China’s ambitious attempt to compress medical specialization into a single three-year window has produced a system that saves time but leaves its trainees caught between two roles they cannot fully occupy at once. A narrative review published in Frontiers in Medicine on 23 October 2026 examines more than ten years of the integration of professional postgraduate education with standardized residency training (SRT), the uniquely Chinese arrangement in which master’s degree candidates simultaneously complete the country’s mandatory residency program. Drawing on literature published between January 2015 and December 2025 in the Chinese database Wanfang Data and the English-language PubMed, a team from the Department of Urology at Peking Union Medical College Hospital concludes that the model has delivered real gains in efficiency while generating structural tensions that piecemeal adjustments cannot resolve.

The story begins in 2014, when the National Health and Family Planning Commission launched the SRT program nationwide, with the Chinese Medical Doctor Association entrusted with developing training curricula and accreditation standards. The system was designed to homogenize the competence of China’s physician workforce, targeting six core domains: professionalism, clinical capability, patient-centered care, communication and collaboration, teaching proficiency, and lifelong learning. Most Chinese medical schools offer a five-year Bachelor of Medicine program, after which graduates must complete three years of standardized residency before practicing independently. The integration model allows a subset of these graduates to enroll in a three-year professional master’s program in which residency training runs concurrently with graduate coursework and thesis research. By contrast, academic master’s students focus on medical research and, if they later want to practice clinically, must complete a separate three-year residency after graduation.

The arithmetic of the integrated pathway explains its appeal. Delivered separately, postgraduate education and residency training would consume six years; merged, they take three, halving both the timeline and the costs for trainees and the state. Professional postgraduates gain substantially richer clinical exposure than they would in a purely academic program, redundant learning is reduced, and employing hospitals can recruit graduates who are ready to work immediately without bearing the cost of post-hoc residency training. Several universities have built continuous “5+3” programs that combine the undergraduate degree with integrated postgraduate residency training and waive the separate master’s entrance examination, while 14 institutions offer eight-year programs and Nanjing Medical University launched a nine-year track in 2019 that folds undergraduate, master’s, and doctoral education together with residency. Yet the review’s authors characterize the integration system as a transitional model unique to China, one whose internal contradictions have become increasingly difficult to ignore.

At the heart of those contradictions is what the authors call the dual identity problem. Postgraduate education falls under medical universities and education authorities, whose priority is the master’s degree; residency training falls under health authorities, whose priority is producing competent independent clinicians. Professional postgraduates are therefore simultaneously “students” and “residents,” subject to two governance systems with different objectives, funding streams, and evaluation logic. The regulatory requirements make the squeeze concrete: within a 36-month residency, clinical training must occupy at least 33 months, during which trainees attend teaching rounds, mortality and morbidity conferences, and mini-lectures, supervise junior learners, complete general and specialty-specific coursework, pass the National Medical Licensing Examination and the SRT completion examination, and produce a clinically oriented degree thesis. What remains for dedicated scientific research is, by the review’s account, insufficient.

The consequences show up in measurable training outcomes. Because rotations scatter trainees across departments, contact with master’s tutors who guide research and thesis work is limited, hindering research progress; conversely, research obligations degrade clinical skill development, and professional postgraduates score lower on clinical practical skills examinations than on theoretical ones. Some training base administrators reportedly allow trainees to shorten clinical rotations to complete graduation theses. A questionnaire survey found that 41.8 percent of professional postgraduates considered their course timetable unreasonable, with classes encroaching on ward rounds, rest periods, and departmental activities. The review also identifies a deeper institutional mismatch: tutor evaluation relies heavily on research output with little weight given to clinical proficiency, pressuring time-poor trainees toward superficial publications and producing what the authors describe as the dual predicament of weak research capabilities and limited clinical competencies.

The dual identity also determines material conditions. Because professional postgraduates hold student status, they pay tuition, receive no salary, and rely solely on postgraduate funding subsidies, prompting calls for national and provincial health and education departments to coordinate toward “equal pay for equal work.” Their student status also delays the practicing physician license, typically obtained only during the first year of residency, a lag that breeds patient distrust and further limits opportunities to practice clinical skills. The workload is heavy: studies cited in the review indicate that three-quarters of professional postgraduates work 50 to 60 hours weekly, and compared with socially recruited residency candidates they show significantly higher depression scores and perceived stress, with academic, research, and employment pressures as the primary stressors. The authors warn that such pressure can feed back into clinical care quality and patient safety.

