Astrocyte

EDITORIAL
Year
: 2015  |  Volume : 2  |  Issue : 3  |  Page : 107--110

Setting course for a global medical varsity and third generation reforms in medical education


Yatish Agarwal1, Bipin Batra2,  
1 Prof. Yatish Agarwal is the Editor-in-Chief of Astrocyte and Professor of Radiology at New Delhi's Safdarjung Hospital and VM Medical College
2 Prof. Bipin Batra is the Executive Director, National Board of Examinations and Executive Editor, Astrocyte

Correspondence Address:
Yatish Agarwal
Prof. Yatish Agarwal is the Editor-in-Chief of Astrocyte and Professor of Radiology at New Delhi's Safdarjung Hospital and VM Medical College.




How to cite this article:
Agarwal Y, Batra B. Setting course for a global medical varsity and third generation reforms in medical education.Astrocyte 2015;2:107-110


How to cite this URL:
Agarwal Y, Batra B. Setting course for a global medical varsity and third generation reforms in medical education. Astrocyte [serial online] 2015 [cited 2019 Dec 8 ];2:107-110
Available from: http://www.astrocyte.in/text.asp?2015/2/3/107/181517


Full Text

Beset with outdated, fragmented, fossilized curricula, knowledge texts which make little allowance for the native landscape and associated host and system peculiarities, ill-equipped faculty hibernating in static age-old teaching methods, medical students who bunk classes and clinics from their early years in school to acquire knowledge skills vital for cracking the postgraduate entrance exams. Falling clinical competencies, particularly so with generation-next physicians. Education systems which do little to inspire enquiry, exploration or critical thinking. Postgraduate research reduced to a sham. Public investments in professional medical education on a shrink, and private players filling this drought, where the enterprise must measure success in terms of financial harvest rather than the fulfillment of social chores.

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Truly, there's precious little to cheer about the country's present day medical education system which must weigh itself before taking on the major changes that the Global Commission on the Education of Health Professionals for a New Century has affirmed in its report published in the Winter of 2010 in The Lancet.[1]

A shot in the arm

More than five years have elapsed since this well-crafted, well-researched report was first published. The big irony, however, is that till date it has generated very little discussion and debate in the related quarters in the country. In this apathetic climate, the recent article: A Global University can be a shot in the arm for medical teaching in a newspaper [2] penned by the two primus inter pares of the medical realm, Devi Shetty and Vinay Kumar – makes for a most interesting read, spinning off as it did several deep-seated messages enunciated in the Global CommissionReport.[1]

A straight take off as if a cue from the Global CommissionReport, it paints an exciting landscape of a virtual medical varsity, which could take in its fold all larger than 300-bedded hospitals willing to be a part of the exercise. A win-win model for all stakeholders, it offers a dynamic blueprint for maximizing the existing resources and keeping the cost of medical education low.

A simple model

The model is simple. Create a virtual medical varsity. Where a global faculty, comprising the best among the best, combine to host e-didactic lectures through an electronic hook-up, exploiting the power of information technology to universalize high standards of teaching and learning. A robust, integrated, dynamic curriculum lives up to the dictum of “Science is not just growing, it is also changing” and paves the way for a constant alteration and evolution.

Simultaneously, the focus shifts to emphasizing on developing core competencies. A hands-on training program that begins from the very first year of school. All larger than 300-bedded hospitals willing to be a part of the journey find themselves eligible to join the bandwagon. With it, all existing eligible specialists working in the institution get recognized as clinical teachers. The hands-on training program, where a medical student in the first few years works his way through exercises in nursing care and what paramedics do, envisages a seamless integration of diverse streams of healthcare professions – be it the nursing staff, paramedics or doctors. In effect, this helps break down the professional silos while enhancing collaborative and non-hierarchical relationships and acts as a touchstone for building effective healthcare teams.

Not just this, the ideology of globalization, of universal standards, of equal competence among healthcare professionals could also come good. A universal on-line quarterly assessment system could easily sift the silver from the dross, the serious from the non-serious actors!

