GHF2010 – PS37 – Globalization Reshaping Medical Education: Case Studies

Session Outline

Parallel session PS37, Wednesday, April 21 2010, 11:00-12:30, Room 14
Chair(s): Joan L. and Julius H. Jacobson, Professor of Public Health, Department of Immunology and Infectious Diseases, Harvard School of Public Health, USA
Summary: The increasing globalization of medicine, manifested in the migration of medical doctors and nurses as well as in the growth of cross-border education programmes, has raised the need to establish international quality assurance in medical education. The latter implies defining global standards, not only to address the increasing mobility of health workers but also to meet national needs and challenges. New medical schools, some with insufficient resources, are seeking international assistance to build their educational programmes. This development has pushed medical leaders in various countries to look at their educational programmes, qualifications standards, and certification processes through a new, 'global' lens. In this session, a panel of practitioners involved in medical education will illustrate specific case studies that elucidate the challenges of adapting medical training to changing global and local needs.
Krishnan Ganapathy, President, Apollo Telemedicine Networking Foundation; President Elect, Telemedicine Society of India
Closing the Gap between Medical Education and Community Needs 
Jan De Maeseneer, Chairman, Department of Family Medicine and Primary Health Care, University of Gent & Secretary General of TUFT, Belgium
Reform of the Swiss Medical Curriculum: Balancing Quality Assurance with Autonomy of Medical Schools
Charles Bader, Vice Dean for Education, Faculty of Medicine, University of Geneva, Switzerland

Session Documents

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Session Report

Photo by John Brownlee, ICVolunteers.org

Professor Nu Viet Vu, Director of Development and Research in Medical Education at University of Geneva chaired this interactive session emphasising the need for rapid re-adaptation of medical education to keep up to speed with the changes brought on by globalisation. Unfortunately, Barry Bloom, Bruno Gryseels, Joel Ladner and Azieb Ogabaghebriel were unable to attend this session.

Jan De Maeseneer, Chairman, Department of Family Medicine and Primary Health Care, University of Ghent and Secretary General of the network Towards Unity for Health (TUFH), Belgium, provided insights on Closing the Gap between Medical Education and Community Needs.

With changes in science, technology, culture and socio-economic factors, reshaping medical education is essential to continually meet needs. Dr. De Maeseneer introduced the TUFH network to the meeting, describing it as a global organisation of health professionals, groups and institutions seeking to create partnerships, reorientate medical education to serve the local community and promote patient-centred care. TUFH relies on partnerships between policy makers, health professionals, communities and academic institutions to achieve its goals. It aims to train “Five Star Doctors” as defined by the World Health Organisation (WHO). The WHO award for Five Star Doctors recognises practitioners who focus on primary health care, training and making changes in the local community. In fact, Dr. De Maeseneer was the recipient of the first Five Star Doctor award in 2006! The need for training of doctors within communities in order to increase retention rates was also emphasised in this presentation. One method of accomplishing this is through twinning universities with small communities that lack universities to deliver local medical education, with the hope that students trained in that location are more likely to practice there. The speaker also stressed that it is important for trainee doctors to be exposed to family medicine and primary health care in communities early in their training in order to maintain their motivation to stay in that area of practice. To achieve this a programme called Community Orientated Primary Care (COPC) was started in South Africa, in which students from the University of Ghent have taken the opportunity to work for one week in the community to learn of patients’ lives, collect data, make a community diagnosis and develop solutions for that community’s health problems. Finally, Dr. De Maeseneer noted that education is only part of the solution of ‘reshaping’ and there is a need to reverse the deadly carousel of brain drain. He feels that vertical programmes create duplication and inefficient processes, and that a horizontal positive approach is the way forward. To conclude, Dr. De Maseneer extended an invitation to the upcoming conference in Kathmandu, Nepal, on “Advancing quality through partnerships of health professions education and health services institutions.”

Charles Bader, Vice Dean for Education, Faculty of Medicine, Université de Genève gave a presentation on Reform of the Swiss Medical Curriculum: Balancing Quality Assurance with Autonomy of Medical Schools.

An organisation track was presented showing the route towards becoming a medical doctor in Switzerland over a six year programme. Reforms to this programme in Switzerland were prompted in 1995 by a report which highlighted the need for doctors who are able to adapt to an ever-evolving society with rapidly progressing science. Questions about whether medical students are being prepared for the future and taught to adapt to the evolving field were raised. Dr. Bader said that adult learning retention is a better approach when learning is pertinent to the final objectives of the studies chosen and, overall, learning a skill is a long-term effort requiring years to develop.  Dr. Bader spoke about medical education reform in Switzerland and emphasised that such reforms are a political process. Change is only initiated where an interest is expressed and despite initial objections an effective change will take time. The reformed programme in Geneva now involves problem based learning, clinical reasoning and learning in the clinical environment, and also requires students to be aware of their own learning objectives. An unexpected side effect of the reform was that it led to the reshaping of research at universities. Basic research was re-modelled and made more interactive. Finally, Dr. Bader stressed that students are crucial partners when reforming medical curricula and both problem based learning and lecture-based teaching by outstanding professors are an illuminating means of learning. In conclusion, reform never ends but is a continuous process that requires a structured framework to carry it out.

Finally, with only two hours notice,  Krishnan Ganapathy, President of Apollo Telemedicine Networking Foundation, Chennai, India, happily provided a lively discussion on his perspectives of the topic Reshaping Medical Education.

Dr. Ganapathy is effectively a receiver of medical education having being taught how to diagnose and treat patients traditionally. Moving with the times and being a technology enthusiast himself, he emphasised that technology is only an enabler and essentially it is the ‘man’ behind the machine that counts. Through his own practice at the Apollo Hospitals, Dr. Ganapathy notes that many international patients receive care and treatment and there is a need for doctors to be culturally sensitive and aware of more than one language in order to deliver patient care effectively. In modern times, the patient can be even more knowledgeable of their disease than the practitioner, as a result of access to the World Wide Web and Google search engines. Knowledge and wisdom are two key aspects Dr. Ganapathy feels passionately about, highlighting that wisdom is the tool we should be using to learn from others’ mistakes. So much could be achieved by sharing information. Ultimately ‘reshaping’ does not stop and there is a need to re-certify Practitioners to confirm their competency after a significant number of years of practicing medicine. Otherwise the ‘pyramid’ structure of accessing information from a higher professional could potentially reverse in the future. Technology is reshaping medical education with video conferencing capabilities, simulations to learn surgical techniques, cameras used for surgery and digital libraries.

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