Education of Health Professionals Must Change in an Interdependent World

Susan Kreimer

December 03, 2010

December 3, 2010 — Massive reform would overhaul the education worldwide of physicians and other healthcare workers, preparing them for advances in practice, according to a new report from the Global Commission on Education of Health Professionals for the 21st Century published online November 29 in The Lancet.

Change is essential in an interdependent world, the authors note, because of the accelerated flow of knowledge, technologies, and financing across boundaries, as well as the migration of professionals and patients.

A team of 20 professional and academic leaders from diverse countries convened to create a shared vision and strategy for postsecondary education in medicine, nursing, and public health. This type of schooling would extend "beyond the confines of national borders and the silos of individual professions," they state in the report.

Every year, on a global scale, 2420 medical colleges, 467 schools or departments of public health, and an indeterminate number of postsecondary nursing institutions train about 1 million new health professionals. Four countries — China, India, Brazil, and the United States — each have more than 150 medical schools, whereas 36 countries are without any medical college. Such imbalances highlight a striking discord between the quantity of institutions, population size, and disease burden.

"The problems are systemic: mismatch of competencies to patient and population needs; poor teamwork; persistent gender stratification of professional status; narrow technical focus without broader contextual understanding; episodic encounters rather than continuous care; predominant hospital orientation at the expense of primary care; quantitative and qualitative imbalances in the professional labour market; and weak leadership to improve health-system performance," the authors write.

Although high-income nations grapple with rising costs and shifting demographics, poorer countries fare even worse. A large proportion of the world's 7 billion inhabitants find themselves trapped in health conditions of a century ago.

"Laudable efforts to address these deficiencies have mostly floundered, partly because of the so-called tribalism of the professions — i.e., the tendency of the various professions to act in isolation from or even in competition with each other," the authors note.

In recommending instructional and institutional reforms, the 20 professional and academic leaders on the commission advocate for innovative use of information technology, preparation of students for the realities of teamwork, and development of global collaborative networks.

"Reliable evidence from low-income and middle-income countries shows that the most important barrier to achieving health is the generation and application of knowledge," Richard Horton, FRCP FMedSci, editor-in-chief of The Lancet, writes in a commentary. "Health professionals are the mediators of knowledge between those who generate it and those who need it."

In a separate commentary, students from Austria and the Netherlands applaud the authors' efforts toward reform. They cite an emerging innovation called Health Sciences Online, which offers learning resources from renowned institutions at no charge. Such initiatives would be particularly beneficial to students in low-income nations. "As health-care students," they conclude, "we encourage all stakeholders to use the Global Commission's report as a basis for further discussion and action."

The authors of the report and commentaries have disclosed no relevant financial relationships.

The Lancet. Published online November 29, 2010.