Proceedings from the International Conference on the Future of Health Professions Education 2022

Introduction

In its 2010 report, the Lancet Commission on Health Professionals for the twenty first Century called for a redesign of health professional education (HPE) in order to develop the human resources needed to overcome persistent gaps and inequities in health and to respond to emerging health challenges, such as new infections/pandemics, social and environmental changes and behavioral risks. The report brought an interdisciplinary, multi-professional perspective to its ten recommendations for instructional and institutional reforms, which included adoption of competency-based curricula to rapidly changing needs; promotion of interprofessional and transprofessional education; exploitation of the power of information technology for learning; and facilitating regional global networks, alliances, and consortia (Frenk et al. 2010).

Many of the ideas raised in the Commission’s 2010 report were in formation or already in place when COVID-19 emerged ten years later, but the pandemic accelerated their significance and in many instances accelerated their implementation. COVID-19 had a profound effect on the systems designed to deliver healthcare, including those in higher education that develop the knowledge, skills, and values of health professionals. When COVID struck, an examination of the impact of the Commission’s report was already underway, led by its Co-chairs Julio Frenk and Lincoln Chen, with a faculty team at the University of Miami. In the follow-up Commission’s report in The Lancet, Frenk, Chen, et al. made three core recommendations: (1) using education for life as a principle for health professional education; (2) expanding competency-based education into newly recognized areas; (3) and using learning technology to make health professional education more effective, efficient, and inclusive (Frenk et al. 2022).

The need to build a “better normal” in the aftermath of COVID-19 brought a greater sense of urgency to convene a companion to the 2022 Commission report with an International Conference on the Future of Health Professions Education (ICFHPE). This conference called upon its audience of educators, researchers, practitioners, and students to help define a path forward by spotlighting reforms and innovations already underway, considering bold new steps to better align HPE with social needs, and opening collaborative channels that will facilitate a global exchange of successful experiences and innovative ideas (Frenk et al. 2022; Frenk 2022a).

Over the course of the three-day conference, presentations and discussions focused on lessons from the pandemic, global advances and challenges in HPE, equity and leadership, and the outlook for the future. Breakout sessions on competency-based education, interprofessional education, and information technology for education created fora to link some of the Commission’s recommendations to real-world practices. Running through all these sessions were several recurring themes, including the following questions, which provide an organizing structure for this report:

• What did we learn from the pandemic that we can build upon? Where do these insights take us, and how do we use them to enrich HPE?

• How do we educate and support the health workforce needed to build and sustain a new and better normal?

• What is the future we want and what are the steps needed to build that better tomorrow?

The impact of COVID-19 on HPE: Lessons from the pandemic from across the globe

For HPE, Covid was a game changer!

The panel discussion moderated by Dr Timothy Evans featured Drs Wanicha Chuenkongkaew, Stephanie Ferguson, Patricia Garcia, and Shanta Zimmer who discussed their experiences and learnings from the COVID-19 pandemic related to HPE (Evans et al. 2022). COVID’s impact on health professions education was both swift and widespread. It forced universities to immediately pivot from in-person to remote forms of instruction, and faculty to design new courses to replace the in-person experiences students would normally engage in. COVID also generated a new spirit of collaboration, across institutions and disciplines, which enabled some long-standing barriers to innovation to be lowered, at least temporarily (Gordon et al. 2020; Stojan et al. 2022). Greater appreciation for interprofessional and transprofessional education emerged as diverse teams rallied to care for COVID patients, conduct testing and contact tracing, deliver information to the public, and administer vaccinations. At the same time, the pandemic exposed the consequences of underinvestment in the health workforce, including a severe shortage of nurses, and shortages of personal protective equipment limited opportunities for students to deliver care and learn on the front lines.

Concrete examples from different countries were illustrative of the many innovations that the pandemic catalyzed, and provided ideas on ways to think about the future and to shape a better normal:

• Thailand expanded access to healthcare through greater reliance on telemedicine and remote monitoring of patients, and it took steps to democratize healthcare by developing new learning platforms and devices for caregivers, including more than eight million healthcare volunteers.

• Faculty at the University of Colorado School of Medicine developed a course on pandemics on short notice by reaching out to colleagues at other schools within the university and at other institutions – demonstrating that difficult things can be accomplished quickly when crisis lowers institutional barriers.

• Past efforts to introduce a law for telemedicine in Peru were unsuccessful because health professionals opposed it. However, the earlier groundwork on this initiative proved valuable when COVID emerged, as telemedicine could be launched quickly. Peru had instituted a system for electronic death certificates prior to COVID, enabling it to obtain reliable data on COVID-related deaths during the pandemic.

Responding to needs that COVID brought to the surface can be taken as an opportunity for building a better normal, and should include the following steps, among others;

• Developing a “fit for purpose” health workforce requires greater attention to interprofessional education (IPE) and defining what the purpose is. Remedying the lack of coordination and collaboration across health professions can begin by working across siloes in universities.

