This week Dan sends us his brief analysis of directions in medical education and curriculum development. He discusses the need for socially accountable curricula, which allow students to participate in 'the global village': this includes a renewed focus on primary health care.  Have your say, contribute to the conversation, in the comments box below, or on the forum. 

The medical education community this year celebrated the 100-year anniversary of the Flexner report. The report penned by Abraham
Flexner in 1910 changed the trajectory of medical education in the Western world. It advocated for a strongly scientific based curriculum and is attributed with improving the quality of medical education, teaching and research. However, it also cast a long legacy of rigidly science focused medical curriculum, which was apparent to Flexner himself as early as 1925 when stating, “scientific medicine in America — young, vigorous and positivistic — is today sadly deficient in cultural and philosophic background.” The extent to which this critique still holds true in many Western medical curricula today provided an appropriate rationale for the Global Community Engaged Medical Education Muster I attended from the 18-21st October this year. 

The aim of the conference was to challenge the constructs of contemporary medical education in Australia and ask the question; “how can we raise awareness of the diverse global interests of members of the community as key stakeholders in medical education and by doing so strengthen community-engaged Medical Education both nationally and internationally?” There is an increased imperative to answer this question given a number of “wicked”★ problems that are currently facing are health system. 

There is an inherent need for medical schools to deliver a curriculum that is socially accountable. The acute lack of well-trained, motivated and supported health workers is one of the greatest impediments to improving health in a world of unconscionable health inequities. In low and high-income countries alike, medical schools have drifted from their social mandate to serve the most vulnerable. The consensus at the conference was that medical schools need to break out of their ivory towers and bring research, service and learning back to the communities that most need them.

Stemming from this first point is the need for a reorientation in the way clinical education is delivered, so students are fostered towards careers in Primary Health Care (PHC), stopping the “specialist tsunami”.  The answer to the intensifying chronic disease problem in the global North and South lies in community-based, comprehensive PHC. Ironically, our medical schools are producing a greater proportion of hospital-based specialists than ever. 

Finally, medical education must become more cogniscent of the globalised village we now work in and thus strive to create clinicians with truly global perspectives. If doctors are to continue fulfilling our Hippocratic professional ideals we must learn how to lead on the global stage. This increasingly means looking outside the traditional healthcare system to a complex array of social, economic and political determinants of health. 

The changing dynamic of our community’s health requires medical curricula that are responsive to these 21st century needs. The challenge is in not only defining the appropriate content to be taught, but also the ability to deliver it in a way that emphasises its importance relative to the traditional biomedical content. There is a moral and ethical imperative for medical schools to achieve this responsiveness and social accountability to the communities that we ultimately serve.

★“Wicked” in a sense that they are problems that are very difficult and or near on impossible to solve because of incomplete, contradictory, and changing requirement that are in turn difficult to recognise.