- Email: [email protected]
Educating health professionals: the Avicenna project
Comment
I can only hope that Mönkemüller and colleagues’ review offers an eye-opener to all those involved in the development and assessment of new endoluminal therapies for GORD. Their overview should help to raise the standards of safety and success by which we evaluate these therapies. But most importantly, their systematic review highlights the fact that, up to this point, there is no clear evidence to support the use of any of the endoluminal therapies, however promising the early data may seem, in routine clinical practice.
3 4
5
6
7
8
Mehran Anvari
9
St Joseph’s Healthcare, Hamilton ON, Canada L8N 4A6 [email protected]
10
I declare that I have no conflict of interest. 1
2
Fry LC, Mönkemüller K, Malfertheiner P. Systematic review. Endoluminal therapy for gastro-oesophageal reflux disease: evidence from clinical trials. Eur J Gastroenterol Hepatol 2007; 19: 1125–39. Kahrilas PJ. Radiofrequency therapy of the lower esophageal sphincter for treatment of GERD. Gastrointest Endosc 2003; 57: 723–31.
11
12
Houston H, Khaitan L, Holzman M, Richards WO. First year experience of patients undergoing the Stretta procedure. Surg Endosc 2003; 17: 401–04. Johnson DA, Ganz R, Aisenberg J, et al. Endoscopic, deep mural implantation of Enteryx for the treatment of GERD: 6-month follow-up of a multicenter trial. Am J Gastroenterol 2003; 98: 250–58. Cohen LB, Johnson DA, Ganz RA, et al. Enteryx implantation for GERD: expanded multicenter trial results and interim postapproval follow-up to 24 months. Gastrointest Endosc 2005; 61: 650–58. Schiefke I, Zabel-Langhennig A, Neumann S, Feisthammel J, Moessner J, Caca K. Long term failure of endoscopic gastroplication (EndoCinch). Gut 2005; 54: 752–58. Schiefke I, Neumann S, Zabel-Langhennig A, Moessner J, Caca K. Use of an endoscopic suturing device (the ‘ESD’) to treat patients with gastroesophageal reflux disease, after unsuccessful EndoCinch endoluminal gastroplication: another failure. Endoscopy 2005; 37: 700–05. Pleskow D, Rothstein R, Lo S, et al. Endoscopic full-thickness plication for the treatment of GERD: a multicenter trial. Gastrointest Endosc 2004; 59: 163–71. Noh KW, Loeb DS, Stockland A, Achem SR. Pneumomediastinum following enteryx injection for the treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005; 100: 723–26. Wong RF, Davis TV, Peterson KA. Complications involving the mediastinum after injection of Enteryx for GERD. Gastrointest Endosc 2005; 61: 753–56. Tintillier M, Chaput A, Kirch L, Martinet JP, Pochet JM, Cuvelier C. Esophageal abscess complicating endoscopic treatment of refractory gastroesophageal reflux disease by enteryx injection: a first case report. Am J Gastroenterol 2004; 99: 1856–58. Tuebergen D, Rijcken E, Senninger N. Esophageal perforation as a complication of EndoCinch endoluminal gastroplication. Endoscopy 2004; 36: 663–65.
