- Email: [email protected]
Transforming health professionals' education
Correspondence
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Leach M, Palzzi J, Muderi P. Prescription for healthy development: increasing access to medicine. London: Earthscan, 2005. Dayrit MM, Dolea C. The health workforce crisis—where are the pharmacists? Int Pharm J 2006; 20: 5–7. Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 1923–58. Anderson C, Bates I, Beck D, et al. The WHO UNESCO FIP Pharmacy Education Taskforce: enabling concerted and collective global action. Am J Pharm Educ 2008; 72: 127. Anderson C, Bates I, Beck D, et al. The WHO UNESCO FIP Pharmacy Education Taskforce Human Resources Health 2009; 7: 45.
insights into the operationalisation of the reform. This is a golden opportunity bioethicists must not let go by unacknowledged. I declare that I have no conflicts of interest.
Renaud F Boulanger [email protected] University of Toronto, Toronto, ON M5G 1L7, Canada 1
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The participants in the Commission on the Education of Health Professionals for the 21st Century1 call for “third-generation reforms” in health education. These reforms, they say, should emphasise the development of “leadership attributes” and produce “enlightened change agents”. It is a bold but promising move to try to “develop a shared vision…for postsecondary education in medicine, nursing, and public health”. Absent from the Commission’s report, however, is an explicit mention of how bioethics should position itself in relation to this renewed vision for health education. The question is less frivolous than might first appear. First, at a pragmatic level, bioethicists are increasingly becoming an integral part of healthcare systems. As such, and despite their own ambiguous relationship to professionalisation,2 their presence cannot be excluded from “interprofessional and transprofessional education that breaks down professional silos”. Second, the work of the Commission also indirectly raises questions about the future of bioethics education, which continues to be non-standardised and often ad hoc. Third, the health professions must not forget that at the very core of the bioethical enterprise is already a commitment to nurture, in Frenk and colleagues’ words, “effective leadership to transform health systems”. All this suggests that bioethics might not only directly benefit from the Commission’s work, but might also provide valuable www.thelancet.com Vol 377 April 9, 2011
Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 1923–58. Regenberg AC, Mathews DJH. Resisting the tide of professionalization: valuing diversity in bioethics. Am J Bioeth 2005; 5: 44–45.
The report of the Commission on the Education of Health Professionals for the 21st century1 has formulated a vision for comprehensive educational reforms. As young professionals, we applaud the Commission’s move to place health professionals’ education on the global agenda. Its laudable vision, however, must be supplemented with a more grounded analysis and rigorous components to ensure implementation action. We are concerned that, owing to the neglect of crucial components including the political economy, drivers of social change, sources of knowledge, and educational outcomes (see webappendix),2–5 some of the key recommendations could remain merely rhetorical. We are also troubled by the idea that a global social movement can be deployed from the top rather than by recognising that it evolves through partnerships between communities, students, and health workers who seek greater transparency, democracy, accountability, and social relevance. Nevertheless, the debate on health professionals’ education needs to be kept vital and we urgently need to move from visions to implementation. As young professionals, we call on WHO to take the lead in facilitating progress towards the reform of health professionals’ education and:
• Initiate regional working groups on health professionals’ education in all WHO regions. • Ensure the participation of UNESCO, national ministers of health and education, professional and student bodies, academic associations, civil society, and grassroots organisations within these working groups to refine analysis and define priorities in educational reforms and research according to regional or national needs, or both. • Facilitate exchange and interaction between regional working groups by putting health professionals’ education on the agenda of the upcoming Second Global Symposium on Health Systems Research in China. • Ensure that national reforms on health professionals’ education align with the values and principles of the Alma Ata Declaration.
Reuters
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All authors commented on drafts of the Commission on the Education of Health Professionals for the 21st century as members of the Young Professionals Commission (YPC) without receiving financial benefits. The opinions expressed in this letter are the authors’ alone and not necessarily shared by other members of the YPC.
*Kayvan Bozorgmehr, Lalit Narayan, Rohan Radhakrishna [email protected] Institute for Social Medicine, Epidemiology and Health Economics, Charité—University Medical Centre Berlin, 10098 Berlin, Germany (KB); Department of Anthropology, Syracuse University, Syracuse, NY, USA (LN); University of California Berkeley/San Francisco Joint Medical Program, CA, USA (RR); and Christian Medical College, Vellore, India (RR) 1
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See Online for webappendix
Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 1923–58. Jacobs LR, Soss J. The politics of inequality in America: a political economy framework. Annu Rev Political Sci 2010; 13: 341–64. Nguyen VK, Peschard K. Anthropology, inequality, and disease: a review. Annu Rev Anthropol 2003; 32: 447–74. Buchmann C, Hannum E. Education and stratification in developing countries: a review of theories and research. Annu Rev Sociol 2001; 27: 77–102. Kumanan R, Johanna N, Nicole V. Realizing human rights-based approaches for action on the social determinants of health. Health Hum Rights 2010; 12: 49–59.
