The final night shift of a medical graduate student: never-ending work, research that can't be stopped

Ask AI · Where does the pressure driving medical students’ multi-front battles come from?

Source: The Economic Weekly (时代周报) Author: Fu Yibo

“My night shift is over! The next patients may have to trouble all of you!”

On the evening of March 14, at around 11 p.m., Sun Ping, a postgraduate student in the 2023 cohort at the Xiangya School of Medicine of Central South University, sent this message and completed the final night-shift handover.

The next day, this 25-year-old student in a master’s program for professional degree tracks was confirmed to have died after falling into the river. For her, who was originally expected to graduate in July this year, leaving was “the end of suffering.”

Xiangya Hospital outpatient department

This is clearly recorded in her last words: trapped for a long time in the pressure of “multi-front battles”—on one side, high-intensity clinical work as part of the standardized residency training (规培); on the other, joining research projects’ enrollment follow-ups, ethical reviews, and all kinds of application materials. Such pressure even made her develop fear of the sound of the phone ringing.

After the incident, public discussion erupted about the training pressure faced by medical students. As of now, the Hunan Provincial Health Commission has set up a joint investigation team to conduct an investigation.

The last night shift

As a professional master’s student at Xiangya Medical School. If all this hadn’t happened, Sun Ping might have graduated around July this year and become a physician.

But her dream ended on March 14.

At 11:03 p.m. that night, Sun Ping sent a message in the graduate student group: “My night shift is over! The next patients may have to trouble all of you! Wishing you all a happy life!”

Right after that came a eulogy of more than a thousand Chinese characters.

“Starting in October 2024, I repeatedly reported to my counselor, the Academic Affairs Office, and others that the tasks assigned by my supervisor have seriously affected my standardized residency training work.”

“While handling clinical work, I also have to be responsible for multiple projects’ enrollment, follow-ups, and ethical reviews, and I have to make slide decks, make applications… No matter how you look at it, it’s always being scolded.”

“I need to take the white-night shifts, and I also have to go to the outpatient department. I often can’t sleep, and when I hear the phone ringing, I get scared.”

“Farewell, everyone. Please don’t be sad for me. I have ended all my suffering.”

She used “suffering” to sum up those days.

Xu Yi was Sun Ping’s classmate. Both of them were professional master’s postgraduate students at the Xiangya School of Medicine, Central South University, and they had once rotated through the same department.

Xiangya Hospital, Department of Neurology — inpatient ward building

In Xu Yi’s impression, Sun Ping had a round face, wore glasses, and was very good at studying. She spoke neither hurriedly nor slowly, and was easy to get along with. Sun Ping would share notes she had organized in the class group, turning scattered and complex medical knowledge into a clear structure. She also would proactively organize meals when it was classmates’ birthdays.

As professional master’s students, their time was split up by different wards and laboratories. At that time, the two of them were rotating through standardized residency training at the Department of Neurology’s inpatient ward. Because of the needs of the job, they had to move back and forth between the outpatient department and inpatient ward from time to time.

The atmosphere on the inpatient ward was tense. Because entry and exit required access control, with the access control console controlled at the duty desk, if the door was not opened for a long time, the patients and their families waiting outside would pile up. As a result, medical staff were not only busy with various matters inside the ward but also had to handle the people waiting outside—so their steps were especially fast.

The elevator up and down was relatively slow. With many people entering and leaving, the door was constantly opening and closing, making the running speed even slower. Once, Xu Yi met Sun Ping at the elevator entrance. Sun Ping looked anxious. She stepped forward to ask, and learned that Sun Ping was rushing to deliver patient records to the department. “That side needs it urgently,” Sun Ping said, then turned around and reassured the other person, telling her not to worry.

“Many things she would digest herself. She wasn’t very willing to make things difficult for others.”

Later on, Xu Yi heard from classmates that Sun Ping had once passed out: “(I heard) it was from being too tired.”

At the time, Xu Yi didn’t pay much attention to these details. Only after the incident did she repeatedly think back to those fragments. She said that many situations had been encountered before, but everyone’s coping methods and handling were different.

Caught in between: professional master’s students

In hospitals, there are usually two kinds of students: one is standardized residency trainees (规培 students), and the other is professional master’s students.

