Who will be wielding the lancet for China's patients in the future?

In recognition of this fact, the Chinese government has made notable recent efforts to standardise surgical training programmes, as part of the National Health and Family Planning Commission's (NHFPC) complete set of model residency training programmes.2 Although the effort is laudable, the lack of credible mandatory minimums for procedures done, and of clear quality assurance systems, has left a major training gap unaddressed. Taking cataract surgery as an example, a recent study that included some of China's best known eye hospitals showed that mainland Chinese ophthalmology residents had undertaken a median of zero independent cataract operations during their training, compared with 100 cases for trainees in the Hong Kong Special Administrative Region (HKSAR) over a similar period.3 Differences in national requirements partly explain this finding: the current minimum standard for cataract surgeries is 100 cases by the completion of residency training in HKSAR,4 86 in the USA,5 120 in Singapore,6 and 350 in the UK,7 whereas the required number of cases for residents in training in China is only 15 according to regulations recently published by the Chinese NHFPC.8 About 90% of US ophthalmology residents exceed the national target,9 which does not seem to be the case in China.3 Differing approaches to enforcement of existing standards also appear to play a role: in the USA,10 HKSAR,11 and other countries, programmes not providing adequate training for residents risk losing accreditation, but the same consequences do not generally exist in China.