Global Priorities in Medical Education SCOME Approach
IFMSA
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Contents
General Overview Page 5
Non-Communicable Diseases Page 6
Antimicrobial Resistance Page 8
Environment, Climate Change and Health Page 10
Refugees, Migrants and Health Page 12
Humanitarian Action Page 14
Children’s Health and Rights
www.ifmsa.org
Page 16
Social Accountability in Medical Schools Page 18
Global Health Workforce Page 20
Access to Research and Research Education Page 22
Sexual and Reproductive Health and Rights (SRHR) Page 24
SCOME Approach to Global Priorities
04
Global Priorities in Medical Education
General Overview The International Federation of Medical Students’ Associations (IFMSA) has adopted Global Priorities to focus the internal and external work and assure the best possible impact of our efforts. Standing Committees have a key role in providing a strategic, field focused approach to the chosen areas of action and structuring the possibilities for collaboration between different fields. With the shared understanding that global health challenges can be addressed from the start of medical training, the Standing Committee on Medical Education (SCOME) has gathered, for each Global Priority, ideas for trainings, advocacy or community projects directed towards an impact in medical education. In light of SCOME’s mission, we aim to “enable medical students to complement and effect change in the education, as well as to develop individuals in a personal and professional basis”, doing it so with a comprehensive involvement to support the different areas IFMSA focuses on. The present document was developed according to the adopted IFMSA Global Priorities for 2018-2019. Each section corresponds to a global priority and follows the proposed structure: • Brief introduction to the topic • Problem statements, considering the curriculum perspectives shared in SCOME • Proposed solutions • Educational activities – they can take the form of lectures, seminars, workshops, trainings that target medical students and development of their knowledge on the topic • Advocacy activities – for initiatives attempting to effect change on medical education • Community-based activities – implying that even if the main target of the activity is the community, medical students are being exposed and educated on the topic The information conveyed throughout the document was the one found most relevant to argue the medical education perspective, attempting to provide clear suggestions without being too exhaustive. Any member can build on these ideas and formulate new proposals. “Dare to think!”
Global Priorities in Medical Education
05
Noncommunicable Diseases Noncommunicable diseases (NCDs) represent the largest and even growing proportion of the global burden of disease. The main types of NCDs are cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, to which it was added the mental health cluster. Premature deaths from NCDs are largely preventable and many are mainly driven by lifestyle related risk factors such as physical inactivity, unhealthy diets, tobacco use, the harmful use of alcohol. Health professionals have a key role in educating their communities and promoting healthy lifestyles, as well as engaging in efforts to minimize the conflicts of interest of the commercial, private interests.
• Curriculum does not address noncommunicable diseases as a group, neglecting the opportunities to tackle their social determinants together. • Curriculum does not adequately cover the promotion of healthy lifestyles and preventive medicine, neither is it up to date with the public health changing dynamics
Problem Statements
• Medical education trends are hospital based, drifting from the community-based practices, prevention and management of early stages of NCDs • Education practices ignore the private sector’s influences in health policies • Academic community does not have healthy lifestyle practices
Proposed Solutions
06
Global Priorities in Medical Education
• On the promotion of healthy lifestyles and preventive medicine (e.g. nutrition courses, prescribing physical activity) • On basic medical skills for prevention and management of NCDs (e.g. checking blood pressure, using glucometer, calculating body mass index) • On patient education and health literacy amongst the general population • On implementing individual healthy lifestyle habits (e.g. healthy cooking or balance nutrition workshops)
• To include the promotion of healthy lifestyles and preventive medicine in the medical curriculum and have a community-based education • To promote healthy habits in the campus and hospitals grounds (e.g. provide healthy food and beverage options by default, ban smoking in the student areas) • To raise awareness amongst the academic community about private sector’s influences in health policies
Educational Activities
Advocacy Activities
•
To promote healthy lifestyles, smoking cessation and moderate alcohol consumption and raise awareness of the many industries’ influence in the promotion of these habits • To conduct check-ups and measure the risk factors for NCDs
Communitybased Activities
Healthy and Proud (IFMSA-Quebec)
Established Activity
Peer-to-peer education program centred around the development of self-esteem by covering topics such as dieting and physical activity as well as animating discussions about the adolescents’ fears and questions. It aims to build on the students’ experience and knowledge to foster optimal overall health from a prevention point of view. By engaging medical students in these projects, we are also enhancing their knowledge and skills on healthy lifestyles promotion, thus shaping the future health advocates
Global Priorities in Medical Education
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Antimicrobial Resistance Antimicrobial resistance (AMR) refers to the increasing ability of microorganisms (such as bacteria, fungi, viruses and parasites) to multiply or persist in the presence of an increased level of an antimicrobial agent which is accelerating a natural biological phenomenon. The emergence of this resistance is due to many factors such as insufficient standards of prescription policies, misuse of medication, overuse of antibiotics in livestock-breeding and lack of sufficient infectious disease surveillance programs. Health professionals have a key role in educating promoting responsible behaviors within their communities, as well as engaging in efforts to minimize the conflicts of interest of the commercial, private interests.
