Meeting Report
MEETING ON HEALTH PROFESSIONAL EDUCATION REFORMS IN TRANSITION ECONOMY COUNTRIES
24–25 APRIL 2018 PHNOM PENH, CAMBODIA Meeting on Health Professional Education Reforms in Transition Economy Countries 24–25 April 2018 Phnom Penh, Cambodia WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC
RS/2018/GE/10(KHM) English only
MEETING REPORT
MEETING ON STRENGTHENING HEALTH PROFESSIONAL EDUCATION REFORMS IN TRANSITION ECONOMY COUNTRIES
Convened by:
WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC
Phnom Penh, Cambodia 24–25 April 2018
Not for sale
Printed and distributed by:
World Health Organization Regional Office for the Western Pacific Manila, Philippines
June 2018
NOTE
The views expressed in this report are those of the participants of the Meeting on Strengthening Health Professional Education Reforms in Transition Economy Countries and do not necessarily reflect the policies of the conveners.
This report has been prepared by the World Health Organization Regional Office for the Western Pacific for Member States in the Region and for those who participated in the Meeting on Strengthening Health Professional Education Reforms in Transition Economy Countries in Phnom Penh, Cambodia from 24 to 25 April 2018.
CONTENTS
SUMMARY ...... 1 1. INTRODUCTION ...... 2 1.1 Meeting organization ...... 2 1.2 Meeting objectives ...... 2 2. PROCEEDINGS...... 3 2.1 Opening session ...... 3 2.2 Technical sessions ...... 3 2.2.1 Session 1: Setting the scene – driving service delivery transformation through health professional education reforms ...... 3 2.2.2 Session 2: Health professional education reforms – health professional competencies for current and future health needs ...... 4 2.2.3 Session 3: Market Place – country posters...... 4 2.2.4 Session 4: Addressing the health professional education reform challenges – role of teaching hospitals ...... 6 2.2.5 Session 5: Addressing the health professional education reform challenges – clinical simulations ...... 6 2.2.6 Session 6: Addressing the health professional education reform challenges – clinical placements ...... 6 2.2.7 Session 7: Open Space ...... 7 2.2.8 Session 8: Country presentations ...... 7 2.3 Brown bag seminars ...... 9 2.4 Country-specific sessions ...... 9 3. CONCLUSIONS AND RECOMMENDATIONS ...... 9 3.1 Conclusions ...... 9 3.2 Recommendations ...... 11 3.2.1 Recommendations for Member States ...... 11 3.2.2 Recommendations for WHO ...... 11 ANNEXES ...... 13 Annex 1. Programme of activities Annex 2. List of participants Annex 3. Opening remarks Annex 4. Health professional education: entry points for action
KEYWORDS
Education, Public health professional / Health education-economics / Health manpower / Universal coverage
SUMMARY
Commitment to universal health coverage has created an urgent need to improve the quality and safety of health services. In this context, health professional education plays an important role in preparing a fit-for-purpose health workforce. Although governments have undertaken initiatives to reform health professional education, these efforts have often been piecemeal, suggesting the need for a strategic focus to support systematic improvements and to build a workforce that is competent and responsive to health service needs.
The objectives of the Meeting on Health Professional Education Reforms in Transition Economies were:
1) to take stock of progress on policy developments and the status of implementation of the recommendations and action plans developed during the previous meeting; 2) to review the current situation of clinical training and identify measures to strengthen clinical competencies; and 3) to identify areas of technical cooperation and support to strengthen the linkages between education, regulation, and the health system.
The meeting provided an opportunity for 25 representatives from the five transition countries (Cambodia, China, the Lao People’s Democratic Republic, Mongolia and Viet Nam), which included senior representatives from the ministries of health, education, academic institutions and professional regulatory bodies. They were given the opportunity to share experiences, discuss supportive policy options and explore possible areas for technical cooperation at country and regional levels to enhance the quality and relevance of health professional education. Challenges faced by the participating countries include lack of coordination between the health professional institutes and teaching hospitals, limited opportunities and incentives for faculty development, non-standardized student assessments, poor integration of training in basic and clinical sciences, and lack of clarity regarding the roles and responsibilities of each participating institution. The latter, in transitional economies, could be the outcome of the shift from a state-owned centrally planned economy to a pluralistic system with greater influence of market forces.
Four main dimensions to strengthen clinical training of health professionals were discussed: (i) core competencies, (ii) teaching hospitals, (iii) clinical simulations and (iv) clinical placements.
The meeting underlined the need to equip health professionals with competencies (clinical and social) that are aligned with the service delivery needs. Participants were reminded that health professional education is a lifelong journey of learning. The content of the learning process has to be guided by the evolving disease burden and concurrent socio-demographic changes.
1 1. INTRODUCTION
1.1 Meeting organization
Comprehensive approaches to improving and scaling up health professional education are essential in supporting and advancing health system performance. To achieve universal coverage of quality health services, the focus should shift from producing more health workers towards reforming the quality and relevance of health professional education, to prepare a workforce that is competent and committed to respond to population health needs.
The first Meeting on Health Professional Education Reforms in Cambodia, China, the Lao People’s Democratic Republic and Viet Nam, which was held in Hanoi, Viet Nam in 2017, brought together experts and staff from the ministries of health and education, educational institutions and health professional bodies. It focused on four domains: curriculum reforms, faculty development, student assessment and quality assurance. The meeting provided recommendations on how to develop country-specific action plans for the implementation of competency-based curricula, newer pedagogical and student assessment approaches, opportunities for faculty development, and quality assurance mechanisms.
Member States across the Western Pacific Region, in particular the transition economy countries, have undertaken initiatives to improve health professional education, as part of a broader strategy to improve the quality of health services. However, challenges remain, creating the need to adopt more comprehensive approaches in the design and implementation of health professional education reforms.
