I
1/ I
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(WP)HRH /ICP /HRH/018 -E Report series No. RS/93/GE /07(PHL)
ENGLISH ONLY
REPORT
WHO/ ASSOCIATION FOR MEDICAL EDUCATION IN THE WESTERN PACIFIC REGION (AMEWPR) CONSULTATIVE MEETING ON MEDICAL EDUCATION
Manila, Philippines 30-31 March 1993
Not for sale Printed and distributed by the Regional Office for the Western Pacific World Health Organization Manila, Philippines April1993
NOTE The views expressed in this report are those of the members of the Association who participated in the consultative meeting and do not necessarily reflect the policy of the World Health Organization.
This report was prepared by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for the members of the Association for Medical Education for the Western Pacific Region.
CONTENTS
SUMMARY ......................................................................................................................... 1 1. INTRODUCTION .............................................................................................................. 1 1.1 Objectives ..................................................................................................................... 2 1.2 Participants .................................................................................................................. 2 1.3 Organization ................... ............................................................................................. 2 2. PROCEEDINGS ................................................................................................................. 3 2.1 Summary of reports .................................................................................................... 3 2.2 Review of survey results, examination and adoption of the draft regional report ....................................................................................... 5 3. CONCLUSIONS AND PROPOSALS ............................................................................ 5 ANNEXES: ANNEX 1 - PROVISIONAL AGENDA...................................................................... 7 ANNEX 2 - OPENING REMARKS OF THE REGIONAL DIRECfOR AT THE WHO/ASSOCIATION OF MEDICAL EDUCATION FOR THE WESTERN PACIFIC REGION (AMEWPR) CONSULTATIVE MEETING ON MEDICAL EDUCATION ........................................................................................... 9 ANNEX 3 - LIST OF TEMPORARY ADVISERS AND SECRETARIAT ..... 11 ANNEX 4 - REGIONAL REPORT OF THE AMEWPR TO BE PRESENTED AT THE WORLD CONFERENCE ON MEDICAL EDUCATION, EDINBURGH, 8-12 AUGUST 1993 ................................................................................ 13 ANNEX 5 - CONSTITUTION AND BY-LAWS OF THE ASSOCIATION FOR MEDICAL EDUCATION IN THE WESTERN PACIFIC REGION (AMEWPR) ........... :................................................................ 27 ANNEX 6 - THE 1988 EDINBURGH DECLARATION AND ITS 12 PRINCIPLES ...................................................................................... 33
Keywords Education, Medical I Western Pacific I Philippines
SUMMARY
The participants successfully covered all the topics contained in the Provisional Agenda for the Consultative Meeting, namely: the report of the President of the Association for Medical Education for the Western Pacific Region (AMEWPR); individual reports by each participating member; review of the results on the questionnaire survey on developments since 1988; and the examination/adoption ofthe draft regional report to be submitted to the World Conference of the World Federation for Medical Education at Edinburgh on 8-12 August 1993 (Annex 1). The group also clarified some technical and procedural matters, namely, The Manila Conference is to be recorded as a meeting of the Advisory Board ( 1) rather than of the Executive Committee; The participants established the procedures for official communication of the (2) Association with China and the Republic of Korea; At the World Conference in Edinburgh, the AMEWPR will convene an (3) official meeting of its Advisory Board to confirm/ratify the term of office of the President Professor M. Nishizono and of his designated Secretary/Treasurer who will serve out the remaining term of Dr H. Mahmud Mohd Nor, who retired from the presidency of AMEWPR on 12 September 1992. At this meeting, the members of the Association's Executive Committee will be selected.
1. INTRODUCTION
The WHO/Association for Medical Education in the Western Pacific Region Consultative Meeting was convened in preparation for the Second World Conference on . Medical Education to be held in Edinburgh, Scotland, on 8-12 August 1993. Participants in the meeting included representatives from China, Fiji, Japan, the Republic of Korea, Malaysia, and the Philippines, representing the majority of the members of the Advisory Board of the Association for Medical Education in the Western Pacific Region (AMEWPR). Prior to the World Conference in August 1993, each regional Association for Medical Education is expected to draft its contribution to the "Consolidated World Report on Medical Education." The Manila Conference therefore represents the counterpart efforts of AMEWPR to prepare its regional report, which will be presented at the 1993 Edinburgh Conference. The first World Conference on Medical Education was also held in Edinburgh on 7_12 August 1988, under the auspices of the World Federation for Medical Education. The 12 principles of the Edinburgh Declaration emerged from this earlier conference. The Declaration was strongly supported by the Forty-second World Health Assembly in its resolution WHA 42.38, in May 1989. ·The support provided by the WHO Regional
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Office for the Western Pacific for the consultative meeting is part of the continuing collaboration between AMEWPR and WHO in promoting the Edinburgh Declaration. 1.1 Objectives
The principal objective of the meeting was to draft the regional report based on the results of a questionnaire survey previously cohducted among members of the AMEWPR Advisory Board. Particular emphasis was to be placed on four aspects: (a) (b) (c) (d) developments since 1988; actual re-orienting of programmes and projects; the major obstacles to change; the new developments that have emerged in the Region since 1988.
