Medical Educuatiori 1992, 26, 1-2
Editorial The second quarter-century responsibility of government; admission policies and manpower; team-work; and continuing medical education. The world bodies in the health field have each further consolidated their stake in medical education. The World Health Organization has issued a discussion document, Changing Medical Education: An Agenda for Action ( W H O 1990). The United Nations Children’s Fund held a World Summit in 1990, the resolutions of which contain critically important demands on medical schools and other educational bodies for saving the lives of children and improving the lot of their mothers (UNICEF 1990). UNESCO, the global cultural organization with universities under its responsibility, has for the first time entered the field of medical education, sponsoring as UNESCO’s initial project the major reorientation of all stages of medical education in a country, namely Portugal, serving as a demonstration of the change process in medical education. The political transformation of the middle and eastern European countries, in the past year, has found expression in medical education by their most urgent approaches to other countries for advice and assistance. As these countries change to a market economy there is pressing need for advice about insurance systems or other methods for financing the delivery of health care. These countries now need instantly to devise systems for coordinating their disparate hospitals and health services, medical schools, postgraduate institutes and medical science academies. They insistently need to build up the public health traditions and provisions lacking until now. The responsibility of neighbouring countries to respond to such appeals is recognized as imperative. Current reports from the USSR, for instance, convey a state of breakdown in health care provision which can only deteriorate, at a time when medical education systems are also in
Medical Education, entering its second quartercentury, is the senior Journal in its field internationally. (Its North American predecessor, the Journal of Medical Education, ceased in 1988, to reappear in a different form with other aims [Editorial 19881). As the 26th year of publication begins, the field of medical education is in a state of activity amounting to ferment. The insistent pressure to change medical education, so that it can become more congruent with the health care needs of populations, communities, patients and individuals, has culminated in great movements of reorientation. The Alma Ata Declaration of 1978 (World Health Organization 1978) set forth the requirements for a new concept of primary health care, to augment existing medical practices. N o t to be confused, as it often is, with general practice, the primary health care concept gives main emphasis to prevention of illness, promotion of health, the responsibility of- patients for their own health, team-work among the health professions, involvement of the community in health care, and recognition of intersectoralization (i.e. the fact that many sectors other than the health professions are implicated in health care, e.g. finance, politics, the law, religion, engineering, etc.) The Edinburgh Declaration of 1988 (World Federation for Medical Education 1988) recognised as the counterpart -in the field of medical education - of Alma Ata in the field of health care, sets out 12 principles, dealing in turn with: educational settings; national health priorities; active learning throughout life; health promotion and disease prevention; integration of science with clinical practice; selection of students; Correspondence: Professor H. J. Walton, World Federation for Medical Education, International Medical Education, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
1
t r ~ n s i t ~ ocuniplicatcd ii by serious under-resourcing, and the reflection 111 medical education itself of the prcvailiiig civic dcratigcnicrit. ‘Jhc dpparciitly more stable countries have tlicir u \ ~ cd~icatioiidl n crises to surmount: organi 7 ~ t i o i i r l l uplicavals in health services, ccotioniic constraints. altering managerial structurcs, .ind iic\v and m‘issi\~cpolitical influence (such a s the European Comniunity directives, for instance, n o w require free intercountry movement of doctors, postgraduate training rcgulatiotis, aiid the hospital-univcrsity linkages necessary for adequate clinical training). T h e state of medical education in the iic,velopitig countries, and the deteriorating state of both health services and medical schools in many third world countries certainly require collcgid and practical support from the developed countries. Loss of niedical teachers through brain drain to more affluent countries, the parlous condition of the medical libraries, and the disappearance of many material necessities for training medical students (often o f the simplest kind, such as photocopying, surgical gloves, and petrol for transport to community clinics) must bc heeded if the standard of the Ivorld’s doctors is not to drop disastrously. (Chi the one hand is enornioiis and insistent dcniand, and on the other hand, reciprocally, is evidence that medical education has reached a \ t J t e of readiness for responding, as never before, to the needs of communities for improved health care, both 011 a national aiid international basis. The challengc is that the medical schools and othcr training bodies are required to perceive and to nicer - flexibly arid realistically - the iicw demands o f the country’s health services. At last there arc signs, 80 years post-Flexncr, that the established ‘traditional’ mcdical schools a r e recognizing that in them almost all thc world’s fitture doctors have to be trained (Association of Anicricaii Medical Colleges 1984; General Medical Council 1991). Harvard, after a partial
trial period, has just tiiovcd entirely t(i a problem-based learning approach; the University of Sydney aniioiiiices a shortened curriculum, to which all entrants will be university postgraduates, selected on the basis o f noti-ititellcctual rl\ well as cognitive criteria. T h e creation of new medical schools meanwhile continues apace, eight in the south of Africa alone, at Eldoret in Kenya, a second school in Uganda at Mbarara, in Malawi at Rlantyre, with additional new medical schools planned for Botswana aiid Mauritius. ThisJoirvrial, as it enters its second quarter-century, will continue to report the educational provisions in ‘111 stages o f the training of doctors, identifying deficiencies and promoting reforms, and to serve as a vehicle for riiaking widely k n o w n the educational efforts and achievements of medical teachers aiid researchers.