The Meeting on Strengthening Health Professional Education Reforms in Transition Economy Countries was held in Phnom Penh, Cambodia from 24 to 25 April 2018. It focused on clinical training and competencies of health professionals (doctors, dentists, nurses, midwives, pharmacists and other allied health professions). Twenty-five participants from five countries (Cambodia, China, the Lao People’s Democratic Republic, Mongolia and Viet Nam) attended from the ministries of health and education, educational institutions and health professional bodies. The meeting gave representatives an opportunity to: share experiences, good practices and challenges; discuss supportive policy options; and explore possible areas for technical cooperation at country and regional levels, to enhance the quality and relevance of health professional education. Meeting participants also reviewed the progress on the recommendations and outcomes since the first meeting. It also helped facilitate dialogue between government representatives, development partners and experts on policy trends and critical issues in the implementation of health professional education reforms, emphasizing the importance of intersectoral collaboration to produce competent and responsive health professionals that support universal health coverage.
The meeting agenda is available in Annex 1 and the list of participants in Annex 2.
1.2 Meeting objectives
The objectives of the meeting were:
1) to take stock of progress on policy developments and the status of implementation of the recommendations and action plans developed during the previous meeting;
2 2) to review the current situation of clinical training and identify measures to strengthen clinical competencies; and 3) to identify areas of technical cooperation and support to strengthen the linkages between education, regulation, and the health system.
2. PROCEEDINGS
2.1 Opening session
The Minister of Health, Royal Government of Cambodia opened the meeting. In his opening message, the Minister reflected on the changing expectations of the role of health professionals, as well as the importance of understanding the cultural context within which health service delivery occurs. He also underlined the vital role of health workers in achieving the universal health coverage and Sustainable Development Goals agenda, hence the importance of this meeting in preparing a competent and committed workforce.
Dr Vivian Lin, Director, Division of Health Systems, WHO Regional Office for the Western Pacific delivered the opening address on behalf of Dr Shin Young-soo, WHO Regional Director for the Western Pacific (Annex 3). Dr Lin stressed that health care is a knowledge-intensive process. Mastering only the reality of today will not ensure that students are prepared to meet the challenges of tomorrow. Health workers need expertise that goes beyond the right clinical competencies, or the ability to diagnose, manage and treat diseases. They also need the right social competencies, to become responsive to individual and community needs and expectations, and create a culture of well- being.
In his address, Professor Saphonn Vontanak, Rector, University of Health Sciences, Cambodia welcomed the participants to the meeting. He recognized the challenges in the health workforce that Cambodia has been facing, such as shortage of health professionals, including of qualified educators. He also made reference to the University of Health Sciences Strategic Plan (2014–2018) that identifies the strategies and activities to implement in terms of training, research and provision of services in the health sector.
Dr Liu Yungao, WHO Representative, Cambodia emphasized that the meeting provides an opportunity to share experiences, discuss supportive policy options and explore possible areas for technical cooperation among the participating countries.
2.2 Technical sessions
Each technical session of the meeting was combined with group discussions to identify key issues and challenges related to the technical area and develop concrete priority actions.
2.2.1 Session 1: Setting the scene – driving service delivery transformation through health professional education reforms
Dr Indrajit Hazarika, Technical Officer, Health Workforce Policy, WHO Regional Office for the Western Pacific presented on the importance of health professional education reforms to drive service delivery transformation. He highlighted the transitions in the health-care landscape in the context of changes in health needs, shifts in expectations in health care, and alterations in organization and
3 practice of health care. He also drew attention to the actions plans from the previous year’s meeting to highlight common country-level challenges and priorities. Using a cross-country comparison of competency frameworks, he underlined the importance of clinical, social and cultural competencies of health professionals. It was emphasized that clinical competencies are not only for the quality and safety of health services but also the community trust in the health systems. Good practice examples on effective usage of teaching hospitals, clinical simulations and clinical placements were shared to provide context on health professional education status in other nonparticipating countries. Countries were encouraged to design interventions that can be implemented to advance health professional education reforms.
2.2.2 Session 2: Health professional education reforms – health professional competencies for current and future health needs
Professor Gabriel Leung highlighted the unprecedented advances in life expectancy but also the ongoing changes in disease burden that called for a set of core competencies that all health professionals should possess, regardless of their discipline, to meet the new health system challenges. In his presentation, he outlined changes that health professional education has undergone over the past decades, examined the state of contemporary health professional education and outlined some ideas that would benefit the training of health professionals. It was emphasized that health professional education reforms must address current and future health needs of the population and encourage lifelong learning. In addition to the clinical competencies, the focus should also be on the social competencies tailored to fit the cultural and ethical aspects of care.
Following the presentations, participants were encouraged to work in groups to further deliberate on health professional competencies for current and future health needs, and identify the key issues and develop strategies to address them.
2.2.3 Session 3: Market Place – country posters
The session gave each country the opportunity to provide an update on the status of implementation of the action plans developed at the previous year’s meeting in Hanoi. The country updates provided an encouraging picture of the progress in moving forward with the reform agenda.
Cambodia Efforts have been made to standardize the implementation of a competency-based curriculum along with ongoing work to align the education outcomes. A faculty development programme has been introduced with support from international partners. In addition, staff and student exchange programmes have also been strengthened. Student assessment initiatives are still ongoing that include standardization of ongoing assessments, efforts to establish an objective structured clinical examination (OSCE) as a summative clinical assessment in training institutions, and improving the quality of student selection through the National Entry Examination. Furthermore, quality assurance measures – internal and external – have also been progressively implemented. Moving forward, there are plans to establish a university teaching hospital to strengthen clinical skills training.