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The first two generations of reforms

The narrative does not, of course, stop at this singular model. Building on the platform set by the first generation of the 20th century reforms in medical education sparked by the Flexner report (1910),[3] which instilled a science-based curriculum and introduced the modern sciences as foundational for the medical curriculum into two successive phases: 2 years of basic biomedical sciences, followed by 2 years of clinical training in academic medical hospitals and centers. This ushered in a remarkable change. It transformed the medical education from an apprenticeship model to an academic model, punctuated by the caveat that research was viewed not as an end in itself but as a link to improved patient care and clinical training. This first generation of reforms brought in a sea change: It equipped health professionals with robust scientific knowledge and contributed to the doubling of life span during the 20th century.

Around mid 20th century, the second generation of reforms were born. They introduced problem-based instructional innovations. Even though most medical universities in the country never took to these second generation of reforms and continue to be guided by the Flexnerian philosophy, time is ripe for initiating a third generation of reforms that shall mark the 21st century. Based out of Global CommissionReport,[1] these reforms shall be systems based and shall aim at improving the performance of health systems by adapting core professional competencies to specific contexts, while drawing on global knowledge.

Advancing the third-generation reforms

To advance the third-generation reforms, the Global Commission has put forward a vision:

“All health professionals in all countries should be educated to mobilize knowledge and to engage 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. The ultimate purpose is to assure universal coverage of the high-quality comprehensive services that are essential to advance opportunity for health equity within and between countries.

Realization of this vision will require a series of instructional and institutional reforms, which should be guided by two proposed outcomes: Transformative learning and interdependence in education.

In this model, transformative learning is taken as the highest of three successive levels, moving from informative to formative to transformative learning. Informative learning is about acquiring knowledge and skills; its purpose is to produce experts. Formative learning is about socializing students around values; its purpose is to produce professionals. Transformative learning is about developing leadership attributes; its purpose is to produce enlightened change agents. Effective education builds each level on the previous one.

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As a valued outcome, transformative learning involves three fundamental shifts: 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; and from non-critical adoption of educational models to creative adaptation of global resources to address local priorities.

Interdependence is a key element in this systems approach. It underscores the ways in which various components interact with each other. Interdependence in education involves three fundamental shifts: From isolated to harmonized education and health systems; from standalone institutions to networks, alliances, and consortia; and from inward-looking institutional preoccupations to harnessing global flows of educational content, teaching resources, and innovations.”

(reproduced verbatim from the executive summary of the Global Commission Report [1])

The Commission Report makes a series of specific recommendations to improve systems performance. It proposes to bring in a new sociological ethos, which emphasizes on building core competencies; promotes inter-professional and trans-professional education, and faculty development; aspires to expand academic centers to academic systems encompassing networks of hospitals and primary care units linked together through global networks, alliances, and consortia; and nurtures a culture of critical inquiry. Whether these objectives shall be met, ushering in an enlightened new professionalism presenting better services and improvements in the health of patients and populations, this only time shall tell. However, this thought of a new era of universal and equitable progress in health through a passionate and participatory action is certainly in no way less pious than the one enunciated in the Upanishads, which commend:

Sarve bhavantu sukhinah

Sarve santu nirāmayāh

Sarve bhadrāni paśyantu

Mā kashchit duhkha bhāgbhavet

translated thus:

May all be happy,

May all be free from disease,

May all experience what is good,

May no one suffer.

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References

1Julio F, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, et al. 2010. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet 376 (9756): 1923-1958. doi: 10.1016/S0140 6736 (10) 61854-5.
2Shetty D, Kumar V. A global university can be a shot in the arm for medical teaching. The Hindustan Times, Apr 08, 2016. .
3Flexner A. Medical education in the United States and Canada: A report to the Carnegie Foundation for the Advancement of Teaching. New York: The Carnegie Foundation for the Advancement of Teaching, 1910.