The report was to take into consideration the fact that the challenge for change is uniform throughout the world, but that there are region-specific variations which are profoundly affected by political forces, health care finance, ideology and ethical considerations. The participants also used relevant sessions of the consultative meeting as opportunities for working out some administrative and legal matters concerning the management structure of the Association, and the procedures for official communications with AMEWPR members from China and the Republic of Korea. 1.2 Participants
Participants consisted of: individuals representing medical education associations in their respective countries; members of faculties of medicine and institutions for medical education; and officials of national health services (Annex 3). A regional perspective as well as supplementary project information were provided by senior staff of WHO, who comprised the secretariat for the conference. Continuing efforts to revitalize the Fiji School of Medicine as a major source of appropriate medical workers for the Pacific were cited as an example of innovation in medical education in the Western Pacific Region. The Head of the School participated in the meeting in his capacities as principal of the institution and as an officer of the Fiji Ministry of Health. 1.3 Organization
The sessions of the consultative meeting were held on 30-31 March at the WHO Regional Office for the Western Pacific, and covered a set of related sub-topics involving clarification of the current situation, examination and approval of a draft regional report for the 1993 World Conference, and future collaboration with WHO. Dr S.T. Han, Regional Director for the WHO Regional Office for the Western Pacific, delivered the opening remarks (Annex 2). The Association President and his designated Secretary collaborated in summarizing the current situation, and in presenting the President's Report. Each participant in turn gave a brief description of the country situation, followed by an open forum. The draft regional report, which was completed in advance of the meeting on the basis of partial
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responses to the questionnaire sutvey, was discussed and approved in principle. This draft has been incorporated as part of the conference report (Annex 4).
2. PROCEEDINGS
The meeting adhered closely to the conference structure prescribed in its provisional agenda. The President's report provided the participants with up-dated information regarding the tenure of the Association's President and his designated Corporate Secretary/Treasurer. Brief country reports made by each participant provided highlights of recent developments in medical education and in the health professions. 2.1 2.1.1 Summary of reports Report by the President of AMEWPR
Professor Masahisa Nishizono, President of AMEWPR, recounted the events leading to his assumption of the presidency, and took the opportunity to express the gratitude of the whole Association to Dr H. Mahmud Mohd Nor, Faculty of Medicine, Universiti Kebangsaan Malaysia, who had retired from his academic and medical posts on 11 November 1992. His third two-year term as AMEWPR President was only irito its ninth month at the time of his retirement. After due consultations and a teleconference in 1992, Professor Masahisa Nishizono of the Fukuoka University School of Medicine had been mandated to setve the unexpired term of Dr H. Mahmud Mohd Nor. Professor Kenzo Kiikuni, Institute of Community Medicine, University of Tsukuba, the incoming President's nominee, had taken over the post of the Association's Corporate Secretary and Treasurer from Dr Sharifah H. Shahabudin, Universiti Kebangsaan Malaysia. · 2.1.2 China There are about 100 institutions engaged in teaching traditional medicine and about 25 in western methods of medical training. The majority of medical students are trained for practice in farm or rural communities. Areas to be opened for specialty training as well as the methods appropriate for such training programmes are under discussion between the Government and the medical associations. Some changes in the curriculum and content of medical courses at the undergraduate level are continually being made. In the area of continuing medical education, the sheer size of the country implies that the training needs will vary from one area to another. In the same manner, medical training cannot be limited to classroom settings. Provisions are being made to include farms, factory and community settings as learning places as well. Fiji The new curriculum at the Fiji School of Medicine was described in the light of the professional and political conditions prevailing in the mid-1970s. Now in its third year, the programme runs parallel to the traditional MBBS curriculum, which is expected to be Reports by members present
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phased out completely in three years' time. Essentially, the course consists of two tiers: the first is a three-year programme leading to a Diploma in Primary Health Care and the second is a two-year course in hospital-based clinical practice. Prior to entry into the second tier, students will undertake a one-year service internship in their respective communities, duly supervised by members of the health service who have been previously accredited by the school. The two terminal assessments occur at the end of each tier. Japan The 79 institutions for medical education produce about 8,000 graduates each year. Forty-two are national institutions, 29 are private while eight are public municipal schools. The medical course takes a total of six years after high school, after which the student sits for a national examination conducted by the Ministry of Health and Welfare. The 320 questions contained in the examination influence the curriculum design. A Reform Committee for Medical Education has recently been constituted, which has encouraged new approaches to medical education, including a liberalized curriculum and problembased methods. Re-licensure for practitioners is one of the methods being explored for continuing medical education. Aging is also a major area of concern. Twelve of the 79 medical schools actually have separate departments dedicated to geriatric medicine. Other elements that are being incorporated into the medical curriculum are communication skills, behavioural science, and health promotion, although the emphasis is .still on the curative aspects. Malaysia Two new medical schools incorporating innovations in their academic curriculum are to be added to the existing two traditional and one innovative institution in the country. The new elements in the undergraduate medical curriculum are concerned with relevance, community orientation and interdisciplinary linkages. In allied health sciences, courses are to be upgraded into university programmes. Postgraduate work is to be standardized into four-year courses for all disciplines. Distance-learning concepts and techniques such as teleconferencing are also being considered. Continuing medical education will focus on practice-linked curricula and methods. Recertification in specialties will result in the formalization of credentials in hospital-based procedures. Philippines Of the 27 schools of medicine in the country, four are state or city government institutions, while the rest are private schools. The standard medical course takes a total of four years plus a one-year internship. The prerequisites are a bachelor's degree and passing a qualifying examination conducted by the Government. One innovation is a programme which introduces the medical curriculum midway into the students' baccalaureate course, effectively reducing study time by two years. The other non-traditional programme is a ladder-type curriculum which grants a set of health worker qualifications to students cumulatively, with the Doctor of Medicine degree at the top ofthe ladder. In the area of health care delivery, the entry of health maintenance organizations accompanied the inclusion of practitioners of traditional medicine into the system. While national health concerns such as population and environment are being integrated into medical courses, practical obstacles remain, including the opposition of the Catholic church to artificial means of preventing conception.