• Health professionals need to improve their communication skills. On the front lines of healthcare, they need to feel comfortable discussing difficult situations and decisions with patients and families. In broader discussions with the public, they need to explain health decision making in the face of imprecise and changing information. Universities should look for opportunities to develop these skills.

• Introducing new competencies means leaving space in the curriculum to include unexpected learning opportunities – a flexible curriculum which itself is fit for purpose.

• A willingness to tear down orthodoxy with respect to practice, accreditation, and licensing is needed, making them agents of positive change rather than hurdles.

• Students want to be on the front lines and can help to fill gaps in the delivery of healthcare services. This reinforces not only what they are learning but why they are learning.

Diversity, equity, and inclusion in health professions education

David Skorton, President and CEO of the Association of American Medical Colleges (AAMC), was a keynote speaker for this session. He underscored that developing competencies in diversity, equity, and inclusion (DEI) is an essential step in providing culturally responsive care and achieving optimal patient centered outcomes. He noted that the AAMC, as part of its New and Emerging Areas in Medicine Competency Series, has developed guidance to help institutions integrate DEI competencies across the learning continuum (Skorton, 2022).

In her keynote remarks, Erica Frank, Professor at the University of British Columbia and founder of NextGenU, offered a model for increasing access to education for those who have been marginalized, and for democratizing the process of developing the content of professional education. The NextGenU learning portal offers free courses to support professional development in medicine, nursing, and public health, including courses for physicians, physicians in training, and other health providers, as well as curricula for nursing and public health. Demand for NextGenU’s courses points to a need for this type of learning platform: to date, its public health, nursing, professional development, community health, and health sciences have been provided to 2,100 universities and institutions (Frank 2022).

Global advances and challenges in HPE: Developing the workforce needed for current conditions and emerging challenges

The 2010 Commission report set out a rationale for reforming HPE, giving reformers the “why” for undertaking needed reforms. In rich discussions over multiple conference sessions, conference participants identified some guideposts for continuing reforms of HPE (Chandran et al. 2022; Sullivan-Marx et al. 2022).

Match competencies to society’s needs

Building resilient health systems requires greater recognition of health workforce needs and optimizing HPE to develop a resilient and trained workforce. Institutions need to ensure that their graduates have been trained to respond to change and unexpected upheaval; that they are grounded in the social determinants of health as well as biomedical science and clinical skills; and that they are employable upon graduation and into the future. Experiential learning in the community, with local leaders delivering some of the training, will enable students to make direct connections between the social determinants of health and the lived experience of diverse populations.

Re-imagine the composition of the health workforce

Health-related work goes beyond the professions of physicians, nurses, midwives, pharmacists, and public health specialists; it includes all those whose work contributes to effective health systems, including health economists, lawyers, ethicists, scientists, and others. Health systems rely upon strong data systems, and a skilled workforce is needed to connect those systems to innovative modes of instruction and delivery of care. Building talented cadres of professionals with these areas of expertise will be essential in developing and sustaining responsive, effective health systems.

Although often considered outside of the formal health workforce, community workers, patients and their families, have insights of value to health systems. Their perspectives should be taken into consideration in designing optimal systems to deliver care and in determining the competencies that healthcare practitioners will need to engage with them in meaningful ways. For example, Uganda has found that organizing communities and giving them trained workers expands care, and that non-physicians often can take the lead in reproductive healthcare and in managing HIV/AIDS care.

IPE will prepare members of an interdisciplinary health workforce to work together effectively, by increasing understanding of the skills and strengths of each member of the team; by strengthening collaborative work, team leadership, communication, and other skills; and through experiential learning. At the University of Pennsylvania, the schools of medicine, nursing, and social work collaborated to develop an all-inclusive system of care for elders who were nursing home-eligible but wanted to stay at home; this exercise served as a meaningful training ground for IPE.

Re-examine the role of the university

Universities will need to undertake three fundamental shifts if they are to meet the health needs of the dynamic societies they serve. Rather than a closed system in which students progress from admission to learning to graduation, universities will need to design an open architecture to meet the changing needs of professionals throughout their careers. The traditional standardized system of teaching and learning, which begins with study of the biomedical sciences and proceeds to clinical training, would benefit from becoming more responsive to the diverse needs of learners. A reliance on front-loaded school-based education will need to shift to a system of education for life – that is, learning throughout life, learning to promote and restore healthy lives, and health professionals learning to build and sustain their own healthy lives. While this time-honored model has changed at many institutions around the world where students encounter patients the first week of school, it has not been universally adopted (Yardley et al. 2010). Initiating those three shifts requires asking fundamental questions about what to teach, how to teach, when to teach, and whom to teach.

