Where the China Initiative all began
September 7, 2023

In August 2022, the USC Chan Division celebrated the first cohort of graduates from the USC–PKUHSC dual-degree program. Students in the program earn an entry-level master’s degree in rehabilitation therapy (occupational therapy track) at PKUHSC followed by a post-professional occupational therapy doctorate (OTD) at USC. This collaboration is made possible by PKUHSC occupational therapy instructors Yijun Liu, Liguo Qian and Hui Wang, who all received their master’s and OTD degrees at USC Chan. Assistant Clinical Professor Elena Meng 孟令昱 and former China Initiative doctoral residents Sanny Ning 宁沁 MA ’21, OTD ’21 and Li Shan Wee 黄丽宪 MA ’20, OTD ’21, OTR/L spoke with these instructors to hear more about their inspirations and get an update on graduate-level occupational therapy education and the profession in mainland China.

Yijun (Jane) Liu 刘奕君 completed her Bachelor of Medicine degree and was in her second year of her medical residency at Peking University First Hospital when she was admitted to the USC entry-level master’s program as one of the inaugural instructors for the USC–PKUHSC dual-degree program. Liu completed her entry-level master’s and post-professional OTD degrees at USC and returned to Peking University First Hospital to teach in the master’s program in rehabilitation therapy (OT track). With support from her medical education, USC and her family and friends, Liu also completed her Doctor of Medicine degree, merging her medical and OT backgrounds to complement her practice.

What led you to pursue occupational therapy?
Yijun Liu 刘奕君: I am from the Sichuan Province and witnessed the devastating Wenchuan Earthquake in 2008. I was deeply inspired by the work of the medical staff and made up my mind to study medicine. As part of my eight-year clinical medicine program at PKUHSC, after the fifth year we had to choose a direction to specialize in. I chose to pursue the physical medicine and rehabilitation program because I liked its holistic perspective. Although the medical model has transitioned to a biopsychosocial model, many departments still typically focus on the biological components. I liked rehabilitation medicine’s focus on function and participation in everyday lives, and it was a good track that reflected the ideals of medicine. In my second year of medical residency, the Director of Rehabilitation Medicine, Professor Wang Ninghua, told me about the new collaboration between USC and PKUHSC for OT. I had briefly learned about OT as a medical student and realized that OT is much more holistic and can focus on life. I was already very interested in OT and even more so when I heard about the collaboration.

What was the focus of your OTD project/placement?
YL: I tailored my OTD experience with the main goal of becoming a competent instructor for the PKUHSC master’s program. Because it is a brand new program, administration was a huge part, but I also developed clinical skills so that I could teach both knowledge and practical skills. I participated in curriculum development for the PKUHSC master’s program and also helped facilitate summer courses for the USC Chan entry-level master’s program to learn how to prepare for class, as well as how to develop and grade assignments. I took elective classes at the USC Rossier School of Education and participated in the Center for Excellence in Teaching Future Faculty Teaching Institute.

Clinically, I focused on learning Lifestyle Redesign, which is one of my interest areas, and spent time in primary care and with the Occupational Therapy Faculty Practice. In the second half of my OTD experience, I returned to PKUHSC and taught three courses — Foundations: Creativity, Craft and Activity Analysis; Foundations: Kinesiology; and Therapeutic Use of Self and Communication Skills for Effective Practice — with mentorship from USC faculty. During that time, I was also involved with administration and was helping to coordinate the World Federation of Occupational Therapists (WFOT) approval for the program.

How has your understanding of occupational therapy evolved from when you first started as a student, to now being an instructor of occupational therapy?
YL: I think my initial perspective of OT has stayed — that OT is holistic and that OT takes care of the mind, body and soul. But I think the picture itself has become more enriched. In China, OT mainly focuses on upper limb function and rehabilitation, even though ideal OT is not that way. When I learned more about OT in the US, I found that OT’s role is very rich and provides a much clearer picture of what OT can contribute to Chinese society. Being an instructor, I need to teach my students what OTs can do in many emerging areas of practice in China so that they can expand their reach and provide comprehensive services to people in need.

I also developed a deeper understanding of occupations and occupational science. I was initially a learner, but now I’m also thinking about what I can contribute to the body of knowledge of OT and OS. Recently, I developed a Model of Occupational Harmony, so I’m thinking about what Chinese culture brings to OT, and to help with the cultural adaptations of OT, contributing to the Eastern perspective of OT and OS globally.

