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What next for medical education?

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John Norcini

on 9 September 2013

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Transcript of What next for medical education?

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Quality of health professions education is a concern
Accreditation processes were created to ensure school quality
Flexner sought to improve the quality of medical education
Widespread adoption
John Norcini and Seke Banda
Licensure processes were created to ensure individual quality
Capacity of health professions education is a concern
Global shortfall of 4.3 million health care workers (WHO)
Greatest problem in sub-Saharan Africa
11% of the world's population
24% of the disease burden
3% of the health care workers
< 5% of the medical schools
Patient safety
What next for medical education?
Evidence-based educational practice
Education focused on quality and capacity
Accreditation and capacity
Academic leadership does not rely on educational research
Reform is initiated and then studied
Problem-based learning
Change is difficult
Current research informs practice in a limited way
Need for basic and clinical scientists in education?
Not enough research has been done
Need for additional medical educators particularly in low income countries
Change from the Flexnerian focus on quality primarily to an equal emphasis on capacity
Research needs to focus on efficiency while maintaining quality
Develop a cadre of investigators in areas of greatest shortage
Judge quality and efficiency against health care outcomes
Use intermediate measures such as scores on assessments
"The principle is, that a few bad reasons for doing something neutralise all the good reasons for doing it"

Cornfield from Microcosmographia Academica
Accreditation processes have codified the Flexnerian principles
Prescriptive standards
Which departments and courses, how many faculty, etc?
Process standards
Broad flexible categories such as content and educational environment
Permit innovation but it is harder to judge compliance
Ensures compliance but stifles innovation
Outcome standards
Focus on competencies
Locally responsive but too reliant on assessment
Research on efficacy of standards is needed
Sensitivity of accreditation to local needs is critical
Challenges going forward
Current issues in medical education
Add a focus on capacity to our focus on quality
Shift to evidence-based educational practice
Ensure the validity of accreditation processes
Lack of observation during clinical training
Poor responsiveness to social needs
Professional values and qualities
Difficulty integrating new skills
Challenges going forward
Strategies for meeting the challenges
Current challenges are quality and efficiency
Educational research can address these challenges
Research that focuses on educational practice
Research that takes effeciency as a priority
Research that focuses on what produces quality
Accreditation needs to be responsive to capacity
Standards based on evidence are needed
Difficult to link standards to relevant outcomes
No published work on efficacy
North American recently
US Licensure in 1915 and specialty certification in 1917
Extensive body of research on efficacy
In high income countries this matters less
More resources available
Healthcare workers are imported, shifting costs
Properly equipped medical schools
Academically qualified students
Original research as a core activity
Migration adds to the problem
1 in 4 doctors and 1 in 20 nurses work in the 30 most industrialized countries
Migration is almost always permanent
Maldistribution adds to the problem
Health worker density is disproportionately greater in urban areas
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