Internationalizing Chinese Medicine Education Across Selected Settings: A Critical Integrative Review and Six-Domain Framework for Curriculum Negotiation

Abstract

Background

Chinese medicine education increasingly crosses national, institutional and regulatory boundaries, yet its evidence base remains fragmented across empirical studies, historical accounts, programme descriptions, policy analyses and technology-supported teaching reports. The central curriculum challenge is to preserve epistemic and cultural identity while demonstrating patient safety, educational quality and public accountability.

Methods

We conducted a critical integrative review using targeted searches of PubMed, Google Scholar, journal websites, institutional repositories and backward citation tracking, updated through 16 July 2026. Empirical, policy, historical and conceptual sources were charted across regional context, curriculum architecture, clinical education, regulation and accreditation, research literacy, and digital pedagogy. The synthesis was interpretive rather than exhaustive and used iterative comparison to identify recurrent curriculum tensions and derive a theory-informed framework.

Results

Across China, Australia, the United Kingdom, Canada, the United States and selected additional settings, the literature indicates shared commitments to safe and competent practice but marked differences in learner backgrounds, clinical resources, regulation, research expectations and public legitimacy. Recurrent tensions concern heritage knowledge vs external accountability, contact-hour equivalence vs demonstrated competence, clinical exposure vs local scope-of-practice restrictions, and digital innovation vs pedagogical governance.

Conclusions

Internationalization is better understood as curriculum negotiation than curriculum export. We propose six linked domains: epistemic and cultural foundations; biomedical and safety literacy; clinical competence and entrustment; research and evidence translation; intercultural and interprofessional competence; and responsible digital and AI-enabled pedagogy. The framework is a theory-informed design tool that requires empirical validation through curriculum audits, consensus studies, assessment validation and graduate outcome research.

Introduction

Chinese medicine education is a distinctive test case for international curriculum reform. It is grounded in a historically accumulated knowledge system that includes classical theory, pattern differentiation, acupuncture, herbal medicine, dietary and preventive practices, and embodied clinical reasoning. At the same time, it is delivered through universities, private colleges, hospitals, online platforms and professional regulatory systems outside China. This dual location—within traditional knowledge and contemporary higher education—raises broader curriculum questions: how professional knowledge travels across borders, how culturally situated reasoning is translated without being diluted, and how educational quality can be assured when a field’s epistemic assumptions differ from dominant biomedical models.

This review approaches Chinese medicine education as a case of curriculum internationalization, professional formation, intercultural translation and quality assurance in a culturally embedded health field. The question is not simply whether a Chinese curriculum can be exported. The more consequential question is how curricula can be redesigned, assessed and governed to preserve epistemic identity while demonstrating patient safety and public accountability.

The need for curriculum reform is driven by four converging developments. First, the WHO Global Traditional Medicine Strategy 2025–2034 prioritizes stronger evidence, safety and regulation, appropriate integration into health systems and cross-sectoral value.¹ Education is therefore inseparable from public protection and workforce quality. Second, health professions education has moved toward outcome-based, competency-based and systems-responsive approaches.^2–6 Curricula organized mainly around contact hours or inherited course labels may be insufficient for demonstrating graduate capability. Third, internationalization has shifted from mobility and degree export toward curriculum internationalization, internationalization at home and intercultural competence.^7–10 Fourth, digital learning and generative AI are changing how students access knowledge, practice reasoning and receive feedback.^11–20 These developments require explicit pedagogical governance rather than ad hoc technology adoption.

This review addresses three questions: (1) What does the comparative literature reveal about the internationalization of Chinese medicine education across selected regions? (2) Which curriculum tensions recur across different regulatory and institutional contexts? (3) How can these findings inform a transferable curriculum reform framework for culturally embedded health professions education?

Materials and Methods

Review Design and Rationale

This study used a critical integrative review design because the evidence base spans empirical educational studies, policy and standards documents, historical analyses, professional reports and conceptual scholarship. Unlike a systematic review focused on a narrowly defined intervention or a scoping review intended to map an exhaustively searched field, the integrative approach permits comparison across heterogeneous evidence types and supports theory-informed framework development.^21–25 The objective was therefore interpretive rather than effect-estimating: to identify recurrent curriculum tensions, compare how they are handled across settings and derive propositions for future empirical testing.