China The reforms have focused on strengthening general education, basic education and professional education, alongside integration of basic and clinical medicine. Standardization of clinical practice management has enhanced the ability of medical students to improve quality of clinical services. Efforts have also been undertaken to improve the quality of education in vocational colleges,
4 including national and provincial training for educators. In addition, the Chinese Medical Doctor Association organized a series of training sessions for clinical preceptors of residency programmes. At the national level, the central government has awarded subsidies for the implementation of the resident training system according to the agreed standards. As outlined in national teaching standards and requirements, students are routinely assessed by the schools. With the need for increased quality assurance measures, the national teaching standard system has taken shape with a focus on professional catalogues, professional teaching standards and so on. In 2018, China’s clinical medicine certification body is expected to receive institutional certification from the World Federation of Medicine Education.
Lao People’s Democratic Republic Efforts to review the current curriculum were launched, as well as a workshop on curriculum development in line with accreditation. This was convened by the University of Health Sciences with support from Seoul National University and WHO. Support has also been received for faculty development initiatives, including clinical teaching and mentoring of district medical doctors in central and provincial hospitals. Regular meetings of the Training Management Committee and Medical Teaching Unit were also held to discuss clinical practice in order to increase skills and competencies. This has led to the development of a handbook outlining clinical teaching development. The Lao People’s Democratic Republic is also in the process of developing a student admission policy to improve the quality of students admitted to their programmes. Licensing concerns from previous meeting were addressed via ongoing work for the establishment of a National Licensing Examination system supported by the Asian Development Bank. This is expected to be piloted in 2019. Furthermore, guidelines for registration and licensing of health professionals are currently being finalized.
Mongolia A competency framework for health professionals training programmes is currently in place. In order for hospitals to conduct professional/postgraduate training, they must obtain permission from the health professional development committee of the Ministry of Health. In 2017, the accreditation standards for public hospitals were updated. Systems are currently in place for continuing professional development but need to be further strengthened. Due to weak collaboration between the ministries of health and education, challenges have arisen in the postgraduate training system that need to be addressed. The government has undertaken several initiatives to strengthen regulations and increase the available funding. This has helped to improve clinical practice sites through curriculum updates and proper training of clinical preceptors.
Viet Nam Curriculum reforms implemented since the previous meeting include development of a framework to guide universities in delivering competency-based medical education. In addition, a set of recommendations have been developed for the implementation of an 18-month internship. Faculty development programmes have started with the identification of gaps in the skills of clinical preceptors. Efforts are also under way to develop a plan to build the capacity of teaching hospitals. Discussions are under way for the introduction of a two-part national medical licensing exam, which is expected to be piloted in 2019. Furthermore, guided by the 2017 Communist Party Resolution 20, a National Medical Council will be established and tasked with the job to develop and administer the national licensing examination and to develop the framework for residency-style hospital-based postgraduate medical education.
5 2.2.4 Session 4: Addressing the health professional education reform challenges – role of teaching hospitals
Teaching hospitals provide the learning environment for health professionals. They can only be effective, however, if the environment is well aligned with the curriculum so that students can seamlessly translate acquired academic concepts into clinical practice. This requires close collaboration between the health professional training institutions and the hospitals. Clinical rotations provide the opportunity for coaching of students with a focus on people-centred care, quality and safety. Teaching hospitals are also the main learning environment for postgraduate training programmes. However, in transition economies, teaching hospitals continue to face a range of challenges that include lack of standards for teaching hospitals, limited collaboration with health professional training institutions, inadequate capacity of clinical preceptors, insufficient learning resources and unsupportive environment for learning.
Several examples of good practices were discussed that aimed to strengthen the role of teaching hospitals. These included the formation of consortiums and collaborations among pre-existing teaching hospitals in Malaysia. In Singapore, academic medical centres have been established to provide support to clinicians and educators.
Following the discussions, participants were encouraged to work in groups to further identify the current challenges with teaching hospitals and develop key actions to address them.
2.2.5 Session 5: Addressing the health professional education reform challenges – clinical simulations
Acquiring clinical and social competencies requires a structured training programme that provides an opportunity for students to learn from clinical preceptors and patients. Unfortunately, in most transition economy countries, training programmes are often not affiliated with clinical placement sites to provide necessary exposure to diverse clinical settings and cases. Clinical simulation attempts to address this need by exposing trainees and faculty members to various methodologies of interactive learning, clinical decision-making, clinical procedures and so on to improve quality and promote patient safety. These methods include the use of case scenarios, simulated patients and manikins. Even in low-resource settings, clinical simulation sessions can be effectively organized using low-cost manikins and case scenarios to encourage critical thinking and application of skills. It was also discussed that the simulation sessions should have a structured debriefing. This allows trainees to methodologically analyse given situations and learn from each scenario effectively. Through debriefing and discussions, and repeat simulations, trainees become better versed in the application of procedures, to avoid clinical errors that can adversely affect patient care.
Following the discussions, participants were encouraged to work in groups to identify strategies to strengthen the role of clinical simulation in health professional education.
2.2.6 Session 6: Addressing the health professional education reform challenges – clinical placements
Clinical placements enable students to witness practical application of concepts acquired during didactic lessons and how they relate to patient care. In addition to the physical presence of students at training sites, clinical placements also expose students to a clinical environment, interaction with other health professional cadres, the importance of teamwork in care delivery, and techniques beyond
6 the classroom setting. These rotations are instrumental in preparing competent health-care providers for entry into practice.
Typically, the focus and location of clinical placements depend on the nature of the programme and the institution involved. For instance, certain programmes intentionally place students in primary care health facilities and rural settings to provide the exposure to a wider range of clinical environments and influence their career choices. At the clinical placement sites, the preceptors are expected to serve as guides, evaluators and resources for the trainees. However, transition economies continue to face challenges such as the lack of available faculty, unstructured clinical rotations and ineffective student assessments. It was emphasized that the quality of the clinical placement is crucial to produce competent, socially and culturally conscious health professionals.
Following the discussions, participants were encouraged to work in groups to identify key issues and challenges affecting clinical rotations and develop actions to address them.
