T1 S1-2 - Change agent in unknown future (Prof Ben van Heerden)

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T1 S1-2 - Change agent in unknown future (Prof Ben van Heerden)

  1. 1. THEME 1: CHANGE AGENT FOR THE 21ST CENTURYSession 1-2: Change agent in an unknown future Prof Ben van Heerden Centre for Health Professions Education Faculty of Medicine and Health Sciences Stellenbosch University Sentrum vir Gesondheidsberoepe Onderwys Centre for Health Professions Education Fakulteit Geneeskunde en Gesondheidswetenskappe  Faculty of Medicine and Health Sciences
  2. 2. OutcomesAfter this contact session you shouldbe able to do the following:• Describe recent developments that are related to the leadership role of health professionals to effectively address the health needs of the country’s population.• Discuss the knowledge, skills and attitudes that you need to develop to become a capable and appropriate doctor.
  3. 3. Recent developments• International and national developments in the training of health care professionals • Transformative learning and interdependence in education • Graduate attributes• Developments in leadership and management theory (discussed in sessions 3-4)
  4. 4. International trends in HSE• Future of Medical Education in Canada (2010)• Tomorrow’s doctors (GMC, 2009)• Reform in educating physicians (Carnegie Foundation, 2010)• Revisiting medical education at a time of expansion (Macy Foundation, 2008)• A snapshot of medical student education in the USA and Canada (AAMC)• Global consensus for Social Accountability of Medical Schools (2010)
  5. 5. International trends in HSE• Health professionals for a new century: transforming education to strengthen health systems in an interdependent world (www.thelancet.com,2010;376:1923-1958)
  6. 6. South African trends and priorities• Re-engineering primary health care in SA (SA Department of Health)• The contribution of South African curricula to prepare health professionals for working in rural or under-served areas in South Africa: A peer review evaluation (SAMJ, 2011;101:34-38)• The human resource supply constraint: The case of doctors. (Econex Health Reform Note 8, November 2010)
  7. 7. Lancet Commission ReportJ Frenk, L Chen, ZA Bhutta, et al: Health Professionals for a newcentury: transforming education to strengthen health systems in aninderdependent world. www.thelancet.com ,2010;376:1923-1958 Century after Flexner’s report – all is not well: • Gaps and inequities in health care • New infectious, environmental and behavioural risks in context of rapid demographic and epidemiological transitions • Health systems complex and costly
  8. 8. Lancet Commission ReportProfessional education has not kept pace –fragmented, outdated & static curricula and illequipped graduates: • Mismatch of competencies to patient/population needs • Poor teamwork skills • Narrow technical focus lacking broader contextual understanding • Episodic patient encounters rather than continuous care • Predominant hospital orientation at expense of PHC • Weak leadership skills to improve health system performance • Professional “tribalism”
  9. 9. 1900 Science based Problem based Systems 2000+ based Scientific Problem-based Competency driven;Instructional curriculum learning Global-local University based Academic centres Health-EducationInstitutional systems Lecturer centred Student centred Patient and population centred Basic sciences Small group lectures Inter and transprofessionalInnovations IT empowered learning Leadership, policy and management skills Adapted from: J Frenk, L Chen, ZA Bhutta et al: Health Professionals for a new century: transforming education to strengthen health systems in an inderdependent world.
  10. 10. Traditional educational model Educational objectives Curriculum Assessment Competency-based educational model Health needs Competencies of population Outcomes Curriculum AssessmentAdapted from: J Frenk, L Chen, ZA Bhutta et al: Health Professionals for a new century: transformingeducation to strengthen health systems in an inderdependent world.
  11. 11. Labour market Supply of health for health Demand for health workforce professionals workforce Provision Provision Education Health System System Demand HSE Demand Needs Needs Populatio nAdapted from: J Frenk L Chen, ZA Bhutta et al: Health Professionals for a new century: transforming education tostrengthen health systems in an inderdependent world. www.thelancet.com, 2010;376:1923-1958
  12. 12. KEY DIMENSIONS OF EDUCATION SYSTEM Institutional design Instructional design Proposed Outcomes Interdependence Transformative in Education learningAdapted from: J Frenk, L Chen, ZA Bhutta et al: Health Professionals for a new century: transforming education tostrengthen health systems in an inderdependent world. www.thelancet.com, 2010;376:1923-1958
  13. 13. Three levels of learning• Informative learning Learning of knowledge and skills required to become technical expert• Formative learning Learning of attitudes, values and norms required to become a professional• Transformative learning