Search Strategy and Source Selection

Targeted searches were conducted in PubMed and Google Scholar and supplemented by journal websites, institutional repositories and backward citation tracking. The evidence base was updated through 16 July 2026. Search terms combined “Chinese medicine education”, “traditional Chinese medicine education”, “acupuncture education”, “Chinese herbal medicine education”, “curriculum”, “internationalization”, “competency”, “clinical training”, “accreditation”, “research literacy”, “e-learning” and “artificial intelligence”, together with country or regional terms. Google Scholar was used as a supplementary discovery tool to locate relevant grey literature, institutional material and articles not readily retrieved in PubMed; it was not treated as an exhaustively searchable database. Candidate sources identified through Google Scholar were retained only when their bibliographic identity could be verified through a journal, publisher, official organization or institutional repository. Sources were eligible when they directly addressed curriculum, pedagogy, clinical training, regulation or accreditation, research education, internationalization, or technology-supported learning in Chinese medicine, or when they provided established curriculum theory or standards directly used to construct the framework. Purely clinical studies without an educational component, duplicate reports and sources whose bibliographic identity could not be verified were excluded.

Screening, Charting and Evidence Appraisal

Source screening and charting were undertaken by the review team during iterative manuscript development. Because the targeted search was not prospectively registered and candidate-source counts were not logged at each discovery step, a precise screening denominator and inter-rater agreement statistic cannot be reconstructed retrospectively without creating false precision. We therefore report the final corpus transparently: 53 references are cited, of which five support integrative-review methodology and 48 form the analytical corpus of curriculum theory, standards, policy, historical, empirical and technology-related evidence. No PRISMA flow diagram is presented because the search was not exhaustive. For appraisal, sources were not pooled into a single quality score because they served different evidentiary functions. Instead, each source was considered according to (i) bibliographic verifiability, (ii) directness to the curriculum question, (iii) source type and methodological transparency, and (iv) transferability to the setting under discussion. Direct empirical educational evidence was given greater weight for claims about learner outcomes; official standards and policy documents were used for normative or regulatory claims; historical and programme reports were treated as contextual evidence; general education theory was identified as transferred theory; and author-generated propositions were explicitly labelled as requiring validation. These distinctions are reflected in Tables 1 and 2.

Table 1.

Comparative Evidence and Curriculum Implications Across Selected Regions

Region	Evidence Identified and Limitations	Implications for Curriculum Reform
China	Historical and policy analyses plus selected institutional comparisons; strong affiliated-clinic claims are not nationally representative.14,26–28	Define international outcomes without weakening Chinese medicine identity; strengthen global communication, evidence translation and bilingual resources.
Australia	Comparative studies, policy analyses and professionalization accounts; much evidence is descriptive or institution-specific.27–32	Use outcome-based accreditation, transparent clinical standards and continuing professional development as a model for quality assurance.
United Kingdom	A historical transnational collaboration report; current regulatory and programme diversity requires updated primary data.33	Build sustainable partnerships that align academic awards with professional regulation and supervised clinical learning.
Canada	Provincial overview, historical account and one mixed-methods student study; limited graduate-outcome evidence.34–36	Integrate research literacy that respects both biomedical evidence and Chinese medicine reasoning.
United States	Institutional and professional overviews; substantial state-level variation and limited comparative outcome data.37,38	Map state and professional expectations to explicit competencies, patient safety and interprofessional communication.
Other settings	Context-specific reports from Hong Kong, Malaysia, Indonesia and South Africa; transferability is uncertain.12,39–42	Avoid one-size-fits-all export; support culturally sensitive adaptation and digital access.

Table 2.