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Republic of Korea Medical education in the Republic of Korea is placing due consideration on disease prevention, afflictions that are associated with the aging process, and promotion of healthy behaviour. Pressures to increase the number of medical schools and consequently the number of medical practitioners are being felt from city hospitals and local and provincial governments. Some quarters feel that the increases in medical ranks will tend to bring down salaries of medical practitioners, thereby effectively reducing the costs of health care. 2.2 Review of survey results, examination and adoption of the draft regional report
The participants reviewed the results of the questionnaire survey, copies of which had been previously distributed to members of AMEWPR, in relation to the draft regional report to be presented at the World Conference on Medical Education in August 1993. The draft was approved in outline with the understanding that further refinements would be made by the office of the President based on further responses received at the time of the meeting (Annex 4).
3. CONCLUSIONS AND PROPOSALS
The consultative meeting in Manila should be recorded as a meeting of the 3.1 Advisory Board rather than of the Executive Committee. The participants in the consultative meeting in Manila, together with an eighth 3.2 nominee from Australia, should form the core of the AMEWPR delegation to the World Conference in August. The final list should be drawn up after due consultations between the President of the Association and the WHO Regional Director, Regional Office for the Western Pacific. During the World Conference in Edinburgh, the Association should convene an 3.3 official meeting of the.Advisory Board in order to ratify and confirm the term of office of Professor M. Nishizono and his Corporate Secretary /Treasurer-designate. The latter should serve the unexpired term of Dr H. Mahmud Nor, who retired from active service on 12 September 1992. The official notification should be sent to all members in due course. Some transitional directions should likewise be formulated at the Edinburgh 3.4 meeting. Members of the Executive Committee should be nominated and elected to serve out the tenures of office stipulated in the Association's Constitution and By-laws (Annex 5). The issues concerning the type of membership in the Association should also be clarified. Provisions for funding the 1994 regional meeting of the Association's Advisory 3.5 Board in Kuala Lumpur should be considered at the 1993 meeting in Edinburgh. It is felt that the country of the Association President should bear part of the costs. Issues related to membership fees, sourcing of funds for publications and other 3.6 operating expenses, establishment of a seed fund, and other such mechanisms should be explored.
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ANNEX 1
PROVISIONAL AGENDA
1. 2.
Opening ceremony Clarification of current situation (a) (b)
Report by the President of AMEWPR Reports by Executive Members of AMEWPR Review of Survey Results
(c) 3. 4.
Examination and approval of the Draft Regional Report to be submitted to the World Conference on Medical Education, Edinburgh, 8-12 August 1993. Adoption of the Regional Report Future activities and collaboration with WHO, WPRO Other matters Closing ceremony
5. 6. 7.
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Annex 1
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ANNEX2
OPENING REMARKS OF THE REGIONAL DIRECfOR AT THE WHO/ASSOCIATION OF MEDICAL EDUCATION FOR THE WESTERN PACIFIC REGION (AMEWPR) CONSULTATIVE MEETING ON MEDICAL EDUCATION
Manila, 30-31 March 1993
Esteemed Colleagues and Friends representing medical education in the Western Pacific Region: It is a pleasure and a privilege to be here with you this morning, to open this Regional Consultative Meeting on Medical Education. The Regional Office is particularly happy to host this gathering because the development of human resources for health is one of our top priorities. As good physicians are still the key to good health care, the way they are trained and educated is obviously of great concern to us. Globally and in this Region, WHO has a long history of collaboration in efforts to ensure the relevance and usefulness of the products of the long and expensive process of medical education. Such collaboration was accelerated in the 1970s and 1980s when primary health care was adopted by WHO as the main strategy for the attainment of health for all. Thus, WHO has collaborated in strengthening teacher training programmes to develop new educational methods needed for reorienting academic curricula and training programmes. In 1985, the Declaration of Tokyo outlined new strategies for educating health personnel for the 21st century. This was followed by the Edinburgh Declaration of 1988 which emphasized the continual need for the reorientation of medical education. As a result of these activities, many innovations have been introduced in the medical programmes of institutions throughout the world. One exciting example in this Region is the ongoing effort to revitalize the Fiji School of Medicine as a major source of medical workers for the Pacific. I am sure that during this meeting you will have the opportunity to hear more about this from the Head of the School, Dr Jimi Samisoni, who is with us today. In the last few years this Office has also been involved in clinical training in Japan, postgraduate and continuing education in Malaysia and the Republic of Korea, and undergraduate curriculum development in China and the Philippines. It is clear to everyone that the health situation of the world has changed deeply during the time that WHO has been in existence, and will continue to do so as we enter the twenty-first century. .A review of past and existing programmes is therefore indispensable, if we are to chart a realistic course for the future. Naturally, WHO in the Western Pacific fully supports your aim of reviewing medical education in the Region in preparation for the World Conference on Medical Education in Edinburgh this summer.