2.2.7 Session 7: Open Space
The session provided an opportunity for participants to engage in small group discussions on the following topics: (i) regional network of health workforce regulators; (ii) models of team-based training; (iii) challenges in the transition to competency-based training; and (iv) methods for increasing active student participation in the learning process. The participants were highly supportive of the proposed regional network that will be established in collaboration with the Australian Health Practitioner Regulation Agency (AHPRA).
2.2.8 Session 8: Country presentations
Each country presented their action plans to further strengthen health professional education reforms.
Cambodia Planned initiatives aim to strengthen core competencies of health professionals. This includes plans to revise the curricula to be competency-based along with application of student-centred approaches. The Ministry of Health’s sub-decrees 21 and 22 establish the minimum standards that apply to all training courses. The importance of strengthening cooperation with the education ministry, training institutions and professional bodies was also underscored.
The role of teaching hospitals is weakened by the lack of standards and limited clarity regarding their involvement in clinical training. In addition, lack of clinical preceptors and learning resources further undermines the effective use of teaching hospitals. To address this, the plan includes action to: delineate the role and responsibility of teaching hospitals, provide training and incentives for clinical preceptors, and establish standard criteria for accrediting teaching hospitals.
To further the potential of clinical simulation, initiatives have been identified that include training opportunities for faculty and clinical preceptors, standardized students assessment methods, and minimum infrastructure for clinical simulation in all institutions.
Overall, the focus will be on strengthening clinical placements, especially the role of teaching hospitals to provide appropriate clinical training.
7 China Application of the core competency to all health professional training courses was identified as a challenge. To address this, efforts have already been undertaken to establish and expand a system of accreditation of the medical training institutions. In addition, over the next 12 months, the country plans to create a number of national clinical training centres to support the development of faculty and clinical preceptors.
To strengthen the teaching hospitals, efforts are under way to increase the collaboration between academic departments. This will be further promoted through the national clinical training centres.
To maximize the potential of clinical simulations, a national skills clinical skills competition and simulation technology have been established. Through these efforts, it is expected that the clinical competencies of health professional students will be further enhanced. In addition, the training opportunities for interns will be further increased by optimizing the availability and utilization of clinical preceptors. The plan acknowledges the need to further strengthen the collaboration between the education ministry and national health commission to achieve the intended objectives.
Lao People’s Democratic Republic Efforts to strengthen the core competencies of health professionals have been challenged by the lack of communication and coordination between providers, and outdated teaching methods. This led to efforts to improve content of the curricula, support for faculty development and increased monitoring to improve the quality of health professional training programmes.
To strengthen role of teaching hospitals, the Ministry of Health has been working on a decree that will specify the roles of clinical preceptors, assessments, development opportunities and incentives. To strengthen the coordination between the training institution and hospital, the position of coordinator will be created in the faculty or department. The use of clinical simulation is currently limited. However, actions identified for the next 12 months include development of case scenarios, teaching tools, and capacity-building of faculty and preceptors to more widely use simulation as an integral component of the curriculum.
To strengthen the clinical placement sites, actions included in the plan are the assignment of clinical mentors, better coordination between the universities and teaching hospitals, and more structured clinical teaching activities.
Mongolia With support from the Japan International Cooperation Agency (JICA), the Ministry of Health has been focusing on strengthening the collaboration between academic training institutions and hospitals. This includes initiatives to monitor the implementation of the memorandum of understanding between these institutions and assessment of the need to undertake any regulatory policy revisions. The concerns regarding the lack of a standardized competency framework are currently being addressed through the development of competency-based programmes and related revisions. Within the next 12 months, the curricula will be finalized and will emphasize the importance of clinical placements and rotations.
To strengthen the role of teaching hospitals, the Ministry of Health plans to draft a legislation that will outline the selection criteria of teaching hospitals as well as regulations that can govern their accreditation. To further enhance the application of clinical simulations, academic institutions have
8 established simulation laboratories and there are plans to fully integrate the simulation sessions into the curriculum.
Viet Nam Communist Party Resolution 20 creates leeway for the establishment of a medical council. This council will lead the plans for the introduction of a national medical licensing exam. In addition, work is also being undertaken to standardize the curriculum for the training of family medicine doctors. Discussions are also under way to develop criteria for the designation of teaching hospitals. This also includes plans to build the capacity of clinical preceptors.
In order to maximize the potential of clinical simulations, activities outlined in the plan aim to assess required clinical skills and ways to integrate simulation in the teaching curriculum. In the effort to improve clinical placements, the Ministry of Health plans to develop a blueprint that identifies the training and development plan for hospital staff.
The country-specific action plans highlighted the commonalities in the issues across the countries, underscoring the potential for collaboration and sharing of experiences among the participating countries. The participants requested WHO to create a network of the participants to facilitate discussions and ongoing dialogue. Also, to ensure continuity in the policy dialogue, the countries have requested WHO to organize a third meeting in 2019.
2.3 Brown bag seminars
The lunchtime seminars on “Health care ethics – making it work!” and “Preparing a primary care workforce” discussed the importance of preparing students to practise with respect to ethics and professionalism, while motivating them for a career in primary care. It was agreed that students in health professional courses and practitioners need to learn and understand ethics within a framework that is well founded, rigorous and longitudinally based.
2.4 Country-specific sessions
Finally, the country-specific discussions provided an opportunity for the WHO Secretariat to discuss one-to-one with the country participants on health workforce and broader health system issues. These sessions also helped identify priority areas for technical support from WHO.
The WHO Regional Office and WHO country offices will work with Member States on the highlighted challenges and issues to provide support and help to the health professional education reforms.
3. CONCLUSIONS AND RECOMMENDATIONS
3.1 Conclusions
Health workers are critical to achieving the universal health coverage and Sustainable Development Goals agenda. Ongoing health transition that encompasses demographic as well as epidemiological changes will have profound effects on the quantity and type of health workers needed. The reforms in
9 the professional education system have to support the preparation of a health workforce with requisite competencies.