Educating health professionals: the Avicenna project We do not know enough, and we need to know more, about how health professionals are educated, where they are educated, how well, and by whom. This will change with the recent launch of the project to create the Avicenna Directories of educational institutions for the health professions,1 marked by the inaugural meeting in Copenhagen of the Avicenna Advisory Committee. New web-based global directories of universities and schools for all the academic professions in health will now be developed. For medical education, these directories will replace the World Directory of Medical Schools published by WHO since 1953.2 In August, 2007, WHO and the University of Copenhagen signed an agreement to transfer responsibility for the directories to the university with the assistance of the World Federation for Medical Education (WFME), which has a long-standing collaboration with WHO.3 WHO will continue its involvement together with other partners. The Avicenna project will start with medical schools, sequentially encompassing pharmacy schools, schools of public health, and the other academic health professions. One important element is that the use of information technology will allow timely updating and 966
comprehensive information, in particular quantitative data about institutions and their programmes and about quality assurance. All this information will tell us not just where, but also how, the world’s health professionals are educated. The need for this information is ever greater when the number of institutions has been growing uncontrollably in some parts of the world, with some institutions treating the provision of education for health professionals as a trade for profit and not for the needs of society. Schools of dubious provenance may be a disservice to their students and to the patients they wish to serve, which is an important consideration in an age of increasing international professional mobility. The main rationale for creation of the new directories is the need to collect and collate data that are required by international organisations and national governments to direct their technical and financial resources. Without solid information about education there can be no rational understanding of the world’s increasing needs for trained health professionals, to overcome shortages and imbalances in the mix of health workers. The creation of the Avicenna Directories opens wider possibilities. The information about educational institutions and their programmes is of general www.thelancet.com Vol 371 March 22, 2008
worldwide interest. It will be a valuable tool for national registration agencies that are responsible for licensing health practitioners. It will be an instrument to promote international collaborations. It will provide information for potential students or staff wishing to learn about a school or faculty, or about all schools in a particular country. And it will be a reliable and comprehensive database for research. This last use should not be underestimated: both education and research in health sciences will be enhanced. The directories will be an open and user-friendly electronic resource with the latest and most accurate information for users. Which data will be included, and how will they be collected? Some elements are basic. For example, at a national level the information will include the number of institutions, requirements for quality assurance in education, and qualifying criteria. For the university or school, basic information will include contact details, admission rules, a description of the content of the programme of education, the titles of degrees and diplomas awarded, and accreditation status. A new and prominent feature of the Avicenna Directories will be information on the quality, quality assurance, and accreditation mechanisms of institutions and their programmes. To know that a programme exists is a start, but it is also essential to know how it is evaluated, and details of quality assurance and accreditation for each programme may be complex. Furthermore, formal evaluation and proper accreditation do not exist in all countries or for all health professions, and the directories will therefore also include information about institutions and programmes that can be used as benchmarks and indicators of quality. The environment in which medical and other schools work and are established is changing. If new accreditation agencies of dubious quality and provenance were to emerge, programmes validated by them—even if the programmes appear to be satisfactory— cannot be accepted without other evidence. Thus quality assurance and accreditation information is essential.4 Any school that is within the remit of the Avicenna Directories will wish to be included. Contact will normally be through the appropriate national authority. Governments will be invited to join and provide information to the directories, including questionnaires for completion. Electronic questionnaires will be forwarded to institutions, and completed questionnaires will normally be verified by the national government. www.thelancet.com Vol 371 March 22, 2008
Science Photo Library
Comment
Why Avicenna? Avicenna, also known as ibn-Sina, was a physician and philosopher who was active 1000 years ago and noted for his synthesis of knowledge from both east and west.5 He has had a lasting influence on the development of medicine and health sciences. The use of Avicenna’s name symbolises the worldwide partnership that is needed for the promotion of health services of high quality. *David Gordon, Leif Christensen, Manuel Dayrit, Flemming Dela, Hans Karle, Hugo Mercer Faculty of Health Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark (DG, FD); World Federation for Medical Education, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark (LC, HK); and Department of Human Resources for Health, WHO, Geneva, Switzerland (MD, HM) [email protected] We are all involved in the Avicenna Directories. 1 2 3
4
5
http://avicenna.ku.dk (accessed Mar 17, 2008). World Health Organization. World directory of medical schools, 7th edn. Geneva: WHO, 2000. World Federation for Medical Education. WHO/WFME strategic partnership to improve medical education. January, 2004. http://www.wfme.org (accessed Feb 14, 2008). Executive Council, World Federation for Medical Education. International recognition of basic medical education programmes. Med Educ 2008; 42: 12–17. Wikipedia contributors. Avicenna. http://en.wikipedia.org/w/index.php?titl e=Avicenna&oldid=191350261 (accessed Feb 14, 2008).
