Creating Health Professionals for the 21st Century

In the 21' century world there are glaring gaps and inequities in health within and between countries.' This fact underscores our collective failure to share the dramatic health advances equitably.' At the same time fresh challenges loom. New infectious, environmental and behavioral risk factors have led to a variety of chronic infectious and non -communicable diseases due to rapid demographic and epidemiological transitions. Such transitions have also happened in India where over the last 25 years, non -communicable diseases have become the most important cause of mortality and morbidity.' This change threatens health security for all. Health systems worldwide are struggling to keep up, as they become more complex and costly, placing additional demands on capacity of health workers. Professional education has not kept pace with these challenges, largely because of fragmented, outdated and static curricula that produce ill-equipped graduates. The problems are systematic: mismatch of competencies to patient and population needs; poor teamwork; persistent gender stratification of professional status; narrow technical focus without broader contextual understanding; episodic encounters rather than continuous care; predominant hospital orientation at the expense of primary care; quantitative and qualitative imbalances in the professional labor market; and weak leadership to improve health systems performance. The respected medical journal, Lancet, formed an advisory commission to address changes in health education for creation of health professionals empowered to tackle various health issues in their local and global context.' The Commission called for a redesign of professional health education in view of the opportunities for mutual learning and joint solutions offered by global interdependence due to acceleration of flows of knowledge, technologies and financing across borders, and the migration of both professionals and patients. The 20th century is characterized by three generation of health educational reforms. The first generation, launched at the beginning of the century taught a science -based curriculum. Around the mid century, the second generation introduced problem -based instructional innovations. A third generation is now needed that should be systems -based to improve the performance of health systems by adapting core clinical and professional competencies to specific contexts, while drawing on global knowledge (Figure).