Remo AguilarThere are several methods of curriculum development in medical education. I’m familiar with Kern’s Six Step Approach to Curriculum Development which I discussed briefly in this post. This approach is far from perfect but components of medical education ( knowledge, skills, attitudes and values) may be effectively taught using this approach.
On top of of this Six Step Approach is a well conducted general needs assessment of the community where health professionals are to be deployed. This needs assessment also determines the context that wrap health issues in that specific community. Implementing a health education program without prior contextual needs assessment is like running a car without a definite destination. Resources are spread thin across multiple objectives, draining resources and produce graduates who are “misfits”- physicians who just don’t fit the target community’s context of health issues. A misfit health professional so to speak.
For years I believe, our goals for educating health professionals didn’t change much and remained true to the ideals of health profession. We still want to train ethical and moral health professionals serving our country in the most excellent and conscientious way. Our instruments in achieving these goals however have changed dramatically in todays digital age. Access to information greatly improved but processing these information lags behind. We have access to western health research but such data just don’t fit especially in the countryside where the context of health issues is radically different. We train our would be physicians that western medical knowledge and skills is the way to go in medicine but what is in the books and journals are vastly different from what we have here on the ground. The stark difference is even more palpable in the attitude and values being taught at healthcare academe. We have forgotten the socio cultural context of our health issues. We train highly skilled and knowledgeable physicians yet they don’t seem to fit the community they’re placed in. Most of them just gravitate towards the urban tertiary centers where western medicine, the context of how we train them, resides.
Teaching medical knowledge and skills has evolved so much in recent decades. Attitudes and values however remains the hardest, most elusive component teach and assess. Thus we hear of health professionals who’s attitudes and values are way off what’s expected of a health professional. Whispers of “lazy, easily discouraged, whiner, scum” health professionals can sometimes be heard on performance evaluations. The lack of a clear context and need assessments predisposes a program to produce such health professionals. The lack of validated instruments to impart and assess our methods of teaching attitudes and values in our health education programs remains challenge to the medical academe. We’ve tried teaching methods like “fellowships” or paired didactic/clinical exposures, increasing patient exposures, community immersions and other but we yet to figure out exactly how to teach and assess desirable attitudes and values to our health professionals. We knew teaching methods are customised on the context of the community and cannot be standardized across regional difference. Perhaps a basic framework to work on and modified regionally according to context would be a good way to start.
So far, a standard method of evaluating attitudes of health professionals needs to be implemented and validated widely. The closest we can get after going through the rigodon of trying to each time, is the multi peer assessment. This is an assessment method wherein everyone in the health professionals working environment gives an assessment as to the attitude of that health professional. The assessment is quite comprehensive and is reflective the working atmosphere of that health professionals. It is however tedious. Categorising components of this assessment tool and making sure everyone in the working environment uniformly understand its content requires training.
In summary, our goals in teaching the “right” attitude for health professionals, hasn’t changed much in the past decades. The lack of clear context and needs assessment plus the scarcity of teaching and assessing ” attitudes and values ” among our health professionals is contributing much to “misfits” in the health community. A multi peer assessment is the closest tool we can use but is tedious and time consuming. A basic framework for training should be created on a national level but modified regionally according to the specific context of health issues present in that region.