Problem Statements
• Curriculum is not effective in addressing the global threat of antimicrobial resistance, rational prescribing and the need for evidence-based medicine • Curriculum does not have a strong focus on patient education to avoid misuse or overuse of antimicrobials, neither does it address the “one health” approach and importance of having a systemic and interprofessional approach to antimicrobial resistance • Education practices give too little emphasis to hygiene and infection control measures • Education practices ignore the private sector’s influences, namely pharmaceutical companies
Proposed Solutions
08
Global Priorities in Medical Education
•
On antimicrobial resistances, rational prescribing and evidence-based medicine • On hygiene procedures and infection control in hospital settings • On patient education and health literacy amongst the general population
• To implement an active approach to pharmacology related courses in Medical Curriculum, confronting students with clinical cases and invite them to search for the best evidence, for example a portfolio • To include and emphasize the need for antimicrobial resistance prevention and control within the clinical modules • To raise awareness amongst the academic community about private sector’s influences in health policies and prevent pharmaceutical industry influence on Medical Education • To include the focus on health professionals’ education in antimicrobial resistance prevention adopted policies
• To conduct visits to community groups and promote sanitation, hygiene, vaccination, infection control measures and raise awareness to the risks of consumption of food with antimicrobials • To take advantage of opportunities of contact already established within the community (e.g. Teddy Bear hospitals)
Educational Activities
Advocacy Activities
Communitybased Activities
Antimicrobial Resistance (IFMSA Egypt)
Established Activity
This project includes a series of activities such as trainings on antimicrobial resistance, workshop delivery on the topic, campaigns and questionnaires to the general population to understand the awareness regarding the matter to promote research on the topic.
Global Priorities in Medical Education
09
Environment, Climate Change and Health Evidence has shown that climate change puts the lives and wellbeing of billions of people at increased risk. Health impacts can be directly mediated, through weather events, or indirectly mediated, through the effects on economies, access to healthcare, social structure and ecosystems. Moreover, by taking action on climate change such as reducing air pollution or promoting dietary changes, there is a clear opportunity for improving global public health. Health professionals should understand the impact climate change may have on the population’s health and focus efforts on understanding its scope, as well as to be trained to respond to emergent threats to health related to weather events.
Problem Statements
• Curriculum does not address climate change as a public health threat or the implications of climate change on disease patterns and disasters • Academic community is not aware on climate change, its implications on disease and the importance of environmentally conscious actions within health • Educational practices ignore the importance of environmentally conscious actions to minimize the impact of professionals and healthcare facilities • Healthcare facilities contribute considerably to the ecological footprint by lacking environmentally conscious practices
Proposed Solutions
10
Global Priorities in Medical Education
• On climate change as a public health threat or the implications of climate change on disease patterns and disasters • On responding to emergent threats to health related to weather events • On environmentally conscious actions to minimize our impact as individuals and as part of the Health System
• To include the topic of climate change and its implications on disease patterns and disasters in the medical curriculum • To implement environmentally conscious policies and sustainable practices in medical schools and hospital amongst medical students • To promote environmentally conscious practices within the academic community • To develop research on the link between climate change and health
• To promote environmentally conscious practices within the community • To establish partnerships within the community to mitigate the environmental impact of health facilities
Educational Activities
Advocacy Activities
Communitybased Activities
IMCC Earth (IMCC Denmark)
Established Activity
Student activity group which works towards a greener institution, and raise awareness on the issue climate change has on health through social media and advocacy action at events on campus. The main goal is to raise awareness among medical students on the impact climate change has on our health, make the institution and students more sustainable.
Global Priorities in Medical Education
11
Refugees, Migrants and Health The world has seen a significant rise in conflict and subsequent mobility. Refugees and migrants represent a unique group of populations, with very specific health and other needs that require specialized and contextualized care. Issues such as culture, language, access can compromise their health status, both physically and mentally, adding to the already existing challenges in healthcare. Regardless of their status, people on the move must have all their rights protected and fulfilled and their access to social and health services must be ensured.