Health professional education means lifelong learning. Health professional competencies (clinical and social) have to be aligned with the evolving health service needs. The content of the learning process should include key skills such as communication, teamwork, information and management, leadership, and health system structure. These are required by all health professionals to practise in the changing health-care environment.
Transition economy countries have made considerable progress on the implementation of the action plans developed at the 2017 meeting in Hanoi. Some common challenges persist: lack of coordination between the health professional institutes and teaching hospitals, limited opportunities and incentives for faculty development, non-standardized student assessments, and poor integration of training in basic and clinical sciences. Also included is lack of clarity regarding the roles and responsibilities of each participating institution, which – in transitional economies – could be the outcome of the shift from a state-owned centrally planned economy to a pluralistic system with greater influence of market forces.
Clinical competency of health professionals influences clinical judgement, decisions and actions. This has important implications for the quality and safety of care, patient outcomes, rational use of medications and diagnostics, health-care costs, and trust and confidence in the health systems. Teaching hospitals, clinical simulation and clinical placements provide important entry points to strengthen clinical competencies (Annex 4).
Traditionally, most clinical teaching occurs in teaching hospitals. Improving clinical teaching in affiliated teaching sites requires a standard that specifies dedicated clinical preceptors, facility, equipment and educational resources. A training department or unit in the teaching hospitals can assist in coordinating with the academic institution.
Clinical simulation can be an important adjunct to traditional clinical teaching methods. Clinical skills laboratories using low-fidelity manikins and facilitated by motivated trainers using realistic clinical scenarios can be equally effective in skills transfer and retention among health-care students.
Structured clinical placements are an important part of the teaching curriculum. The placements can take place in a primary, secondary or community health or social care settings. Students should be actively involved in patient care as they observe the health or social care processes under effective supervision. The effectiveness of the clinical placements should be regularly evaluated.
Teaching in ethics and professionalism is important to produce judgement-safe practitioners. This should take into account the influence of the “hidden curriculum” and role modelling of behaviour. Current pedagogical approaches to teaching ethics have limitations. To make learnings in ethics more engaging and effective, institutions and faculty consider using tabletop exercises and simulated scenarios.
Developing and retaining a primary care workforce is a challenge for transitional economies. The composition and competency of primary health workers is determined by the health system context. Countries should consider upskilling/multiskilling existing health workers, including introducing incentives packages (financial and non-financial) to attract and retain health workers, particularly in rural and underserved areas.
10 Across the transition economy countries, commonalities in the issues underscore the potential for collaborating and sharing experiences. The meetings provide a mechanism to maintain continuity in the policy dialogue and share good practices to reform health professional education to meet the health system needs.
3.2 Recommendations
3.2.1 Recommendations for Member States
Member States are encouraged to do the following:
• Initiate policy dialogues at the national level to garner support for the implementation of the country-specific actions to strengthen health professional education reforms. • Establish standards for clinical teaching sites to improve clinical and practical skills of health professionals in an appropriate environment. • Use clinical simulation as an adjunct to traditional clinical experience to provide training in clinical skills and minimize the risk to patients. • Introduce structured clinical placements with effective supervision and regular evaluation as an important component of the curriculum. • Improve teachings in ethics and professionalism by using table top exercises and simulated scenarios.
3.2.2 Recommendations for WHO
WHO is requested to do the following:
• Support the implementation of the country-specific actions to strengthen health professional education reforms. • Continue to work closely with the WHO country offices, academic institutions, collaborating centres and other stakeholders to support and strengthen ongoing health professional education reforms. • Encourage and facilitate regional collaboration to strengthen the capacity of governments, professional bodies and the academic community at the country level. • For country-specific support: China - Provide assistance in coordinating support to Belt and Road Initiative countries on curriculum reforms, faculty development, institutional strengthening, accreditation and so on. Cambodia - Provide technical assistance to strengthen the integrated health workforce database; development of standards for teaching hospitals, including the training of clinical preceptors; and implementation of the Law on Regulation of Health Practitioners. Lao People’s Democratic Republic - Provide technical support to develop standards for teaching hospitals, training of clinical preceptors, including on clinical simulation; and support the roles and responsibilities of the Health Professional Council.
11 Mongolia - Provide technical support on the implementation plan for the State Health Policy, use of clinical simulation for health professional education, and postgraduate training reforms. Viet Nam - Provide technical support for the establishment of the national medical council, including the implementation of the national licensing examination; medical curriculum reforms; development of standards and accreditation process for teaching hospital; and establishment of a residency-style postgraduate training programme.
