On Education of Health Professionals


Health Professionals for a new century: transforming education to strengthen health systems in an interdependent world..(Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P, Kistnasamy B, Meleis A, Naylor D, Pablos-Mendez A, Reddy S, Scrimshaw S,
Sepulveda J, Serwadda D, and Zurayk H. The Lancet, 2010. 376 (9756): 1923-1958).

Transformative Learning

I found this report to be very interesting as it covers a topic that is current and very applicable to health professional education today. I was especially interested in the concept of transformative learning, which is the proposed outcome of improvements in instructional design. It is the highest of three successive levels namely informative (acquiring knowledge and skills, produces experts), formative (socializing students around values, produces professionals) and transformative learning (developing leadership attributes, produces change agents).

Transformative learning involves three fundamental shifts from:

  1. Memorization → Searching, analysis and synthesis of information
  2. Seeking professional credentials → Achieving core competencies for effective team work in health systems
  3. Non-critical adoption of educational models → Creative adaptation of global resources to address local priorities

In the 20th century, the Flexner, Welch-Rose, and Goldmark reports transformed the state of health profession education via the integration of modern science into University curricula. Though this was quite revolutionary and groundbreaking at the time, little has been done in the 21st century for health profession education to help improve the health systems as they struggle to keep up with global demands.

Their report addresses the challenges that would be faced and calls for a systems-based approach to improve the state of the health system. They noted that a balance between the health and education system is important for the efficiency, effectiveness and equity of the system-based approach. They also emphasized the need to break down the professional �Silos� that exist by promoting inter-professional education and collaboration in order to enhance teamwork for a patient-centered care. To achieve this, they presented six instructional and four institutional education reforms as per table below.

There is a long road up ahead to achieve this kind of reform that requires a change in mind set and work-style and further discussion and collaboration between all the stakeholders. We can all contribute to this and we need to identify strong leaders in health profession education that can push this forward.

Instructional Reform
1. Adoption of Competency-based curricula that are responsive to rapidly changing needs Competencies should be adapted to local contexts and be determined by national stakeholders
2. Promotion of inter-professional and trans-professional education that breaks down professional silos Inter-professional education should focus on analytical abilities, leadership and management capabilities, and communication skills
3. Exploitation of the power of IT Universities/Institutions should harness the new forms of transformative learning made possible by IT revolution
4. Harnessing global resources and adapting them locally Flexibly address local challenges while using global knowledge, experience and shared resources
5. Strengthening of educational resources Increase investment in education, stable and rewarding career paths and constructive assessment linked to incentives for good performance
6. Promote professionalism that uses competencies as objective criterion for classification of health professionals A set of common attitudes, values and behaviors should be developed for professionals with their roles as accountable change agents, competent managers of resources and promoters of evidence-based policies.
Institutional Reform
1. Establishment of joint planning mechanism in every country to engage key stakeholders Assessment of national conditions, setting priorities, shaping policies, tracking change and harmonizing the supply of and demand for health professionals
2. Expansion from academic centers to academic systems Extending the traditional discovery-care-education continuum in schools and primary hospitals into primary care settings and communities
3. Linking together through networks, alliances, and consortia between educational institutes worldwide and across to allied actors Regional and global consortia need to be established, taking advantage of information and communication technologies with the aim to overcome constraints of individual institutions and to expand resources
4. Nurturing of a culture of critical inquiry To mobilize scientific knowledge, ethical deliberation, and public reasoning and debate to generate enlightened social transformation

Table adapted from: Health Professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet, 2010. 376 (9756): 1923-1958).

For further reading on these topics, consider:

  1. Interprofessional Education Collaborative Expert Panel (2011). Core Competencies for Interprofessional Collaborative Practice: Report of an expert panel. Washington DC: Interprofessional Education Collaborative.
  2. DaRosa DA, Skeff K, Friedland JA, Coburn MC, Cox S, Pollart S, O'Connell M, and Smith S. Barriers of Effective Teaching. Acad Med. 2011;86:453-459.
  3. Schmitt M, Blue A, Aschenbreber CA, and Viggiano TR. Core Competencies for Interprofessional Colaborative Practice: Reforming Health Care by Transforming Health Professionals' Education. Acad Med. 2011;86 (11):1351.

Reviewed in October 2012 by:
Deema Al-Sheikhly, MRes
Manager, Graduate Medical Education