Date of Award

January 2011

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Andrea Asnes

Second Advisor

Yuping Cao

Subject Area(s)

Social research


Identifying a global definition of child abuse is a challenge. Culture influences perception both about what constitutes appropriate disciplinary practice and about what action should be taken if an abused child is identified. We hypothesized that medical trainees in China would have significant differences in attitudes about childhood discipline when compared to medical trainees in the United States (US). In addition, because China lacks the structure of a child welfare system, we questioned what actions Chinese medical trainees would propose if they were to identify an abused child.

We conducted a cross-sectional survey at Xiangya Medical School and Yale Medical School to compare the acceptability of 37 childhood discipline practices and to assess Xiangya student and resident opinions on reporting abuse. Ninety-four Chinese medical students, 154 Chinese residents, and 63 US medical students (97%, 77% and 64% of those invited, respectively) completed the questionnaire.

Attitudes regarding 13 and 9 of the 37 discipline practices differed significantly between Yale and Xiangya students and Xiangya students and residents respectively. More Xiangya students found restrictive and verbal discipline practices unacceptable than Yale students, while more Yale students found corporal discipline practices unacceptable. Xiangya residents were more accepting of most discipline. Yale students were most likely to identify discipline practices as in need of intervention. Xiangya students and residents reported similar rates of experiencing corporal punishment in school (47.9% and 48.1% respectively, p=0.978) while Yale students reported a significantly lower rate (12.7%, p<0.001). Xiangya students reported the highest rate of childhood physical abuse (48.9%) compared to Xiangya residents (29.9%, p=0.003) and to Yale students (6.3%, p<0.001). Only 68.1% of Xiangya students and 75.2% of Xiangya residents (p=0.241) compared to 100% of Yale students felt that abuse is a problem in their respective countries (student comparison p<0.001). More than 50% of Xiangya respondents indicated family, government, police, neighbors and health professionals as having responsibility to intervene/report abuse and the government, police and Women's Federation as groups to whom abuse should be reported.

Yale students, Xiangya students, and Xiangya residents differ significantly with respect to what they identify as acceptable discipline and what discipline practices they believe warrant intervention to protect a child. Despite significantly higher rates of personal experience with physical abuse and corporal punishment in school, Chinese trainees were less likely to recognize abuse as a problem in their country. Chinese trainees identified a diffuse group of those responsible for reporting child abuse and a similarly diffuse group of those to whom abuse should be reported.

Continued research about the nature and extent of child abuse would improve understanding of the nature of the problem in China. Given the high reported rates of child abuse by individuals in China, both improved recognition of abuse as a national problem to be solved as well as development of a robust child welfare system are essential for the protection of Chinese children.


This is an Open Access Thesis.

Open Access

This Article is Open Access