Editorial

Abstract

Although the technical resources for health care have never been greater than today there is growing concern, in developed and developing nations alike, that the discrepancy between potentially available and actually delivered health service is becoming intolerably great, at least for substantial segments of the population. How medical doctors will be prepared for the role they will play in a changing health care system, in collaboration with other health professionals, is a central problem with which medical school leaders, and those directing other medical educational bodies, must grapple as they devise instructional programmes for a new generation of medical students. It is this issue which represents a central theme for National and Regional Conferences and ultimately for a World Conference on Medical Education on 8–12 August 1988, entitled ‘Medical Education for the Future: an Action-oriented World Conference’. There is now general acceptance that medical schools must play a major role in improving both the quality and the availability of basic health care in every nation. A great challenge which is now coming before the medical schools and the postgraduate training bodies derives from an international agreement reached in 1978 at Aima-Ata in the USSR. All countries adopted a resolution at the 34th World Health Assembly in 1979 proposing ‘Health for All by the Year 2000′. The method proposed to promote this ambitious goal is a new concept of ‘primary health care’, which calls for developments now relatively lacking in most countries: education of the public about prevailing health problems; a major emphasis on promotion of health; a serious concern with prevention of illness; proper nutrition; attention to family health; and appropriate treatment of common illnesses. If equity in health care is to become a reality (it has been adopted as the official policy of the World Health Organization), a major change will be demanded of the medical schools, with vast organizational and educational implications; delivery of health care will also have to be modified extensively. Doctors will have to work much more closely with members of the other health professions, and training will have to be provided in common. As things stand, governments have so far failed adequately to convey to medical schools what their countries at the World Health Parliament have committed them to implement. Medical education in every country unquestionably stands to gain greatly from the more effective contact and improved communication of medical schools with the country's health care system, and with the government's health department. Despite the pledge from 156 governments represented in the 1979 World Health Assembly, there remain both individuals and groups who regard the theme as misleading, the goal as unachievable, and the method questionable. But whatever their reservations, either felt or expressed, the desirability of that ultimate objective seems undeniable, and the need for movement in that direction urgent. The means by which it might be accomplished may be debatable, but without the active support of medical doctors it is inconceivable that any such effort can be successfully carried out. The World Federation for Medical Education is implementing a Programme of wide reassessment of the training of doctors on a global level (this Journal, 1986, 20, 1). In order to assure focused and productive discussion nationally and internationally, the Planning Commission of the World Federation has issued a document, consisting of six theme papers which highlight the key issues, and pose specific questions that must be answered in order to address the central problems. While no specific actions have been formulated in the document, it should be read and responses proposed with one overriding principle in mind: doctors themselves, and those who educate and train them, should participate actively in reorienting medical education to be as relevant as possible to contemporary health needs of communities.