12 ANNEXES
Annex 1. Programme of activities
Time Session
Day 1--Tuesday 24 April 2018 08:00 - 08:15 Registration
08:15 - 08:40 Welcome remarks HE Rector, UHS Remarks WHO Representative, Cambodia Opening address Director, DHS, WPRO Opening speech HE Minister of Health, Royal Government of Cambodia 08:40 – 08:50 Group photo [10 mins] 08:50 -09:15 Break [25 mins] 09:15 – 09:45 Introductions [30 mins] Technical Officer, HWP, DHS Administrative announcements WPRO Objectives of the meeting Open space [Introduction to the process]
09:45 – 10:15 Session I: Setting the scene –Driving service delivery transformation through health profession education reforms Presenter: [30 mins] Technical Officer, HWP, DHS WPRO Format Overview presentation [15 mins] Discussions [15 mins]
10:15 -12:00 Session II: Health profession education reforms – Health professional competencies for current and future health Presenter: Prof. Gabriel Leung needs [105 mins] Panel: Prof. Gabriel Leung;
13 Format Prof. Jwa-Seop Shin; Prof. TA presentation [15 mins] Erlyn Sana; Prof Ram Panel discussion [30 mins] Natarajan Country group work [60 mins] Moderator: DHS, WPRO
12:00 -13:30 Lunch [30 mins] Brown Bag on Health Care Ethics – Making it work! [60 mins]
13:30 -14:45 Market place [15 mins per country poster] - Country posters on status of implementation of action plans 14:45 – 15:00 Break [15 mins] 15:00 – 16:30 Session III: Addressing the health profession education reform challenges - Role of teaching hospitals [90 mins] Facilitator: WCO Cambodia
Format Presenter: Prof. Jwa-Seop Shin Presentation [10 mins] Discussant [20 mins] Country discussions – Individual countries will complete a pre-formatted template with support from WHO country office staff, Temporary Advisors and Observers/Representatives [60 mins] 16:30 – 17:10 Country-specific discussions - WHO Secretariat with Country Participants - China WHO Secretariat - Viet Nam Help desk session with Temporary Advisors Temporary Advisors - Cambodia - Lao People’s Democratic Republic - Mongolia
18:00 – 19:00 Welcome reception Day 2: Wednesday 25 April 2018 8.00 – 8.15 Review of the day’s agenda and objectives WCO VNM Summary of Day 1 8.15 – 9.45 Session V: Addressing the health profession education reform challenges - Clinical simulation [90 mins] Facilitator: WCO Lao PDR
Format Presenter: Prof. Ram Nataraja Presentation [10 mins] Discussant [20 mins]
14 Country discussions – Individual countries will complete a pre-formatted template with support from WHO country office staff, Temporary Advisors and Observers/Representatives [60 mins]
9.45– 10.00 Break [15 mins] 10.00– 11.30 Session VI: Addressing health profession education reform challenges - Clinical placements [90 mins] Facilitator: WCO China
Format Presenter: Prof. Erlyn Sana TA presentation [10 mins] Discussant [20 mins] Country discussions – Individual countries will complete a pre-formatted template with support from country offices, temporary advisors and observers [60 mins]
11.30- 12.15 Session VII: Open space [45 mins] Facilitator: WCO Mongolia
12:15 – 13:45 Lunch [30 mins] Moderator: Brown Bag – Preparing a Primary Care Workforce [60 mins] Technical Officer, HWP, DHS WPRO 13:45 – 15:25 Session VIII: Country presentations [100 mins] Moderator: Indrajit Hazarika
Format: Individual country presentations + Discussions [20 mins each]
15:25 – 15:40 Break [15 mins] 15:40 – 15:50 Session IX: Summary & conclusions [10 mins] DHS, WPRO
15:50 – 16:50 Country-specific discussions [60 mins] [WHO Secretariat with Country Participants] WHO Secretariat Cambodia Lao People’s Democratic Republic Mongolia
15 Annex 2. List of participants
LIST OF PARTICIPANTS, TEMPORARY ADVISERS, OBSERVERS AND SECRETARIAT
1. PARTICIPANTS
CAMBODIA H.E. Professor YIT Sunnara Undersecretary of State for Health # 33 St. 143, Sangkat Veal Vong, Khan 7 Makara Phnom Penh Tel. No. : 855 12 959557 Email : [email protected]
H.E. Professor SAPHONN Vonthanak Rector University of Health Sciences # 73 Monivong Blvd. Phnom Penh Tel. No. : 855 92 2226 Email : [email protected]
H.E. Professor LAM Eng Hour Vice President Medical Council of Cambodia, Deputy Secretary General Council of Agriculture and Rural Development # 90 St. 108, Wat Phnom, Daun Penh Phnom Penh Tel. No. : 855 12 049787 Email : [email protected]
Dr Chhavyroth SO Deputy Director Department of School Health Ministry of Education, Youth and Sport Street 380, Ponheahok Primary School, Khann Chamkarmorn,, Phnom Penh
Dr Sam Song PHOM Deputy Director Human Resources Development Department # 80 Samdech Penh Nouth Blvd. Sangkat Boeung Kak, Khan Toul Kork Phnom Penh Tel. No. : 855 12 822 035 Email : [email protected]
16
CAMBODIA (continued) Mr SAR Team Head Health Professional Education Unit, University of Health Sciences No. 197 Street 371 Sangkat Beung Tompun, Khan Mean Chey, Phnom Penh Tel. No. : 855 23 430 559 Email : [email protected]
CHINA Ms JIA Dandan Deputy Director Department of Medical Administration National Health and Family Planning Commission Beijing Tel. No. : 86 10 68792203 Email : [email protected]
Mr XIA Shaohua Project Officer Ministry of Education No. 37 Damucang Hutong, Xiden Beijing Tel. No. : 86 134 66388155 Email : [email protected]
Mr WANG Bo Clerk Department of Science and Education National Health and Family Planning Commission 14 Zhichun Road, Haidian District Beijing Tel. No. : 86 139 11796496 Email : [email protected]
Mr YU Zhongguang Clerk China-Japan Friendship Hospital 2 East Yinghua Road, Chaoyang District Beijing Tel. No. : 86 10 84206250 Email : [email protected]
LAO PEOPLE'S DEMOCRATIC Mr Ketsomsouk BOUPHAVANH REPUBLIC Director Educational Development Center University of Health Sciences Vientiane Tel. No. : 856 21 254820 Email : [email protected]
17
18 LAO PEOPLE'S DEMOCRATIC Dr Sengchanh KOUNNAVONG REPUBLIC (continued) Deputy Director National Institute of Public Health Ban Kaognod, Sisattanack District Vientiane Tel. No. : 856 20 5592 3232 Email : [email protected]