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Annex2 I am sure that this meeting will make a very valuable contribution to our planning for collaboration in the future. I would like to suggest that you give particular attention to three areas of medical care which will be very important in the 21st century. First, dealing with degenerative diseases and problems associated with aging. Second, management skills, and third the promotion of healthy behaviour. I therefore wish you every success in your work during the next two days and look forward to our continued collaboration in the coming years.
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ANNEX3
LIST OF TEMPORARY ADVISERS AND SECRETARIAT
1. MEMBERS Professor Chen Hua Beijing Medical University c/o Ministry of Public Health Beijing People's Republic of China Dr Elena Cuyegkeng Executive Director Association of Philippine Medical Colleges Foundation Room 306, Lung Center of the Philippines Quezon Avenue, Quezon City 1100 Philippines Professor Kenzo Kiikuni Professor Institute of Community Medicine University of Tsukuba Tsukuba City, Ibaraki 305 Japan Professor Masahisa Nishizono President Association for Medical Education Western Pacific Region (AMEWPR) 6-3-21 Iikura Sawara-Ku Fukuoka 814-01 Japan Dr Hyung-Jong Park Vice-President and Dean, Graduate School of Public Health Inje University 638-165 Gaegum-dong Pusanjin-gu, Pusan 614-735 Republic of Korea Dr Jimi Samisoni Head, Fiji School of Medicine Private Mail Bag Suva, Fiji
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Annex 3 Associate Professor Dr Sharifah H. Shahabudin Department of Medical Education Faculty of Medicine Universiti Kebangsaan Malaysia Jalan Raja Muda Abdul Aziz 50300 Kuala Lumpur Malaysia 2. SECRETARIAT Dr T.M. Biumaiwai Acting Regional Adviser Development of Human Resources for Health WHO Regional Office for the Western Pacific Manila Dr A.G. Romualdez, Jr. Director Health Services Development and Planning WHO Regional Office for the Western Pacific Manila
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ANNEX4 REGIONAL REPORT OF THE ASSOCIATION FOR MEDICAL EDUCATION, WESTERN PACIFIC REGION (AMEWPR)
1. Activities since 1988 Since the First World Conference on Medical Education in Edinburgh in 1988, WHO, WPRO has been actively working for improvement of medical education and health professional education. The executive members Some
of AMEWPR have been cooperating with them in various aspects. of our activities are mentioned below in chronological order;
1) The WHO/World Psychiatric Association Joint Meeting on Psychiatric Education for the 21st Century. Fukuoka, Japan, 13~17
March, 1989.
2) Intercountry Symposium on Postgraduate and Continuing Medical Education for Primary Health Care. 30 June, 1990. 3) WHO, WPRO/RTC Intercountry Workshop on Continuing Medical Education for Primary Health Care, Sydney, Australia, 8-23, 1990. 4) The Meeting of Deans of Medical Schools on Education about 13Seoul, Korea and Fukuoka, Japan, 27-
Behavioral and 18 July, 1991.
Psychosocial Aspect of Health.
Beijing,
China,
5) Western Pacific Advisory Committee on Health Research, Subcommittee on Health Promotion. Manila, Philippines, 7-9 October, 1991. Tokyo, Japan, 17-
6) International Conference on Medical Education. 19 November, 1992. 7) WHO/AMEWPR Consultative Meeting on Medical
Education.
Manila,
Philippines, 30-31 March, 1993.
In conjunction with an international seminar "Integrating continu-
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ing medical education with the health care delivery system", AMEWPR held an advisory November, 1990. committee meeting in Kuala Lumpur, Malaysia on 6
At the meeting we discussed our role as a regional
association and reported activities in each country. In April 1992, President Dr. Mahmud Mohd Nor attended a regional meeting of presidents in Edinburgh at which the World Conference 1993 was discussed. He also gave a statement to the WHO Regional Assembly
in Hong Kong on behalf of AMEWPR in September, 1992. Additionally WHO, WPRO/AMEWPR Consultative Meeting on Medical
Education was held in Manila on 30-31 March, 1993.
2. Changes in Medical Education in Each Country and the Edinburgh Declaration
In advance
of drafting
this regional report,
a questionnaire
survey was conducted among the advisory committee members of AMEWPR and those invited to the WHO/AME\oJPR Consultative Meeting on Medical Education as mentioned above. and clarified problems and We examined the results at the Meeting changes in medical education in each The
country,
and how
they make use of the Edinburgh Declaration.
results of the questionnaire are as follows:
A. as to the Edinburgh Declaration; 1. Have you had any meeting on medical education in your country since the 1st World Conference on Medical Education in 1988? yes; Australia, Fiji, Japan, Philippines, Malaysia and Korea no Papua New Guinea
2. If yes, was the Edinburgh Declaration reported at the meeting?
- 15Annex 4 yes; Australia, Japan, Philippines, Malaysia and Korea no ; Fiji 3. Please write down YOUR opinion how the 12 principles in the Edinburgh Declaration were evaluated at the meeting. Many the respondents answered Declaration are that although worthwhile as the 12 principles of theory, they think it
Edinburgh
was difficult to make use of them to reform present medical education which in some countries is entrenched in a long history of
conservatism.