Standardized residency trainees are residents undergoing standardized residency training, with no requirements for scientific research or papers. Before graduating, these students do not touch clinical practice; but after graduating, if they want to work as clinical physicians, they must, within three years, receive rotation training in different departments of the hospital. Each department is 2–3 months, following teaching physicians to do rounds, write case histories, and take on new patients. After the rotation period ends, they take a department-exit exam before entering a new department.

Xu Yi and Sun Ping were professional master’s students. This type of professional master’s program implements parallel research and standardized residency training over three years, with the goal of being able to complete the “four certificates in one” (the diploma, degree certificate, standardized residency training qualification certificate for resident physicians, and the practicing physician qualification certificate) at graduation, so that they can enter clinical work faster. To do so, besides rotating through different departments and completing the department-exit exams, they also had academic evaluations and research tasks assigned by their supervisors.

So their time was cut into multiple fragments by different tasks.

Xu Yi said that during standardized residency training, the morning shift arrived at the department before 8 a.m., and the normal time to get off work was around 5 p.m. “But if you can get off work at 7 p.m., that’s already considered early.”

After getting off work, not a single task—papers,资料 to look up—could be left undone. Time was the most precious thing for professional master’s students. If you walked a bit faster, you could save a few minutes, which meant you could have a few more minutes for research.

A reporter from The Economic Weekly previously visited the inpatient ward of the Department of Neurology at Xiangya Hospital and saw a professional master’s student with patient records in one hand and newly printed literature in the other, pacing back and forth at the elevator entrance. One moment, she would look down at the time on her phone; the next, she would mutter about how much time was left.

When asked why, he said that the lab was still doing research. Because experiments have strict requirements for time precision, if anything goes wrong, they have to start over. As the experiment entered the countdown, he had to control the timing precisely—deliver the patient records to the outpatient doctor, then rush back to the lab.

Their predicament is not uncommon among medical students. Globally, medical education is generally accompanied by high-intensity training alongside multi-front tasks. In his book 《医疗再生》 (Medical Regeneration), Damu Longsheng, a former surgery professor at the Albert Einstein College of Medicine in the United States, described something similar: unable to rest for thirty consecutive days; never receiving a salary during internship; during the day at the hospital, and at night and on weekends, working to make a living.

But Xu Yi said that tight time was not the biggest pressure. “Sometimes the time your supervisor asks you to do things conflicts with the rotations arranged by the teaching physician. We become the filling in a sandwich. No one can afford to offend anyone.”

Xu Yi would tell her supervisor directly about the difficulties. “If I really can’t get it done, I’ll tell my supervisor straight that I hope the schedule can be arranged so it doesn’t overlap with the standardized residency training work, and I also hope there can be a bit of space.”

During her lunch break or in the gap between night and day shifts, she had seen Sun Ping sitting alone in a corner of the ward organizing her research materials. For a period of time, she even felt that Sun Ping’s face looked not too good, so she advised Sun Ping not to push herself so hard and suggested she talk to her supervisor. “She said they needed (the materials) urgently on the supervisor’s side. She also wanted to finish it early and be able to get out of it sooner.”

According to the 《Central South University proposed admitted 2023 recommended graduate students (including direct PhD track) public disclosure list》，Sun Ping was admitted to Central South University Xiangya School of Medicine via recommendation-for-admission (保研). Her major was neurology, and her supervisor was Gu Moumou, an attending physician in neurology, a professor, and a master’s student supervisor.

The official website of Xiangya Hospital, Central South University shows that Gu Moumou graduated from the Department of Clinical Medicine (medical department) of Hunan Medical University (later merged into the Xiangya School of Medicine, Central South University), and had done postdoctoral research at Stanford University in the United States. Her research project had won first prize in science and technology achievements awarded by the Hunan Provincial Health Department, second prize in science and technology achievements awarded by the provincial science and technology commission, and she had also won second prize for Beijing’s science and technology progress and third prize for science and technology progress from the Ministry of Health. The hospital’s official mini program shows that she has authored or co-authored more than 100 papers and has participated in editing multiple academic monographs.

