UCLA Health System Foreign Exchange

By Justin Berman. Photography by James Bollen.

Originally published by U Magazine

RUSHING DOWN THE HALL of the Second Affiliated Hospital of Zhejiang University School of Medicine wearing white lab coats and clutching computers, Qian Huan and Hu Wen look like the type of serious, hard-working medical students who are about to graduate and begin their careers as doctors. It’s only when they begin recounting their 10-week exchange program at Ronald Reagan UCLA Medical Center last year that they start to giggle like teenagers, even when describing the endless hunt for housing near campus.

“Renting an apartment in L.A. can be a nightmare,” says Qian, a 25-year-old dermatology major, sounding as world-weary as someone who has lived in Los Angeles her whole life. “So we tried to walk every street around campus. That was tough.”

On the day before they were to begin their rotations, Qian, Hu and their four classmates from Zhejiang University finally found a house. “It was quite near the hospital, so we can walk there in 10 minutes and we can stay up late,” says Qian, trailing off into more giggles. “All around us were fraternities, so that was quite new to us.”

Of course, this wasn’t a typical foreign-exchange program that’s more about the partying than it is the classes. The visit by the Zhejiang University students, all of whom are fluent in English and at the top of their class, was part of a much broader and more involved collaboration between UCLA and Zhejiang (pronounced JEH - jee-ahng) University in the eastern Chinese city of Hangzhou that could become the model for other universities seeking to bridge the educational and medical-research gap between the U.S. and China.

Driven by the mutual desire to boost their competitiveness in a rapidly globalizing healthcare industry, the two schools formed a partnership several years ago that sought to connect not only the academic sides of their institutions, but also the clinical functions of their hospitals. For Zhejiang University, the goal was simple: to improve its curriculum and hospital standards so it could one-day join the elite club of the world’s best medical universities and healthcare systems. “We believe that through a collaboration with such a world-class university as UCLA , it can bring our level up and improve our hospital to be a world-recognized hospital,” says Wang Jian-an, M.D., Ph.D., president of the Second Affiliated Hospital. “Bit by bit, we can change our behavior and style of thinking and how to work and make us synchronized with the world.”

UCLA had a very different motivation; it felt that in order to remain relevant in the new global order, it would need to start looking outward in a significant way. “The great medical schools of the 21st century are going to be international,” says Tom Rosenthal, M.D., chief medical officer for UCLA Health System. “In 20 years, we’re not just going to be competing to be among the top five or top 10 in the United States, we’re going to be competing to be one of the top five or top 10 in the world, and you’re not going to achieve that without having international presence.”

FORMING THAT PRESENCE IN HANGZHOU had as much to do with personal connections as with strategy on UCLA ’s part. Zhejiang University, located on a sprawling campus of tree-lined boulevards and modern high-rises built on farmland outside the city, has one of China’s top engineering programs, but it has not especially been known for its medical school, which it only acquired 12 years ago. Since the merging, the medical school has been evolving and improving. UCLA ’s engagement with the school began in the mid- 2000s with one of UCLA ’s professors of molecular and medical pharmacology, Ren Sun, Ph.D., who was born in Hangzhou. After arranging a few student exchanges with Zhejiang University, Dr. Sun met with the then-president of the university, Pan Yunhe, who had been an exchange student at UCLA himself in the 1980s, and they began discussing the possibility of Zhejiang University using UCLA ’s curriculum to train its students. Before settling on the partnership with Zhejiang University, however, UCLA did reach out to the top medical schools in China to gauge their interest in collaborating. The response was surprising. Other schools showed little interest, perhaps because they were not inclined to change their systems, but Zhejiang University had signaled its desire right away, Dr. Rosenthal says. “There was a lot of enthusiasm of how a relationship with UCLA could enhance what they were trying to accomplish in their schools and hospitals and in their city,” he adds.

Specifically, Zhejiang University wanted to revamp the entire way of learning at its medical school. The traditional educational model in China is based on rote learning: Students memorize the lessons in their books and their lecture notes and then regurgitate the information on their exams. There is very little room for creativity or interaction with one another.

The UCLA system, by comparison, is centered on problem-based learning (PBL). In addition to attending lectures, students are given a specific problem or case that they are tasked with solving, so they have to “go out (and) acquire the knowledge rather than the knowledge being downloaded in the classroom to the student,” Dr. Sun says. “That is fundamentally different from the education philosophy and the methodology in China.” The Chinese were also impressed by UCLA ’s integrated curriculum, in which individual courses like anatomy and biochemistry have been replaced by three-to-12-week “blocks” of related subjects, such as a grouping together of the respiratory, renal and cardiac systems.

Considering the magnitude of adopting UCLA ’s entire curriculum, Zhejiang University devoted several years to the project, sending batches of professors to UCLA for two-month stints to participate in lectures and experiments and observe problem-based learning in action.

“They rented a few apartments in Westwood, and one group would trade out for the next group,” says LuAnn Wilkerson, Ed.D,, senior associate dean for medical education in the David Geffen School of Medicine at UCLA . “Our courses occur one block at a time, so they could really concentrate on how everything in this course fits together. So by the end of the year, they had site-visited the entire curriculum that they wished to adopt.”

When they returned to China, the professors began translating the curriculum and making necessary adjustments, moving certain courses up in the schedule, for instance, to accommodate the different educational backgrounds of the Chinese students, says Xia Qiang, M.D., Ph.D., chairman of the Department of Physiology at Zhejiang University and one of the professors who visited UCLA . Then, after training other faculty in the new approach, the system was implemented in the fall of 2009. Dr. Xia says they are already seeing the results: On exams in February, the students using the new curriculum outperformed students learning in the traditional method by a sizeable margin. “It is very encouraging,” he says.