B. as to the main theme, "The Changing Medical Profession; Implication for Medical Education", of the 2nd World Conference; 4. Can you recognize any changes in health care or the health service system in your country in the last 5 years? them down. a. national level; 1) Many respondents raised the problems of escalating cost of If yes, please write
care caused by: increasingly aging populations; changing environmental factors and life-style patterns; increasing psychosocial determinants of health; increasing and costs for the development of new medical young
equipment
technology;
increasing
specialty-oriented
physicians; imbalance between primary care, or general practitioners, and other community level services and so on. 2) The total number of hospitals beds is controlled nationally in both Australia and Japan. Act was revised whereby hospitals Moreover in Japan, the Medical Service
j_n 1992 to correspond to changes in medical needs, are divided into 3 groups: university hospitals
and national centres equipped with high technology for special disease,
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Annex4
general hospitals and chronic care hospitals for patients with chronic illnesses . 3) The private practice sector at primary health care level has been rapidly expanding in some countries such as Fiji and Malaysia. On the contrary, human resources and developme nt within the governmen t sector have been declining , for example in Fiji. 4) Many countries reported that they recognized increasin g concern for ethical, moral and religious issues in health care. b. community level: There is an increasin g demand for the following and changes caused by them; 1) establishm ent and maintenan ce of emergency care system 2) network for cooperati on among health care centres or institute s 3) adoption of high technolog y such as computers in health care support system in rural area·s 4) increasin g consumers ' expectati ons for high quality, comprehensiv e health care accompani ed by an increased legal awareness 5) concern about excessive specializ ation of medical care 6) more emphasis on preventiv e and promotive aspect of care 7) more emphasis on community health education 8) increasin g involveme nt of NGOs in health care c. others: 1) encourage ment to introduce communit y-oriented curricul~m;
several examples were cited at the meetings of medical education by several medical schools in Korea and Fiji School of Medicine. 2) trials on distance education for continuin g education for
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physicians in Australia, Malaysia and Fiji 3) integration of traditional or oriental medicine in health care in China 5 . Can you recognize any changes or problems regarding human resources for health in your country? If yes, please write them down.
1) warning that there are too many physicians in Japan 2) maldistribution of human resources for health in isolated rural areas in many countires 3) an absolute shortage of human resources and more seriously a qualitative deficiency in specialist skills/expertise in Fiji 4) migration of health manpower especially of physicians to other countries in several countries 5) deficiency of adequate and appropriate positions for well-trained physicians 6) remarkable deficiency of nursing personnel in JRpan and Malaysia 7) inadequate number of allied health or co-medical staff in general . 8) shortage of fully qualified specialism in many disciplines in New Zealand 9) too much emphasis on specialist training in Korea 6. Can you recognize anything changed or about to change in medical education at national level in your country? write them down. a. undergraduate; Australia 1) increase ' in length of curriculum in 2 medical schools from If yes, please
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Annex4 5 to 6 years, but also a move towards medicine being taught as a graduate 4-year progremme: this is occurring in medical schools. 2) more integration between basic sciences and clinical sciences 3) increasing emphasis on behavioral and community medicine
4) increasing tendency to use community hospitals for teaching 5) accreditation system in place for all medical schools
6) future move towards a system of graduate medical education
in 3 medical schools Fiji training progammes being reoriented and reformulated on an integrated training approach, using a problem-based format Korea 1) introduction of integrated medical teaching method against traditional departmentalized teaching 2) more emphasis on problem solving teaching methods and its reflection in the national licensure examination for physicians 3) encouragement of field practice in the community and the need to develop adequate texts and successful teaching methods 4) development of evaluation criteria for medical education and schools Malaysia 1) new curricula reflecting health priorities with emphasis on active learning through problem-based learning and integration. 2) emphasis on thinking and reasoning skills as well as student's problem-solving and management abilities in examinations 3) utilization of wide range of learning environments
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Annex 4
Japan 1) reform of accreditation criteria for medical colleges 2) reform of clinical clerkship toward practice-oriented 3) reform of premedical course Philippines 1) increasing community orientation 2) changing method of teaching community medicine with greater emphasis on community orientation, people empowerment and use of teamwork and other health workers 3) increasing emphasis on research --development of research capabilities of both students and the faculty --encouraging increasing output from the faculty 4) reduction of hours for hospital training and shifted to the community experience 5) teaching/emphasis on national health priorities such as population, environment, nutrition, etc. 6) more social sciences integrated into the curriculum 7) better linkage of medical schools with Department of Health New Zealand 1) increasing use of community hospitals and practices for teaching 2) gradual increase of problem-based learning in preclinical curriculum 3) medical school accreditation by Australian Medical Council b. postgraduate; Australia 1) new branches such as occupational medicine and postgraduate
