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  • Healthcare issues across the globe: Part II

    By Aliye Runyan, MD
    AMSA Education and Research Fellow


    Professionalism

    The conversation surrounding professionalism was fascinating and brought to light a huge unmet need in global medical education. The speaker from the World Federation of Medical Education (WFME) spoke about tenets of professionalism: social accountability of the physician, training to take into account needs of the changing face of medicine, adaptability, training students to understand their global responsibility, and of the need for role models for students. Another speaker pointed out threats to professionalism, including commercialization of medicine, the role of pharmaceutical companies and industry, the deteriorating doctor-patient relationship, and that there are MANY medical schools with no formal curriculum on ethics and professionalism. She described attempts at some formalization, but also brought to light the issue that a lot of professionalism standards are from a Western cultural mindset, and do not take into account vastly different cultural standards from Latin America to India (two of the examples she used). She stressed that professionalism attributes must be integrated throughout medical school curricula and not just taught as a standalone course (as many in the US are).

    This brought to mind incredible potential for the IFMSA pre-departure training for clinical exchanges (bilateral, international exchanges of clinical year medical students) to include a (student developed, faculty advised) curriculum on professionalism and medical ethics issues with a culturally sensitive perspective. Perhaps this could even be the beginning of cross-institution and student-faculty collaboration of professionalism courses that may eventually be integrated into formal medical education.

    Burnout and self care during training

    Burnout of trainees occurs as a result of many factors, including lack of time for self care, growing cynicism towards the system of practice, little time actually spent with patients, and as a result of poor role modeling from higher level physicians who can promote unprofessional behaviors towards patients and colleagues. Furthermore, there are hospital systems in many countries in which residents commonly work 36 hour shifts, a dichotomy from other systems which have recognized the unsafe consequences of such extended work with no sleep. There is the need to raise awareness of work hours reform, as well as proper role modeling for physicians in training.

    One speaker noted "new med students go from naive and idealistic [committed to the profession] to knowledgeable and cynical". Development of unhealthy (to the physician) and unprofessional behavior (toward patients and/or colleagues) is a function of context more than education - the hidden curriculum and role modeling. There was a call to action to redefine the definition of excellence for both teachers and students, leading to policy changes in assessment and promotion, which would ideally lead to those most qualified and in line with professional and healthy behavior to move to teaching positions and be promoted within the training process.

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  • Healthcare issues across the globe: Part I

    By Aliye Runyan, MD
    AMSA Education and Research Fellow

    I recently attended the America's medical education meeting and IFMSA general assembly. There was very interesting and often passionate discussion on the importance of primary care, and how it is practiced in various countries in the Americas. There is consensus that quality of care is important, and that culturally sensitive standards for quality of medical care must be developed. Most agree than universal curricula are not the answer. The point was made that primary care is a critical part of comprehensive health care services, and not an end in itself – there is obvious need for specialists in many cases. The point was made that primary care must be incentivized, respected, and treated with the same standards as any other specialty, as well as taught (and experienced by students) from the first year of medical school. Using evidence based medicine was brought up multiple times – as this may not be the cultural norm.

    Some of the faculty brought up criticisms of the Alma Ata declaration of 1978 (the first international declaration to underline the importance of primary care for all) by stating that it prompted some countries to focus on only the most basic health care needs ( in the name of “primary care”) while not pushing resources to develop comprehensive health care services.

    Out of this conversation came the overwhelming sentiment of the need to “teach learners how to learn” – meaning to train physicians to adapt to our changing health care world by teaching them how to problem solve, navigate issues other than just strict science, to understand their accountability to the society at large, and to respond to the needs of society.

    Competency based medical education

    This was a wonderful segue into the discussion around competency based education, which is becoming the norm in the US and Canada. The themes behind competency based education include greater accountability, training relevant to society, supporting students learning at their own pace, and adjusting for “new competencies” such as teamwork, patient safety, humanitarian needs, and social justice. There is more focus on evaluation and outcomes of learning. One speaker presented a continuum from societal health needs à competencies à curriculum à evaluations, to highlight how competencies might determine curriculum, which is then evaluated for constant improvement. Assessment methods, such as 360 feedback, where an individual is evaluated by peers, supervisors, and colleagues on the health care team, come into play as the value of subjective judgment and observation is considered. The higher number and more diverse the observations, with open ended questions like “would you send a family member to see this doctor?” provide a larger picture of a physician’s abilities than a multiple choice test or standardized exam. They also take into account humanistic qualities and professionalism.

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