1. Education of Health Professionals: Global Lessons & Challenges
Lincoln Chen, MD
CMB
8th International Medical Education Leadership Forum
Canadian College of Physicians & Surgeons
October 21, 2015
Fairmont Hotel, Vancouver

2. Presentation
Flexner Century: Lessons Emerging Forces Global Connections & Challenges Canada: inter-professional leadership China: postgrad training systems

4. Welch-Rose and Goldmark
Flexner Report 1910
Welch-Rose and Goldmark

5. Supply of health workforce Demand for health workforce
Systems Approach
Provision
Needs
Demand
Supply
Supply of health workforce
Demand for health workforce
Provision
Education
System
Health
System
Demand

6. Interdependence in Education Transformative Learning
Education System
Structure
Institutional Design
Stewardship
Accreditation
Collaboration
Financing
Instructional Design
Criteria admission
Competencies
Channels
Career
Process
Context
Global-Local
Outcomes
Interdependence in Education
Transformative Learning

7. Science based Problem based Systems based
Three Generations of Reform
Science based Problem based Systems based
1900
2000+
Scientific curriculum
Problem-based learning
Competency driven:
Global-local
Instruction
University
based
Academic 
centers
 Academic Health-Educ Systems
Institution

8. Commission Recommendations
Instructional Design
Competencies-roles
Transformative learning for team work (Canada)
IT revolution in learning
Ethical professionalism
Institutional Design
Health-education systems (China)
Academic health systems
Collaboration-partnerships

9. Vietnam

10. Bangladesh

11. India

12. Lesson: Power of Knowledge
Knowledge Professional
Producer Researcher – scientist Agents Service professionals Clinicians-specialists Primary care Population health Reproducer Faculty – students Based Policy-maker, manager

13. Lesson: Brighter-Darker Sides
Knowledge broker
Service provider
Technology
Quality assurance
Team leader
Advancing Health
Darker
Monopoly knowledge
Financial self-interests
Professional chauvinism
Over-specialization
Urban preference
Inequities in health

14. Emerging Global Forces

15. epidemiologic transitions
Global Forces
Demographic
epidemiologic transitions
Global change
Educated patients
Co-production
Biosciences
ICT
Private markets
Social justice

16. Life Expectancy (2013)
81.4
75.4
Health Financing (2013)
Health expenditure % GDP 11 6
Government % of total health expenditure 70 56
Government % of total gov’t expenditure 18 13
Per capita health expenditure (US PPP$)
4,800
650
Health Professionals (Canada 2010, China 2011)
Physicians (No.)
0.07
2.0
Nurses and midwives (No.)
0.30
2.2
Physicians density (per 1000 popn)
2.1
1.5
Nurses-midwives density (per 1000 popn)
9.5
1.7
Nurse-physician ratio
4.6
1.1

18. University of Alberta Medical School

19. Transformative Learning for Leadership
Level
Objectives
Outcome
Informative
Information
Skills
Experts
Formative
Socialization
Values
Professionals
Transformative
Leadership attributes
Change agents

20. Norman Bethune Shanghai Medical College

21. China Health Systems Output-Outcomes
Health Status
Financial Protection
Patient Satisfaction

23. Health Insurance Coverage (China-USA 2000-2013)

24. Symptoms Diagnosis Patient Satisfaction Weak professionalism
73% hosps reported violence against doctors
9,831 major disturbances in 2006
Double (17,243) disturbances by 2010
Diagnosis
Mistrust doctors-patients
Weak professionalism
Vicious circle – low-level equilibrium trap

25. Patient Dissatisfaction

26. Hospital System Imbalances
Top hospital 5% but care for 36% patients
66% hosp (Grade I)
treat only 5% patients
Source: China Ministry of Health; Technomic Asia Analysis

27. Overcrowded Hospitals
Vicious Circle
Limited time
Financial incentives
Drugs & testing
Poor communications
3-yr residency
Lack primary care
5-yr schooling
Students
Supply
Demand
No Accreditation
No Certification
Professionals
No Jobs
Overcrowded Hospitals
Curriculum mismatch
No quality control
Faculty-student ratio
Education
Health
Low satisfaction
Distrust
Violence
Patient
Flow
Not top students
Status
Salary
Career
Workload 6-in-1

28. Doctors by Education

29. Fragmented Circle Education Health Supply Demand Professionals
Primary care
Village - Township
Assistant Doctors
Da Zhuan & Zhong Zhuan
Village Doctors
Supply
Demand
Professionals
5+3
Big Hospitals
Cities
Education
Health
Weak Referral

30. Doctor-Patient Circle
Family want
Doctors
Patients
Prescribe
Cultural Feedback Loop
Unnecessary IVs
Expensive drugs
Equipment for testing

31. Virtuous Circle Supply Demand Tertiary hospitals Professionals
3-yr residency
Primary care
5-yr schooling
Students
Supply
Demand
Tertiary hospitals
Professionals
Graduates=Jobs
Quality standards
Accreditation
Certification
Competency-based
curriculum
Referral
system
Satisfaction
Both Patients &
Professionals
What we want
Status
Salary
Career
Workload 1-in-1
Top students

32. Health Services = People Business
Flexner Century
Global forces
Transformative leadership for team work
Virtuous circle education-health systems
Patients and Professional Satisfaction!