ERIC ED378314: Increasing the Relevance of Education for Health Professionals. Report of a WHO Study Group on Problem-Solving Education for the Health Professions. WHO Technical Report Series 838.

41 Pages·1993·0.76 MB·English

by  ERIC

DOCUMENT RESUME
ED 378 314
CE 065 900
TITLE
Increasing the Relevance of Education for Health
Professionals. Report of a WHO Study Group
on
Problem- Solving Education for the Health Professions.
WHO Technical Report Series 838.
INSTITUTION
World Health Organization, Geneva (Switzerland)
.
REPORT NO
ISBN-92-4-120838-4; ISSN-0512-3054
PUB DATE
93
NOTE
41p.
AVAILABLE FROM
WHO PublicatIons Center USA, 49 Sheridan Avenue,
Albany, NY 12210 ($7.20).
PUB TYPE
Reports
Research/Technical (143)
EDRS PRICE
MF01/PCO2 Plus Postage.
DESCRIPTORS
*Allied Health Occupations Education; Developed
Nations; Developing Nations; *Educational Needs;
*Educational Practices; Foreign Countries; *Futures
(of Society); Higher Education; *Medical
Education;
*Policy Formation; Public Policy
ABSTRACT
This report explores various ways to increase the
relevance of education for health care professionals
as a strategy
for improving the quality of health
care and increasing access to
services. Noting that the health work force
can account for up to 70
percent of the health budget, the report concentrates
on innovations
in education that can make learning easier and
more efficient while
also producing graduates equipped with the knowledge
and skills most
relevant to high priority health problems. Particular
attention is
given to factors that are known to influence the
success of two kinds
of innovations: those dealing with the learning
process and those
dealing with the relevance of education to
community needs and
practices. The report also challenges educational
institutions to
expand their sphere of influence to include advice
and guidance on
the development of health policy and services
and provides examples
of innovative approaches. The report is organized in
five main
sections that cover the following topics:
(1) the need for a fresh
look at the education of health professionals,
(2) learning from
innovations in the education of health professionals;
(3) creating
links with new partners in the community; (4) strategies
for change
applied to health syst.. r,s and to educational
institutions; and (5)
organizational and practical issues. Recommendations
are made to
educational institutions, member nations of the
World Health
Organization (WHO), and to WHO as
an organization. Contains 24
references and 10 suggestions for further reading.
(KC)
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Reproductions supplied by EDRS
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CE
WHO Technicill Report Series
838
INCREASING THE RELEVANCE
OF EDUCATION FOR
HEALTH PROFESSIOIVALS
OG
a WHO Study Group on
Report of
Problem-Solving Education for the Health Professions
U.S DEPARTMENT OF EDUCATION
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Points of mew or opinions staled in this
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INFORMATION CENTER (ERIC)."
World 'Health Organization
Geneva
BEST COPY AVAILABLE
2
4
The World Health Organization is a specialized agency of the United Nations with
primary responsibility for international health matters and public health. Through this
organization, which was created in 1948, the health professions of some 185 countries
exchange their knowledge and experience with the aim of making possible the attainment
by all citizens of the world by the year 2000 of a level of health that will permit them to lead
a socially and economically productive life.
By means of direct technical cooperation with its Member States, and by stimulating such
cooperation among them, WHO promotes the development of comprehensive health
services, the prevention and control of diseases, the improvement of environmental
conditions, the developme t of human resources for health, the cooraination and
development of biomedicai and health services research, and the planning and
implementation of health programmes.
These broad fields of endeavour encompass a wide variety of activities, such as
developing systems of primary health care that reach the whole population of Member
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controlling malaria and other communicable diseases including tuberculosis and leprosy;
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the eradication of smallpox, promoting mass immunization against a number of other
preventable diseases; improving mental health; providing safe water supplies; and
training health personnel of all categories.
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Technical Report Series makes available the findings of various international
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groups of experts that provide WHO with the latest scientific and technical advice on a
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such reports, costs Sw. fr. 120.- (Sw. fr. 84.- in developing countries).
3°
.