  14. 14. Transformative learning• Aim: Leadership attributes• Outcome: Change agents• Three fundamental shifts from: • Rote learning higher level of cognitive functioning • Seeking professional credentials achieving core competencies for effective teamwork • Non-critical adoption of educational models creative adaptation of global resources to address local priorities
  15. 15. Interdependence in Education• Key element in systems-based educational approach• Underscores the ways in which various components of the systems interact• Three fundamental shifts from: • Isolated harmonised education and health systems • Standalone institutions networks, alliances and consortia • Inwardly-focused institutions creative use of global educational content, teaching resources and innovations
  16. 16. Interdependence Transformative in Learning Inter and Education transprofessionalCompetency-based Leaders teams Locally responsiveResponsive to rapidly Task sharing Change agents Globally connectedchanging needs Open educationalCreative use of IT resources Health Equity Patient-centred Population based VISIONAdapted from: J Frenk, L Chen, ZA Bhutta et al: Health Professionals for a new century: transformingeducation to strengthen health systems in an inderdependent world.
  17. 17. Interdependence HP for the Transformative in Education 21st Century Learning Three Shifts: Three Shifts:Inter- & 1. Isolated to harmonised 1. Rote learning to analysis; synthesis Edu & Health SystemsTransprofessional 2. Standalone Institutions 2. Seeking credentials to to Networks; Alliances; teamwork competenciesTeams Consortia 3. Educational models to 3. Inward looking to Global global resources flow of educationalTask sharing content, resources, innovationGlobally connectedLocally responsive Needs of Society and Leaders &Open Educational Health Systems Change agentsResources (OER)Harmonised Competency-driven instructional DesignEducation andHealth Systems Curriculum Competencies as Outcomes
  18. 18. OutcomesAfter this contact session you shouldbe able to do the following:• Describe recent developments that are related to the leadership role of health professionals to effectively address the health needs of the country’s population.• Discuss the knowledge, skills and attitudes that you need to develop to become a capable and appropriate doctor. GRADUATE ATTRIBUTES
  19. 19. Graduate attributes• “…the qualities, skills and understandings a university community agrees its students should develop during their time with the institution.• These attributes include, but go beyond, the disciplinary expertise or technical knowledge that has traditionally formed the core of most university course.• They are qualities that also prepare graduates as agents of social good in an unknown future.” Bowden et al. (2000)
  20. 20. Lancet December 2010Health professionals have made hugecontributions to health and socio-economicdevelopment over the past century,but we cannot carry out 21st century healthreforms with outdated or inadequatecompetencies….That is why we call for a new round of moreagile and rapid adaption of corecompetenciesbased ontransnational, multiprofessional, and long-term perspectives to serve the needs ofindividuals and populations
  21. 21. The CanMEDS Competency Framework7 Key roles necessary to effectively function as a healthcarepractitioner Medical ExpertCanMEDS, 2005
  22. 22. CanMEDS 2005Level DescriptionLevel 1 A health care professional’s (HCP) complete array of competencies (determined by needs of community / system)Level 2 Thematic groups of competencies (“meta-competencies”) (e.g. 7 CanMEDS Roles)Level 3 Key competencies thematically grouped by Role (broad abilities)Level 4 Enabling competencies - made up of knowledge, skills and attitudes (sub-abilities to attain key competency)Level 5 Profession-specific objectives of trainingLevel 6 Programme-level objectivesLevel 7 Rotation objectivesLevel 8 Instructional-event-specific objectives
  23. 23. Role of the Health Professions Council of SA (HPCSA)• Statutory body• Comprising 12 Professional Boards• Regulates education and training of health professionals represented by these Boards• Medical and Dental Professions Board (MDB) • Represents Medical Doctors, Dentists, Medical Scientists and Clinical Associates (CA) • Undergraduate Education and Training (UET) Subcommittee • Oversees the E & T of CA, Dentists and Medical Doctors
  24. 24. UET subcommittee• Adopted the key recommendations of the Lancet Commission• Adapted CanMEDS competency framework to ensure that it is appropriate for: • Undergraduate education and training • All health care professionals • South African context
  25. 25. OutcomesAfter this contact session you shouldbe able to do the following:• Describe recent developments that are related to the leadership role of health professionals to effectively address the health needs of the country’s population.• Discuss the knowledge, skills and attitudes that you need to develop to become a capable and appropriate doctor.

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