References Association of Amcrican Medical Collegcs (1984) Piiysiciarr, .Fir thc Twenty-First Ccwrirry. Association of American Medical Colleges, Washington, IIC. T h e Edinburgh Declaration (1988) Lnrii-er ii, 465. Editorial (1988) The changing of colors. ]oirrrrnl of hledical Ediriafiori 83, 927 (;enera1 Medical Council (1991) Keijirtu OJ L‘ridrqydirorr Medicnl Edrrcnriorr. General Medical Council, London. United Nations Children’s F u n d (1990) l’ltirr 17f Aifi~ri fbr Implerrrerrth,y the World Sirrnrnir O I I thc Sicrvival, Prorectiorr orid Developrwrrrr i f Childrw iw fhc 1990s. United Nations Children’s Fund, New York. World Federation for Medical Education (1988) R p r r of rlir U’orld Corferrrrcr o j Air
Editorial The second quarter-century responsibility of government; admission policies and manpower; team-work; and continuing medical education. The world bodies in the health field have each further consolidated their stake in medical education. The World Health Organization has issued a discussion document, Changing Medical Education: An Agenda for Action ( W H O 1990). The United Nations Children’s Fund held a World Summit in 1990, the resolutions of which contain critically important demands on medical schools and other educational bodies for saving the lives of children and improving the lot of their mothers (UNICEF 1990). UNESCO, the global cultural organization with universities under its responsibility, has for the first time entered the field of medical education, sponsoring as UNESCO’s initial project the major reorientation of all stages of medical education in a country, namely Portugal, serving as a demonstration of the change process in medical education. The political transformation of the middle and eastern European countries, in the past year, has found expression in medical education by their most urgent approaches to other countries for advice and assistance. As these countries change to a market economy there is pressing need for advice about insurance systems or other methods for financing the delivery of health care. These countries now need instantly to devise systems for coordinating their disparate hospitals and health services, medical schools, postgraduate institutes and medical science academies. They insistently need to build up the public health traditions and provisions lacking until now. The responsibility of neighbouring countries to respond to such appeals is recognized as imperative. Current reports from the USSR, for instance, convey a state of breakdown in health care provision which can only deteriorate, at a time when medical education systems are also in
Medical Education, entering its second quartercentury, is the senior Journal in its field internationally. (Its North American predecessor, the Journal of Medical Education, ceased in 1988, to reappear in a different form with other aims [Editorial 19881). As the 26th year of publication begins, the field of medical education is in a state of activity amounting to ferment. The insistent pressure to change medical education, so that it can become more congruent with the health care needs of populations, communities, patients and individuals, has culminated in great movements of reorientation. The Alma Ata Declaration of 1978 (World Health Organization 1978) set forth the requirements for a new concept of primary health care, to augment existing medical practices. N o t to be confused, as it often is, with general practice, the primary health care concept gives main emphasis to prevention of illness, promotion of health, the responsibility of- patients for their own health, team-work among the health professions, involvement of the community in health care, and recognition of intersectoralization (i.e. the fact that many sectors other than the health professions are implicated in health care, e.g. finance, politics, the law, religion, engineering, etc.) The Edinburgh Declaration of 1988 (World Federation for Medical Education 1988) recognised as the counterpart -in the field of medical education - of Alma Ata in the field of health care, sets out 12 principles, dealing in turn with: educational settings; national health priorities; active learning throughout life; health promotion and disease prevention; integration of science with clinical practice; selection of students; Correspondence: Professor H. J. Walton, World Federation for Medical Education, International Medical Education, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