How has your OT perspective changed your experience now as a medical resident?
YL: My perspective has changed radically. I think it has integrated into myself, so I see everything in an OT perspective, even though I’m a medical resident. One of the experiences I remember deeply is my rotation in the neurology department, where I helped a lot of patients from what I see through an OT perspective. Some clients had really good outcomes after my care, and our chief physician gradually took notice. Very interestingly, he started giving me more and more clients, and he said, “Can you see more clients from your OT perspective?” That was a very proud moment for me and OT at that time. I think we can contribute a lot to the medical team so that we can meet the client’s needs.

What are your personal future goals?
YL: My scholarship goal is to develop further assessment tools related to the theoretical model for occupational harmony I developed, so that it can be really used in practice in China. For education and curriculum, we have talked about program evaluation and quality improvement and, after three years, we really need to think about making adaptations to meet the local needs and student’s needs. In the clinical realm, I still want to explore what OT can bring to the clients and to different settings. Outside of hospitals, I’m especially interested in mental health in college students; many have anxiety or depressive symptoms. This is a huge problem in China and this is a very important problem because they are in a special transition stage. Developing OT services to help college students is also one of my interest areas and goals.

In one or two sentences, what do you want people to know about your students?
YL: They are great! I already see that the heart of OT is sowed into their hearts, minds, and souls. They have a passion to contribute and they will be the future leaders of OT in China.

What are your hopes for occupational therapy in China?
YL: My biggest hope is for OT to grow in China and to help more and more people. Right now, I think we only have 3,000 to 4,000 OT practitioners, but our total population is more than 1 billion people, so millions need OT services. Also, in the aging world and in China, more and more people will need OT. One way I see it will grow is that OT can contribute to the Healthy China 2030 Initiative. Before, the Chinese government was focused on treating the disease, and healthcare policies were related to curing the disease, not focused on health itself. Now, policies are based on health: creating healthy lifestyles and environments, and how we can contribute to disease prevention and health promotion. This change really reflects OT’s perspectives and OT’s ability to contribute to health care needs in the Chinese society.

Liguo Qian 钱李果 received his bachelor’s degree in rehabilitation therapy from Capital Medical University, specializing in occupational therapy. In 2015, while attending an occupational therapy conference in Shanghai, Qian met USC faculty members Danny Park and Adley Chan, who shared with him two of USC Chan’s exciting international opportunities: the Summer Occupational Therapy Immersion (SOTI) program and the China Initiative. After participating in the SOTI program in the summer of 2016, Qian was compelled to return to pursue graduate degrees at USC. During his OTD program, Liguo was hired by Peking University Third Hospital as one of the inaugural instructors in the USC-PKUHSC dual-degree program.

Can you describe your educational and professional background?
Liguo Qian 钱李果: In China, students select their majors for undergrad before the national college entrance exam. My father is a professor in special education. When I selected my major with my parents, he recommended a major called “rehabilitation therapy.” He said, ‘That’s a major where you help people with disabilities — people with special needs.’ I was eventually admitted into that major and received my bachelor’s degree in rehabilitation therapy from Capital Medical University. In my second year of the program, we had the opportunity to select which direction of Rehabilitation Therapy we wanted to focus on — OT or PT. Before we made the decision, we had a tour at a rehabilitation center. I was completely attracted by the sunshine that shined in the OT room and the warm interaction between the clients and the therapists. Witnessing this and having this image in my mind influenced my choice to become an OT!

I also knew that I wanted to continue my studies beyond just the bachelor degree. Capital Medical University was the first Chinese program accredited by World Federation of Occupational Therapy (WFOT), but there were no graduate-level programs for OT in China. My professor told me that if I want to continue my studies after I graduate, I would have to study abroad, which eventually led me to do the USC SOTI program, and to pursue my post-professional master’s and occupational therapy doctorate degrees.

How did you get involved with the China Initiative?
LQ: When I applied for the post-professional master’s program, one of my career goals was to help promote OT education in China because there were no graduate OT degree programs here. Many OT students found no place to pursue a higher degree in their own major. When I went to USC, one of my visions and career goals was to someday help promote higher level OT education in my home country. During my time in the master’s program, I heard about the China Initiative program and had many conversations with Dr. Julie McLaughlin Gray and Dr. Adley Chan. They recommended that, if I wanted to pursue that career goal, I may need more clinical experience in the US. This is why I completed the clinical practice track for the OTD at a pediatric clinic. During that year, I became roommates and friends with Dr. Hui (Angela) Wang and Dr. Yijun (Jane) Liu, who were actively involved in the China Initiative program. We would talk about the program everyday at the dinner table, share advice and opinions, and I gradually became more interested in it.