838
INCREASING THE RELEVANCE
OF EDUCATION FOR
HEALTH PROFESSIONALS
..41i
Report of a WHO Study Group on
Problem-Solving Education for the Health Professions
World Health Organization
Geneva 1993
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Contents
1. The need for a fresh look at the education of health professionals
1
2 Learning from innovations in the education of health professionals
2
Educational innovations
2 1
2
2 2 Measuring the effects of educational innovations
5
3 Creating links with new partners
9
Identifying and solving priority health problems in and with the community
31
10
3 2 Working in the community
13
3 3 Shaping health policy
15
4 Strategies for change applied to health systems and to educational
institutions
16
Barriers to change
.11
16
Strategies for chang6
4 2
18
5 Organizational and practical issues
21
Getting started
21
1
5 2 Resource needs for curricular development
21
3 Community sites
22
5.:
Creating favourable administrative structures
23
s Conclusions
24
7 Recommendations
25
Recommendations to educational institutions
25
Recommendations to Member States
25
Recommendations to WHO
26
Acknowledgements
26
References
27
Recommended further reading
28
Iii
111
WHO Study Group on Problem-Solving Education for the
Health Professions
Geneva, 20-23 October 1992
Members
Dr P. A. J. Bouhuijs, Associate Professor, Department of Educational Research and
Development. Faculty of Medicine. University of Limburg, Maastricht.
Netherlands
Professor P. Carteret, Director, University Centre for Health Sciences, University of
Yaounde, Yaounde. Cameroon (Vice-Chairman)
Professor Chitr Sitthi-amorn Acting Dean, College of Public Health. Faculty of
Medicine. Chulalongtorn University. Bangkok, Thailand
Dr C. M. K. Ghazi. Professor of Nursing. Cairo University. Alexandria, Egypt
Dr A. Kaufman, Professor and acting Chair, Department of Family and Community
Medicine, University of New Mexico School of Medicine, Albuquerque, NM. USA
(Co-Rapporteur)
Dr S. H. Shahabudin, Associate Professor, Department of Medical Education,
Faculty of Medicine, National University of Malaysia. Kuala Lumpur, Malaysia
(Chairman)
Ms B. Stilwell, Principal Lecturer in Health and Community Studies, Institute of
Advanced Nursing Education. Royal College of Nursing, London, England
Representatives of other organizations
International Council of Nurses
Mrs M. Kingma. Nurse Consultant, International Council of Nurses. Geneva.
Switzerland
Network of Community-Oriented Educational Institutions for Health Sciences
Dr S. P Mennin, Director, Primary Care Curriculum and Program Evalr
Iron, and
Associate Professor of Anatomy. Department of Anatomy, University of New
Mexico School of Medicine, Albuquerque. NM. USA (Co-Rapporteur)
World Federation for Medical Education
Professor H. J. Walton, President. World Federation for Medical Education.
Edinburgh. Scotland
Secretariat
Dr C. Boelen, Chief Medical Officer. Educational Development of Human Resources
for Health, Division of Di olopment of Human Resources for Health, WHO.
Geneva. Switzerland (Secretary)
Dr E. H. T. Goon, Director. Division of Development of Human Resources for Health.
WHO, Geneva. Switzerland
7
IV
The need for a fresh look at the education of
1.
health professiodsals
Many improvements are still required in most health care systems
to
ensure equal access to all who seek health care, as well as optimal
protection against avoidable causes of suffering and death. To make these
improvements, there is a need for additional resources for health
care.
including human resources, and a need to use existing
resources better in
both rich and poor countries ( /). Because the
ealth workforce can
account for up to 70% of the recurrent health budget. it is natural that it
should be carefully analysed and rationalized as an important step towards
better use of existing resources.
Health professidnal education has been widely criticized
as being not
relevant enough to society's health needs. Most health professionals have
had little training in the wider aspects of health: the sophistication of their
biomedical and clinical training is not matched by comparable training in
relevant social sciences, and they have little opportunity to learn from role
models how to address the social, economic and political forces affecting
health. In addition, the institutions in which health professionals
are
trained are often isolated from decision-making about health service
delivery and health policy.
Innovative approaches aimed at improving health professional education
have emerged in recent decades. Most have focused
on reforming the
educational processes within the institution. New instructional strategies
have been introduced in various schools to enhance professional skills.
Some such strategies, while focusing on community' needs, have been
based solely within the educational institution. In other strategies,
experience in the community has been introduced to supplement
an
existing programme. Educational planning has remained isolated in
most
cases from consumer needs and the needs of health service delivery.
Moreover, many innovations have been reactive rather than proactive. The
result is that most innovations are likely to have
a limited impact on the
evolution of health services. It is unlikely that educational reform persewill
improve health unless it is the result of close interaction and planning
between health services and other sectors in society.