1
t r ~ n s i t ~ ocuniplicatcd ii by serious under-resourcing, and the reflection 111 medical education itself of the prcvailiiig civic dcratigcnicrit. ‘Jhc dpparciitly more stable countries have tlicir u \ ~ cd~icatioiidl n crises to surmount: organi 7 ~ t i o i i r l l uplicavals in health services, ccotioniic constraints. altering managerial structurcs, .ind iic\v and m‘issi\~cpolitical influence (such a s the European Comniunity directives, for instance, n o w require free intercountry movement of doctors, postgraduate training rcgulatiotis, aiid the hospital-univcrsity linkages necessary for adequate clinical training). T h e state of medical education in the iic,velopitig countries, and the deteriorating state of both health services and medical schools in many third world countries certainly require collcgid and practical support from the developed countries. Loss of niedical teachers through brain drain to more affluent countries, the parlous condition of the medical libraries, and the disappearance of many material necessities for training medical students (often o f the simplest kind, such as photocopying, surgical gloves, and petrol for transport to community clinics) must bc heeded if the standard of the Ivorld’s doctors is not to drop disastrously. (Chi the one hand is enornioiis and insistent dcniand, and on the other hand, reciprocally, is evidence that medical education has reached a \ t J t e of readiness for responding, as never before, to the needs of communities for improved health care, both 011 a national aiid international basis. The challengc is that the medical schools and othcr training bodies are required to perceive and to nicer - flexibly arid realistically - the iicw demands o f the country’s health services. At last there arc signs, 80 years post-Flexncr, that the established ‘traditional’ mcdical schools a r e recognizing that in them almost all thc world’s fitture doctors have to be trained (Association of Anicricaii Medical Colleges 1984; General Medical Council 1991). Harvard, after a partial
trial period, has just tiiovcd entirely t(i a problem-based learning approach; the University of Sydney aniioiiiices a shortened curriculum, to which all entrants will be university postgraduates, selected on the basis o f noti-ititellcctual rl\ well as cognitive criteria. T h e creation of new medical schools meanwhile continues apace, eight in the south of Africa alone, at Eldoret in Kenya, a second school in Uganda at Mbarara, in Malawi at Rlantyre, with additional new medical schools planned for Botswana aiid Mauritius. ThisJoirvrial, as it enters its second quarter-century, will continue to report the educational provisions in ‘111 stages o f the training of doctors, identifying deficiencies and promoting reforms, and to serve as a vehicle for riiaking widely k n o w n the educational efforts and achievements of medical teachers aiid researchers.
References Association of Amcrican Medical Collegcs (1984) Piiysiciarr, .Fir thc Twenty-First Ccwrirry. Association of American Medical Colleges, Washington, IIC. T h e Edinburgh Declaration (1988) Lnrii-er ii, 465. Editorial (1988) The changing of colors. ]oirrrrnl of hledical Ediriafiori 83, 927 (;enera1 Medical Council (1991) Keijirtu OJ L‘ridrqydirorr Medicnl Edrrcnriorr. General Medical Council, London. United Nations Children’s F u n d (1990) l’ltirr 17f Aifi~ri fbr Implerrrerrth,y the World Sirrnrnir O I I thc Sicrvival, Prorectiorr orid Developrwrrrr i f Childrw iw fhc 1990s. United Nations Children’s Fund, New York. World Federation for Medical Education (1988) R p r r of rlir U’orld Corferrrrcr o j Air