Dr Bouakhan PHAKHOUNTHONG Deputy Director General Department of Healthcare and Rehabilitation Ministry of Health P.O. Box 867 Vientiane Tel. No. : 856 20 222 04685 Email : [email protected]
Associate Professor Niranh PHOUMINDR Director General Department of Health Professional Education No. 155, Unit 4, Nakham Village, Souphanouvong Avenue, Sikhot District, P.O. Box 2821 Vientiane Tel. No. : 856 20 5566 2931 Email : [email protected]
Dr Thongsavanh SENGKONGDALA Deputy Head Health Professional Regulation Office Department of Healthcare and Rehabilitation Ministry of Health Vientiane Tel. No. : 856 20 9789 9191 Email : [email protected]
Mr Khampasong THEPPANYA Deputy Director General Health Personnel Department Department of Organization and Personnel Ministry of Health Vientiane Tel. No. : 856 20 22414 001 Email : [email protected]
Mr Lavanh VONGKHAMSANE Deputy Director General Ministry of Education and Sports P.O. Box 1067, Lane Xang Avenue Vientiane Tel. No. : 856 20 5541 8808 Email : [email protected]
19
MONGOLIA Mr Ganzorig MUNKHJARGAL Head Health Law Department Ministry of Health Government Building VIII, Olympic Street-2 Ulaanbaatar Tel. No. : 976 9911 5324 Email : [email protected]
Dr Oyunkhand RAGCHAA Director Policy and Planning Department Ministry of Health Government Building VIII, Olympic Street-2, Ulaanbaatar Tel. No. : 976 9915 3923 Email : [email protected]
Ms Chimedlkham TSEDEVDORJ Senior Officer Department of General Education Policy Ministry of Education, Culture, Science and Sports Government Building-3, Sukhbaatar District Ulaanbaatar Tel. No. : 976 9306 0017 Email : [email protected]
VIET NAM Dr BUI MY Hanh Director Center for Development of Curriculum and Human Resources in Health, Hanoi Medical University No. 1 Ton That Tung Street, Dong Da District Hanoi Tel. No. : 84 983 070 973 Email : [email protected]
Ms NGUYEN Phuong Hien Official Department of Higher Education Ministry of Education and Training 35 Dai Co Viet Street, Hai Ba Trung District Hanoi Tel. No. : 84 913 048 868 Email : [email protected]
Dr PHAM Hoang Ha Associate Professor Viet Duc University Hospital 40 Trang Thi Street, Hoan Kiem Hanoi Tel. No. : 84 9042 50853 Email : [email protected]
20
VIET NAM (continued) Associate Professor TRAN Diep Tuan President University of Medicine and Pharmacy 217 Hong Bang Street, Ward 11, District 5 Ho Chi Minh Tel. No. : 84 985 598 528 Email : [email protected]
2. TEMPORARY ADVISERS
Professor Gabriel LEUNG Dean, Li Ka Shing Faculty of Medicine Chair, Public Health Medicine School of Public Health The University of Hong Kong Hong Kong Tel. No. : 852 3917 9280 or 3917 9282 Email : [email protected]; [email protected]
Dr Ramesh NATARAJA Consultant, Paediatric and Neonatal Surgeon Director, Paediatric Surgical Simulation Monash Children's Hospital Melbourne, Australia Tel. No. : 61 450 608213 Email : [email protected]
Professor Erlyn SANA Professor 10 National Teacher Training Center For the Health Professions University of the Philippines Manila, Philippines Tel. No. : 63 2 526 4259 Email : [email protected] [email protected]
Professor Jwa-Seop SHIN Chair, Department of Medical Education Seoul National University College of Medicine Seoul, Republic of Korea Tel. No. : 82 2 9401186 Email : [email protected]
21
3. OBSERVERS
BOSTON UNIVERSITY Dr Laura GOLDMAN GLOBAL HEALTH Director of Geriatrics COLLABORATIVE Deputy Director Global Health Collaborative Associate Professor of Family Medicine Boston University School of Medicine Boston Medical Center Boston, MA 02118 United States of America Email : [email protected]
JIU JIANG INSTITUTE Professor XIA Xiulong Dean of International School Jiu Jiang Institute Jiangxi Province China Fax. No. : 86 10 6879 2250 Email : [email protected]
THE PARTNERSHIP FOR Dr Todd POLLACK HEALTH ADVANCEMENT Country Director IN VIET NAM The Partnership for Health Advancement in Viet Nam Beth Israel Deaconess Medical Center Hanoi, Viet Nam Email : [email protected]
WHO COLLABORATING Dr Hideomi WATANABE CENTRE FOR RESEARCH Director AND TRAINING ON WHO Collaborating Centre INTERPROFESSIONAL for Research and Training on EDUCATION Interprofessional Education, Gunma University Gunma, Japan Email : [email protected]
Dr Akinori KAMA Professor WHO Collaborating Centre for Research and Training on Interprofessional Education, Gunma University Gunma, Japan Email : [email protected]
22
WHO COLLABORATING Dr Hiromitsu SHINOZAKI CENTRE FOR RESEARCH Professor AND TRAINING ON WHO Collaborating Centre INTERPROFESSIONAL for Research and Training on EDUCATION Interprofessional Education Gunma University Gunma, Japan Email : [email protected]
WHO COLLABORATING Ms CHEN Zhejuan CENTRE FOR HUMAN Deputy Director RESOURCES DEVELOPMENT WHO Collaborating Centre CENTRE for Human Resources for Health Health Human Resources Development Center Beijing, China Email : [email protected]
WHO COLLABORATING Dr Caryn WEST CENTRE FOR NURSING AND Director MIDWIFERY EDUCATION WHO Collaborating Centre for AND RESEARCH CAPACITY Nursing and Midwifery Education BUILDING and Research Capacity Building James Cook University Australia Queensland, Australia Email : [email protected]
WHO COLLABORATING Dr Noriko FUJITA CENTRE FOR HEALTH Director SYSTEMS RESEARCH WHO Collaborating Centre for Human Resources for Health, Systems Research, National Centre for Global Health and Medicine Tokyo, Japan Email : [email protected]
Mr Toyomitsu TAMURA Senior Technical Officer Division of Training Department of Human Resource Development, Bureau of International Health Cooperation WHO Collaborating Centre for Health Systems Research, National Centre for Global Health and Medicine Tokyo, Japan Email : [email protected]
23
4. SECRETARIAT
WHO/WPRO Dr Vivian LIN Director, Division of Health Systems WHO Regional Office for the Western Pacific 1000 Manila, Philippines Tel. No. : 632 528 9951 Email : [email protected]
Dr Indrajit HAZARIKA (Responsible Officer) Technical Officer (Health Workforce Policy) Division of Health Systems WHO Regional Office for Western Pacific 1000 Manila, Philippines Tel. No. : 632 528 9845 Email : [email protected]