In a conversation with a reporter, a doctor from Xiangya Hospital’s Department of Neurology said that Dr. Gu has strong professional competence in the field of cerebrovascular diseases and gets along well with colleagues. Some patients said that they had been seeing her (Dr. Gu) for a long time and that they found her “reliable in medical skills.” There are also standardized residency students who have encountered her who said that Dr. Gu “has strict requirements and speaks relatively directly.”

As of the time of this article’s publication, the reporter has tried multiple times to contact Gu Moumou, but the phone was not answered.

Pressure transmitted layer by layer

“Under the current evaluation system, for students who want to stay and become doctors, the pressure they face is extremely high. They need to perform exceptionally across all dimensions.”

Wang Lei is a surgeon who has practiced in local hospitals for many years and is familiar with Xiangya Hospital’s system and internal situation. He explained that standardized residency training is the basic dimension for evaluating students. Because clinically, standardized residency trainees do mostly basic work—for example, making rounds, issuing medical orders, writing medical records, handling patient examinations, and so on. “These tasks are highly homogeneous. It’s hard for students to distinguish themselves, and individuals are difficult to be noticed.”

But in research, papers and projects are the direct standards for measuring students’ level. “The gap between excellent and average will be very obvious.” Wang Lei said that some students can co-author papers in authoritative journals; others can only publish articles on general paper websites. “The order of authorship is also different. The first author is often more outstanding, and it’s relatively easier for them to find jobs afterward. This is also the hospital’s standard for choosing people.”

To improve their competitiveness, professional master’s students have no choice but to invest time and energy into academic research.

Pressure doesn’t come out of thin air. Wang Lei said it is related to the logic of survival in industry competition for hospitals.

Xiangya Hospital, neurology inpatient building exterior view

Wang Lei said, “In a sense, the hospital is also like a business; it has to consider profitability.” He said that when patients choose a hospital, they look at its ranking and the reputation of doctors. For that reason, hospitals need to maintain their competitiveness through clinical experience, research achievements, and doctors’ reputations.

Research output has become key in the hospital evaluation system—for example, the number of national-level projects, and the number of high-level papers published, all affect a hospital’s ranking.

Wang Lei said that in the past, research in department performance contribution did not exceed 20%. Now, in some departments, the proportion exceeds 30%. In other words, the quantity of research achievements and doctors’ income, and the hospital’s ranking, are correlated.

According to New Hunan, based on the most authoritative bibliometric data in the global biomedical field for 2025, the NCS editorial board released the NCS Global Hospital Index (NCS Hospital Index 2025). Xiangya Hospital, Central South University made the list, ranking 2nd in China and 14th globally.

Such leading results will transmit pressure step by step to every individual within the hospital.

Wang Lei admitted that, in essence, it is a screening mechanism: using extremely high-intensity pressure tests to eliminate the inferior and select the superior. “Most of the heads of major departments today came out of this pathway.”

He mentioned that Central South University has Xiangya Hospital, Xiangya Second Hospital, and Xiangya Third Hospital under it, all of which are comprehensive hospitals. Because their department setups overlap, the hospital’s competitive pressure will also be transmitted to students.

Xiangya Hospital on workdays

For young students, they have to push through. This process is not easy. “It’s the norm for students to encounter setbacks when they enter the clinical stage. They need to calibrate their position and adjust their mindset.”

Within a mechanism that keeps pushing things to the limit, the difference is this: some people make it through, and some people stop.

After Sun Ping’s accident, a doctor from Xiangya Hospital told a reporter from The Economic Weekly that on the afternoon of March 19 the hospital held an emergency meeting for graduate student supervisors, emphasizing that this should serve as a warning and that more attention should be paid to the life and mental health of graduate students. Meanwhile, Dr. Gu’s outpatient clinic has been closed, and there is not yet a specific follow-up appointment time.

“Our (pressure) is actually the same.” Xu Yi said. In recent times, underclassmen and junior students had come to ask her for advice on preparing for graduate school entrance exams. She thought about it and only said one thing: “This path is pretty exhausting. You need to be prepared.”

(To protect personal privacy, the names Sun Ping, Xu Yi, and Wang Lei in the article are pseudonyms.)