“PUMC’s Three Treasures”: can their glory remain?

This year, I took on the task of teaching the “Fundamentals of Surgery” course to undergraduate students in the school library. It dawned on me that this marked my first visit to the library in over a decade of working at my current institution.

To be honest, it’s not surprising at all, given that during my university years in the 2010s, I rarely visited the library except for attending the “Medical Informatics” course held there. What truly amazed me was the fact that this library, where the course was held was none other than the library of the Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC)—a library held in the same high regard as the esteemed professors and medical records of Peking Union Medical College (PUMC), the three treasures of PUMC!

But what does this signify, after all?

Before the advent of the Internet, access to professional information was limited, and academic journals in the library undoubtedly served as the best way to stay updated with the latest international research. The library of the CAMS & PUMC, renowned for its extensive collection of journals, had amassed over 75,000 books and more than 400 world-class medical journals since the 1940s. This undoubtedly reflected PUMC’s leading position in the Chinese medical field, earning the library a well-deserved place among the “Three Treasures of PUMC”. It is said that back in the day, individuals from different regions of the country frequently traveled to Beijing solely to conduct research with medical information at the library.

However, the Internet has diminished the importance of libraries over time, and due to the exponential growth in the number of journals, it has become challenging for any single library to claim to have a truly “comprehensive” collection. During the COVID-19 pandemic, the new form of professional information dissemination called “pre-published”, bypassing the traditional peer-review process of journals, gained more attention and recognition. This further altered the means of accessing professional information and had a great impact on traditional libraries. For today’s medical students, the library perhaps transitioned into more of a study space rather than a place for acquiring knowledge.

In fact, as the new era approaches, traditions are often reluctantly abandoned. Given this consideration, can the library still be regarded as one of the “Three Treasures of PUMC”?

A renowned medical education expert saying, “All rules are meant to be broken.” Not only the library, but medical records and esteemed professors all encounter challenges to varying degrees after a century of PUMC’s establishment.

The esteemed professors of PUMC once represented an unparalleled legend in the history of medical development in China. Nine out of the first twelve founding presidents of the Chinese Medical Association’s specialty societies hailed from PUMC. In 1955, two-thirds of the medical members among the initial members of the Chinese Academy of Sciences were from PUMC. With over 50 academicians and esteemed professors gathered throughout the years, they epitomized PUMC’s unquestionable standing in the Chinese medical field.

However, in light of the rapid advancements in medical technology and shifting ideologies, the clinical experience and perspectives offered by esteemed professors carry less weight in today’s context, as medical education no longer relies exclusively on mentorship from professors. This raises the question of how we can truly acknowledge the value that esteemed professors bring.

Regarding medical records, the extensive collection of records of renowned individuals such as Sun Yat-sen, Soong Ching-ling, and Liang Qichao, among others, has played a crucial role in shaping the unique narrative of PUMC in the history of Chinese medicine. Furthermore, these records encompass numerous accounts documenting challenging and rare diseases, including notable instances of being the first case in China or even the world. These records constitute invaluable treasures that are both scarce and impossible to replicate on a global scale.

However, with the rise of information technology and the shift towards paperless records, along with the expansion of hospitals, shortened average length of hospital stays, and increased turnover rates, the declining quality of clinical medical records become a genuine concern, undermining the very foundation of the value of medical records.

So, what is the value of medical records?

Records that remain dormant hold no value. Medical records serve as the fundamental raw material for clinical medicine, scientific research, and education. Through summarization, integration, extraction, and synthesis, they embody the clinical value of records. During my student days, access to records was necessary for conducting clinical research. Standing before the vast archives of medical records in the Medical Records Department, one of the “Three Treasures of PUMC”, left a lasting impact on me.

However, my younger colleagues will no longer experience such an impact, as information technology no longer requires delving into stacks of dated archives. Yet, information technology should not merely involve digitization but also provide efficient information organization. The extent to which information technology is utilized determines the value of medical records.