A WHO Study Group was convened in Geneva from 20
to 23 October
1992 to consider, and evaluate the impact of, current practices
in
problem-solving education for the health professions. From the Study
Group's early deliberations emerged the conviction that
a wider
perspective was appropriate for its discussions; its
report is therefore
intended to outline, more generally, how health professional educational
[hew
indny definitions of "conanunity- Here it is defined as the tamel population of a
health seivice unit
The term can he broadened to include individthils ',haring a
common
clef cpanhii
dod'ol
(ultia,11.
-,IS
..-,y:;tein. of individuals in a common
worksite school 01 omipdtion te.)
8
institutions can influence health care delivery by redefining their role and
expanding it in the domain of health policy and health service delivery.
Collaboration of the health professional education sector with the health
services sector will help ensure that future health professionals are better
prepared to identify and address health problems in society, while enabling
the health services sector to provide and support career opportunities for
these graduates that are consistent with their training.
Within the general context of health professional education and practice,
whose impact can only he analysed holistically, this report focuses on new
challenges for educational institutions.' It reviews the current situation and
makes proposals for action that stem from a perception of education as
both an art and a science to prepare future health professionals to function
properly in society. Educational institutions should be actively concerned
with the conditions and circumstances under which future graduates will
function (3). This implies accountability to society at large for the number
and nature of graduates and the relevance of their training to prevailing
health needs.
Educational institutions are encos.:,:+g,ed to extend their responsibilities
and programmes beyond their traditio..:1 sphere of influence. Links
between educational institutions and the service environment now exist to
various degrees: for example. when students are assigned to health settings
and when teachers supervise health personnel, as well as their own
students.
The proposed linkage between education and services should integrate
and build upon past efforts to improve relevance and previous innovations
from student selection,
at all levels of health professional education
training and continuing professional education to health service delivery,
and from primary through to tertiary care. Finally, such a linkage should
address the priority health care needs of society.
Learning from innovations in the education of
2.
health professionals
Educational innovations
2.1
research and teaching tend to ignore the
"traditional academic interests
realities of health service delivery. Yet the search for relevance in the
education of health professionals has been a continuing process and has
had many important positive results. In the past, the scrutiny has largely
been on curriculum or teaching methods, and has often been based on a
hypothetical and idealized professional role. The result is heavily biased
Ow term
an odo( ationdl iii!;111titam to,
Irl!(1
c1ucdtwil;i1
health professionals
i
9
2
towards what it is desirable for a student to know, rather than what
a
student needs to know. But enormous advances in scientific knowledge,
often rapidly superseded, have more recently required educators
to
reconsider the methods and objectives of health professional education.
During the last two decades, certain concepts and approaches have
become popular, some of which are explained in the box.
Imparting discrete facts and organizing knowledge by discipline simplify
the task of teachers, but do not necessarily help learners to acquire easily
and efficiently the skills they need to address the health problems they
are likely to encounter in practice. When compared with traditional
educational strategies, innovations such as problem-based learning
are
more consistent with the manner in which health professionals identify and
address problems in their workplace. Besides having benefits for the
learner, problem-based learning can make programmes
more relevant and
responsive to health care needs. It offers greater opportunities for
team
teaching, which can include teachers from a broad range of disciplines:
an
Problem-based learning is a method by which the student or health
worker uses the situation of an individual patient, a health delivery
question or a research topic as a stimulus for learning. After an initial
analysis of the problem. students define learning objectives for their
self-directed learning and obtain the information needed to address the
problem. They then report their findings and evaluate what they have
gained. Problem-based learning in health professional education "has
three educational objectives: the acquisition of an integrated body of
knowledge related to the problem, the development or application of
problem-solving skills, and the learning of clinical reasoning skills" (4).
Student-centred education refers to instructional strategies that depend
upon the capacities and motivation of the learner. Although the teacher
may provide the student with considerable guidance in the beginning, the
student is expected eventually to take full responsibility for self-learning.
The emphasis is on active acquisition of information and skills by the
student, depending on the way he or she learns best, an appropriate
pace
of learning, and the student's ability to identify personal educational needs
and evaluate progress (4).
Community-based education "consists of learning activities that
use the
community extensively as a learning environment, in which not only
students but also teachers, members of the community, and representa-
tives of other sectors are a( tively engaged throughout the educational
experience" (5).
Community-oriented education is characteristic of an institution whose
aims, objectives and basic principles are determined by the needs of the
community within which the in,;titution
is located, whose programme
adopts a comprehensive rather than a mainly curative approach to health,
and whose,
()gramme activities indicate commitment to the goal of health
for all.
.10
3
Qi