Problem Statements
• Curriculum does not address the challenges posed by cultural differences and language barriers, nor the particular health status, physically and mentally of refugees and migrants • Academic community and education practices ignore the different social, political and cultural contexts, potentially overlooking the healthcare needs of minority or emergent groups in the population
Proposed Solutions
12
Global Priorities in Medical Education
• On intercultural learning and understanding of different political, social and cultural context • On responding to the healthcare needs related to refugees and migrants
• To include intercultural learning and deepen the understanding of the impact of the social determinants of health in the medical curriculum • To promote medical students’ opportunities to engage with this population groups and understand the specific context
Educational Activities
Advocacy Activities
• To create direct interactivity opportunities for medical students with refugees and migrants through visiting organized camps visits
Communitybased Activities
Free Medical Day (LeMSIC Lebanon)
Established Activity
An initiative from medical students around Lebanon to provide free healthcare, awareness, and screening to whoever needs it, for free. This project’s focus area are vulnerable populations, namely migrants and refugees that constitute a large percentage of the Lebanese population. It works on empowering people from these vulnerable populations to have the knowledge to follow-up on their health.
Global Priorities in Medical Education
13
Humanitarian Action As currently the world’s population is exposed to violence, conflict and disaster, the risk is disproportionately related to the readiness of the health workforce whether in its numbers, availability and quality. In such situations, the population needs health professionals that are able to respond its direct needs, whether physical or mental health related. Preparing the health professionals with the right knowledge and skills should play a central role in risk mitigation.
Problem Statement Curriculum does not address sufficiently disaster and emergency medicine
Proposed Solutions
14
Global Priorities in Medical Education
• On the community’s disaster risks and possible health consequences • On disaster management and health professionals’ participation in its mitigation
• To include knowledge about disaster exposure, relevant skills in healthcare management in disaster or conflict situations and development of humanitarian attitudes among medical students in the medical curriculum • To raise awareness of the importance of healthcare facilities and the role of health professionals’ in situations of conflict
• To encourage volunteerism among medical students, whether through providing hospitalized care or mental health follow-up with the exposed community
Educational Activities
Advocacy Activities
Communitybased Activities
SPORADIST - SCORP Prepared Disaster Response Team (CIMSA-ISMKI, Indonesia)
Established Activity
Project that aims to improve knowledge related to disaster mitigation and evacuation and forming active cadre in the community in an effort to decrease the number of casualties caused by natural disaster. Medical students are provided with the knowledge by experts that will enable them to provide a peer-to-peer education to high school students in risk areas .
Global Priorities in Medical Education
15
Children’s Health and Rights Children represent one of the most vulnerable age groups for human right violations. Today millions of children have no access to education, work long hours under hazardous conditions and are forced to serve as soldiers in armed conflict. They suffer targeted attacks on their schools and teachers or languish in institutions or detention centers, where they endure inhumane conditions and assaults on their dignity. Health professionals are fundamental to promote the wellbeing of children by ensuring their rights are being realized, as established by the Convention of the Rights of the Child. Actions as addressing the social determinants of health, understanding the parental guidance and support and promoting vaccination should be taken.
Problem Statements
• Curriculum does not acknowledge children’s specific social determinants for health and possible vulnerability factors, as well as communication skills on age brackets • Medical students are not properly trained on good communication skills with children and parents and onto understanding vulnerable situations • Academic community does not recognize or emphasize on the issues related to discrimination based on disability, gender, race or ethnicity
Proposed Solutions
16
Global Priorities in Medical Education
• On the specific vulnerabilities and risk factors children might experience • On communication skills with children and parents to understand the context and the possible vulnerabilities of the person • On the aspect of mental health of children, how to approach and support them
• To include the topic of ethics and social determinants of health focused on pediatrics in the medical curriculum • To raise awareness on the issues related to discrimination based on disability, gender, race or ethnicity amongst the academic community
Educational Activities
Advocacy Activities
• To involve medical students in the provision and support of access to education and healthcare for children • To promote actions of vaccination where medical students are trained to and deliver vaccines to children
Communitybased Activities
What to do in the case of child abuse? (IFMSA Honduras) This activity is a workshop facilitated by a pediatrician, a psychologist and a lawyer. The main objective is to teach the tools to the medical, nursing and psychology students and professionals to correctly address a situation of child abuse. It will be evaluated through a Google Survey.
Teddy Bear Hospital (IFMSA NL)
Established Activity
This project has its emphasis on the children’s right to health and access to healthcare services. It aims to tackle children’s lack of knowledge and fear related to healthcare, as well as educate medical students on the different approach demanded when communicating and delivering care to children.