Imagine when you mention a surgical procedure, you can immediately retrieve a complete collection of basic information regarding all the patients who have undergone that surgery within a specific period. This collection would provide details like the average amount of bleeding during the operation, the duration of the surgery, any postoperative complications, and the average duration of hospitalization, etc. I firmly believe that such an advancement would be a remarkable breakthrough, exemplifying the power of the digital era.

Consequently, the question is not whether the “Three Treasures of PUMC” still hold significance but rather how to apply and develop them in this new era.

Similarly, the integration of the library’s information system with the medical records system holds immense potential, transforming passive information resources into proactive providers. This integration can revolutionize clinical workflows and processes.

Likewise, information technology can address the issue of declining quality in medical records. The original intention of structured medical records is to standardize and improve clinical work efficiency while ensuring the integrity of key information and providing a foundation for subsequent data analysis and integration.

At this point, I can’t help but feel that writing medical records no longer requires the presence of doctors. It seems to become a mere data entry task, or perhaps artificial intelligence could do it better.

However, is that truly the case? My experiences during my student days have made me doubt the content I wrote myself.

During my internal medicine rotation, we were required to complete twelve handwritten medical records, and each student was assigned a senior professor as a “medical record mentor” to guide and revise our writing. I didn’t anticipate the mentor to take this assignment so seriously. When I nervously handed in my first writing records, she did not respond right away. Instead, she told me that she would carefully review it and then arrange a specific time to discuss its details with me.

“You need to work more on differential diagnosis”, said my medical record mentor during our scheduled discussion. Her words surprised me and left me perplexed. Isn’t that how a differential diagnosis is supposed to be written?

“You wrote the differential diagnosis based solely on what the textbooks state. The textbooks provide a list of diseases for consideration in the differential diagnosis, and you simply include those diseases for differentiation. However, patients don’t get sick according to the textbook, do they? The process of writing the differential diagnosis involves reflecting on our clinical thinking based on the particular patient. What symptoms, signs, and test results does the patient exhibit? Based on these factors, what diseases might be indicated? And which symptoms, signs, and test results support or contradict this diagnosis? That’s the true essence of a differential diagnosis.”

As I observed the meticulous red markings on the record and listened to explanations from my mentor, I realized for the first time the significance of medical records and the role of esteemed professors in the “Three Treasures of PUMC”.

Medical records go beyond mere documentation; they serve as a training process that nurtures rigorous and practical clinical thinking when writing. They act as teaching tools, and they represent the outcomes of this educational approach. Similarly, the term “professor” does not simply denote academic authority; it embodies the spirit of excellence in medicine and genuine care for patients that has been passed down through generations of PUMC professors through teaching. Their unwavering commitment to rigorous and genuine medical practice, coupled with their responsibilities in patient care, represents the enduring and irreplaceable spiritual legacy left behind by esteemed professors.

The “Three Treasures of PUMC” are concrete yet abstract. Their manifestation may change with time. For instance, this year I lecture in the library because a portion of the library was transformed into a new skills training center.

However, the spiritual core of the “Three Treasures of PUMC” remains. When I participate in ward rounds, sometimes I naturally hold the patient’s hand, just as my teachers used to do, which represents the warmth of medicine as a part of PUMC’s patient-centered spirit.

Therefore, as I pen these words to delve into the “Three Treasures of PUMC”, the discussion should not be limited to uncovering their inherent meaning. It should also delve into how to find the value of the “Three Treasures of PUMC” in today’s medical society and whether new “Three Treasures of PUMC” should be established.

This discussion is also about PUMC, once the supreme medical institution in China, how does it define its own uniqueness and establish its standing in the field of Chinese and even global medicine today?

As someone who has left PUMC and now works in a teaching hospital of another medical institution, I possess mixed perspectives. On one hand, I feel that the progress of various medical schools and teaching hospitals make PUMC no longer the sole outstanding institution. This is not a negative outcome for medical education in China. After all, in a country with a population of 1.4 billion, it would be abnormal to rely solely on one institution like PUMC. On the other hand, I sincerely hope that PUMC can once again lead Chinese medical education in this new era, continuing its legendary journey.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Hepatobiliary Surgery and Nutrition. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-23-331/coif). The author has no conflicts of interest to declare.

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