In the spring semester of my OTD, I met with the PKUHSC leadership and knew they were looking for more OT instructors for the incoming USC-PKUHSC program. After careful consideration and reaching out to Dr. Hui (Angela) Wang and Dr. Yijun (Jane) Liu, I decided to pursue a second residency with the China Initiative and was provided many opportunities to be involved with the curriculum development process and class preparation with USC Chan faculty.

After more than three years of teaching in the program, how has your understanding of occupational therapy evolved or changed?
LQ: One of the most important and challenging things for me is transitioning my role from a student to an instructor. When I graduated as a student, and then directly transitioned to a new role as an instructor, teaching and providing lectures to students who are just two or three years younger than me was very stressful. I was in a new role in a new environment with new people. After teaching for one year, I became more familiar with the class preparation process and felt more efficient in my work. I have learned how to better read students’ facial expressions and their responses. I can also better tell if I am speaking too fast, or if the content is slightly too complex and if I may need to explain it again. Overall, I feel more comfortable in my role as an instructor now. From an instructor’s perspective, I now understand the amount of care and responsibility involved in this role.

What has your experience collaborating with the China Initiative team and the faculty at USC been like?
LQ: USC Chan’s faculty and the China Initiative team have always been there for me throughout my entire process as a student and instructor. As part of the PKUHSC team of instructors, we have met and discussed with the USC Chan teaching faculty to get their ideas, experiences and advice on how to transition and adapt OT learning and teaching in China. We also have China Initiative team members and OTD residents who are well-versed in both the American and Chinese culture and context. This team is like a bridge between cultures, with USC Chan in the US, and PKUHSC in China.

I remember in 2019, Dr. Julie McLaughlin Gray traveled to Beijing to attend a conference. Professor Zhou Mouwang, one of the leaders of the PKUHSC program, shared that he feels Dr. Gray is like Norman Bethune, a Canadian physician in China known for his humanitarian efforts during World War II and contributions to advancing modern medicine in China. Chinese people really respect Bethune and see him as a hero for this country because he was very supportive, altruistic and made a lot of contributions and saved a lot of people’s lives without any hesitation. Professor Zhou sees a similarity with Dr. Gray, as she has supported the PKUHSC program in occupational therapy tremendously, and also views her as a very altruistic and detailed leader.

How do you feel about having recently started clinical work at PKUHSC?
LQ: I am practicing as an occupational therapist at Peking University Third Hospital, which is one of the top hospitals in China. Frankly speaking, there is still a long way to go in terms of OT’s professional popularity and acceptability here. Most of our clients are not well-informed about the potential benefits of receiving OT services, and our colleagues do not know much about occupational therapy. However, I think they are willing to learn and be more curious about occupational therapy because of this program. They have heard a lot about this program, and want to know about what OT can do, what kinds of clients they can refer to us, and what services we can provide. As of now, we start small and become bigger. We can let our clients know there are occupational therapists who can help them not only with their bodies, but with their overall lives, routines and daily activities.

What are your hopes for occupational therapy in China?
LQ: While it is changing a lot, OT in China is currently in its infancy stage. I had received a notification one morning in March 2021 that China had published our first version of the Occupational Therapy Practice Framework, called the Chinese OT Process (COTP), which we did not have before. We have been members of WFOT since 2018 and grown to have our own national OT association. There have been many changes in recent years, and I also see this program as one of the biggest contributors to OT development in China. I am confident that this graduate program will train more and more members who have very strong leadership, enthusiasm and ambition to move the profession forward.

What are your personal future goals?
LQ: I would love to continuously cultivate newer generations of OT in China and promote educational standards here. I am also curious about finding a better way to apply OT and OS theories in the Chinese local context. It is challenging while worthy to identify our professional value, roles and power in the local healthcare community and the larger society. In terms of clinical practice, I am working with Dr. Hui (Angela) Wang to establish our adult rehabilitation services and show the department and hospital what occupational therapy is capable of. If I get the chance, I would like to explore the possibility of providing OT services in the community as well as other potential practicing areas, such as home-health, primary care and long-term care facilities. Being in the community and in clients’ homes is more like real occupational therapy to me because it is closer to clients’ real and natural environments. 