Global Priorities in Medical Education
17
Social Accountability in Medical Schools Defined as “the obligation of medical schools to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve”, this approach presents as a possible solution to improve the quality, equity, relevance and effectiveness in health care delivery, to reduce the mismatch within healthcare delivery, to redefine the roles of health professionals and to produce evidence of positive impact on the people’s health status. In order to be socially accountable, medical schools need to be dynamic and adjust freely to the growing and changing demands of the patients and community in which they serve, a principle which applies to all health professions’ education.
Problem Statements
• Medical schools are detached from their social obligations and do not promote a community based educational environment • Curriculum is mainly hospital based, disease centered and does not sufficiently promote research within the community and towards its health needs • Health workforce trends show imbalance between rural and urban areas placements and the need for a better proportion of specialties related to the health needs of the population
Proposed Solutions
18
Global Priorities in Medical Education
• On social accountability, its concept, values and application • On interprofessional education and skills to collaborate and work in a team with different roles and expertise
• To increase the awareness and understanding of social accountability concept among Medical Schools and academic community • To conduct an assessment on Social Accountability through medical schools and follow up on it • To advocate for curriculum changes and involve social accountability in Medical Schools
• To hold researches based on community needs and related issues to health. • To promote activities where medical students deliver healthcare to the community and in community setting
Educational Activities
Advocacy Activities
Communitybased Activities
AMOMA: To Care, Nurture, or Cherish (Philippines, AMSA-Philippines)
Established Activity
Amoma is a community development and communityenabling project by AMSA-SOMA geared towards improving the health resilience of this island community while at the same time, nurturing future physicians who are willing to serve the community. A baseline survey was done to identify the primary health problems in the community and our interventions will be based in these health problems. Through our intervention, we seek to educate and empower the people in the community so that they may be more resilient and independent in the future. We are tapping other key players to ensure sustainability of better access to quality health care in this rural island community even though the project is over.
Global Priorities in Medical Education
19
Global Health Workforce With a growing population, longer lifespans and increasing burden of diseases there has been increasing demand on the health systems and for health workers. It is projected that by 2030, there will be a global shortage of 18 million health workers and a demand of 40 million new health worker jobs to be created. Action is needed for a transformative and capacity building platform, meeting the needs for health professionals in the right number, with the right skills and in the right place.
Problem Statements
• Medical schools do not meet the health needs of the population by forecasting the number of doctors needed and/or having a community-based curriculum that promotes engagement with the population and retention of health workers • Education tends to be discipline based without emphasis on the health needs of the population and the main sectors where health workers are needed • Academic and Health Professionals community ignore the scope of decent working conditions (right to productive work, fair income, personal development, safety and social security and to express concerns) and its promotion amongst the future health workforce careers
Proposed Solutions
• On health systems and the impact of health policies, enabling medical students to understand the dynamics of the health workforce • On the consequences of strategy lacking in health workforce planning to health systems and to the health workers individual health • On the topics most relevant to the community’s needs
20
Educational Activities
Global Priorities in Medical Education
• On the wellbeing amongst medical students to prevent mental health illnesses prevalent amongst the health care professionals’ community • To promote a competency-based education in the medical curriculum • To promote quality medical education through accreditation and the involvement of students in the accreditation processes. Medical schools should follow the Basic Standards for Medical Education proposed by WFME • To develop national policies that assure the proper planning and forecasting of the health workforce needs
• To promote medical career opportunities among medical students, with an emphasis on the specialties’ need addressed in the target population • To have opportunities for placements in areas of need such as rural areas
Advocacy Activities
Communitybased Activities
Together for the Rural Health (FASMR Romania)
It is a project which is being carried out at the initiative of the students aiming to give a helping hand to the medical system in Romania through the active involvement of medical students, resident physicians and specialists, partners and medical institutions in investigations and providing healthcare in rural areas.
Interprofessionalism (bvmd Germany)
Established Activity
In collaboration with the executive board of different health care student associations (pharmacists, psychologists, dentists, veterinarians, physicians, physical therapists, medical technicians) we work for an interprofessional holistic healthcare system where all the disciplines work together efficiently and in harmony. Started with national cooperation and structure in an Interprofessional Council of Students in Health Care, we extend the project to the local faculties and plan to include more disciplines like nurses and occupational therapists. Workshops and trainings provide space for interprofessional discussion, connection and competency acquisition.