Six-Domain Curriculum Reform Framework

Domain	Core Question	Suggested Curriculum Indicators	Evidence Status
1. Epistemic and cultural foundations	How is Chinese medicine identity preserved during contextual adaptation?	Classical theory, terminology, history, translation, pattern differentiation and ethical cultural representation.7–10,43	Policy/conceptual support; empirical validation needed
2. Biomedical and safety literacy	How are patient safety and biomedical communication demonstrated?	Anatomy, physiology, red flags, infection control, herb safety, pharmacovigilance and referral.1,6,43,44	Standards/policy support; outcome evidence limited
3. Clinical competence and entrustment	What can graduates be trusted to do, under what conditions?	Candidate entrustable activities, supervised clinics, OSCEs, documentation and progressive responsibility.2–4	Theory transferred from health professions education
4. Research and evidence translation	How do students evaluate evidence without erasing Chinese medicine reasoning?	Critical appraisal, qualitative and mixed methods, pragmatic trials, complex-intervention research and model-validity debate.36,45	Direct educational evidence plus author synthesis
5. Intercultural and interprofessional competence	How do graduates communicate across cultures and health systems?	Global competence, patient-centred communication, teamwork and bilingual documentation.7–10,46	General education theory transferred to TCM
6. Responsible digital and AI-enabled pedagogy	How can technology support learning under human governance?	LMS, simulation, AI literacy, privacy safeguards, source verification, human oversight and audit trails.11–20	Early-stage and indirect evidence; controlled studies needed

Synthesis and Framework Development

Sources were charted across six analytic categories: regional and institutional context; curriculum architecture and intended outcomes; clinical teaching and assessment; regulation and accreditation; research and evidence translation; and digital or AI-supported pedagogy. Iterative comparison was used to identify recurring tensions within and across settings. Framework development proceeded in three stages: evidence was first grouped by analytic category; recurrent curriculum tensions were then translated into candidate curriculum domains; and each domain was mapped to learning outcomes, learning activities, assessment and quality assurance. The synthesis deliberately distinguishes direct empirical evidence from policy or standards support, transfer from general education theory, and author-proposed components requiring future validation.

Comparative Evidence: Regional Pathways and Recurring Curriculum Tensions

Historical Legitimacy and Policy Trajectories

Chinese medicine education has been repeatedly shaped by struggles for legitimacy. Historical accounts from China describe how Chinese medicine education was challenged during political and professional contests over modernization and biomedical dominance.²⁶ More recent policy analyses suggest that Chinese TCM education policy has evolved from standardization to distinctiveness, then systematization and internationalization, driven by national strategic needs, cultural heritage protection and global competition.¹⁴ This trajectory indicates that internationalization is simultaneously an institutional, regulatory and pedagogical project.

In overseas contexts, legitimacy has often been linked to occupational regulation and public safety. Australia provides one of the most extensively documented examples in the included literature. Earlier comparative work described the adaptation of Chinese medicine education to local institutional and professional conditions,^27–30 while later analyses documented the shift from privately organized provision to accredited degrees, national registration, and continuing professional development.^31,32 The Australian literature therefore illustrates how curriculum credibility can be linked to educational standards, legal recognition and public accountability; it should not be treated as a universal template.

The United Kingdom, Canada and the United States show more heterogeneous pathways. The 2005 Middlesex University–Beijing University of Chinese Medicine collaboration is retained here as a historical example of transnational degree delivery rather than evidence of the current UK regulatory landscape.³³ Canadian accounts emphasize provincial variation and the role of translation, institution-building and professional advocacy.^34,35 United States literature likewise describes a diverse professionalization pathway and continuing debates about educational standards and evidence-informed practice.^37,38 These cases caution against assuming a single natural model of international Chinese medicine education.

Curriculum Architecture: Similar Goals, Divergent Implementation

Comparative China–Australia studies show that curricula may share broad goals while differing in student profiles, sequencing, teaching approaches, clinical access, and quality assurance. A comparison of Beijing University of Chinese Medicine and RMIT University identified common commitments to safe practice alongside differences in health systems, teaching resources and clinical facilities.²⁷ A later case study reported greater use of flipped learning and educational technology at the University of Technology Sydney, whereas Chengdu University of Traditional Chinese Medicine had stronger access to affiliated clinical facilities and specialist physicians.²⁸ These observations are based on selected institutional comparisons and should not be generalized to all programs in either country.