The University of Miami’s Next Gen Curriculum Taskforce (2017–2019) set out to re-imagine the university’s approach to medical education. It started by recognizing that the ultimate goal of training students is to empower them to transform healthcare and to inspire them to serve. Achieving that goal begins with changing the admissions process; emphasizing clinical skills, professionalism, communication skills, and the social determinants of health early in their training; and creating opportunities for community practice (Ford and Munro 2022).

Empower students

Students become health professionals from the moment they enter medical school, nursing school, or professional training programs. Students want to learn from the real world, and in some cases, COVID put them on the front lines. In Vietnam, faculty and students from the University of Medicine and Pharmacy at Ho Chi Minh City, conducted COVID tests, tracked patients and close contacts, ran mobile labs, and set up isolation centers. They also piloted a community-based care model to provide home monitoring of COVID patients. Beyond such extraordinary circumstances, there may be ways to introduce clinical training or other forms of experiential learning at earlier stages of the curriculum. And, as students seek professional role models, universities will need to recruit and train faculty who not only deliver the course content effectively but model its underlying values.

Within the university, students should recognize the importance of taking ownership of their own education, and that their learning should not be limited by the established curriculum. Taking ownership of education should not be viewed as a short-term, school- based goal but the beginning of a lifelong journey of self-directed learning and growth, refining, sharpening, and making oneself a better health professional.

Learn across countries especially from the Global South

An outdated mindset has persisted too long: that innovative practices and models flow in only one direction, from the advanced economies of the Global North to the low- and middle-income countries of the Global South. In fact, schools in the Global South have much to share about effective HPE practices with their global counterparts. Working in low-resource settings can drive innovation, engage students in clinical care at an early stage in their education, empower community workers as health agents, and forge interprofessional teams to respond to natural disasters.

Capitalize on the power of technology and data

Online educational offerings, including MOOCs (massive open online courses), were just emerging when the Lancet Commission issued its report in 2010 – a startling reminder of how new learning technologies have transformed the landscape of education in a short period. Learning technologies, when linked to pedagogical imperatives, can make HPE more effective, efficient, and inclusive. They can improve educational responsiveness to the benefit of both students and teachers. They enable field and clinical experiences to be simulated, with immediate feedback to students. Beyond the campus, technology can facilitate communities of practice, and deliver gains in productivity.

Bring fresh thinking to equity issues

Extending quality healthcare to underserved populations remains a persistent equity challenge, particularly for those who live in rural settings. Graduates of elite medical universities typically prefer to practice in urban rather than rural settings (Sullivan-Marx et al. 2022).

China Medical Board (CMB) launched the Equity Initiative, a fellowship program to nurture young leaders for health equity in Southeast Asia and China. Its fellows − 127 to date, from 12 countries – come from a diverse range of professions, creating opportunities to break down siloes and build on shared values as they deepen their understanding of equity, develop leadership skills, and collaborate on equity-focused projects.

Gender equity at the leadership level remains a persistent challenge in academic medicine, evident in the low percentage of women serving as department chairs and deans of medicine and in leadership positions at national academies of medicine and in healthcare systems. Institutions need to change the arc of leadership and promotion to ensure better gender balance, including taking steps to ensure that women of childbearing age do not lose out on leadership opportunities.

Envisioning the future

By 2050, the landscape of health professions education will have undergone substantial transformation, molded by pioneering trends such as competency-based education, interprofessional education, IT-facilitated learning, and a spotlight on disparities, equity, diversity, and inclusion. Here is a summary from the members of the final panel session envisioning the future of health professions education in 2050.

Holistic health systems approach

The intertwined worlds of health education and health delivery must function in harmony. By developing shared mental models of success—focusing on enhanced learner outcomes, patient care, and competency-based medical education—a cohesive strategy can emerge. The trend will likely move from traditional university and academic health center models to holistic health-education systems models. This will emphasize systems as interconnected units instead of isolated teams or individuals, demanding the collaboration of a broad spectrum of stakeholders in an interprofessional or ideally transprofessional education model. The Nursing Now Campaign highlights the pivotal role of nursing. By 2050, reforms in nursing education and an emphasis on interprofessional education will ensure comprehensive care and collaboration. Finally, as we approach 2050, there will be a rising demand for competencies centered on healthcare quality improvement. Strategic partnerships will be essential to disseminate quality improvement knowledge and practices extensively.

Diversity, equity, and patient-centric approaches

A diverse group of patients should be instrumental in reshaping health education and delivery systems. Tackling structural inequities in both resource-rich and resource-poor nations is a pressing priority. The disparities between urban and rural healthcare in both high-income countries (HICs) and low- and middle-income countries (LMICs), and within these countries, will need dedicated attention, with increased education and training initiatives. Key to ensuring this equity will be the need to provide accessible medical expertise globally without depleting regional talent. Measures should be developed to counteract unchecked medical migration.

