Transformative Education in the Health Sciences

Erlyn A. Sana, PhD erlynsana@yahoo.com.ph

Major References
1. Frenk, Chen, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Published online at www.thelancet.com on November 29, 2010 and at The Lancet, vol. 376, pp.1923-58, December 4, 2010.

Major References
2. WHO. (December 2010). Global consensus for social accountability of medical schools. http://healthsocialaccountability.org/ 3. Domingo, EO. (2010). Reforms in the Health Human Sector in the Context of Universal Health Care. Acta Medica Philippina. Vol. 44, No. 4, pp. 43-55.

http://nttchp.sites.google.com/site/nttchp/

Statement of the problem

The Flexnerian Curriculum turned 100 years old in 2010, Report paved way to the science-based (now the traditional) curriculum, From 1910 to early 2000s, curricula in the health sciences evolved from science based to problem based to system based.

Three generations of reforms in HS Curricula (Frenk, et al, 2010)

1900 Science based
Problem based

2000 System based

Three generations of reforms in HS Curricula (Frenk, et al, 2010)

Curriculum
Science-based

Description
Informative

Aims
For learners to acquire KSA, produce experts Towards socializing students around values; to produce professionals To develop leaders and enlightened change agents

Problem-based

Formative

System-based

Transformative

The science-based curriculum

Internship Clinical sciences Basic sciences

The problem based curriculum

1. Main curricular content is captured in problems that integrate basic and clinical sciences 2. Centered on students in small groups 3. Problems necessitate the use of reasoning and application of previous learning

Same problems persist:

1. Glaring gaps & striking inequities in health persist between and within countries, 2. Poor people in developing countries continue to have common infections, malnutrition, and maternity-related health risks, which have long been controlled in more affluent populations, 3. Mismatch of professional competencies to patient and population priorities because of fragmentary, outdated, and static curricula producing ill-equipped graduates from underfinanced institutions

Three generations of reforms in HS Curricula (Frenk, et al, 2010)

1900 Science based Problem based System based 2000

Instructional Scientific reform curriculum Institutional reform University based

Problem based Competency learning driven: local to global Academic centers Healtheducation systems

Transformative Education

Vision for a new era of professional education (Frenk, Chen, et al, 2010)
Tranformative Learning Interdependence in Education

Equity in Health
Individuals Patient-Centred Popn based

Instructional Reform

Transformative Education

1. Adopts a competency based curriculum 2. Promotes inter professional and transprofessional education 3. Exploits the power of IT learning 4. Harnesses global resources and adapt locally 5. Strengthens educational resources 6. Promotes new professionalism

Institutional Reform

Transformative Education

7. Establishes joint planning mechanisms 8. Expands from academic centers to academic systems 9. Links through networks, alliances, and consortia 10.Nurtures a culture of critical inquiry

Instructional Reform

Transformative education is 1. competency-based

Content

Learning Competencies Objectives

Teaching & learning activities

Assessment

Instructional Reform

Competencies (Epstein &

Hundert in Frenk, et al, 2010)

The habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and the community being served.

Instructional Reform

Why competency-based

Allows learning in a variety of settings, Competencies as focus makes curriculum more transparent and therefore accountable to learners, policy makers, stakeholders, Allows for more imaginative design of health systems, roles and compensation better aligned and traditional boundaries between professions reduced.

Instructional Reform

Transformative education is 2. inter- and trans-professional

1. Collaborations between professional schools 2. Collaborations between educational & other types of institutions

Instructional Reform

Transformative education is 2. interprofessional: THEnet

1. Launched in 2008, Boelen and Woollard (2009) 2. A network of collaborating medical schools experimenting with instructional and institutional innovations to attract, retain, and enhance the productivity of health professionals serving disadvantaged populations often in remote rural areas.

Instructional Reform

Transformative education is 2. interprofessional: THEnet

3. Training centers for health science students:

1. Canada: Northern Ontario School of Medicine 2. Africa: Walter Sisulu University 3. Venezuela: Comprehensive Community Physician Training Programme 4. Philippines: Ateneo de Zamboanga University, School of Health Sciences, UP Manila

Instructional Reform
1.

Transformative education is 2. interprofessional: TUFH

Composed of health professionals & academic organisations dedicated to the creation of a global platform of equitable health care through community-based education, dynamic research, and dedicated rural service,

2.

