffirm medical professionalism in response to the new challenges in healthcare delivery in the new century, the manner in which Chinese medical students agree with and fulfill the principles and responsibilities of professionalism defined in the Physician Charter still remains unknown. In March 2016, 748 fifth-year medical students from China Medical University (CMU) participated in a survey in which they indicated their rate of agreement with and manner of fulfillment of the principles and responsibilities defined in the Physician Charter using a 10-point Likert scale. The data were then analyzed by t-tests, exploratory factor analysis, and multiple linear regressions. The total score of agreement with the Physician Charter was significantly higher than that of fulfillment (p < 0.001). The largest difference between agreement and fulfillment scores were with the principle of social justice (P3), commitments to improving access to care (R6), and a just distribution of finite resources (R7). Exploratory factor analysis distinguished two principles - primacy of patient welfare (P1) and patient autonomy (P2) - from the others in terms of the gap between agreement and fulfillment. This is partially because the proportion of students who rated agreement lower than fulfillment of P1 or P2 was much higher than it was for any other principle or responsibility. Additionally, multiple linear regressions show that students who are enrolled in a five-year program or who was registered as a rural resident (i.e. holding a rural Hukou) had significantly higher scores of agreement, but not fulfillment. Chinese medical students endorsed the Physician Charter and its core values of medical professionalism, although they felt difficult to fulfill in practice. Medical educators and the health authority should act together to support and foster professional values.