-20 Annex4 colleges in response to emerging specialties 2) emphasis on public health and general practice 3) most postgraduat e colleges studying issues of maintenance of specialist competence Fiji 1) formation of Fiji College of General Practitione rs (F.C.G.P.) with distant learning programmes in family practice 2) commitment to establishme nt PGE training programmes at Fiji School of Medicine Korea introducU on of a specialty in "family practice" Malaysia 1) inadequate places available for quality postgraduate training 2) masteral progremme for all clinical specialists , including family medicine have been developed with research and teaching as important components. 3) recertifica tion procedures and establishme nt of a specialist register are being discussed. Japan 1) more emphasis on primary health care competence in junior resident course 2) establishme nt of specialist training and certificatio n system Philippines 1) integration of principles of management, research and education 2) developing programs for masteral degree in family practice/ community medicine 3) inclusion of clinical epidemiolog y in the curriculum 4) masteral programs in basic and clinical sciences
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c. continuin g; Australia 1) issue of recertific ation and maintenan ce of competenc e under review by most bodies 2) one college has already introduce d recertific ation procedure s. Fiji strengthe ning CE initiativ es by establishm ent of F.C.G.P. which in past was responsib ility of Fiji Medical Associati on Korea strengthe ning and expansion of continuin g education for private practitio ners by Korea Medical Associati on in collabora tion with medical schools Malavsia Distance learning through audioconf erence will be launched in July 1993 for CME. Plans are underway for CME to be part of relicensu re procedure s. Japan 1) plan of recertific ation procedure s in most specialis t training and certifica tion bodies 2) promotion of continuin g education by the national professio nal associati on Philippin es 1) previousl y the specialty societies were primarily conducting CME but now medical schools are more active. 2) attendanc e in CME is required for renewal of license to practice by Professio nal Regulatio n Commission. New Zealand certifica tion of continuin g competenc e likely to become a
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Annex4
statutory requirement 7. If innovation in m~dical
education in your country is not going
smoothly, what among factors mentioned below do you think impedes it? a. lack of connection between medical education and health care system b. too traditional attitude of medical school teachers c. financial reason d. shortage of human resources in medical schools e. problems on community side In Australia, 'financial reason' is a major impediment and 'lack
of connection between medical education and health care system' comes next. In Japan, 'lack of connection between medical education and health care system' is major and 'too traditional attitude of medical school teachers' follows it. In the Philippines, medical faculty are still conservative
&
hesitate to make change. In New Zealand, 'too traditional attitude of medical school teachers is a major problem. We can see some differences among countries.
C. as to the three Plenary Sessions to be held in the 2nd World Conference on Medical Education; Theme 1 "The Wider Context; Public Pressures and Expectations" 9. I guess that many medical colleges in your country educate on "Informed Consent" which guarantees human rights. At which level
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Annex 4 does i t start? a. from undergraduate level b. from postgraduate level
c. not"sufficientl y propagated at most medical colleges At most medical colleges, it starts from undergraduate level.
10. It is said that not only education through examination of patients' progress in hospital but also one through understanding of characteristics of their daily life in community is important. Malaysia, it is on trial. Is such an education popularized in your country? and the Philippines say yes and others
New Zealand
11. Is education of psychosocial and behavioral aspect for health adopted in a curriculum at medical colleges in your country? yes Australia, Fiji, New Zealand fairly: Ja,pan, Korea and Philippines ~~laysia,
Papua New Guinea and
Theme 2 "The Changing Nature of ~ledical
Practice; Implications for all
Stages of Medical Education" 12. Please write down anything you would like to regarding this theme. Though there are only a few replies, we can see remarkable changes in medical practice such as; (1.) increasing awareness of medico-legal right, (2) higher clinical competence and trend toward specialization, (3)
increasing and
demand
for
preventive factors and
medicine, so on.
(4)
increasing for
psychosocial
behavioral
Education
physicians who can adequately deal with these problems is required.
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Theme 3 "Coping with the Growth of Kno\~ledge
and Scientific Information"
13. It is said that the problem-oriente d and integrated curriculum is indispensable for medical education to cope with the explosive development of scientific technology. What is the ratio of medical
colleges which adopt such a curriculum in your country? a. 100% In b. 75-100% c. 50-75% of d. 25-50% e. less than 25% the integrated
Malaysia,
75-100%
medical
schools adopt
curriculum. In
Two new schools are adopting problem-based curricula. and Korea, and 25-50% than the of 25% medical adopt schools a or
Australia
adopt
the
integrated curriculum,
curriculum and in
less
problem-oriente d problem-oriente d gra~uate
Australia, to increase
proportion
curricula is
likely
with
the introduction of
medical education. In Fiji, the School of Medicine adopts both problem-oriente d
and integrated curricula. In both Japan and the Philippines, less than 25% of medical
colleges adopt problem-oriente d and/or integrated curriculum. In New Zealand, both medical schools present virtually all their clinical teaching through a problem-oriente d and integrated curriculum. HO\vever, the preclinical course (years 1, 2 and 3) are more
traditional, with about 25% of the learning problem based.
14. Also, it is expected that medical colleges promote well-systemized self-learning by medical students (e.g. Harvard Medical School or Are there
tutorial method of Newcastle Medical College in Australia). such medical colleges in your country?
