Scaling up transformative health education. Dr Bernhard Gaede Rural Health: UKZN 3 July 2012

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1 Scaling up transformative health education Dr Bernhard Gaede Rural Health: UKZN 3 July 2012

3 Transformative health education Interdependent learning Leadership Change agents (Frenk et al) Key in the process is: Orientation toward generalist care (PHC / FM) Clinical and public health integration Training adapted to local site (knowledge, skills, attitudes) Longitudinal exposure situational learning (awkward language) Curriculum evaluation and revision (Manalo GM & Mendoza EC; Doherty J)

4 WHO process Policy guidelines on scaling up and transforming health professional education Commission on HR4H and training Development of policy guidelines focusing on health professional education lit review (2009) and consultative meetings (2010) Core team working on guidelines (2011) PICO process recommendations based on evidence Launch of WHO Policy Guidelines expected by September 2012

5 Recommendations in the guidelines Domain Education Preenrolment Preferential selection of students from underserved backgrounds Students Practitioners Faculty Institution s Competency based curriculum Curriculum reforms elearning Specialization / residency programs Innovative expansion of the faculty (teaching platform) CPD for Policy for mandatory development programs eleaning Integration of education with practice Clinical rotations in rural and remote areas

6 Recommendations in the guidelines Domain Preenrolment Students Practitioner s Faculty Institutions Regulation Compulsory service bonding (bursaries) Certification / licencing Scope of practice Streamlined education programs Accreditation School governance Regulation regarding quality and relevance of CPD

7 Recommendations in the guidelines Domain Preenrolment Financing How funds are allocated to lover levels for preservice education Students Practitioners Faculty Institutions Scholarships in return for service Financial incentive programs How health professional education is financed Systems of recognition and rewards Revenue sources and volumes Partnerships for schools

8 Implications for South Africa Recommendations challenge the idea that current training allows the health care workers to function in any environment Trained at tertiary level Disciplinary isolation Hidden curriculum specialization and then leave.

10 What is possible? Double the health professional student output? Change the orientation?

11 Get real Train health professionals in real situations, with real patients with real responsibility with the end in mind (real teams). If we want to double the output, we cannot manage to achieve this with the same resources and the same teaching platform

12 For health science education Get beyond the co-dependant relationship between key health professions Radical re-curriculation (beyond narrow content issues) Re-focus of outcomes e.g. Canmeds / Five Star Doctor Formulate relationship with colleagues, communities and patients as key outcome Supervisor / mentor : student ratio in order to have meaningful relationship Post-grad rural support and specialization (e.g. registrar rotations) Radical examination of the hidden curriculum

13 For DoH health science education relationship Difficulties with National / Provincial mandates Need to deal with joint appointments No teaching platform with no teachers (no dumping) NB Supervisor / teacher : student ratios Manage bursary schemes to get bang for the buck To double student output needs to be met with commitment on both sides Unhelpful to slate curative care completely we need someone who can lead, not someone who can t cut. Vision for a relationship that makes this happen

15 Good policies principles poor implementation (the fifth burden?) Framework for accountability of DoH and health science educators Need to increase health education research and discourse Put talk into action! Not just scaling and transforming health education but scaling transformative health education

16 Way forward? Improved coordination of policy and link to implementation Get into Action plans, posts, sites Start small, share learning and scale up Put MDT learning on the IMPLEMENTATION agenda Aggressively manage the bursary schemes and use these wrt new policies (recruitment / service requirements)

17 References and acknowledgements Frenk J et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet Vol 376, Dec ; Manalo GM, Mendoza EC. A literature review of academic, institutiona, foundation and governamet publication on innovative health profession education. Unpublished produced for WHO Core Team on /// 2012 Doherty J. Alternative models for Rural Training of Health Professionals: a literature review. Unpublished. Commissioned by Centre for Rural health, Wits, April WHO draft guidelines Sen Gupta T Images: Bob Marley: Paul Weinberg; Others: MSF Gratitude to Ian Couper for his input Dr Bernhard Gaede gaedeb@ukzn.ac.za

18 Thank you

Training Competent Health Professionals for the 20th Century Response National Department of Health

Training Competent Health Professionals for the 20th Century Response National Department of Health SA Committee of Health Science Deans 3rd July 2012 UKZN Response HRH Strategy show need for university