“PBL is very effective in learning, especially in medical education, because it can stimulate the students to learn by themselves,” he adds. “It’s actually an intrinsic, driving force to promote students to study. They just want to study more.”

That’s an easy claim for an administrator to make, but the students say as much themselves. “There’s teamwork – we solve problems together,” says Liang Luo, a 25-year-old in the sixth year of the medical-school program. “If we had to do this one by one, all by ourselves, it would be difficult. And we can learn from each other in the process. It’s a motivation for learning.”

Her classmate, 25-year-old Zhou Yijiang, says that although the students still have a limited number of lectures each week, they are always related to the PBL sessions, creating a better overall educational experience. “We are combining the new way and the old way,” he explains. “The old way still exists, but with the adding of PBL, we can learn in the big classes more efficiently and in a more goal-oriented way.”

Zhejiang University officials realize, however, that there is only so much that can be taught in the classroom, which is why the collaboration also includes on-the-job training in U.S. hospitals for the lucky few chosen to participate in the 10-week UCLA exchange program. One of the elements of the UCLA educational system that’s been hardest to export to China is the focus on developing doctor-patient relationships. “That’s a very important and critical reason why we want to work with UCLA , to change the behavior and working style of our doctors,” says Dr. Wang. “However, this cannot be done in one day or one week, just by one visit or two visits. It’s a long-term thing, and it needs to be changed gradually. That’s why we want to send our students there.”

Hu Wen, one of the students who went to Los Angeles last year, says she was struck by the level of interaction between doctors and patients in the U.S. “When we’re in the clinic in your country, first the patient is seen by the resident, then the resident goes to the attending and then they go back together to see the patient again,” she says. “But here, we don’t have that much time. Our GI doctor sees almost 100 patients in one day.”

"Patients in the U.S. know their diseases a lot better, too,” adds her classmate, Qian Huan, the dermatology student. “They do research before they see the doctor, so they can tell him or her their symptoms and the names of their drugs. But here, doctors have to spend a lot of time educating patients. Sometimes we don’t have so much time.”

CHINESE HOSPITALS ARE INDEED CHAOTIC PLACES. On a recent Wednesday at the Second Affiliated Hospital of Zhejiang University, dozens of people jostled in line to pick up their medicine at the pharmacy, while others waited in queues to register or pay for their visits. Some patients carried suitcases and were accompanied by family members, a sign they’d traveled great distances to see a doctor and would camp out in the hospital until they received treatment. High-tech machines helped alleviate some of the confusion. In one corner, patients scanned the receipts from their doctor visits into machines that would instantly spit out the results of their exams. Another touch-screen monitor provided short bios on all of the specialists, directing patients where to find them.

Chen Gongxiang, Ph.D., the director of the hospital’s Center for Clinical Laboratories, says the Chinese healthcare system faces two main challenges: the sheer number of people demanding better treatment in the country and a lack of resources and training to provide that kind of quality care. After Zhejiang University’s medical school began working with UCLA to improve its curriculum, Dr. Chen says it was only natural for the Second Affiliated Hospital to form a partnership with Ronald Reagan UCLA Medical Center to try to address the latter problem and bring the level of its care up to U.S. standards, as well.

Sensing an opportunity to someday forge a more symbiotic relationship with Zhejiang University, UCLA agreed to share its expertise, starting with the development of a joint diagnostic center. Operational since last October, the center has already helped Zhejiang University doctors diagnose some 100 cases. The system is remarkably fast, given the technological hurdles that needed to be overcome: After a doctor in Hangzhou digitizes the patient’s specimen slide, it is sent electronically to UCLA, where a pathologist reviews the case and either makes a diagnosis or sets up a teleconference with the Hangzhou doctor to ask further questions or request additional tests. The aim is to finish the job in three days.

“All the treatments, remedies, therapies start from the diagnosis. If you have a correct diagnosis, then you can have better treatment,” says Dr. Chen. “For the Chinese doctors, they’ll have more opportunities to learn U.S. ways, U.S. systems, and they can change their habits of working and improve their skills.”

For UCLA, the hope is for a future collaboration with the Second Affiliated Hospital in clinical research and perhaps in the future, even a joint venture, says Dr. Sun. The Chinese government recently relaxed its rules on foreign investment in government-run hospitals, allowing overseas hospitals to invest more capital in joint ventures and set up their own wholly owned private hospitals on a trial basis. “Once diagnosis (at Zhejiang University) is standardized according to American standards, then we can expand into clinical research. And then we can expand into clinical service,” Dr. Sun says.

“Someday we might build a hospital together with a partner, with Zhejiang University,” he continues. “That’s our goal. We’re moving toward that direction.”

Eventually, UCLA would also like to expand this type of partnership elsewhere in China and other Asian countries. “We’ve got a couple of other institutions that have expressed interest in having this kind of relationship,” says Dr. Rosenthal. “The next thing would probably be to see if any of the things we are doing in Hangzhou are exportable to other places, to see what part of what we are doing is franchisable.”

But that could be far down the road, Dr. Sun notes. The first priority is to develop a functioning model. “Once we work out the ins and outs with one university, we can expand it. But at this moment, we’re concentrating on one place to make it work well. And then it will have a significant social impact for people on both sides.”

Based in Shanghai, China, Justin Bergman is a correspondent for the British magazine Monocle and a regular contributor to TIME, China Economic Review and The New York Times.

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