The document discusses reforms to medical education over the past century. It describes how the Flexner Report in 1908 evaluated medical schools and established standards, leading to reforms that implemented a four-year curriculum with basic and clinical sciences. A century later, another report recommended goals like competency-based learning, interprofessional education, and harnessing technology. The document advocates for a third generation of reforms focusing on systems-based and adaptive learning to improve health systems performance.

1. MEDICAL EDUCATION
REFORM
Dr .Basma Mohamed Abd El Aziz
2017

2. One hundred years ago, medical education was
very different than it is today.
There was lack of standards of medical
education and poor quality of medical
training in existence in the late 1800s, .
Though some medical education was delivered
by the universities, many non-university
.

3. In addition, there were more medical schools
at the beginning of the 20thcentury than
there are today, and
they varied greatly in the quality of their
teaching staff and their laboratory and
clinical facilities.
There was little done to try and regulate
the number of practicing doctors at the time
,leading to an oversupply of physicians

4. In 1908, the Carnegie Foundation appointed
Abraham Flexner to undertake a survey of
medical education across the US and Canada in
order to evaluate all medical schools in existence
at that time.
Flexner was an American educator, Though he did
not have a degree in medicine
Flexner visited 155 schools in18 months to
evaluate their laboratory and clinical facilities,
admissions requirements, student fees, and
quality of teaching

6. a four-year medical school curriculum with
two years of basic sciences followed by
two years of clinical instruction in a teaching
hospital.

10. ONE HUNDRED YEARS AFTER THE
FLEXNER REPORT,
 The Carnegie Foundation for the Advancement of
Teaching,
 the same organization that sponsored his study,
conducted an investigation on medical education.
 four goals for modern medical education were
recommended

14. THREE GENERATIONS OF
EDUCATIONAL REFORMS PROGRESS
DURING THE PAST CENTURY
The first generation,
launched at the beginning of the 20th century,
taught a science-based curriculum.
The second generation
Around the mid-century introduced problem-
based instructional innovations.
The third generation
is now needed that should be systems based to
improve the performance of health systems by
adapting core professional competencies to specifi
c contexts, while drawing on global knowledge

18.  Our vision calls for a new era of professional education that
advances transformative learning and harnesses the power
of interdependence in education.
 our Commission believes that the future will be shaped by
adaptation of competencies to specific contexts drawing on
the power of global flows of information and knowledge.
 Our Commission aspires to spark a second century of
reforms in all countries and all professions facing new
contexts and fresh challenges.
 Our vision is global rather than parochial, multi-
professional and not confined to one group, committed to
building sound evidence, encompassing of both individual
and population-based approaches, and focused on
instructional and institutional innovations.

19. TO ADVANCE THIRD-GENERATION
REFORMS, THE COMMISSION VISSION
 Our goal is to encourage all health professionals, irrespective of
nationality and specialty, to share a common global vision for the
future.
 In this vision all health professionals in all countries
should be educated to mobilize 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.
.

20. Adoption of competency-based curricula
 responsive to rapidly changing needs rather than
being dominated by static coursework.
 Competencies should be adapted to local contexts
and be determined by national stakeholders,
 the present gaps should be filled in the range of
competencies that are required to deal with 21st
century challenges common to all countries—eg,
the response to global health security threats or
the management of increasingly complex health
systems.

21. Promotion of interprofessional and
transprofessional education
 enhancing collaborative and non-hierarchical
relationships in effective teams.
 interprofessional education should focus on cross-
cutting generic competencies, such as analytical
abilities (for effective use of both evidence and
ethical deliberation in decision making),
 leadership and management capabilities (for
efficient handling of scarce resources in
conditions of uncertainty)
 communication skills (for mobilisation of all
stakeholders, including patients and
populations).

22.  Adaptation locally but harnessing of resources
globally in a way that confers capacity
 to fl exibly address local challenges while using
global knowledge, experience, and shared
resources, including faculty, curriculum, didactic
materials, and students linked internationally
through exchange programmes.

23. educational resources
 Strengthening of educational resources, since
faculty, syllabuses, didactic materials, and
infrastructure are necessary instruments to
achieve competencies.

24. new professionalism
 Promote a new professionalism that uses
competencies as the objective criterion for
 the classification of health professionals,
transforming present conventional silos.
 A set of common attitudes, values, and
behaviours should be developed as the
 foundation for preparation of a new generation of
professionals to complement their learning of
specialties of expertise with their roles as
accountable change agents,
 competent managers of resources, and promoters
of evidence-based policies.

25.  Linking together between educational
institutions worldwide and across to related
actors, such as governments, civil society
organizations, business, and media.
 The aim is to overcome the constraints of
individual institutions and expand resources in
knowledge, information, and unity for shared
missions.

26.  Nurturing of a culture of critical inquiry as a
central function of universities and other
institutions of higher learning,
 which is crucial to mobilise scientific knowledge,
ethical deliberation, and public reasoning and
debate to generate enlightened social
transformation.

