To the Editor
In China, 3000 m above sea level is always considered as high altitude. China has the largest plateau area in the world, which includes the whole of Tibet, and part of Qinghai, Xinjiang, Yunnan, and Sichuan provinces. The plateau area is 257.2 × 104 km 2 , which accounts for approximately 26.8% of the total area of China. 1 As of 2006, approximately 12 million people were permanently living on the Qinghai-Tibetan Plateau between 2200 m and 5200 m altitude. 2 Most of the population live dispersed around the 3000 m to 4500 m level, but some soldiers live at an altitude of above 5000 m. Therefore, knowing how to manage healthcare on the plateau is an important task for medical workers and all the high altitude population. The former medical education system in China has been documented to be lacking in specific knowledge about high altitude medicine. To improve the level of high altitude medical practitioners, we tried to construct an academic training model, a continuing education program, and a high altitude medical health science education. During the teaching of each level, we focused on different professional skills to build a comprehensive high altitude medical education system.
The purpose of our educational program was threefold. The first goal of our program was to cultivate undergraduate students who fully grasp high altitude medical knowledge and who demonstrate knowledge of advanced clinical techniques and scientific research skills in their academic work. These students entered Third Military Medical University (TMMU) after taking the college entrance examination and meeting or exceeding key undergraduate admission standards. These students had a good foundation, demonstrated an ability to absorb knowledge quickly, and will be the leaders of high altitude medicine in the future. During the actual teaching process, we focused on high altitude medical theory and basic skills of high altitude disease management. After students fully grasp basic information about high altitude medicine, they are ready to be introduced to special incidence diseases of high altitude and common diseases of high altitude, thus laying a solid foundation for their future work on the plateau. 3
The second goal of our educational program was to utilize continuing education to train doctors in the latest developments and approaches to high altitude medical treatments. Many of these students were the backbone of the health units on the plateau; some of them served as leaders in their own units. Most students had junior college qualifications, and the age distribution ranged from 25 to 50 years. These students had sufficient work experience on the highland; most of them had mastered a basic knowledge of high altitude medicine. During their continuing education, we focused on introducing high altitude disease pathogenesis, diagnosis, and new advances in treatment. For example, we introduced the role of sildenafil for antihypoxia and told them of the advantages and disadvantages of this medicine. Through reading the latest research in high altitude medicine, the students can understand the current developmental direction of high altitude medicine. At the same time, some of these students have unique experiences in high altitude disease prevention and treatment and a strong understanding of the most urgent health needs and the real-life circumstances of members of the plateau population. During the teaching process, we also encouraged them to select popular health topics that affect the plateau populations. For example, a student found that urine, red blood cells, and other indicators increase in the permanent plateau population. We helped them analyze the results and summarize the baseline urine data of the permanent plateau population to lay the foundation for overcoming high altitude health problems.
The third goal of our educational program was to utilize science education to bring high altitude medical knowledge to the entire high altitude population. A high altitude medical support service unit was composed of the faculty of TMMU and had a rich knowledge of high altitude medicine. Every year, this unit traveled to Lhasa, Rikaze, Golmud, Thirty Miles Barracks, and Ali, and along the Qinghai-Tibet Road in Tibetan or Xinjiang province. At each stop on the plateau, they delivered lectures on high altitude health and provided answers to various issues about high altitude sickness. Most of these audiences lacked medical knowledge; therefore, during these lectures, simple and vivid words were used to introduce essential knowledge about the prevention and treatment of high altitude sickness. Through this method, high altitude medical knowledge was shared with members of the high altitude population, and they learned how to prevent high altitude disease in their daily lives.
In short, using academic teaching, continuing education, and health education tailored to the audiences' skills, experience, and knowledge base, we built a 3-dimensional high altitude medical education system. Through this system, the high altitude population had the knowledge to diagnose early, treat, and prevent high altitude sickness. The medical student can deal with the many kinds of high altitude disease skillfully, and 99% of employers in the plateau were satisfied with the quality of the high altitude medical students who graduated from TMMU.3,4 The doctors on the plateau understood what was needed on the plateau and found out what will need to be done in the future to prevent and treat high altitude disease better. 5 This methodology showed that the education system brought a large number of high-quality high altitude medical personnel to high altitude medical institutions and greatly improved the level of healthcare on the plateau.