Teaching in Medicine

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Health Professionals for a New Century

  • 1910 flexner report- changed health professional education, putting modern science into curricula
  • current professional education has not kept pace with changes and inequities in health
    • mismatch of competencies to patient/population needs
    • narrow technical focus without broader contextual understanding
    • episodic encounters rather than continuous care
    • hospitalist orientation over primary care
    • imbalances in professional labor market
    • weake leadership in health-system performance
    • professions acting in isolation
    • Current landscape
      • 2420 medical schools worldwide, 467 schools/depts. Of public health, unknown # of nursing schools.  1 million new nurses, doctors, public health professionals yearly
      • 4 countries (china, india, brazil, USA) have more than 150 med schools, 36 schools have no med schools (26 in sub-Saharan Africa)
      • stewardship, accreditation, learning systems are weak
      • History
        • 1st generationà science-based curriculum
        • 2nd generationà problem-based instructional innovations
        • 3rd generationà now needed, systems based “improve the performance of health systems by adapting core professional competencies to specific contexts, while drawing on global knowledge”
        • Commission’s vision:
          • “All health professionals in all countries should be educated to mobilize knowledge in critical reasoning and ethical conduct so that they are competent to participate in patient and population-centered health systems as members of locally responsive and globally connected teams”
          • Requirements:
            • Transformative learning (informativeàformativeà transformative)
              • Informative-> acquire skills/knowledge, produce experts
              • Formative-> socializing students around values, produce professionals
              • Transformative-> developing leadership attributes, produce change agents
              • Requires:
                • From fact memorization to searching, analysis, and synthesis of information for decision making
                • From seeking professional credentials to achieving core competencies for effective teamwork in health systems
                • From non-critical adoption of educational models to creative adaptation of global resources to address local priorities
  • Interdependence in education
    • Isolatedà harmonized education systems
    • Stand-alone institutionsà networks/alliances
    • Inward-lookingà global flows of content, teaching resources, innovations
  • Instructional reforms
    • Break down professional silos
    • Collaborative and non-hierarchical teams
    • System that emphasizes competencies
  • Institutional reforms
    • Academic systems encompassing hospitals and primary care centers

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Other Resource:

Teaching in Rwanda

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