Undertakes policy-based projects and case studies on issues of great importance,

3.

Collaborations on rural internship programmes (Brazil), promotion of healthy behaviours (Czech Republic), integrative participatory research (Kenya), family practice research in resource-poor settings (Greece), and international graduate programmes on pharmacy (Canada).

Instructional Reform

Transformative education is 2. interprofessional: TUFH

4. In 2007, TUFH launched eEducation for healthan open access electronic journal aimed at enhancing transnational exchange of knowledge and information. 5. Holds annual conferences on a variety of topic. This years conference was recently held at Thunderbay, Canada from October 9-14, 2012 1. Theme: Rendez-vous 2012: Together and engaged 2. Website: http://www.thenetworktufh.org/conferences/thisyear

Instructional Reform

Transformative education 3. exploits IT for learning

1. Access to research evidence 2. Capacity for data collection, analysis, simulation, & testing 3. Distance & other forms of e-learning 4. Connectivity in educational management

Instructional Reform

Transformative education 4. harnesses global resources but adapts locally

In 2000, 1.9 million deaths worldwide 98% of these deaths in the developing world About 350,000 deaths due to TB/HIV 8.7 million new cases, 80% in 22 high-burden countries Multi-drug resistance (MDR TB) present in 63 of 72 countries surveyed between 1994-1999

Instructional Reform

Transformative education 4. harnesses global resources but adapts locally

Global knowledge on the cause, cure, treatment, & prevention TB is available locally TB consistently ranks in the first 6 causes of mortality & morbidity for 4 decades Local management models and best practices are developed

Instructional Reform

Transformative education 5. Strengthens educational resources

Sustainable and regular Promotion of faculty development independent learning programs among students Systematic and Development and developmental advancement of educational organization instructional materials and management

Instructional Reform

Transformative education 6. Promotes new professionalism Identifies which professions and HPs are required by the schools These personnel should have transformed sets of values & orientations: to be change agents

TL Activites Objectives TL Resources Competencies Content Assessment

Institutional Reform

Transformative education 7. Establishes joint planning mechanisms

Academic Communities Schools Dept of Finance

TE
Prof organizations

Dept of Education Dept of Health

Institutional Reform

Transformative education 7. Establishes joint planning mechanisms To decide collectively on: Assessment of national conditions Tracking changes Harmonizing supply and demand of HPs Recruitment of students

Academic Communities

Schools

Dept of Finance

Prof organizations

TE
Dept of Education

Dept of Health

Institutional Reform

Transformative education 8. expands from centres to academic systems

Institutional Reform

Transformative education 9. Links through networks, alliances, & consortia

Governments

Schools

Civil society

TE
Other partners Business

1. Partnerships among governments, civil society organizations, business, and media groups. 2. Activate the power of ICT to reach to the far flung areas

Media

Institutional Reform

Transformative education 10. Nurtures a culture of critical inquiry

1. The central function of HS schools is to mobilize scientific knowledge, ethical deliberation, public reasoning and debate 2. To generate enlightened leaders as they lead to social transformation

Enabling actions
1. 2. 3. 4. Mobilize leadership Enhance investments Align accreditation Strengthening global learning

Enabling actions
1. Mobilize leadership 2. Enhance investments 3. Align accreditation 4. Strengthening global learning Tapping philanthropic leadership Ministerial summits of governments and international organizations National forums for professional organizations Academic summits

Enabling actions
1. Mobilize leadership 2. Enhance investments 3. Align accreditation 4. Strengthening global learning Efficiency in public financing in health professional education Increasing donor funding to developing countries Private financing of HP schools

Enabling actions
1. Mobilize leadership 2. Enhance investments 3. Align accreditation 4. Strengthening global learning Development of national accreditation systems: criteria & metrics of outputs Glob al cooperation with international standards and bodies

Enabling actions
1. Mobilize leadership 2. Enhance investments 3. Align accreditation 4. Strengthening global learning Metrics on professional education must be defined, gathered, assembled, analyzed, and widely disseminated Built in evaluation mechanism Integration of research

The full model for transformation

Instructional & Institutional Reforms

Enabling actions

Transformative & interdependent HPEd for equity in health