Innovation in education and assessment

The assessment methodologies will mirror the evolution of the educational landscape. Technology will drive scalable and pertinent learning experiences. Transitioning from "assessment of learning" to "assessment for learning" will foster trust in the system, emphasizing enhancement. Mutual learning from LMICs and marginalized communities in HICs will introduce reciprocal innovation, fostering a richer and more diverse educational ecosystem.

Empowerment and collaboration in global health

Regulatory harmony will be essential for a borderless healthcare system by 2050, empowering professionals to employ their skills and knowledge to the fullest across international borders. Sustainable, mutually beneficial collaborations should replace traditional, unidirectional partnerships, with long-term impacts at the forefront.

Focus on health creation and primary care

The spotlight should shift from disease treatment to health prevention and creation, addressing the social determinants of health and transforming healthcare professionals into agents of transformative change. By 2050, there should be a heightened emphasis on competencies surrounding primary care and community health. Given that a significant portion of preventable deaths occur in LMICs and community settings, especially rural ones, this shift will address pressing global health concerns.

In the decade since the 2010 Lancet publication, Health Professionals for a New Century, a visible wealth of energy in the field of health professional education has emerged, evidenced in part by the remarkable increase in HPE research and publications. That energy, combined with the urgency of taking lessons from the COVID-19 pandemic, creates momentum to seize the moment and set a bold agenda for HPE reform. That, in turn, calls for a willingness to question existing processes for education and professional accreditation. “No more incrementalism” was a guiding light for the University of Miami’s Next Gen Curriculum Taskforce, and that sentiment also can rally champions for HPE reform (Issenberg et al. 2022).

Challenging times call for health professionals, including those who lead, teach, and conduct research within educational institutions, to be agents of change. They can draw greater attention to the social determinants of health, disrupt entrenched systems that impede access to quality health services, and develop ways to respond to emerging threats to human health, such as climate change. They can work to incorporate socio-cultural contexts into the competencies of clinical, diagnostic, and management reasoning. They can put community needs at the forefront of research projects, and advocate for putting people and place at the center of health policies. These actions would be important steps in making patient-centered care the core of HPE.

This work cannot be done alone: appropriate and purposeful collaborations and alliances are needed to initiate and sustain reforms. The siloes that separate health professionals, over the course of their education training and their professional practice, should give way to partnerships that drive innovation. The exchange of knowledge, experience, and models to strengthen HPE should be truly global, recognizing that the Global South has as much to share as the Global North, with lessons learned from and with each other.

Before the closing remarks by Dr Julio Frenk, Dr Harvey V Fineberg, a trustee of the China Medical Board and the President of the Gordon and Betty Moore Foundation gave the inaugural Lincoln C Chen Lecture in Global Health.

Closing remarks

“This is the moment to pursue a quantum leap in HPE innovation,” University of Miami President Julio Frenk said in his closing remarks, as it can enrich other fields of education, transform universities, and expand opportunity and equity throughout societies (Frenk 2022b). The challenge will be to transform the conference’s fertile exchange of ideas into a plan of action. That is a duty owed to those whose lives were lost or disrupted during the pandemic, as well as an obligation to young people pursuing careers as health professionals. Connecting young people to a meaningful course of study and practice will build their confidence in institutions, in each other, and in the future. It will strengthen their belief that what lies ahead is better, and that they have an important role to play in defining and creating a better future.

Acknowledgments

The authors wish to acknowledge the contributions of the following thought leaders for leading or moderating the discussions at the ICFHPE.

Julio Frenk, Lincoln Chen, Barbara Stoll, Harvey Fineberg, Richard Horton, Victor Dzau, Timothy Evans, Shanta Zimmer, Wanicha Chuenkongkaew, Patricia Garcia, Stephanie Fergusson, David Skorton, Erica Frank, David Duong, Francis Omaswa, Fadlo Khuri, Tran Diep Tuan, Felicia Marie Knaul, Henri Ford, Cindy Munro, Jason Frank, Eileen Sullivan-Marx, Alison Whelan, Tore Laerdal, Tao Le, Danielle Laraque-Arena, Phuong Nhan le, Timothy Evans, Peter Berman, Suwit Wibulpolprasert, Nigel Crisp, Michael Barone, Trevor Gibbs and Roger Glass.

Rose van Zuilen and Xiaoqing Zhang for organizing the poster submissions reviews and final presentations.

Anne Phelan for capturing the conference summary.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

S. Barry Issenberg

S. Barry Issenberg, MD, Professor of Medicine Michael S Gordon Chair of Medical Education, Senior Associate Dean for Medical Education, Department of Medical Education, University of Miami Miller School of Medicine.

Latha Chandran

Latha Chandran, MD, MPH, MBA, Executive Dean for Education, Bernard J Fogel Chair, Department of Medical Education, University of Miami Miller School of Medicine.