These findings demonstrate the limits of nominal curriculum equivalence. International comparison should therefore move beyond course titles and credit hours to examine whether learning outcomes, clinical opportunities, assessment tasks and quality assurance mechanisms generate comparable graduate capabilities. A module titled “Chinese herbal medicine” may have different educational meaning depending on whether it is supported by hospital clinics, botanical gardens, supervised dispensaries, language access to classical texts, standardized patient encounters or online resources.

Clinical Training as the International Bottleneck

Clinical learning appears to be one of the least transferable curriculum components. The comparative studies reviewed describe greater access to affiliated hospitals and specialist clinical teachers at the selected China-based institutions, whereas some overseas programs rely on smaller teaching clinics and operate under different patient flows and scope-of-practice boundaries.^27,28,39 These contextual differences may affect skill acquisition and professional identity formation, but the available evidence is predominantly descriptive and does not establish that one institutional model produces superior graduate outcomes.

Competency-based and entrustment-based approaches offer a potentially useful language for making clinical learning internationally legible.^3,4 Rather than defining clinical education only by placement hours, programs could specify observable activities that graduates are expected to perform safely under defined levels of supervision. Candidate activities may include conducting a structured Chinese medicine history, documenting pattern differentiation, identifying red flags and referral needs, explaining treatment options, applying infection control, identifying herb–drug interaction risks and communicating with biomedical professionals. Such activities could support comparison of graduate readiness while respecting local scope-of-practice rules, but they require consensus and validation in Chinese medicine education.

Research Literacy and Model Validity

Research literacy is a recurring theme in international Chinese medicine education. In Canada, Ijaz found that more than 80% of Chinese medicine students reported high research interest and viewed research as relevant to clinical practice and professional legitimation, but they also expressed concern about the validity of the model used by conventional bioscientific research methods for Chinese medicine interventions.³⁶ This is a crucial finding. It suggests that students do not simply reject evidence; rather, they want research methods that can evaluate Chinese medicine without erasing its theoretical assumptions and individualized clinical reasoning.

Research literacy curricula should avoid two opposing reductions: treating external evidence standards as irrelevant, or translating Chinese medicine into isolated mechanisms that ignore its diagnostic logic. A stronger curriculum can combine clinical epidemiology, qualitative inquiry, pragmatic trials, mixed methods, complex intervention research, and critical appraisal of biomedical and classical sources.^36,45 This approach treats research fluency as a professional capability while allowing students to examine how study designs represent—or fail to represent—individualized Chinese medicine practice.

Pedagogical Reform and Digital Learning

Evidence from Chinese medicine education suggests that experiential, blended and problem-based approaches may strengthen engagement and preparation, although the evidence base remains small and heterogeneous.^47–50 The Hong Kong field-trip study identified perceived benefits as well as weaknesses in teacher–student ratio, post-field review and assessment.⁴⁸ A later quasi-experimental study reported higher assessment scores and satisfaction when Moodle-supported learning was integrated before and after field teaching.⁴⁹ These studies support further evaluation but do not establish broad effectiveness across institutions or learner populations.

Digital platforms may expand access through video, quizzes, worksheets, progress tracking and international expert networks.¹¹ Emerging reports propose language support, adaptive learning and simulation in Chinese medicine education,^12,13 but direct comparative evidence remains limited. General medical education literature also identifies risks of hallucination, bias, privacy loss, conceptual flattening and overreliance.^15–20 AI-supported learning should therefore be treated as an experimental, governed pedagogical infrastructure, with teacher-curated content, explicit limitation statements, audit trails, human assessment and evaluation of students’ verification behavior.

Taken together, these regional comparisons reveal shared reform priorities alongside substantial contextual variation in regulatory environments, clinical training, research literacy and pedagogical capacity. Table 1 summarizes the evidence identified across the selected regions, its principal limitations and the corresponding implications for curriculum reform.

