‘Working Differently in the 21st Century Means Learning Differently!’
by George Lueddeke OCT MEd PhD
Consultant in Higher and Medical Education
20th February 2012
The global Lancet Commission report1 was released in December 2010 and is fast becoming the new Abraham Flexner report (1910)2,’which paved the way for medical/healthcare delivery across the globe in the 20th century.’ The Commission co-chairs, Professor Julio Frenk, dean of Harvard's School of Public Health (formerly Mexico's Minister of Health) and Dr. Lincoln Chen, president of The China Medical Board, commended the book as 'an important work,' which independently complemented their own findings and recommendations. In their view, as an enabling mechanism, the book might help support the implementation of proposed Commission reforms and recommendations.
In addition, the book has enjoyed considerable support (non-financial) from senior members of the World Health Organization (WHO) and the Global Health Workforce Alliance (GHWA).Most recently, it was recommended by Dr. Susan Skochelak, Vice President of Medical Education at the American Medical Association (AMA).
The premise for the book is quite simple: in terms of health and social care, we need to learn to work differently in the developed, underdeveloped and the developing worlds in this decade and beyond and that requires new approaches to education and training. Knowing what we know with c 5.7 billion in developing nations and c. 1.3 billion in the developed and underdeveloped, we cannot go on as if we are still in the 20th century.
My main argument is that if we want people to function differently and more effectively - with greater compassion, empathy, commitment, competence, thoughtfulness, and teamworking, - then they need to be educated and trained differently.3
Things would need to change considerably in medical/healthcare education at undergraduate (UG), postgraduate (PG) and continuing professional development (CPD) levels, including, inter alia:
- aligning competencies to population health needs– ensuring that student and trainee knowledge, skills and attitudes match workforce expectations, now and in the more immediate future (e.g., care of the young and elderly and addressing the rise of non-communicable diseases);
- balancing prevention and curative measures in medical/healthcare (minimising the notion of ‘a pill for every ill’) and ensuring that consultations take a more holistic or ‘whole person’ approach, including early diagnosis and intervention;
- optimising interprofessional teamworking at undergraduate and postgraduate levels that flattens hierarchies, empowers people, and reduces, ideally eliminates, professional fragmentation;
- strengthening training in hospitals and the community, thereby decreasing waiting times (e.g. A&E, surgery), improving treatments of the elderly and increasing investments in infrastructure - polyclinics, community health and well-being centres, care home visits and bringing back home visits-24/7).
Since the book focuses on current and future issues facing medical/healthcare education in both the developed and developing worlds, it may be a useful catalyst for discussion and reference for both practitioners and students-perhaps as a core or supplementary text for medical, nursing and other allied health students.
The book also raises awareness about the growing importance of public and global health, primary health care and the need for greater collaboration among the developed, underdeveloped and the developing worlds.
Several chapters in the book are concerned with developing competency-based frameworks and curricula, particularly 'with a view to innovation in skill mix and clinical roles which is crucial to achieving a more efficient and flexible workforce.'4,
Dr. Richard Horton, a UK physician, editor-in-chief of the US-based The Lancet and a Lancet Commissioner, calls for a ‘re-moralising’ of the healthcare system, one which builds ‘a new kind of professionalism -patient-centred, interprofessional and team-based,’ and one that rises above the ‘rigid and damaging tribalism that afflicts the professions today.’1
Indeed, Dr. Ruth Collins-Nakai, former Chair of the Canadian Medical Association (CMA) and now Chair of the Canadian Medical Foundation, echoes Dr Horton’s observations, envisaging a type of leadership that ‘would be courageous enough to act in the best interests of the populations they serve rather than the best interests of business or economics.’3
In terms of health systems, including the training of health professionals, Dr. Margaret Chan, director-general at WHO, observes there is a need to ‘get back to basics’ and a ‘shift to thrift’ ;‘a thirst for efficiency and an intolerance for waste’ ;streamlining and integrating health programmes ‘; and ‘channelling good aid ‘in ways that strengthen existing infrastructure and capacities.’5
She also calls for ‘nothing less than a radical change in mindset, a fundamental rethinking of the way health systems deliver services and maintain good health outcomes.’6
Reflecting on the last decade, Lord Crisp, who ran the UK National Health Service (NHS), from 2000-2006, and is also a Lancet Commissioner, acknowledges that while the reforms following the NHS Plan of 2000 ‘brought many improvements in services and service re-design,’ they ‘were too focused on economic incentives and hospital services.’ He further reminds us that ‘[a]s the NHS enters a new phase in the continuing development of GPs as commissioners and providers, there is a need to look for insights from around the world and to develop a new approach to educating and training primary care and public health professionals, which takes account of this global perspective and global learning’ and ‘in helping develop an NHS workforce for the future.’7, 8
In summary, providing more compassionate and competent patient/social care in this decade and beyond necessitates structural changes in the way we prepare our health/social care professionals. It also requires broader and more ‘joined-up’ thinking and commitment -social, political, economic- on what needs to be done, by whom, how and by when – in terms of health and social care. Given the state of finances across many nations, deliberations along these lines cannot start soon enough.
An important theme throughout the book is that, while health systems will have to change to meet health and social care expectations, so do we! - in order to embrace the transition to a healthier social and cultural environment.
Author’s note: Reviews of the book from different corners of the world have been numerous and positive. An in-depth review by Peter Sharp, CEO of the UK Centre for Workforce Intelligence (CfWI), is available to read on The Lancet Commission website.9 Several others can be found on the publisher’s web link, which also provides a table of contents.10
1Frenk J, Chen L, Bhutta ZA, Cohen J, et al. ‘Health Professionals for a New Century: transforming education to strengthen health systems in an interdependent world.’ The Lancet.
2Duffy TP. The Flexner Report undefined 100 Years Later. Available at:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178858/ (accessed 8 October 2011).
3Lueddeke GR. Transforming Medical Education for the 21st Century: megatrends, priorities and change. London UK: Radcliffe Publishing Ltd; 2012.
4House of Commons (Health Select Committee). First Report-Education, Training and Workforce Planning. Available at:http://www.publications.parliament.uk/pa/cm201213/cmselect/cmhealth/6/602.htm (accessed 25 May 2012).
5Chan M. Best days for public health are ahead of us, says WHO Director General. Address to the Sixty-fifth World Health Assembly. Geneva, Switzerland: WHO; 21 May, 2012.
6Chan M. WHO Director-General addresses conference on health systems. Keynote address at the International Conference on Oman Health Vision 2050: Quality Care, Sustained Health. Muscat, Oman. Geneva, Switzerland: WHO; 30 April 2012.
7Crisp N. A Global Perspective on the Education and Training of Primary Care and Public Health Professionals. London Journal of Primary Care; November 2011.
8Crisp N. Turning the World Upside Down – the search for global health in the 21st century. London: Royal Society of Medicine; 2010.
9Sharp P. New Book on Transforming Medical Education Reviewed. Available at: http://healthprofessionals21.org/index.php?option=com_content&view=article&id=109:lueddeke-book-reviewed&catid=7:news&Itemid=136 (accessed on 14 July 2012).
10Radcliffe Publishing. Transforming Medical Education for the 21st Century: megatrends, priorities and change. Available at:http://www.radcliffehealth.com/shop/transforming-medical-education-21st-century-megatrends-priorities-and-change(accessed 12 February 2013).
George R Lueddeke PhD
George is keen to share and discuss findings from his research on the future of medical/healthcare education and, time permitting, welcomes invitations to present to either small or larger groups (firstname.lastname@example.org)
LinkedIn Connection: http://www.linkedin.com/pub/dr-george-lueddeke/42/4b0/401