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Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

Authors: Frenk J, Chen L et al. and the Commission on Education of Health Professionals for the 21st Century

Published Online November 29, 2010

In this major review, the Commission on Education of Health Professionals for the 21st Century, consisting of 20 professional and academic leaders from diverse countries, state the problem that, after 100 years of the Flexner report and the groundbreaking reforms that consequently occurred, at the beginning of the 21st century gaps and inequities in health persist within and between countries. At the same time, new health challenges have appeared: new infectious, environmental, and behavioural risks that, in conjunction with rapid demographic and epidemiological transitions, threaten health security of all.

Professional education has not kept pace with these challenges, mainly due to the following factors:

  • Fragmented, outdated, and static curricula that produce ill-equipped graduates;
  • Mismatch of competencies to patient and population needs;
  • Poor teamwork;
  • Gender stratification of professional status;
  • Narrow technical focus without broader contextual understanding;
  • Episodic encounters rather than continuous care;
  • Predominant hospital orientation at the expense of primary care;
  • Quantitative and qualitative imbalances in the professional labour market;
  • Weak leadership to improve health-system performance
  • Tribalism of professions (tendency to act in isolation from or in competition with each other)

The Commission envision “that all health professionals in all countries should be educated to mobilise knowledge and to engage in critical reasoning and ethical conduct so that they are competent to participate in patient and population-centred health systems as members of locally responsive and globally connected teams. The ultimate purpose is to assure universal coverage of the high-quality comprehensive services that are essential to advance opportunity for health equity within and between countries”.

“Realisation of this vision will require a series of instructional and institutional reforms, which should be guided by two proposed outcomes: transformative learning and interdependence in education”. “Transformative learning” is about developing leadership attributes; its purpose is to produce enlightened change agents. It involves three fundamental shifts:

  1. from fact memorisation
to searching, analysis, and synthesis of information
for decision making;
  2. from seeking professional credentials to achieving core competencies for effective teamwork in health systems; and
  3. from non-critical adoption of educational models to creative adaptation of global resources to address local priorities.

“Interdependence” is a key element in a systems approach, and also requires three fundamental shifts:

  1. from isolated to harmonised education and health systems;
  2. from stand-alone institutions to networks, alliances, and consortia; and
  3. from inward-looking institutional preoccupations to harnessing global flows of educational content, teaching resources, and innovations.

I have no financial interests related to this recommendation (GP)

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