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Leach M, Palzzi J, Muderi P. Prescription for healthy development: increasing access to medicine. London: Earthscan, 2005. Dayrit MM, Dolea C. The health workforce crisis—where are the pharmacists? Int Pharm J 2006; 20: 5–7. Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 1923–58. Anderson C, Bates I, Beck D, et al. The WHO UNESCO FIP Pharmacy Education Taskforce: enabling concerted and collective global action. Am J Pharm Educ 2008; 72: 127. Anderson C, Bates I, Beck D, et al. The WHO UNESCO FIP Pharmacy Education Taskforce Human Resources Health 2009; 7: 45.
insights into the operationalisation of the reform. This is a golden opportunity bioethicists must not let go by unacknowledged. I declare that I have no conflicts of interest.
Renaud F Boulanger [email protected] University of Toronto, Toronto, ON M5G 1L7, Canada 1
2
The participants in the Commission on the Education of Health Professionals for the 21st Century1 call for “third-generation reforms” in health education. These reforms, they say, should emphasise the development of “leadership attributes” and produce “enlightened change agents”. It is a bold but promising move to try to “develop a shared vision…for postsecondary education in medicine, nursing, and public health”. Absent from the Commission’s report, however, is an explicit mention of how bioethics should position itself in relation to this renewed vision for health education. The question is less frivolous than might first appear. First, at a pragmatic level, bioethicists are increasingly becoming an integral part of healthcare systems. As such, and despite their own ambiguous relationship to professionalisation,2 their presence cannot be excluded from “interprofessional and transprofessional education that breaks down professional silos”. Second, the work of the Commission also indirectly raises questions about the future of bioethics education, which continues to be non-standardised and often ad hoc. Third, the health professions must not forget that at the very core of the bioethical enterprise is already a commitment to nurture, in Frenk and colleagues’ words, “effective leadership to transform health systems”. All this suggests that bioethics might not only directly benefit from the Commission’s work, but might also provide valuable www.thelancet.com Vol 377 April 9, 2011
Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 1923–58. Regenberg AC, Mathews DJH. Resisting the tide of professionalization: valuing diversity in bioethics. Am J Bioeth 2005; 5: 44–45.
The report of the Commission on the Education of Health Professionals for the 21st century1 has formulated a vision for comprehensive educational reforms. As young professionals, we applaud the Commission’s move to place health professionals’ education on the global agenda. Its laudable vision, however, must be supplemented with a more grounded analysis and rigorous components to ensure implementation action. We are concerned that, owing to the neglect of crucial components including the political economy, drivers of social change, sources of knowledge, and educational outcomes (see webappendix),2–5 some of the key recommendations could remain merely rhetorical. We are also troubled by the idea that a global social movement can be deployed from the top rather than by recognising that it evolves through partnerships between communities, students, and health workers who seek greater transparency, democracy, accountability, and social relevance. Nevertheless, the debate on health professionals’ education needs to be kept vital and we urgently need to move from visions to implementation. As young professionals, we call on WHO to take the lead in facilitating progress towards the reform of health professionals’ education and:
• Initiate regional working groups on health professionals’ education in all WHO regions. • Ensure the participation of UNESCO, national ministers of health and education, professional and student bodies, academic associations, civil society, and grassroots organisations within these working groups to refine analysis and define priorities in educational reforms and research according to regional or national needs, or both. • Facilitate exchange and interaction between regional working groups by putting health professionals’ education on the agenda of the upcoming Second Global Symposium on Health Systems Research in China. • Ensure that national reforms on health professionals’ education align with the values and principles of the Alma Ata Declaration.
Reuters
1
All authors commented on drafts of the Commission on the Education of Health Professionals for the 21st century as members of the Young Professionals Commission (YPC) without receiving financial benefits. The opinions expressed in this letter are the authors’ alone and not necessarily shared by other members of the YPC.
*Kayvan Bozorgmehr, Lalit Narayan, Rohan Radhakrishna [email protected] Institute for Social Medicine, Epidemiology and Health Economics, Charité—University Medical Centre Berlin, 10098 Berlin, Germany (KB); Department of Anthropology, Syracuse University, Syracuse, NY, USA (LN); University of California Berkeley/San Francisco Joint Medical Program, CA, USA (RR); and Christian Medical College, Vellore, India (RR) 1
2
3
4
5
See Online for webappendix
Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 1923–58. Jacobs LR, Soss J. The politics of inequality in America: a political economy framework. Annu Rev Political Sci 2010; 13: 341–64. Nguyen VK, Peschard K. Anthropology, inequality, and disease: a review. Annu Rev Anthropol 2003; 32: 447–74. Buchmann C, Hannum E. Education and stratification in developing countries: a review of theories and research. Annu Rev Sociol 2001; 27: 77–102. Kumanan R, Johanna N, Nicole V. Realizing human rights-based approaches for action on the social determinants of health. Health Hum Rights 2010; 12: 49–59.
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