Medical education in the emerging market economies

Abstract

Health professional education is essential to strengthen health systems. This will mean adopting a global approach to interprofessional education in an interdependent world. Based on an integrated framework of health and educational systems, we examine and make recommendations on instructional and institutional design. The cornerstone of groundbreaking reforms in health professional education sparked by the 1910 Flexner report was the integration of modern science into the curricula at university-based schools. They equipped health professionals with the knowledge that contributed to the doubling of lifespan during the 20th century. Yet glaring gaps and inequities in health that persist within and between countries, new infectious, environmental, and behavioural risks, and rapid demographic and epidemiological changes present additional challenges to increasingly complex and costly health systems. Fragmented, outdated, and static curricula producing ill-equipped graduates have not kept pace with the new challenges of the 21st century, and call for a thorough re-examination of health professional education. In this chapter we do not confine ourselves to a single profession and articulate a framework aimed at understanding the complex interactions between two core systems—education and health. We identify three key dimensions of education—institutional design (which specifies the structure and functions of the education system), instructional design (which focuses on process), and educational design (which deals with desired results). We call for a new era of professional education that advances transformative learning and harnesses the power of interdependence in education. Since the publication of the Lancet Commission Report (Frenk et al. 2010), follow up activities have revealed widespread interest in innovation and reform in health professional education. How these activities will eventually generate change depends upon five key forces that will shape both the context of health professional education and impose demands upon the educational process: epidemiologic–demographic transitions, explosion of knowledge, market forces, public policy, and professional leadership. Reform must begin with a change in mindset that acknowledges problems and seeks to solve them. No different than a century ago, educational reform is a long and difficult process that calls for leadership and requires changing perspectives, work styles, and relationships among all stakeholders.