Education across boundaries

‘Progress is impossible without change and those that cannot change their minds cannot change anything’.[1]

The Lancet Commission ‘Health Professionals for a New Century’ [2] highlights the importance of transforming education to mirror the demands of changing population needs. This is essential if we are to train a workforce with the knowledge, skills and values appropriate to modern health care delivery. The report stresses ‘the fundamental linkage between professional education, on the one hand, and health conditions, on the other’. It also bluntly states that ‘20th century educational strategies are unfit to tackle 21st century challenges’.[2]

So why are we so reticent to change? We are increasingly experiencing unacceptable pressures on our clinical workforce. There is a global shortage of health care workers. The situation is worsening.[3] The World Innovation Summit for Health is soon to highlight how health-care services and medical education systems are failing to meet wider population needs.[3] The stark global reality is that health professionals provide for the needs of wealthier, educated, and urban dwelling populations. Clinicians continue to be recruited from the more privileged social classes. In the U.K., an increasing introduction of private medical schools risks impeding attempts to widen participation and open our doors to less well-off students. A recent commentary in the Lancet raises these concerns at a global level arguing that poor quality education, underfunding, and the expansion of private medical schools, is detracting from, rather than aiding, the development of the future work force.[3]

Yet we appear to lack a mind set to change educational strategy. I am increasingly concerned by the failure of undergraduate and postgraduate education (arguably also secondary school) to move from traditional curricula to those needed for the future. Why do we remain entrenched in specialty hospital based ‘silo’ driven, indeed often tertiary care orientated, education delivery when there is a clear need for integrated more community orientated care?[4] The increasing population demands of aging and co-morbidity are indisputable. To meet patient needs service models that span organisational boundaries [4] are essential. Yet we continue to face ‘tribalism’ between primary and secondary care which perpetuates a ‘myth’ that generalist community based care is of lower status.[5] We face a harmful culture which pervades education. The professional two-way denigratory ‘banter’ across this boundary is preventing the educational change essential to meet patient needs. It is time we broke down this barrier.[6]

Primary care is not academically ‘below’ secondary care in status – both hold equal weight. The concept of hospitals as part of integrated care systems, or even within population health systems [3] is crucial. Yet medical education seems slow to grasp this. The Lancet commission [2] argues that education must drive workforce change. So why not let go of our entrenched views of ‘speciality’ driven siloed education? To quote Tett,[6] ‘the need to classify, categorise and specialise can make things more efficient, and help give the leaders of any organisation a sense of confidence that they have the right people focusing on the right tasks. But it can also be catastrophic, leading to tunnel vision and tribalism. Most importantly it can create a structural fog’. It is high time we moved out of ‘structural fog’.

So why this protest? It is to positively welcome the initiative of John Spicer and his team in developing education across these boundaries. We offer two papers evaluating a pilot where paediatric and general practice trainees ‘learnt together’ in primary care. Despite trainee expectations that those in general practice would gain the most from their secondary care colleagues, both benefited. Evaluation of patient notes recorded at the time also suggested that consultations and management improved. The pilot proved feasible and deliverable.

Hopefully this new volume, our 28th, will continue to welcome more such initiatives, strengthen our international partnerships and open avenues for more collaboration across boundaries both within primary health care teams and with secondary care colleagues. We most sincerely thank all our reviewers who continue to support us and work to enhance the quality of the journal. With the retirement of Lesley Pugsley we have decided to discontinue the ‘How to’ series. I thank Lesley and her team for leading this so brilliantly over the years. The series offered a door for Masters students to write and offer reflections on their learning. We recognise a need for a short paper section for ‘young writers’ and are in the process of developing this. Embracing technology is a further aim widening readership and opening access on line to papers. We welcome your views. Join us on Twitter – @EPC-journal!

Warmest best wishes
Val Wass
[email protected]
Editor