WHO CAMBODIA Dr Kumanan RASANATHAN Coordinator , Health Systems World Health Organization No. 61-64, Preah Norodom Blvd. Sangkat Boeung Keng Kang I, Khan Chamkamorn Phnom Penh Tel. No. : 855 23 216610 Email : [email protected]
Mr MO Mai SSA in Health Financing and Health Systems World Health Organization No. 61-64, Preah Norodom Blvd. Sangkat Boeung Keng Kang I, Khan Chamkamorn Phnom Penh Tel. No. : 855 23 216610 Email : [email protected]
WHO CHINA Dr Tuohong ZHANG National Programme Officer World Health Organization 401, Dongwai Diplomatic Office Building 23, Dongzhimenwai Dajie Chaoyang District 100600 Beijing Tel. No. : 8610 6532-7189 E-mail : [email protected]
24
WHO LAO PEOPLE'S Dr Monica FONG DEMOCRATIC REPUBLIC Team Leader World Health Organization 125 Saphanthong Road, Unit 5 Ban Saphangthongtai, Sisattanak District Vientiane Capital Tel. No. : 856 21 353-902 81831 Email : [email protected]
WHO MONGOLIA Dr Erdenechimeg ENKHEE Technical Officer World Health Organization Government Building No. 8 Ulaanbaatar Tel. No. : 976 11 327870 Email : [email protected]
WHO VIET NAM Ms Benedicte Pascale GALICHET Adviser, Effectiveness and Efficiency WHO Representative Office in Viet Nam 304 Kim Ma Street Hanoi Tel. No. : 84 4 3850 0276 Email : [email protected]
WHO HEADQUARTERS Mr Ibadat DHILLON Technical Officer Human Resources for Health Policies and Standards, Health Workforce Department WHO Headquarters Genève 1211 Switzerland Tel. No. : 41 22 7914770 Email : [email protected]
25 Annex 3. Opening remarks
Opening remarks on behalf of Dr Shin Young-soo, WHO Regional Director for the Western Pacific
Honorable Minister of Health, Royal Government of Cambodia His Excellency, Rector, University of Health Sciences Distinguished participants, honored guests, ladies and gentlemen:
1. Dr Shin Young- soo, WHO Regional Director for the Western Pacific, regrets not being able to join us due to previous commitments. He has asked me to send his regards and deliver these words.
2. Achieving universal health coverage will require transforming the way services are delivered. It will also require a workforce that is competent to deliver them. Health professional education is about equipping young minds with the knowledge, skills and competencies that are critical to providing high-quality, people-centred care. As we know, the required health professional competencies are shifting rapidly because of changing disease patterns, rapid population ageing, rising expectations by the public, cost pressures and many other factors. Transforming service delivery to respond to these developments will require health workers who are able to help patients navigate the maze of health care, give the patient a voice in their care, and support their journey from illness to wellness.
3. Health care is a knowledge-intensive process. Mastering only the reality of today will not ensure that students are prepared to meet the challenges of tomorrow. They need expertise beyond clinical competencies, or the ability to diagnose, manage and treat diseases. They also need the right social competencies, to be responsive to individual and community needs and expectations, and create a culture of well-being.
4. It is important to recognize the bottlenecks in rolling out health professional education reforms. They include traditional teaching and learning methods, shortages of qualified educators, poor alignment of education with health sector needs and interests, and inadequate budgets and resources of educational institutions in some countries with economies in transition.
5. I am pleased that countries in the Region are already beginning to reform health professional education. At the first meeting in Hanoi last year, countries discussed the need to develop curricula that enabled the delivery of people-centred care through interdisciplinary teams. They also discussed how to strengthen faculty capacity to teach these new curricula, conduct constructive student assessments, and change institutional cultures towards better quality and evidence-based learning. Countries identified their priority areas for action.
6. Since then, countries have advanced the work on curriculum reform. For instance, Cambodia and Viet Nam are refocusing medical education in response to increased public demand for equitable access to prevention and care. In the Lao People’s Democratic Republic and China, health professional education institutions are breaking with the “biomedical and hospital- centred model” and using different academic models to improve the quality of education and health care. At this meeting, I look forward to hearing more regarding progress and successes.
26 7. While these advances are noteworthy, I believe that several issues need further attention.
8. First, the low level of clinical skills and competencies of health professionals that often results in poor patient safety and quality of care. Second, the lack of links between educators and clinicians, which increases the gap between knowledge and practice. Third, the absence of the right clinical environment to enable teaching and clinical practice to occur, with consent of patients and families. Also, practicing professionals often have limited access to resources to keep up-to-date with new knowledge and needed competencies.
9. Evidence suggests that some educational methods are better than others in fostering needed changes. Success depends on the ability to work effectively across government sectors beyond health and with a broad range of stakeholders.
10. WHO remains committed to supporting Member States in building a generation of health professionals that are fit for purpose and ready for a journey of lifelong learning and providing respectful and equitable care.
11. This meeting provides a wonderful opportunity to challenge traditional views and move towards new ways of teaching and learning to encourage action towards these goals. I wish you a most productive meeting.
12. Thank you.
27 Annex 4. Health professional education: entry points for action
28 www.wpro.who.int