Objective  To evaluate the gap between China's top-tier medical institutions and top-tier international medical institutions, and to provide references for the construction of first-class medical science discipline in China.

Methods  Using globally recognized rankings of medical institutions, we selected 24 top-tier international medical institutions and 11 top-tier Chinese medical institutions. Publicly available, general, and comparable data on indicators were collected to analyze the performance and gaps between top-tier international and Chinese medical institutions in human resources development, talent cultivation, scientific research, social services, and discipline construction.

Results In the field of medicine, the largest gap between top-tier international and Chinese medical institutions was in high-level talent. Specifically, the average numbers of individuals who are Clarivate Analytics' Highly Cited Researchers, who are Nobel Prize laureates in Physiology or Medicine, and who serve on advisory boards or editorial boards of top medical journals, and who rank among the Top 2 000 Medicine Scientists were 1.00, 0.09, 0.45 and 4.00, respectively, among top-tier Chinese medical institutions, while those of the top-tier international medical institutions were 131.46, 118.25, 9.72, and 6.76 times, respectively, those of the Chinese medical institutions. The second largest gap was in social services and medical innovation. The average proportion of industrial collaboration papers and the number of clinical trials of China's top-tier medical institutions were 1.51% and 1 851, respectively, while those of international top-tier medical institutions were 3.62 and 1.87, times, respectively, those of top-tier Chinese medical institutions. However, the average number of (untranslated) patents held by top-tier international medical institutions was only 15% of that of China's top-tier medical institutions.The third largest gap was in scientific research. The average number of papers published in New England Journal of Medicine, Journal of the American Medical Association, The Lancet, and British Medical Journal, the percentage of hot papers in papers included in Web of Science, the percentage of highly cited papers, the percentage of international collaboration papers, the total number of citations per paper, category normalized citation impact (CNCI), and the number of publications of top-tier Chinese medical institutions were 78, 0.03%, 1.39%, 22.55%, 19.61, 1.26, 30 706, while those of the top-tier international medical institutions were 6.96, 2.66, 2.57, 2.15, 1.83, 1.58 and 1.54 times those of the Chinese medical institutions, respectively. However the average percentage of zero-citation papers of top-tier international medical institutions was only 71% of that of China's top-tier medical institutions. Furthermore, in discipline development, the average overall scores of the Times Higher Education (THE) and QS rankings for medicine-related disciplines of top-tier Chinese medical institutions were 72.84 and 69.30, respectively, while those of top-tier international medical institutions were 1.38 and 1.21 times those of the Chinese medical institutions. However, in terms of talent cultivation, the average number of students of China's top-tier medical institutions was 10724, which is roughly double that of international institutions.

Conclusion  Currently, China's top-tier medical institutions are still in a basic stage that emphasizes the quality of talent cultivation and medical services. There is considerable room for development and potential for catching up in multiple aspects, especially in high-level talent, medical research, and innovation. It is recommended that the construction experience of top-tier international medical institutions should be fully utilized to build China's first-class medical science discipline.