If so, please write down their
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Annex 4 names. Newcast le and New South Wales (Austra lia) Tokyo Women Medical College (Japan) Fiji School of Medicin e (Fiji) Univers iti Sains Malaysi a School of MP.dical Sciences However, many countrie s are reportin g step by step or evolutio nary changes towards this trend in several of the establis hed schools.
3. Conclus ion The Western Pacific Region consists of various countrie s, each of which has own charact eristics in its history, culture, and economy. religion
Such charact eristics must have had an great influenc e However, .we can see today that
on medical educatio n in each country.
medical educatio n as a whole is aiming at the same objectiv es to meet such problems as; 1. increasi ng awarene ss of human rights 2. medical service with develope d medical science 3. increasi ng and cityward drifting of populati on 4. increasi ng medical service cost caused by factors mentione d above and governm ental policy to reduce it 5. importan ce of concern about life-sty le and/or psychos ocial factors 6. importan ce of preventi on and community health educatio n These challeng es are also seen in WHO's policy as the Declara tion of Alma Ala and New Paradigm for Health. It seems necessar y to reform medical educatio n as soon as possible to cope with such tells us circums tances. The result of the question naire
survey
that in spite of some differen ces among countrie s
in the Western Pacific Region, medical educatio n in each country is
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Annex4 surely changing, aiming at medical practice to meet problems mentioned above. In order to carry forward the reform of medical education we really require a close and long-lasting relationship
smoothly;
between WHO, WPRO and AMEWPR.
This Regional
Report,
which was drafted
by Dr. M.
Nishizono,
President of AMEWPR, and discussed at the WHO, WPRO/AMEWPR Consultative Meeting, has been completed in consideration of all Advisory Committee
Members 1 opinions gathered through the mails and on Dr. Nishizono 1 s responsibility.
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ANNEX5
CONSTITUTION AND BY-LAWS OF THE ASSOCIATION FOR MEDICAL EDUCATI ON IN THE WESTERN PACIFIC REGION (AMEWPR )
CONSTITUTION
The name of th. e Association shall be "THE ASSOCIATION FOR MEDICAL EDUCATI ON IN THE WESTERN PACIFIC REGION". 2. Interpretat ion In this Constitution and in all By-laws, Regulations and decisions made hereunder, the following words and expressions shall (except where or to the extent that the contrary indication appears) have the meaning hereby assigned to them, that is to say: (a) (b) (c) (d) (e) (f) (g) 3. "The Association" shall mean "The Association for Medical Education in the Western Pacific Region". "A.M.E.W.P.R." shall mean "The Association for Medical Education in the Western Pacific Region". "Western Pacific Region" shall mean the "Western Pacific Region of the World Health Organization". "Advisory Board" shall mean the Advisory Board of the Association as constituted under this Constitution. "Executive Committee" shall mean the Executive Committee of the Association as constituted under this Constitution. "Member" shall mean any member of the Association. "National Association" shall mean a national association of medical education.
Objects The objects of the Association shall be: (a) To promote and develop medical education in the Western Pacific Region.
·(b) To provide a forum and mechanism for exchange of information among members.
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Annex5 (c) (d) To establish and maintain a resource center for education materials. To establish linkage with the World Health Organization and similar agencies.
Membership Membership of the Association is available to: (a) (b) (c) (d) 5. all national associations for medical education in the Western Pacific Region. Medical schools in countries of the Western Pacific Region at the discretion of the Advisory Board. Other bodies in the Western Pacific Region concerned with medical education, at the discretion of the Advisory Board. national associations in the Southeast Asian Region, at the discretion of the Advisory .Board.
Amendments to the Constitution Amendments to the Constitution and By-Laws may be made during the biennial meeting of the Advisory Board or any special meeting called for that purpose, upon approval of the majority of the representatives of the members; provided however that such amendments have been submitted to the members at least three months before the meeting.
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Annex 5 BY-LAWS
1.
Office The principal office of the Association shall be situa ted in the country of the President or the Secretary of the Association.
2.
Language The language of the Association shall be English.
3.
Rights and privileges Mem ber of the Association is entitled to: i) ii) iii) iv) one representative on the Advisory board provided there is only one representative per country; voting rights through this representative; access to the facilities of the Association; any privileges as deter mine d by the Association.
4.
Subscriptions The mem ber shall pay an annual membership fee to be deter mined by the Advisory Board.
5.
Office beare rs The Office beare rs of the Association shall consist of: (a) (i) A President who shall be the Chief Executive Officer of the Association. ory Board.
( ii) exercise powers and perfo rm duties as assigned by the Advis (iii) be elected from among the members of the Advisory Board.
(iv) be elected for a term of two years with eligibility for re-election for a furth er . of two years. (b) (i) (ii) A Vice-President who shall exercise powers and perfo rm duties as assigned by the Advis ory Board or President. in the case of incapacity, resignation or death of the Presi dent, act as president until a new president is duly elected.
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Annex5
(iii) be elected from among the members of the Advisory Board. (iv) be elected for a term of two years with eligibility for re-election for a further period of years. (c) (i) A Corporate Secretary and Treasurer who sha)..l attend and record all meetings of the Association as assigned by the Advisory Board.