Six-Domain Curriculum Reform Framework

The synthesis generated a six-domain curriculum reform framework for international Chinese medicine education. The framework is a transferable design architecture rather than a universal syllabus or validated accreditation standard. Regional and institutional evidence was first organized into six analytic categories; recurring tensions were then translated into curriculum domains; and each domain was aligned with outcomes, learning activities, assessment and quality assurance. The framework draws on constructive alignment and curriculum design,^51,52 competency- and entrustment-based education,^2–4 internationalization theory,^7–10 WHO strategy and training standards,^1,43,44 and the evidence on Chinese medicine education reviewed in Historical Legitimacy and Policy Trajectories–Pedagogical Reform and Digital Learning. Table 2 explicitly identifies the evidentiary status of each domain.

Domain 1, epistemic and cultural foundations, addresses classical concepts, historical development, terminology, translation competence and diagnostic reasoning. Domain 2, biomedical and safety literacy, covers red flags, anatomy and physiology, infection control, herb safety, pharmacovigilance and referral. Domain 3, clinical competence and entrustment, translates clinical reasoning and treatment planning into observable developmental milestones. Domain 4, research and evidence translation, prepares students to appraise evidence and understand methodological debates without dismissing Chinese medicine’s internal logic. Domain 5, intercultural and interprofessional competence, addresses patient communication, teamwork and global competence. Domain 6, responsible digital and AI-enabled pedagogy, integrates e-learning, simulation and AI literacy under human governance. The domains are propositions for curriculum design; none should be interpreted as an empirically validated international standard.

The framework applies constructive alignment.⁵² Each domain should connect outcomes, learning activities, assessment and quality assurance. For example, if a program claims graduates can practice evidence-informed Chinese medicine, the curriculum must include research methods, critical appraisal, assignments involving Chinese medicine-specific evidence problems and assessment of evidence communication. If a program claims international competence, it must assess intercultural communication, not only offer English-medium lectures. If a program uses AI, it must assess verification behavior and responsible use, not only platform satisfaction.

Figure 1 summarizes the proposed framework. Its central logic is constructive alignment, while the outer requirement is contextual adaptation: each domain should be translated into locally appropriate outcomes, learning activities, assessment and quality assurance. The figure represents a theory-informed model for testing, not a completed validation study.

Figure 1.

Six-domain curriculum reform framework for international Chinese medicine education. The framework aligns six domains—epistemic and cultural foundations, biomedical and safety literacy, clinical competence and entrustment, research and evidence translation, intercultural and interprofessional competence, and responsible digital/AI-enabled pedagogy—with four curriculum elements: learning outcomes, learning activities, assessment and quality assurance. Contextual adaptation and empirical validation are outer requirements of the proposed theory-informed model. Color coding denotes evidentiary role: direct educational evidence, policy/standards support, theory transferred to Chinese medicine education, and proposed components requiring validation.

Discussion

This review positions Chinese medicine education within mainstream curriculum studies by showing how a culturally embedded health profession negotiates internationalization, regulation, clinical competence and epistemic identity. The contribution is conceptual and comparative rather than causal. Across the selected settings, the most consistent finding is not convergence on a single international model, but the need to make educational equivalence transparent while allowing contextual adaptation. Table 3 summarizes the main discussion themes and the empirical studies needed to test the proposed framework.

Table 3.

Discussion Themes and Empirical Research Agenda

Discussion Theme	Contribution to Education Scholarship	Researchable Next Step
Curriculum internationalization	Shows that internationalization is curriculum negotiation, not course export.7–10	Comparative curriculum mapping across accredited programmes.
Constructive alignment	Links heritage knowledge to outcomes, learning activities and assessment.52	Rubric validation for pattern differentiation and herbal reasoning.
Clinical entrustment	Proposes adaptation of competency-based education to Chinese medicine; no validated cross-national EPA set currently established.2–4	Multi-site Delphi study followed by workplace-based assessment and validity studies.
Research literacy	Addresses the model-validity concern as a learning outcome.36	Mixed-method evaluation of research coursework and evidence communication.
AI governance	Positions AI as a supervised pedagogical infrastructure while recognizing limited direct effectiveness evidence.11–20	Comparative studies of accuracy, learning transfer, verification behaviour and dependence.

