Enrollment Problems and Training Models for Training Postgraduate Students in Clinical Laboratory Diagnosis (Professional Degree) During the “Four Certificates in One” Era in China

Ziyi Yan,1,2 Yunhan Fu,1,3 Yali Cui,1,4,5 Linghan Kuang,1,6 Hua Shi,1 Ting Liu,1 Xingxin Liu,1 Yongmei Jiang1,2 1Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China; 3West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China; 4Department of Laboratory Medicine, Sichuan Provincial Children’s Hospital, Meishan, People’s Republic of China; 5Department of Laboratory Medicine, Meishan Women and Children’s Hospital, Meishan, People’s Republic of China; 6Department of Laboratory Medicine, Chengdu Hi-Tech Zone Hospital for Women and Children (Chengdu Hi-Tech Zone Hospital for Maternal and Child Healthcare), Chengdu, People’s Republic of ChinaCorrespondence: Ziyi Yan, Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, People’s Republic of China, Email [email protected] Yongmei Jiang, Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, People’s Republic of China, Email [email protected]: Postgraduate training in clinical laboratory diagnostics (professional degree) in China operates under a “four certificates in one” framework tightly coupled with standardized residency training. However, a structural recruitment–training mismatch has emerged: eligible applicants increasingly come from clinical medicine undergraduate programs with limited early exposure to laboratory medicine governance, quality systems, and post-analytical assurance, contributing to persistent under-enrollment and heterogeneous training experiences across schools. Using a strengths–weaknesses–opportunities–threats (SWOT) framework, this review synthesized objective enrollment signals and analyzed how policy constraints, competency gaps, and evolving service expectations jointly shape training feasibility. We also examined recent “laboratory physician training” pilot/experimental classes that front-load laboratory exposure and improve pathway continuity and translated these pilots into a rotation-wide competency framework with corresponding teaching activities and workplace-based assessment tools to support implementation across varied settings. Because these pilots are recent and outcome data remains limited, the implications are primarily policy- and design-based. Overall, this review contributes an actionable competency-alignment perspective for medical education and training reform, highlighting early exposure, structured reskilling/upskilling in quality management, interpretive reporting and clinical communication, and context-sensitive incorporation of digital/AI-enabled workflows where available.Keywords: medical education, Chinese medical education, clinical laboratory, professional degree, laboratory physicians, SWOT, China