Transformative Education
for Health Professionals

Key Policy Issue #1: Which competencies should students acquire?

In 1910, following the recommendations of the Flexner Commission and other major commissions of enquiry (e.g. the Gies Commission on the education of dentists in 1926) that explored the quality of the education of health professionals (Frenk, et al., 2010), the principles of current medical curricula were established. The emphasis was put on the acquisition of core competencies, e.g. a minimum set of scientifically based knowledge and skills, needed to deliver health care. As a result, Flexnerian reforms centralized the training of health professionals in hospital settings, with the emphasis placed on a biomedical approach to education, at the expense of a more comprehensive understanding of social  and community health problems. Although not all educational institutions followed this biomedical model at the same pace, the result overall has been a “…mismatch of competencies to patient and population needs, poor team work, persistent gender stratification of professional status, narrow technical focus without broader contextual understanding; episodic encounters rather than continuous care; predominant hospital orientation at the expense of primary care; quantitative and qualitative imbalances in the professional labour market; and weak leadership to improve health system performance.” (Frenk, et al., 2010:5) More overtly, over the past century, the demographic, epidemiological, socioeconomic and technological environment has changed dramatically with increasingly complex and new demands on the health professional workforce. For all of these reasons, Frenk and his colleagues argue that curricula need to be adapted to produce professionals with the capacity to identify and adjust to new environments in a continuous process of learning and adapting their competencies.

Meanwhile, it is widely recognized that it is not sufficient to adapt the curricula in line with the changing environment and technologies, but what is more critical today, is that health professionals must  be able to adapt to cultural variations and values, as well as attitudes to the different health problems of populations. A good example of the sort of adaptation required is HIV/AIDS, where health workers are often faced with providing health care in an environment where the stigma of having HIV hinders their access to patients.