Internationalization is therefore better understood as negotiated curriculum design than as one-way course export. Comparative China–Australia studies show that programmes can share broad goals while differing in learner profile, sequencing, clinical access, pedagogy and quality assurance.^27–29 Historical experience in the United Kingdom and evidence from Canada further show that academic awards, professional regulation, clinical placement and research expectations shape what can be transferred across borders.^33,34,36 Figure 2 summarizes a staged pathway from contextual analysis and outcome mapping to regulatory alignment, evidence translation, digital governance and continuous evaluation. The purpose of this pathway is not to prescribe uniformity, but to make the basis of local adaptation explicit and auditable.

Figure 2.

From curriculum export to curriculum negotiation. The figure contrasts the conventional one-way curriculum export model with a negotiated internationalization pathway. The negotiated pathway proceeds through contextual analysis, outcome mapping, clinical and regulatory alignment, evidence translation, digital and AI governance, and continuous evaluation. Across all stages, curriculum reform should maintain constructive alignment among learning outcomes, learning activities, assessment and quality assurance, with iterative feedback and partnership supporting contextual adaptation.

A second implication concerns the relationship between epistemic identity and public accountability. International reform should not reduce Chinese medicine to decontextualized techniques, yet protection of cultural identity cannot substitute for demonstrable safety and competence. The six-domain framework therefore treats classical concepts, terminology and pattern differentiation as coexisting graduate attributes with biomedical safety literacy, evidence appraisal and interprofessional communication. Constructive alignment provides the organizing principle: claimed outcomes should be visible in learning activities, assessment and quality assurance.⁵²

Clinical education is the area in which contextual differences are most difficult to resolve. Competency-based education and entrustable professional activities provide a possible language for specifying what graduates can safely do under defined conditions of supervision.^3,4 Candidate activities in Chinese medicine could include structured history taking, documenting pattern differentiation, identifying contraindications and referral needs, explaining herbal safety and planning acupuncture treatment. These are proposals rather than validated cross-national EPAs. Their value must be established through Delphi consensus, workplace-based assessment and validity studies that account for local scope-of-practice rules.

Research literacy is similarly more than the acquisition of evidence hierarchies. The Canadian mixed-methods study suggests that students may value research while questioning whether conventional research models adequately represent individualized Chinese medicine practice.³⁶ A mature curriculum should therefore combine critical appraisal and clinical epidemiology with pragmatic trials, qualitative and mixed methods, complex-intervention research and explicit discussion of model validity.⁴⁵ The goal is not to exempt Chinese medicine from external evidence standards, but to enable graduates to judge how well different designs answer different questions.

Digital and AI-supported learning creates a final cross-cutting challenge. Chinese medicine studies suggest potential benefits from structured e-learning, field-based augmentation and problem-based approaches,^{36,48–50,53} while emerging reports describe language support, simulation and access to classical texts.^11–13 These claims remain preliminary. Broader medical-education literature highlights hallucination, bias, privacy risks and dependence.^15–20 Programs should therefore require curated content, teacher moderation, transparent uncertainty, privacy safeguards, source verification and assessment of students’ verification behaviour. Effectiveness claims should await controlled or comparative studies.

Taken together, these implications define a focused research agenda. Future work should prioritize multi-site curriculum audits, consensus development, assessment and rubric validation, graduate outcome tracking, and comparative evaluation of responsibly governed AI-supported learning. Such studies would determine whether the framework functions as more than a conceptual audit tool and would also contribute to wider debates about culturally plural and internationally mobile professional curricula.

This review positions Chinese medicine education within curriculum studies by showing how a culturally embedded health profession negotiates internationalization, regulation, clinical competence and epistemic identity. Its contribution is conceptual and comparative rather than causal: it identifies recurrent tensions, differentiates evidence types and proposes a framework that can be tested in future educational research.

The discussion is organized around five themes: curriculum internationalization, constructive alignment, proposed clinical entrustment, research literacy and AI governance. Table 3 links each theme to a researchable next step, emphasizing that the framework’s practical value depends on empirical validation rather than conceptual appeal alone.