Structural design flaws compound the identity conflict. Majors are designated down to the third-level discipline at application, so a trainee may commit to urology or general surgery before residency begins, narrowing basic training prematurely; yet the 33-month rotation offers no targeted emphasis on that specific discipline, leaving graduates whose employers classify them by specialty unable to meet the requirements for immediate specialty practice. The fixed three-year master’s timeline also prevents residency duration from being tailored to specialty needs, in contrast to the United States, where residency spans three to eight years depending on the field. Meanwhile, rapid enrollment expansion has outpaced the growth of preceptors and hospital beds, so trainees fail to meet stipulated requirements for managed inpatient beds and clinical operations. The surge has produced crowding-out effects as well: it draws stronger candidates away from academic research programs and limits residency bases’ capacity to recruit socially sourced residents, with some bases enrolling only professional postgraduates.

The pipeline problem begins even earlier. Because selection for professional postgraduate programs does not weigh undergraduates’ daily academic performance, students preparing for the postgraduate entrance examination neglect compulsory clinical internships. In one interview study of five-year clinical medicine students, all respondents expressed strong willingness to participate in their internships and recognized their importance, yet under examination pressure they reallocated an average of 60.3 percent of internship time to exam preparation. They then enter residency with weak clinical skills, making supervisors hesitant to delegate responsibilities and patients reluctant to entrust procedures to them.

Scholars have proposed remedies, and the review assesses them soberly. Dual-tutor arrangements pairing a clinical supervisor with a research supervisor have been suggested, but the supervising tutor does not directly administer clinical rotations, limiting the benefit. Incorporating protected research time into the residency program has been proposed, yet within a fixed three-year window any dedicated research period necessarily encroaches on clinical training, leading some to suggest allowing trainees to extend their program. Other proposals include counting research output in performance appraisals, standardizing guidance across the full clinical research workflow, expanding online and MOOC-based coursework to free time for rotations, guaranteeing bed and procedure quotas, prolonging rotations in specialty-relevant departments, and improving pay through scholarships, grants, and performance bonuses. The authors conclude these measures can partially improve conditions but cannot dissolve the combined clinical-rotation, research, and coursework burden while the training period and competency standards remain fixed.

The review therefore argues that reform must confront the dual identity directly, through either flexible decoupling or complete separation of residency from postgraduate education. Under flexible decoupling, residents would complete SRT first and then decide whether to pursue a master’s degree, with mutual recognition between residency curricula and postgraduate credits and variable training durations by specialty. Complete separation would clarify objectives and responsible entities for each pathway but may prolong training, raise fiscal costs, worsen geographic and socioeconomic inequities, and reduce physician supply for primary-care and resource-scarce regions. International systems offer reference points: United States residency is administered by the Accreditation Council for Graduate Medical Education, residents are legally employees rather than students, research is not mandatory, working hours are capped at 80 per week with at least one rest day, and the Association of American Medical Colleges reported average 2025 stipends of about $68,166 for first-year residents rising to about $94,215 by the senior postgraduate year, with funding flowing through Medicare, Medicaid, and hospital sources. In China, a central government subsidy of RMB 30,000 per resident per year is supplemented provincially, but professional postgraduates are not eligible for the dedicated residency stipends and generally earn less than other residents at the same site. The authors close with a research and policy agenda: standardized measures of clinical competence and research literacy, objective payroll and time-motion data rather than self-report, prospective tracking of burnout, depression, and turnover intention by trainee category, micro-costing of each pathway from government, hospital, and trainee perspectives, and evaluation of workforce retention and regional equity, noting that burnout already affects roughly three-fifths of residents, depressive symptoms about one in four, and nearly half report high turnover intention. Only with such evidence, they argue, can China choose among training pathways on grounds of competence, well-being, cost, and fairness rather than inertia.

Subject of Research: The integration of professional postgraduate education with standardized residency training in China

Article Title: A narrative review of the decade-long integration of professional postgraduate education with standardized residency training in China

Article References: Wang, W., Zhao, X., Zhao, Y., Chen, W., & Wu, X. (2026). A narrative review of the decade-long integration of professional postgraduate education with standardized residency training in China. Frontiers in Medicine, 13, Article 1892608. https://doi.org/10.3389/fmed.2026.1892608

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1892608

Keywords: standardized residency training, professional postgraduate education, China, medical education, dual identity, physician burnout, training reform, residency workload, health policy, graduate medical education, mental health, workforce equity