Hui (Angela) Wang 王慧 had 10 years of experience as a rehabilitation therapist in China before finding her way to occupational therapy. In China, rehabilitation therapy is understood as a more generalized field of study that includes components of occupational therapy, physical therapy, speech therapy, Traditional Chinese Medicine, and orthotics and prosthetics. Dr. Wang completed a bachelor’s degree in sports science and initially worked as a rehabilitation therapist with a physical therapy focus at Peking University Third Hospital. During her time there, she learned about the new partnership between the Peking University Health Science Center and USC Chan Division to develop a new dual-degree graduate program. Dr. Wang joined USC as one of two China Initiative scholars and earned both her master’s and clinical doctorate degrees in occupational therapy at USC Chan. She now serves as one of the inaugural instructors teaching in the PKUHSC master’s program in rehabilitation therapy (occupational therapy track).

How did you first get involved with the China Initiative, and why were you interested in joining the team?
Hui (Angela) Wang 王慧: I learned about the China Initiative partnership when I was working as a rehabilitation therapist at PKUHSC. I was feeling burnt out so I went and reviewed what occupational therapy is, its key concepts, and realized it felt like the missing piece in my work as a rehabilitation therapist. My clients would always ask me, ‘Why can’t I go back to living the way I did before?’ I saw them struggle a lot and it didn’t feel like rehabilitation to me — that’s not what it should be. It felt like a calling from destiny — that there is something in OT that would help me understand why some people aren’t getting back to their lives. I thought I should try and see if I can learn more. However, it was not easy for me at the time. I was 33 years old and thought, ‘Who graduates school and then goes back 11 years later?’ Everyone around me also asked me why I would be willing to be a part of this program. ‘You already have your work, your family, etc.’ However, what drew me in was that my role would be taking all the information I learned about OT to China, and to give and teach the information to more people. I had a lot of support from the China Initiative team and PKUHSC faculty. They encouraged me and were confident in my abilities. My mom also changed her career at 34 years old and believed that I could do the same thing.

Can you tell me about your OTD placement and final project while at USC?
HW: Initially, my OTD project was to culturally adapt and modify the syllabi from USC, and actually implement them in the PKUHSC program. However, as this happened to coincide with the start of the Covid-19 pandemic, I ended up having to adapt the curriculum both culturally and to an online teaching format. We were changing the syllabi week by week, while simultaneously trying to teach. I already developed teaching skills during my time as a rehabilitation therapist, as I had taught and supervised previously. I knew how to teach, but I had to learn how to teach brand new content in a virtual world. That was what my OTD project experience was like.

How do you feel now, after more than two years of teaching in the program?
HW: Now, I’m getting more familiar with the content we are teaching. Our environment is also better now, since we can actually be face-to-face, compared to the first year when Covid-19 was happening. We instructors are also strengthening our theory base so that we have more knowledge and information to teach, which allows us to have more discussions with students and practitioners. We also now have reflections from the first and second cohorts of students to aid our learning from previous work. I feel more confident and can be more adaptable.

What was your experience of collaborating with the China Initiative team and the faculty at USC?
HW: Members of the China Initiative team have a lot of knowledge about running the program. They know what happens, and they’re by my side. This experience is like building a plane while flying it, and the greatest engineer would be the China Initiative — strong, supportive professionals always prepared to handle any new problem — that is OT! I have strong people behind me who support me.

You mentioned that you practiced as a rehabilitation therapist with a PT focus; How did you feel about starting clinical work at PKUHSC as an OT?
HW: I had mixed feelings. I had a lot of experience at PKUHSC before going to USC, so I knew what the caseload looked like and what the regulations were. However, now I have to practice in a different way. I keep asking myself, ‘Am I really doing OT?’ I don’t want to keep doing what I did before. In the Peking University Third Hospital we still don’t have an OT department, so when I come to work, I’m trying to build the OT department. That is my job and my dream. I want OT to be there, to tell people what OT means and to inform how OT is valuable in the interdisciplinary team. I feel more confident because I have that knowledge, but at the same time, I feel worried because I need to pave my path. I feel excited because with all the information I’ve learned, I can use it in practice. Practice is really important because you get to apply what you learned.

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