967
I can only hope that Mönkemüller and colleagues’ review offers an eye-opener to all those involved in the development and assessment of new endoluminal therapies for GORD. Their overview should help to raise the standards of safety and success by which we evaluate these therapies. But most importantly, their systematic review highlights the fact that, up to this point, there is no clear evidence to support the use of any of the endoluminal therapies, however promising the early data may seem, in routine clinical practice.
3 4
5
6
7
8
Mehran Anvari
9
St Joseph’s Healthcare, Hamilton ON, Canada L8N 4A6 [email protected]
10
I declare that I have no conflict of interest. 1
2
Fry LC, Mönkemüller K, Malfertheiner P. Systematic review. Endoluminal therapy for gastro-oesophageal reflux disease: evidence from clinical trials. Eur J Gastroenterol Hepatol 2007; 19: 1125–39. Kahrilas PJ. Radiofrequency therapy of the lower esophageal sphincter for treatment of GERD. Gastrointest Endosc 2003; 57: 723–31.
11
12
Houston H, Khaitan L, Holzman M, Richards WO. First year experience of patients undergoing the Stretta procedure. Surg Endosc 2003; 17: 401–04. Johnson DA, Ganz R, Aisenberg J, et al. Endoscopic, deep mural implantation of Enteryx for the treatment of GERD: 6-month follow-up of a multicenter trial. Am J Gastroenterol 2003; 98: 250–58. Cohen LB, Johnson DA, Ganz RA, et al. Enteryx implantation for GERD: expanded multicenter trial results and interim postapproval follow-up to 24 months. Gastrointest Endosc 2005; 61: 650–58. Schiefke I, Zabel-Langhennig A, Neumann S, Feisthammel J, Moessner J, Caca K. Long term failure of endoscopic gastroplication (EndoCinch). Gut 2005; 54: 752–58. Schiefke I, Neumann S, Zabel-Langhennig A, Moessner J, Caca K. Use of an endoscopic suturing device (the ‘ESD’) to treat patients with gastroesophageal reflux disease, after unsuccessful EndoCinch endoluminal gastroplication: another failure. Endoscopy 2005; 37: 700–05. Pleskow D, Rothstein R, Lo S, et al. Endoscopic full-thickness plication for the treatment of GERD: a multicenter trial. Gastrointest Endosc 2004; 59: 163–71. Noh KW, Loeb DS, Stockland A, Achem SR. Pneumomediastinum following enteryx injection for the treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005; 100: 723–26. Wong RF, Davis TV, Peterson KA. Complications involving the mediastinum after injection of Enteryx for GERD. Gastrointest Endosc 2005; 61: 753–56. Tintillier M, Chaput A, Kirch L, Martinet JP, Pochet JM, Cuvelier C. Esophageal abscess complicating endoscopic treatment of refractory gastroesophageal reflux disease by enteryx injection: a first case report. Am J Gastroenterol 2004; 99: 1856–58. Tuebergen D, Rijcken E, Senninger N. Esophageal perforation as a complication of EndoCinch endoluminal gastroplication. Endoscopy 2004; 36: 663–65.
