Training of Health Professionals Requires Transformation

To respond to the needs and challenges of the 21st century, the education of health professionals requires a process of transformation. In this sense, Julio Frenk identifies three major reforms in medical education. The first is called science-based education, which is structured with the recommendations of the Flexner Report, establishing an initial period of training in basic sciences followed by a period of clinical training. This sought academic rigor and standardization of medical schools. The second generation of reforms, identified as problem-based education, emerged after World War II. The main changes introduced with this curriculum reform were problem-based teaching, integrated curriculum and student-centered learning. The emphasis of this model remained on the acquisition of scientific knowledge, incorporating new principles to favor active student-centered learning. With the beginning of the 21st century, the third and most recent generation of reforms, called systems-based education, emerged. This includes patient- and community-centered care; a competency-based curriculum; interprofessional education; the use of information technologies in learning as well as the development of management and leadership skills in health professionals. In accordance with this third perspective, various organizations and experts from universities point out that scientific knowledge and clinical skill are not enough to respond to the new and complex challenges of the population and health systems in this century.

Specifically in medical education, the above changes are compounded by the technological, epidemiological and social transitions faced by health systems. The challenge is to align the needs of the environment with the new educational alternatives.

There are about five trends that are shaping the future of medical education. First, the great and continuous explosion of scientific information.  Then the health care system itself; as models of care have changed so do the ways in which education has to keep up with the rapid pace of that change. Third, adult learning theory. We now better understand how adult learners learn, enabling us to make education more relevant to our students. Fourth, demographics; not only the demographics of our patient populations, such as older patients and those who have had multiple illnesses, but also the demographics of our diverse students. Finally, technology and its impact on patient care and education delivery.

There has been a broad consensus for decades on the need for deep restructuring and breakthrough innovation within the medical education community. Despite this consensus on the changes needed in medical education, experts agree that there is a large gap between how physicians are trained and the future needs of our healthcare system. A new, innovative model of education is needed to train health professionals for an open, intelligent, and interconnected society

Barriers to innovation are preventing institutions that train human resources in health from evolving in the necessary direction. These barriers include the lack of resources available for innovation, regulatory constraints, institutional rigidity and bureaucracy, underdeveloped technological support within and between institutions, and historical divisions between the healthcare system and academic system leaders, without ignoring the survival of anachronistic educational paradigms.

Seeking to speed up change in medical education, the AMA (American Medical Association) outlined the following objectives: Develop new methods to measure and assess the key competencies of physicians at all levels of training to create more flexible and individualized learning plans; Promote exemplary methods to achieve patient safety, performance improvement, and patient-centered team care;  Improve understanding of the healthcare system and healthcare financing in medical training; and Optimize the learning environment. Along the same line of thought, the AMFEM (Mexican Association of Faculties and Schools of Medicine) has recently pointed out that students must be trained to develop skills that prepare them to face an uncertain, complex environment of unlimited possibilities. This requires medical schools to educate students beyond theoretical knowledge and training them, in addition, to develop a series of generic skills that allow them to face their future professional reality.

An innovative proposal, from Tecnológico de Monterrey, is challenge-based learning (ABR), which consists of students developing solutions to real problems that require an interdisciplinary and creative approach for the development of this type of transversal competences in contexts outside the classroom.

The ABR is a learning opportunity in which students collaborate, under the guidance of the teacher, to learn about relevant problems by proposing real solutions. This is a pedagogical approach that integrates the student to work on a real and relevant problem, which must be solved.

Moreover, the ABR is a learning experience that takes place in a defined context and outside the classroom, where participants must face a series of activities that together represent an extraordinary challenge that cannot be solved individually and requires an interdisciplinary and creative approach, with the coordinated participation of different actors:  students, teachers and external experts. This technique differs from classroom activities by applying knowledge demonstrated through competition and guaranteed by an external evaluation.

This teaching technique reviews existing teaching methods to determine best practices for producing learning environments that develop and encourage creativity. The observable results in students are critical and divergent thinking, innovative solutions to problems and new ideas.

Therefore, it is necessary to identify whether current educational systems are capable of training graduates who impact the health and well-being of patients, families, communities and nations through medical care based on ethical principles, high standards of quality and safety, and based on changing trends within a knowledge society.  Organizations that train human resources in health  should have as their ultimate goal to impact health systems with the conditions of the present and the future in a sustainable way. Training institutions must respond to current and future health needs by reorienting their educational models and priorities.