Medical Education 2020

The Med-School The Teacher The Student

Apprenticeship for Learning Skills

• the core of medical skills-teaching is still through apprenticeship

• no substitute for tutor-guided clinical clerkship – no matter how advanced the school is

“Some things will never change”

Why Change? – By 2020,

• New technical information doubles every 72 hours

• ½ of what you know in first year will be out of date by third year

• 5.6 billion Internet searches will be done every month

• 100 trillion bits per second will travel down one strand of optic fiber.

I.C.T.* – Evolution & Progress

* Information - Communication - Technology

• By 2025, a $1000 laptop will exceed the capabilities of the human brain

• By 2049, it will exceed the capability of the human race

• What motor has done to replace muscle power, the ‘chip’ will do to human brain

ICT – impact on Self-Learning

• Heutagogy (self-determined learning) will become more dominant learning method

• Learner decides the time, the setting, the speed and the manner of learning

• The timing of exams too may be self-determined (already implemented in some exams in USA)

ICT – Impact on Assessment

• ICT is adaptable for – Formative assessment (corrective feedback)– Summative assessment (Pass-Fail Decision)

• “Open-book” / “Open-Access” exams may become universal– Refer online resources to solve complex problems– Highest level of learning (problem solving) can be

tested instead of testing only memory & recall

e.g., http://www.pitt.edu/~super1/index.htm has 5000 lectures & 50000 global educators

Diversity in Med-Education • The health-seeking behavior of the public

varies from country to country • This makes the teaching of medicine more

diverse, region-specific and rigid • The differences in medical care will probably

remain unchanged for a long time• Separate, national licensure exam is a marker

for this rigidity

Medical education in Third World• schools in III world (Africa & S-America) will

adapt PBL & PSE and • use them to learn to practice medicine

according to local standard of care• learner is exposed to clinical settings in the

community, where academic resources are scarce

• This prevents dichotomy between what is taught in medical school and their real world

E.g., USA vs. Canada• USA - healthcare system

based on fee-for-service• Medical education - USA – technological advances– sub-specialization and – Income generating

occupations

• Canada - comprehensive health insurance system

• Med-education - Canada– family practice is the

hallmark– most sought after by the

students

Primary Care Vs Specialties• The conflict between the primary care

physician and the super-specialist is not unique to the USA or Canada.

• Globally, Med-schools have to address this issue if Primary care has to flourish in the community.

• Both are essential for quality care: Primary care is like sensitivity and specialties are like specificity (e.g., headache & brain tumor)

International Health & Medicine

• Aim: to educate a physician who will be able to practice anywhere in the world

• With “Globalisation” most progressive varsities will offer MBBS or MD (IHM)

• Such a curriculum is quite difficult to implement at present – being done by Columbia Varsity, US and its partner

in Israel – (University of the Negev, Beer Sheva, Israel)

Geographical location TopicWestern Kenya …………….. Malaria resurgencePeople’s Republic of China SchistosomiasisNewYork ……………… . . . . MDR TB outbreakNegev, Israel . . . . . . . . . Cutaneus leishmaniasisTurkana, Kenya . . . . . . . . Hydatid diseaseIsrael …………………. . . . . Poliomyelitis outbreakHong Kong . . . . . . . . . . InfluenzaGujarat, India . . . . . . . . Plague epidemicPeru …..………. CholeraTropical Ecuador . . . . . . Chaga’s disease

IHM - Student presentations.

ML. Alkan, The global medical school, 2020. Medical Teacher, Vol. 22, No. 5, 2000

The Ball will be in Whose court?• Accreditation bodies

will become more important globally for TQM (Total Quality Management)

• Will it be Win-Win facilitation or a No-Win game of blame-blame?

What does Future Hold?

Let us wait for 3 more years…