(ii) be the financial officer of the Association. (iii) prepare financial reports. (iv) exercise powers or perform duties as assigned by the Advisory Board or President. (v) be appointed by the Advisory Board for a period determined by the Advisory Board. 6. Compensation The Office Bearers of the Association shall receive such salaries or compensation as may be determined form time to time by the Advisory Board. 7. Advisory Board (a) (i) The Advisory Board of the association shall consist of: one representative of each country.
(ii) the members of the Executive Committee. (iii) such other members as determined by the Advisory Board. The Advisory Board shall be the policy making and governing body of the (b) Association arid shall have power to do all such acts as may be incidental or conducive to the attainment of any of the objects of the Association. (c) 8. The Advisory Board shall meet at least once every two years.
Executive Committee The executive Committee of the Association shall consist of: (a) (i) The President of the Association
(ii) The Vice-President of the Association. (iii) The Corporate Secretary /Treasurer of the Association. (iv) three other members elected from the Advisory Board. The Executive Committee may act for the Advisory Board provided that it (b) shall submit its decisions for ratification at the next meeting of the Advisory Board.
- 31 Annex5 (c) 9. The Executive Committee shall meet at least once every year.
Editorial Committee An Editorial Committee shall be appointed by the Advisory Board and shall be headed by the Corporate Secretary.
10.
Finance (a) The financial year ofthe Association shall be from 1 January to 31 December.
(b) The Secretary/Treasurer shall keep proper accounts of the property of the Association and of all monies received and expended and shall cause all such accounts to be presented to a meeting of the Advisory Board at least once every two years. 11 . Publications The Association shall publish a newsletter which shall: (a) (b) 12. inform members of the activities of the Association. be produced by the members of the Editorial Committee.
Meetings (a) Notice of all meetings shall be given at least two months prior to the meetings.
(b) An agenda of all meetings shall be issued not less than one month before the meeting. (c) The Corporate Secretary shall record the proceedings of all meetihgs.
-32Annex 5
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ANNEX6
THE 1988 EDINBURGH DECLARAT ION AND ITS 12 PRINCIPLES
The Edinburgh Declaration The aim of medical education is to produce doctors who will promote the health of all people, and that aini is not being realized in many places, despite the enormous progress that has been made during this century in the biomedical sciences. The individual patient should be able to expect a doctor trained as an attentive listener, a careful observer, a sensitive communicator and an effective clinician; but is no longer enough only to treat some of the sick. Thousands suffer and die every day from diseases which are preventable, curable or self-inflicted, and millions have no ready access to health care of any kind. These defects have been identified for a long time, but efforts to introduce greater social awareness into medical schools have not been notably successful. Such facts have led to mounting concern in medical education about equity in health care, the humane delivery of health services, and the overall costs to society. This concern has gathered momentum from national and regional debates which have involved large numbers of individuals from many levels of medical education and health services in most countries of the world and has been brought into sharp focus by reports which followed from the six regions of the world and which address the basic issues. It also reflects the conviCtions of a growing number of doctors in teaching and clinical practice, other health professionals, medical students, and the general public. Scientific research continues to bring rich rewards; but man needs more than science alone, and it is the health needs of the human race as a whole, and of the whole person, that medical educators must affirm. Many improvements can be achieved by actions within the medical school itself, namely to: 1.
enlarge the range of settings in which educational programmes are conducted, to include all health resources of the community, not hospitals alone; ensure that curriculum content reflects national health priorities and the availability of affordable resources; ensure continuity of learning throughout life, shifting emphasis from the passive methods so widespread now to more active learning, including self-directed and independent study as well as tutorial methods; build both curriculum and examination systems to ensure the achievement of professional competence and social values, not merely the retention and recall of information; train teachers as educators, not solely experts in content, and reward educational excellence as fully as excellence in biomedical research or clinical practice;
2. 3.
4.
5.
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Annex 6 6. 7. 8. complement instruction about the management of patients with increased emphasis on promotion of health and prevention of disease; pursue integration of education in science and education in practice, also using problem solving in clinical and community settings as a base for learning; employ selection methods for medical students which go beyond intellectual ability and academic achievement, to include evaluation of personal qualities;
Other improvements require wider involvement in order to: 9. encourage and facilitate co-operation between the Ministries of Health, Ministries of Education, community health services and other relevant bodies in joint policy development, programme planning, implementation and review; ensure admission policies that match the numbers of students trained with national needs for doctors; increase the opportunity for joint learning, research and service with other health and health related professions, as part of the training for team-work; clarify responsibility and allocate resources for continuing medical education.
10. 11. 12.
Reform of medical education requires more than agreement; it requires a widespread commitment to action, vigorous leadership and political will. In some settings financial support will inevitably be required, but much can be achieved by a redefinition of priorities, and a reallocation of what is now available. By this Declaration we pledge ourselves and call on others to join us in an organised and sustained programme to alter the character of medical education so that it truly meets the defined needs of the society in which it is situated. We also pledge ourselves to create the organizational framework required for these solemn words to be translated ihto effective action. The stage is set; the time for action is upon us.
12 August 1988 World Conference on Medical Education of the World Federation for Medical Education