Medical Education in East Asia: Past and Future ed. by Lincoln C. Chen, Michael R. Reich, and Jennifer Ryan (review)

This collection of eight essays were commissioned for the centennial celebration of the China Medical Board (cmb) in 2014. The volume focuses on medical education of physicians for clinical medicine and that of professionals for public health, including nurses, dentists, pharmacists and other health care providers. Part I provides an outline of medical education in East Asia (China, Hong Kong, Taiwan, Japan, and Korea), with emphasis placed on the role of the United States and the cmb started by the Rockefeller Foundation. Part II, titled "Country Cases" include chapters on China, Taiwan, Hong Kong, Japan, and Korea, and Part III has a chapter on "Future Challenges." The volume reflects the intention of cmb, which is to claim its role as a stakeholder in the "spectacular health achievements" of East Asian countries, measured by the longest life spans of their respective citizens.

In Part I: Overview, "History and Development of Medical Education in East Asia," the editors argue that the education of health professionals was the most crucial link between scientific knowledge and good health, therefore the study of medical education necessitates the examination of the institutions that produce and maintain medical knowledge and transform that knowledge into a service. Additionally, the volume editors argue that by the end of the twentieth century statistical health indicators have been spectacular in East Asia: numbers denoting life spans, mortality rates, ratio of medical practitioners to population form the main data for measuring success and progress. Such views of medicine are further expounded in chapter one by J. Ryan and M.B. Bullock tracing the history of the cmb in East Asia from 1950–2000. The cmb started its work in China in 1914 after its experts concluded that the "sick man of Asia" was "ripe" for the introduction of western medical teaching and training (23). The cmb left China in 1949 and continued its work by channeling millions of dollars to shape medical education in Taiwan, Japan, Hong Kong, and Korea, through fellowships, visiting professorships, medical libraries, purchase of equipment and supplies for laboratories, and funds for construction and renovations of buildings. Other beneficiaries of the cmb funds include the Philippines, Vietnam, Singapore, Indonesia, Thailand, and Malaysia. In 1981, the cmb returned to China to continue its work on global health. The framework guiding the cmb's approach to medical education is the 1910 Flexner Report, described in chapter two by J.B. Bump and P.J. Cruickshank. The Flexner Report transformed American medical education by shifting emphasis from clinical practice to basic science and research. The wartime success of medical research in turn influenced US engagement in East Asia from 1950–1970 against the backdrop of Cold War politics, reflecting narrow US interests informed by politics and economics instead of the humanitarian ideals claimed.

Part II includes specific chapters (3–7) on medical education in China, Hong Kong, Taiwan, Japan, and South Korea over the last millennium. In these cases (except for Japan and Taiwan) medical missionaries and subsequently through the cmb, played significant roles in the introduction and continued use of western medical education. Japan adopted a German model adapted with Japanese features during the Meiji period (1868–1910), which was exported to Taiwan and Korea, colonies of the Japanese empire. However, Japan eventually adopted the US model during the American occupation. China was the only East Asian country to adopt a Soviet style medical education between 1952–1965, and actively attempted to integrate Chinese medicine with western medicine throughout the last millennium.

Each chapter delineates how a modern medical educational structure was established, and how that structure reflected the Flexner report's proposal of focusing on basic science and research. Additionally, authors for each chapter identified problems within the existing systems. In many cases, more research...