Implications for Curriculum Designers, Teachers and Policy Makers

Curriculum designers should begin with a six-domain audit that maps each required course to intended outcomes, learning activities, assessment and quality assurance. The audit should identify over-reliance on content coverage and gaps in safety, research literacy, interprofessional communication, clinical assessment or digital governance.

Teachers should translate the framework into observable tasks: classical theory into case reasoning; field teaching into structured observation; clinical placement into documented supervision decisions; research education into evidence briefs; and AI use into source verification exercises. OSCEs, case portfolios and supervised clinical documentation can complement memory-focused examinations, but their reliability and validity require evaluation.

Policymakers and accreditation bodies should specify minimum expectations for patient safety, faculty qualifications, supervision, clinical exposure, assessment, and continuing professional development, while allowing institutions to meet these outcomes through context-appropriate structures. Equivalence should be judged through demonstrated capability rather than course titles alone.

Researchers should test the framework through Delphi consensus, curriculum mapping, rubric validation, multi-site assessment studies and graduate follow-up. Priority questions include whether proposed entrustable activities are acceptable across regulatory settings, how research literacy changes evidence communication, and whether appropriately governed AI tools improve learning without increasing error or dependence.

Limitations

This review has several limitations. Its targeted integrative design does not provide exhaustive coverage and may underrepresent Chinese-language, locally indexed and institutionally archived materials. Because the original search was iterative and not prospectively registered, a precise screening denominator and inter-rater agreement statistic were not recorded; Google Scholar was used for supplementary discovery rather than exhaustive retrieval. The literature is heterogeneous and dominated by descriptive case reports, policy analyses and selected institutional comparisons, with few direct comparisons of learning outcomes, assessment validity or graduate performance. Country-level statements may obscure variation among provinces, states and institutions. Current claims about AI are especially provisional because much of the evidence is conceptual or early-stage. Finally, the six-domain framework was derived interpretively and has not undergone consensus testing, construct validation or outcome evaluation; it should therefore be treated as a research agenda and curriculum audit tool rather than an international standard.

Conclusions

Chinese medicine education is entering a period in which internationalization, curriculum reform, digital transformation and professional accountability are inseparable. The reviewed literature suggests that internationalization cannot be achieved through simple curriculum export; it requires negotiated alignment among epistemic and cultural foundations, biomedical safety, clinical competence, evidence translation, intercultural communication and responsible digital pedagogy. The proposed six-domain framework makes these requirements explicit while distinguishing direct evidence from policy support, theory transfer and author-generated propositions. Its next stage should be empirical: multi-site curriculum audits, consensus development, assessment validation and graduate outcome studies are needed before the framework can support accreditation or claims of international equivalence.

Funding Statement

This research was funded by Hunan Provincial Research Projects on Degree Conferral and Postgraduate Teaching Reform, grant number 2024JGYB154, 2024JGYB155, 2024JGZD042, 2025JGYB222; Hunan Provincial Research Projects on Teaching Reform in General Undergraduate Institutions, grant number 202502000683; 2024 General Research Projects on Teaching Reform at Hunan University of Chinese Medicine, grant number 18; 2023 General Research Projects on Teaching Reform at Hunan University of Chinese Medicine, grant number 2023-JG016.

Declaration of Generative AI and AI-Assisted Technologies in the Writing Process

During the revision of this manuscript, the authors used Grammarly (version v.1.2.268.1900) for English-language editing, organizational refinement, and consistency checking. The authors confirm the originality and accuracy of the manuscript content. The authors have checked the terms of use for Grammarly and confirm that its use is suitable for publication. The authors independently verified all cited sources, reviewed and edited all AI-assisted output, and take full responsibility for the integrity of the entire content, including the accuracy of all references.

Institutional Review Board Statement

Not applicable because this article is a literature-based review and curriculum framework paper.

Data Sharing Statement

No new empirical datasets were generated or analyzed. All sources reviewed in this article are cited in the reference list.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflict of interest.