Education of Health Professionals for the 21 st Century. Barry Kistnasamy

Transcription

1 Education of Health Professionals for the 21 st Century Barry Kistnasamy

2 Conflict Disclosure Information: Presenter: Barry Kistnasamy Title of Presentation: for the 21 st Century Education of Health Professionals I have no financial or personal relationships to disclose

3 Overview Macro-perspectives The Commission Report Take Home Messages

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5 Nov 2006

6 Life Expectancy 2002, 2030 (WHO, GBD)

7 Health needs Chronic - chronic Diseases diseases IHI Global Strategy Nigel Crisp Crisp N. 2010

8 Complex Set of Risk Factors A few risk factors lead to 4 diseases 50% of global mortality

9 The Real Weapons of Mass Destruction?

10 Tobacco Related Deaths

11 Road Traffic Deaths

12 Quantifying Health Impact of Climate Change Climate change Air pollution Africa region South-East Asia Eastern Mediterranean Latin America and Caribbean Western Pacific region OECD countries Diarrhoeal diseases Malaria Unintentional injuries Protein-energy malnutrition Cardiopulmonary diseases Respiratory infections Trachea/ bronchus/ lung cancers Burden of disease by region: Climate change and air pollution Disability Adjusted Life Year / million. World Health Report 2002.

13 HIV

14 AIDS Deaths Health systems challenges and Crisp N. 2010

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16 More Illness and Fewer Health Workers in Africa WHO: Human Resources for Health, 2006

17 Resized World Maps

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19 The Commission Education of Health Professionals for the 21st Century Advisory Inputs Scientific advisors Youth commissioners Papers Consultations Research Commissioners Global Multi-professional Evidence-based Instruction-institution

20 General Report Outline I. A Century of Progress, a Time of New Challenges II. An Integrative Framework III. Institutional Landscape IV. Instructional Innovations V. A Vision for a New Century

21 Global outlook What s New Focus on all health professions beyond traditional silos, with emphasis on medicine, nursing and public health Long-term perspective on post-secondary education Integrative framework New vision driving specific recommendations

22 Some Findings medical schools, 467 SPHs / departments & many nursing educational institutes produce about 1m doctors, nurses & PH professionals 2. $100b spent on health professional education (<2% of health expenditures) 3. Avg $ for medical student & $ for a nurse (highest cost in N. America and lowest in China)

23 Flexner, Welch-Rose and Goldmark Reports

24 Institutional Instructional Three Generations of Reforms 1900 Science based Problem based Systems based Scientific curriculum Problem based learning Competency driven; local-global University based Academic centers Health & Education Systems

25 Three Generations of Reforms 1 st : Flexner, Rose- Welch, Goldmark 2 nd : Reforms for second half of 20 th century 3 rd : Reforms for 21 st century INSTRUCTIONAL DESIGN Modern sciences sequential curriculum basic clinical Didactic teaching, discipline based Education prioritized over service Academic entry criteria Problem-based learning Integration into organ and functioning system Early exposure to patients Global connection, local responsiveness. Competency driven inter-prof teams Leadership, management and teamwork Technology empowered learning Horizontal integration: basic, clinical, population sciences INSTITUTIONAL DESIGN University base: academic institutions linked to hospitals Closure of proprietary schools Close apprenticeship Worksite experiences clinical training in hospital primary care in communities Systems approach: Education and health Connectivity: global local Networks and partnerships OUTCOMES Professionalism, technical and ethical standards Active learner Life-long active learning Socially accountable professionalism

26 Systemic Failures Mismatch of competencies to need Weak teamwork Gender stratification Hospital dominance over primary care Labour market imbalances Weak leadership for health system performance

27 Professionalism Bright sides: Dark sides: Knowledge broker and manager Organizational leader Multiple roles in health system Social agent with valuesethics Service provider and carer Team work with others Monopolizing knowledge Controlling labor market Seeking financial self-interests Credential creep Seeking social prestige and status Fragmentation, overspecialization

28 A Systems Approach Education System Supply of health workforce Labor market for health professionals Demand for health workforce Health System Provision of education Provision of health care Demand for education Demand for health care Educational needs Health needs Population

29 Challenges to Health Systems Epidemiological and demographic transitions Technological innovation Health System Professional differentiation Population demands

30 Competency-based Education Curriculum Traditional model Educational objectives Assessment Competency-based education model Health needs Health systems Competencies outcomes Curriculum Assessment

31 Models of inter- and trans-professional Education Model Pre-secondary education Post-secondary education Practice MD Dominant Common Nursing Public health Teamwork Other Interprofessional Common Core + specific competencies Systematic teamwork Teamwork Transprofessional Common Core + specific competencies Systematic teamwork Teamwork Community health workers

32 Level Objectives Outcome Informative Formative Levels of Learning Information Skills Socialization Values Transformative Leadership attributes Experts Professionals Change agents

33 Integrative Framework Structure Institutional Design Systemic Level Governance Financing Development of the teaching workforce Interface education-health systems Organizational level Division of labor Incentives Capacity strengthening Global level Stewardship Networks and partnerships Text Context Text Global-Local Process Instructional Design Criteria for admission Competencies (definition) Curriculum Content Courses Channels Didactic methods Teaching technologies Outcomes Interdependence Health and education systems Global and local spheres Categories of the health workforce Context and competencies Teaching and learning Text Transformative learning Inter-professional and team-based IT-empowered and pro-active Life-long Evidence-based Locally responsive and globally connected Adaptive to versatile career paths Socially accountable for new professionalism

34 Recommendations A. Instructional reforms 1. Curricular reform 2. Inter-professionalism B. Institutional reforms 3. Joint planning mechanism 4. Global consortia, alliances, and networks C. Enabling recommendations 5. Sustainable national investment 6. Expanded global investments with appropriate stewardship 7. Monitoring and evaluation of innovations D. Call to action Global social movement for: More detailed studies by institution and profession Implementation of innovative projects Mobilization of support to scale up

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36 Rodgers & MacMahon

37 Brazil

38 Maropeng" The Economist Dec 13 th -19 th 2003

39 A Vision for a New Century Text Transformative Learning Text for a New Century Text Guiding Notions Interdependence Interdependence In in Professional Education Professional Education

40 Number of medical schools New medical schools (public & private) in India and Brazil India Brazil

41 The World Village (n=100) 57 Asians 21 Europeans 14 Americans 8 Africans Lueddeke GR women & 48 men 80 persons living in poverty 70 illiterate 50 suffering from hunger & malnutrition 1 person with a university degree 1 person with a computer

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43 Together we can!