Reorientation of medical

education in WHO South East

Asia Region
(ROME)
@1980 -2000

Outline
Response of SEAR countries to HFA/PHC

Story of ROME 1

Some lessons for today

1
 What might be the usefulness?

If you want to understand today, you have

to search yesterday. ~ Pearl Buck

If you didn't know history, you were a leaf

that didn't know it was part of a tree
tree.
-- Michael Crichton, Timeline

Responses of medical education to support

health development

Globalization
HFA-PHC Issues HSR
Application AIDS pandemic
Development Of Ed. Sc.
of Ed. Sc.
Public health WHO 2000s
(Prevention)
???????
Behav Sciences
90s
Independence-
Quality
Expat Emigration
(Social accountability,
Community Orientation,
80s Ethics etc.)
70s
60s ROME I
50s
(Integration, PBL etc.)
Medical Education
Com Medicine
Quantity

2
ROME 1983

ROME 1986

3
 Rationale for ROME
Mainly a response HFA/PHC
The central health care provider, also most expensive,
remained the doctor and his behaviour largely determined to
whom how and where care is offered.
whom, offered

At the scientific level Recognition of the limits to curative

biomedicine

y Therefore, attention moved from:

{ individuals to populations,
{ pathology to behaviours,
behaviours
{ microbes to environment
{ treatment to health care systems.

triggered by existence of gross inequities in health status within and between countries

Alma Ata Declaration

4
 3 major areas of reorientation of ME

1. Making medical education responsive and

relevant to the community/country in terms of
both quality and quantity of medical graduates produced.
produced

2. Education and training of doctors who are

socially relevant and responsive.

3. Education and training of doctors who have the

appropriate
i t professional
f i l competences
t
including ethical, social, technical, scientific
and management abilities.

SOCIETY

AGEING POPULATION
MORBIDITY : ACUTE-CHRONIC

FAMILY STRUCTURE
Extended Nuclear

EDUCATION HEALTH &

MEDICAL CARE
ATTITUDE TO PROFESSIONALS
BEHAVIOUR
V OU CCHANGE
NG
POLITOCO-ECONOMIC FLUX
ECOLOGICAL SHIFTS

5
 SOCIETY

AGEING POPULATION
MORBIDITY : ACUTE-CHRONIC

FAMILY STRUCTURE
Extended Nuclear

EDUCATION HEALTH &

MEDICAL CARE
ATTITUDE TO PROFESSIONALS
BEHAVIOUR CHANGE
POLITOCO ECONOMIC FLUX
POLITOCO-ECONOMIC
ECOLOGICAL SHIFTS

6
 SOCIETY HOSPITAL BASED SPECIALIST
CARE

AGEING POPULATION
MORBIDITY : ACUTE-CHRONIC
CAPITAL
FAMILY STRUCTURE INTENSIVE
Extended Nuclear LABOUR
INTENSIVE
EDUCATION HEALTH &
MEDICAL CARE HIERARCHIC
ATTITUDE TO PROFESSIONALS SKILL
PRESCRIBED
BEHAVIOUR CHANGE
FROM OUTSIDE
POLITOCO ECONOMIC FLUX
POLITOCO-ECONOMIC
ECOLOGICAL SHIFTS

SOCIETY PRIMARY CARE HOSPITAL BASED SPECIALIST

CARE

AGEING POPULATION MORBIDITY

: ACUTE-CHRONIC
CAPITAL
FAMILY STRUCTURE LOW INTENSIVE
Extended Nuclear CAPITAL
EDUCATION HEALTH &
LABOUR
MEDICAL CARE INTENSIVE
LEAN
ATTITUDE TO PROFESSIONALS MANPOWER HIERARCHIC
BEHAVIOUR CHANGE
SKILL
POLITOCO-ECONOMIC FLUX NON PRESCRIBED
ECOLOGICAL SHIFTS HIERARCHIC FROM OUTSIDE

FLUID SOCIO-MEDICAL INTERFACE STIFF TECHNO-MEDICAL INTERFACE

COMPREHENSIVE HEALTH
SYSTEM BASED ON PHC

7
 SOCIETY PRIMARY CARE HOSPITAL BASED SPECIALIST
CARE

AGEING POPULATION MORBIDITY

: ACUTE-CHRONIC
CAPITAL
FAMILY STRUCTURE LOW INTENSIVE
Extended Nuclear CAPITAL
EDUCATION HEALTH &
LABOUR
MEDICAL CARE INTENSIVE
LEAN
ATTITUDE TO PROFESSIONALS MANPOWER HIERARCHIC
BEHAVIOUR CHANGE
SKILL
POLITOCO-ECONOMIC FLUX NON PRESCRIBED
ECOLOGICAL SHIFTS HIERARCHIC FROM OUTSIDE

FLUID SOCIO-MEDICAL INTERFACE STIFF TECHNO-MEDICAL INTERFACE

UNDERCARE

OVERCARE

Reorientation of medical education

y Social accountability of medical schools

(contribution to system changes)

y Quality of the product

y Curriculum reforms
{ Community orientation
{ Integration

y Staff development in education

y Partnerships between producers, users and

community

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 The 5 star doctor

y Care provider

y Decision maker

y Communicator

y Community leader

y Manager

Reorientation of medical education

y Social responsiveness of medical schools

((contribution to system
y changes)
g )

y Quality of the product

y Curriculum reforms
{ Community orientation
{ Integration

y Staff development in education

y Partnerships between producers, users and

community

9
 Direction of change

Teacher-centred .. Student-centred
Information-based
f b d ..... Problem-based
bl b d
Discipline-based .. Integrated
Hospital-based .. Community-based
Fixed Program .. Electives
Opportunistic .. Systematic