27.  Expansion from academic centres to academic
systems
 extending the traditional education range in
schools and hospitals into primary care settings
and communities

28. the power of IT for learning
 Universities and similar institutions have to
make the necessary adjustments to harness the
new forms of transformative learning made
possible by the IT revolution,
 the competencies to access, discriminate, analyse,
and use knowledge.
 More than ever, these institutions have the duty
of teaching students how to think creatively to
master large flows of information in the search
for solutions.

29. to assure universal coverage of the high quality
comprehensive services that are
essential to advance opportunity for health equity
within and between countries

30. REALISATION OF THIS VISION
two proposed outcomes:
moving from informative to formative to
transformative learning.

32. Informative learning
is about acquiring knowledge and skills; its
purpose is to produce experts.
Formative learning
is about socialising students round values; its
purpose is to produce professionals.
Transformative learning
is about developing leadership attributes; its
purpose is to produce enlightened change

34. The work of the Commission was supported by
funding from the Bill&
Melinda Gates Foundation, the Rockefeller
Foundation, and the China
Medical Board

38.  the AMA has embarked on a new strategic vision.
 One area of focus is:
Accelerating Change in Medical Education—to
 align physician training and education with the
evolving health care system.
 " American Medical Association.

39. Redesigning Education to Accelerate
Change in Healthcare
 is an American Medical Association (AMA) grant-
funded initiative to transform the Brody Medical
School curriculum so that it better prepares
future physicians in
 patient safety,
 quality improvement and
 population health
 in an environment of team-based,
 patient-centered care.

43. new projects to make medical education
meet the needs of the 21st century.
 Developing Flexible, Competency-based
Pathways
 Teaching New Content in Health Systems
Science
 Working With Health Care Delivery
Systems in Novel Ways
 Making Technology Work for Learning
 Envisioning the Master Adaptive Learner
 Shaping Tomorrow's Leaders
 Universal Outcomes

44. Developing Flexible, Competency-based
Pathways
 Medical education at all levels—undergraduate,
graduate and continuing—is shifting away from
time spent in lectures and in classrooms and
toward the necessary knowledge and skills have
been acquired for transition to residency and
patient care.
 Medical schools are incorporating milestones and
entrustable professional activities (EPAs) into
the curriculum to determine the best path for
students to follow in order to move to the next
level of training.
 create physicians who continually update their
abilities and address any deficiencies throughout
their careers.

46. Teaching New Content in Health
Systems Science
 , physicians need to know more than biomedical
and clinical sciences. They need to understand
the content of health systems science.
 This new discipline includes understanding how
to improve health care quality, increase the value
of care provided, enhance patient safety, deliver
population-based medical care and work
collaboratively in teams.
 Physicians need to learn how to advocate for
their patients and communities and understand
the socio-ecological determinants of health,
health care policy and health care economics

48. Working With Health Care Delivery Systems
in Novel Ways
 creating new learning experiences within health
care systems that not only teach principles of
health systems science, but also bring value to
the health care system.
 Training students to be patient navigators, to
plan quality improvement projects and to
perform important functions that benefit patient-
centered teams serve dual purposes.
 Students learn about health care delivery by
working in true settings, and they are able to
contribute to improving the health of patients

49. Making Technology Work for Learning
 teaching the use of electronic health records,
management of patient to improve health
outcomes, and interpretation of "big data" on
health care costs and utilization in order to learn
how to best use resources.
 In addition, schools are applying learning
technology to manage individualized, flexible
progress by assessing student competencies along
their medical education journey.
 New tools are being used for easier self-
assessment by students and review with faculty
coaches.

50. Envisioning the Master Adaptive
Learner
Physicians need to rapidly access and interpret
continuously evolving information and to
understand how the use of new data supports the
delivery of the best patient care.
One of the aims of the consortium is to assist
physicians in becoming master adaptive learners
—expert, self-directed, self-regulated and lifelong
workplace learners.
Preparing today's medical students for careers in
the changing health care system requires more
than clinical skills. Faculty must help medical
students develop skills in adaptive learning, too

51. Shaping Tomorrow's Leaders
 Future physicians will need to do more than
deliver high-quality care. To be effective in the
modern health care system, they will need to
possess the ability to lead teams and participate
in positive change.
 integrating leadership and teamwork training
into curricula that will prepare today's medical
students to become future leaders.
 implementing new learning experiences in
leadership, including identified leadership tracks
that focus on hands-on experiential education,
advanced coursework and learning exercises.

52. Universal Outcomes

57. REFRANCES
 http://www.ccm.pitt.edu/sites/default/files/ebm/calls_for_ref
 http://www.thelancet.com/article/S0140-6736(10)61854-5/fu
 https://www.ama-assn.org/21-medical-schools-join-ama-crea