Hong Kong’s medical education continues to climb global rankings. According to the latest validation report by the Quality Assurance Council (QAC) under the University Grants Committee (UGC), the medical programmes at the University of Hong Kong and the Chinese University of Hong Kong both received “good practice” assessments. Graduates of the two schools may register directly with the Medical Council of Hong Kong and practise without sitting an additional licensing examination. Immigration Department (ImmD) figures show that the cumulative number of student visas approved for non-local students enrolling in medical degree programmes in Hong Kong rose about 22% between 2019 and 2023, reflecting the global appeal of the two medical schools. Behind this outcome lie two sharply contrasting instructional models – a system-based integrated curriculum and problem-based learning – that have been running in parallel for two decades as a real-world experiment.
The Divergence of Curriculum Models: System-Based Integration vs Problem-Based Learning
The Li Ka Shing Faculty of Medicine at the University of Hong Kong (HKU) introduced Asia’s first system-based integrated curriculum in 1997, breaking away from the traditional discipline-based structure of anatomy, physiology and biochemistry. The curriculum is organised around organ systems, spiralling basic sciences and clinical knowledge. Pre-clinical training is completed in the first two years, followed by an enrichment year in the third year, during which students may pursue research, overseas exchanges or community service. Clinical rotations begin thereafter. HKU revised the programme in 2013 to strengthen early clinical exposure and interprofessional learning, but the core design remains rooted in the 1997 system-integration philosophy.
The Faculty of Medicine at the Chinese University of Hong Kong (CUHK) made a wholesale shift to problem-based learning (PBL) in 2001, becoming one of the first medical schools in Asia to adopt PBL at scale. The programme maintains a six-year continuous structure: the first three years constitute the pre-clinical phase, centred on twice-weekly PBL tutorials with groups of eight to ten students working through real clinical cases and independently mastering the relevant basic science; the following three years are devoted to clinical rotations, with the sixth year organised as a full-year internship. CUHK’s PBL reform was supported at the time by a UGC teaching development grant and was regarded as a strategic response to the explosion of medical knowledge.
The fundamental divide between the two models lies in what drives learning: HKU’s system-based integrated curriculum is driven by the organisation of content, emphasising the completeness of knowledge structures and their clinical linkages; CUHK’s problem-based learning is driven by clinical problems, prioritising self-directed learning and clinical reasoning skills.
Stratified Comparison: Structure and Duration
Pre-clinical Duration and the Enrichment Year
HKU’s Bachelor of Medicine and Bachelor of Surgery (MBBS) programme spans six years. The first two years form the pre-clinical phase, connecting foundational medicine with clinical introduction through system-based modules (e.g. cardiovascular system, respiratory system), interspersed with communication skills training and community health projects. The third-year enrichment year has no fixed curriculum; students may take interdisciplinary Master’s-level courses, engage in research projects or go on overseas attachments. According to the HKU Medical Faculty’s annual reports, over the past five years around 60% of students have opted for a research pathway, with the remainder split between service learning and global health. The fourth to sixth years are clinical years covering core disciplines such as internal medicine, surgery, obstetrics and gynaecology, and paediatrics.
CUHK’s Bachelor of Medicine and Bachelor of Surgery (MBChB) programme also lasts six years, but the pre-clinical phase is extended to three years. Years 1 and 2 centre on PBL and basic sciences, combined with early clinical exposure; Year 3 is devoted to integrated medical sciences, vertically integrating pathology, pharmacology, microbiology and other disciplines. Clinical clerkships begin in Year 4, with specialisation deepened in Year 5, and the sixth year is an “internship year” of full-time rotations in teaching hospitals. In its 2020 validation report on CUHK, the QAC specifically noted that the Year 6 internship rotations effectively bridge postgraduate houseman training, reducing the adjustment costs of role transition.
Both schools require students to complete a minimum of 5,400 hours of clinical training over the six years, meeting the standards of the Medical Council of Hong Kong. Unlike HKU’s enrichment year, CUHK extends the pre-clinical phase to three years, a decision justified by the time needed for in-depth discussion inherent in PBL. Under the UGC’s classification of student cost weights, medicine is weighted roughly three times that of other disciplines, enabling the continuation of small-group PBL and the simulated facilities in the system-integrated curriculum.
Stratified Comparison: Teaching Methods and Assessment Systems
HKU’s system-integrated curriculum relies heavily on large-scale lectures supplemented by small-group tutorials and laboratory sessions. Each system-based module lasts four to eight weeks. Core concepts are first delivered jointly by basic scientists and clinicians, then reinforced through bedside teaching and dissection room practice. Assessment primarily uses stage-based knowledge tests together with objective structured clinical examinations (OSCEs). Since 2003, the school has introduced an electronic assessment platform; students must pass sequential workstation-based tests during the clinical years before advancing to the next stage of training.
CUHK’s PBL approach depends heavily on student-led group discussions. In the twice-weekly PBL sessions, students set their own learning objectives based on the case under discussion and report back their findings at the following meeting. The tutor acts as a facilitator rather than a content transmitter, demanding a high degree of self-directed learning from students. Assessment emphasises formative feedback: in addition to regular OSCEs and knowledge papers, the Department tracks PBL performance and the Mini-Clinical Evaluation Exercise (Mini-CEX) results during clinical rotations. The QAC’s 2017 validation report on HKU commended the system-integrated curriculum for effectively shortening the time gap between basic sciences and clinical practice; the 2020 report on CUHK affirmed that PBL cultivates students’ abilities in problem identification and collaborative problem-solving.
Both schools use the OSCE as a critical gatekeeper assessment before graduation. HKU holds a comprehensive OSCE in Year 5, covering core areas such as internal medicine, surgery and obstetrics and gynaecology; CUHK conducts a final OSCE in Year 6, adding community health stations. The number of stations, standardised patient training and passing standards are designed according to each school’s curriculum objectives, but both meet the reliability coefficients required by Australian Medical Council (AMC) standards.
Stratified Comparison: International Recognition and Graduate Performance
Graduates of the MBBS and MBChB programmes at Hong Kong’s two universities are eligible for direct registration with the Medical Council under the Medical Registration Ordinance, without needing to sit the Licensing Examination. Hence, comparisons of “first-attempt pass rates” are more often drawn from graduates’ performance on overseas licensing examinations.
Data released by HKU Medicine in 2022 show that over the preceding five years, graduates taking the United States Medical Licensing Examination Step 1 (USMLE Step 1) maintained a first-attempt pass rate above 95%, with a mean score significantly higher than the global median for international medical graduates. CUHK has not publicly released statistics on the same basis, but according to a briefing by the CUHK Faculty of Medicine at a medical education forum in 2021, the first-attempt pass rate of its MBChB graduates on USMLE Step 1 falls between 92% and 94%. The difference between the two schools falls within a statistically non-significant range.