Making out a strong case for instructional and institutional reforms in medical education, an independent global report by the Lancet Commissions has recommended aligning national efforts through joint planning, especially in the education and health sectors, engaging all stakeholders in the reform process and developing global collaborative networks for mutual strengthening.
It has suggested establishment of joint planning mechanisms in every country to engage key stakeholders, especially the Education and Health Ministries, professional associations and the academic community, to overcome fragmentation by assessment of national conditions, setting priorities, shaping policies, tracking change and harmonising supply and demand for health professionals in order to meet the health needs of the population. It calls for promotion of inter-professional and trans-professional education that will break down professional silos while enhancing collaborative and non-hierarchical relationships.
The report on “Education of Heath Professionals For the 21st Century” comes at a time when the Ministries of Human Resource Development (HRD), Health and Law are engaged in a turf war, all three having drafted Bills to regulate professional education.
The task force set up by the HRD Ministry has drafted a Bill for establishing a National Commission for Higher Education and Research (NCHER) that would function as an overarching regulatory body replacing all existing regulatory bodies in medicine, engineering, law and other disciplines. The only exception is education related to agriculture, a State subject.
Refusing to part with medical education, the Health Ministry too has drafted a Bill for setting up a National Commission for Human Resource in Health (NCHRH), which would regulate medical education that is linked closely to hospitals. The Law Ministry has finalised a Bill for setting up a regulatory authority for legal education.
The NCHER proposes that universities be made more autonomous, with the responsibility for academic content restored to them. The task force has revised its draft three times and held consultations in as many as 12 locations, and has taken the view of the State governments on board. It seeks to promote autonomy and institutional accountability and set standards of academic quality for accreditation.
While the government has announced setting up of the two commissions, the Prime Minister is said to have broadly approved the NCHER draft, but has asked the HRD Ministry to hold wider consultations with the other Ministries as this commission would step into their domains.
The Lancet report has favoured expansion from academic centres to academic systems, extending the traditional discovery-care-education continuum in schools and hospitals to primary care settings and community, strengthened through external collaboration as part of a more responsive and dynamic professional education system. In view of faculty shortages and other resource constraints, regional and global, the report recommends the setting up of consortia as part of the institutional design in the 21st century, taking advantage of information and communications technologies.
On instructional reforms, the report says these should encompass the entire range from admission to graduation, to generate a diverse student body with a competency-based curriculum that, through the creative use of information technology, prepares students for the realities of teamwork, and to develop flexible career paths that are based on the spirit and duty of a new professionalism.
The Lancet Commission report was released in December 2010. Thisindependent initiative — led by a diverse group of 20 commissions from across the world — adopted a global perspective seeking to advance health by recommending instructional and institutional innovations to nurture a new generation of health professionals.
India was represented by K. Srinath Reddy, president of the Public Health Foundation of India. Professionals from the Harvard School of Public Health, the China Medical Board, Aga Khan University, the George Washington University Medical Centre, the School of Nursing at Pennsylvania University, The Rockefeller Foundation, and The Bill and Melinda Gates Foundation participated in the study.