Educating health professionals: the Avicenna project We do not know enough, and we need to know more, about how health professionals are educated, where they are educated, how well, and by whom. This will change with the recent launch of the project to create the Avicenna Directories of educational institutions for the health professions,1 marked by the inaugural meeting in Copenhagen of the Avicenna Advisory Committee. New web-based global directories of universities and schools for all the academic professions in health will now be developed. For medical education, these directories will replace the World Directory of Medical Schools published by WHO since 1953.2 In August, 2007, WHO and the University of Copenhagen signed an agreement to transfer responsibility for the directories to the university with the assistance of the World Federation for Medical Education (WFME), which has a long-standing collaboration with WHO.3 WHO will continue its involvement together with other partners. The Avicenna project will start with medical schools, sequentially encompassing pharmacy schools, schools of public health, and the other academic health professions. One important element is that the use of information technology will allow timely updating and 966
comprehensive information, in particular quantitative data about institutions and their programmes and about quality assurance. All this information will tell us not just where, but also how, the world’s health professionals are educated. The need for this information is ever greater when the number of institutions has been growing uncontrollably in some parts of the world, with some institutions treating the provision of education for health professionals as a trade for profit and not for the needs of society. Schools of dubious provenance may be a disservice to their students and to the patients they wish to serve, which is an important consideration in an age of increasing international professional mobility. The main rationale for creation of the new directories is the need to collect and collate data that are required by international organisations and national governments to direct their technical and financial resources. Without solid information about education there can be no rational understanding of the world’s increasing needs for trained health professionals, to overcome shortages and imbalances in the mix of health workers. The creation of the Avicenna Directories opens wider possibilities. The information about educational institutions and their programmes is of general www.thelancet.com Vol 371 March 22, 2008
worldwide interest. It will be a valuable tool for national registration agencies that are responsible for licensing health practitioners. It will be an instrument to promote international collaborations. It will provide information for potential students or staff wishing to learn about a school or faculty, or about all schools in a particular country. And it will be a reliable and comprehensive database for research. This last use should not be underestimated: both education and research in health sciences will be enhanced. The directories will be an open and user-friendly electronic resource with the latest and most accurate information for users. Which data will be included, and how will they be collected? Some elements are basic. For example, at a national level the information will include the number of institutions, requirements for quality assurance in education, and qualifying criteria. For the university or school, basic information will include contact details, admission rules, a description of the content of the programme of education, the titles of degrees and diplomas awarded, and accreditation status. A new and prominent feature of the Avicenna Directories will be information on the quality, quality assurance, and accreditation mechanisms of institutions and their programmes. To know that a programme exists is a start, but it is also essential to know how it is evaluated, and details of quality assurance and accreditation for each programme may be complex. Furthermore, formal evaluation and proper accreditation do not exist in all countries or for all health professions, and the directories will therefore also include information about institutions and programmes that can be used as benchmarks and indicators of quality. The environment in which medical and other schools work and are established is changing. If new accreditation agencies of dubious quality and provenance were to emerge, programmes validated by them—even if the programmes appear to be satisfactory— cannot be accepted without other evidence. Thus quality assurance and accreditation information is essential.4 Any school that is within the remit of the Avicenna Directories will wish to be included. Contact will normally be through the appropriate national authority. Governments will be invited to join and provide information to the directories, including questionnaires for completion. Electronic questionnaires will be forwarded to institutions, and completed questionnaires will normally be verified by the national government. www.thelancet.com Vol 371 March 22, 2008
Science Photo Library
Comment
Why Avicenna? Avicenna, also known as ibn-Sina, was a physician and philosopher who was active 1000 years ago and noted for his synthesis of knowledge from both east and west.5 He has had a lasting influence on the development of medicine and health sciences. The use of Avicenna’s name symbolises the worldwide partnership that is needed for the promotion of health services of high quality. *David Gordon, Leif Christensen, Manuel Dayrit, Flemming Dela, Hans Karle, Hugo Mercer Faculty of Health Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark (DG, FD); World Federation for Medical Education, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark (LC, HK); and Department of Human Resources for Health, WHO, Geneva, Switzerland (MD, HM) [email protected] We are all involved in the Avicenna Directories. 1 2 3
4
5
http://avicenna.ku.dk (accessed Mar 17, 2008). World Health Organization. World directory of medical schools, 7th edn. Geneva: WHO, 2000. World Federation for Medical Education. WHO/WFME strategic partnership to improve medical education. January, 2004. http://www.wfme.org (accessed Feb 14, 2008). Executive Council, World Federation for Medical Education. International recognition of basic medical education programmes. Med Educ 2008; 42: 12–17. Wikipedia contributors. Avicenna. http://en.wikipedia.org/w/index.php?titl e=Avicenna&oldid=191350261 (accessed Feb 14, 2008).
967