ROME Series

SEARO Regional Publication No. 18 SEARO Regional Publication No. 18

SEARO Regional Publication No.
No 18

Reorientation of Reorientation of
Reorientation of
Medical Education Medical Education
Medical Education SEARO Regional Publication No. 18

The Rationale and vision:
A Springboard for Change
1
World Health Organization
Goal Strategies and Targets
Regional Office for South East Asia
New Delhi, 1991
Introducing Problem-Based
Indicators for Monitoring Learning in the South-East
SEARO Regional Publication No. 18 and Evaluation Asia Region
Reorientation of
3 Medical Education 5
Reorientation of
Medical Education Guideline for Developing
National Plan for Action
World Health Organization
4
World Health Organization Regional Office for South East Asia
Regional Office for South East Asia New Delhi, 1991
New Delhi, 1991

World Health Organization

Regional Office for South East Asia
New Delhi, 1991

World Health Organization

Regional Office for South East Asia
New Delhi, 1991

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 @ 1986 125/278 schools responded .

Teacher-centred .. Student-centred
Information-based
f b d ..... Problem-based
bl b d
Discipline-based .. Integrated
Hospital-based .. Community-based
Fixed Program .. Electives
Opportunistic .. Systematic

@1999

Teacher-centred .. Student-centred
Information-based
f b d ..... Problem-based
bl b d
Discipline-based .. Integrated
Hospital-based .. Community-based
Fixed Program .. Electives
Opportunistic .. Systematic

11
 Reorientation of medical education

y Social responsiveness of medical schools

(
(contribution
t ib ti to
t system
t changes)
h )

y Quality of the product

y Curriculum reforms
{ Community orientation
{ Integration

y Staff development in medical education

science

y Partnerships between producers, users and

community

Regional and National Teacher Training Centers in SEAR

DPR KOREA

NEPAL BHUTAN

MYANMAR
INDIA BANGLADESH

THAILAND

SRI LANKA

MALDIVES INDONESIA

NTTC

RTTC

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 Staff development in
Medical Education in SEAR

By 1999 SEAR had (at least):

16 PhDs
60 + Masters
>500 Certificate level
>4000 Introductory level

Reorientation of medical education

y Social responsiveness of medical schools

((contribution to system
y changes)
g )

y Quality of the product

y Curriculum reforms
{ Community orientation
{ Integration

y Staff development in education

y Partnerships between producers, users and

community

13
 Partnerships

Policy Makers

y Academic institutions
Health
Professionals
y Health professions
Health
Managers
HEALTH
y Health care managers SYSTEM
BASED ON
PEOPLES
y Policy-makers
P li k NEEDS

y Communities

Communities Academic
institutions

Pioneering medical schools in ROME

(70s 80s)

y Ramathibodhi Medical School, Bangkok

y Christian Medical College, Vellore
y Institute of Medicine, Kathmandu
y Jipmer, Pondicherry
y Airlangga
gg Medical Faculty,
y, Surabaya
y
y Chulalongkorn Medical School, Bangkok
y Faculty of Medicine, Peradeniya (RTTC), Sri
Lanka
y Centre for medical education, Bangladesh

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 Innovative schools in the 80s and 90s

Faculty
cu y of
o Medicine,
ed c e, Colombo,
Co o bo, S
Sri Lanka

Indian consortium of medical schools

BPKHIS Nepal

Gaja Mada medical school Indonesia

Thammasat and Songkla medical schools

schools-- Thailand

Institutes of Medicine
Medicine-- Myanmar

Were changes slow? Why?

Weaknesses in:
y Leadership

y Technical know-how

y Resources and capacity

y Motivation (incentives etc.)

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 What determine the future?

y Changing epidemiology and demography

y Inequities among and within countries
y Galloping sophistication and cost of technology
y Ready availability of information to patients
y Globalization and trade agreements
y Market forces and dehumanization of medicine

Some priorities for SEARAME

To Promote:

y Patient and community sensitive medical education

use SDH/MDGs as triggers
y Careful choice of technology-keep costs down
y Ethics competence vs conscience
y More Regional
g and Global p
partnerships
p

16
 p , y
Education-1992.

What we need todayy is the same thing

g I have been crying
y g about for
40 years:

(1) faculty interested in and concerned about medical education

to suit todays societal population needs;
(2) administrative leaders willing to be involved and providing
real leadership in education;
(3) commitment to education of funds and resources necessary
to do the job.

To the above we can add,

(4) International and Regional networks of institutions to

provide global vision and technical leadership in partnerships.

Responses of medical education to support

health development Revitalization
of PHC
MDGs
Globalization SDH
HFA-PHC Issues HSR
Application AIDS pandemic
Development Of Ed. Sc.
of Ed. Sc.
Public health WHO
2000s
(Prevention)
Behav Sciences
90s ROME2
Independence-
Expat Emigration Qualityy
Q
(Social accountability,
80s Community Orientation,
70s Ethics etc.)
60s ROME I
50s (Integration, PBL etc.)
Medical Education
Com Medicine
Quantity

17
18
Thank you very much

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