Global Priorities in Medical Education
21
Access to Research and Research Education Research is one of the key components to successful development in medicine and improved standards of living. It also has an important contribution in shaping the education of a future doctor with the development of critical thinking, skills on data collection, treatment and presentation and promotion of evidence-based medicine and decision making. Unfortunately, it happens quite often that there is a lack of access and promotion of research in the medical curriculum and within the medical schools, which leads to fewer opportunities to be involved and educated about research.
Problem Statements
• Curriculum approaches to research for ineffective and/ or outdated with little emphasis on active learning and longitudinal development of skills • Academic and healthcare professionals’ community do not promote evidence-based medicine, development of research and scholarly inquiry as core practices for a medical expert’s education • Medical schools do not provide systematically and actively opportunities for research and involvement of medical students in research projects • Educational environment does not promote and develop policies and opportunities for open access and open data to medical students • Education practices ignore the private sector’s influences in access to research and research education
Proposed Solutions • • • •
On research education competencies and methodology On evidence-based medicine and decision making On transparency and ethics regarding research Professors’ disposal of involving students in their research projects • Transparency and better promotion of research activities
22
Educational Activities
Global Priorities in Medical Education
• NMOs and LCs will to collaborate with professors and facilitate the access to research projects for students, from different areas: clinical, surgical, laboratory • To assure early and continued exposure to medical research in the medical curriculum • To collaborate with the medical schools and research centers to facilitate the access to research for students and promotion of research activities • To assure medical schools recognition of the academic value of extracurricular opportunities in the research field, such as SCORE exchanges • To offer grants and working conditions for students taking part in research projects • To promote open access and open data in the medical schools and with relevant partners amongst medical students
• To raise awareness and better understanding on the importance of research • To encourage the community to support and take part in research initiatives and projects led by medical students
Advocacy Activities
Communitybased Activities
Research Workshop (Turkey, TurkMSIC)
Established Activity
As medical students and future physicians our main goal is to be a doctor which is fullfill educated, aware of newest medical innovations and curious to learn new knowledges. In order to achieve this goal we all will come across with researches. Unfourtunately some medical students have not the basic knowledge about research and some of them have not the opportunity learn them truly within their faculties. With Research Workshop we create an environment for all willing students to understand the what research is and how they can create their own researches, projects and how they can search them. With the interactive sessions we provide participants to create their own studies under supervision of renowned professors which differs our project in every other related conferences.
Global Priorities in Medical Education
23
Sexual and Reproductive Health and Rights (SRHR) As defined by the United Nations Population Fund, “sexual and reproductive health is a state of complete physical, mental and social well-being in all matters relating to the reproductive system. It implies that people are able to have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so”. The main areas IFMSA focuses on in SRHR are the following: Diverse Sexual Orientation, Gender Identity, Gender Expression and Sexual Characteristics (SOGIESC), Comprehensive Sexuality Education, Women’s and adolescents’ Sexual and Reproductive health including access to safe abortion, Gender Based Violence including harmful practices against girls and women as well as obstetric violence, and HIV-related discrimination in healthcare against people living with HIV and key populations. This global priority aims to strategize around the different areas in the field of SRHR giving priority to the need of increased knowledge among medical students on the impact that discrimination in healthcare settings has on the health outcomes of young key populations.
Problem Statements
• Curriculum does not adequately cover the promotion of sexual and reproductive health and rights and does not prepare medical students to attend these issues in their communities • Education practices tend to ignore the importance of addressing discrimination and fighting stigma regarding sexual and reproductive health and rights topics
Proposed Solutions
24
Global Priorities in Medical Education
• On the basics of comprehensive sexuality education (CSE) • On communication skills and addressing the topics related to reproductive and sexual health and rights • On STIs diagnosis, treatment and prevention • On reproductive health management, including prenatal and perinatal care • On the promotion of sexual and reproductive health rights with inclusive healthcare services
• To include comprehensive sexual and reproductive health education in the medical curriculum • To develop a toolkit about realizing sexual and reproductive health and rights amongst medical students and health professionals • To foster a transversal gender perspective and a safe environment inclusive for anyone, regardless of their sexual orientation, gender identity, gender expression and sex characteristics within the academic community
• To engage medical students and healthcare professions in campaigns about sexual and reproductive health and rights • To develop campaigns about discrimination in healthcare systems towards LGBTQ+ or sex workers targeting medical students and healthcare professionals • To implement activities where medical students spread knowledge about SRHR within the community, considering action in underserved and underrepresented populations
Educational Activities
Advocacy Activities
Communitybased Activities
SCORA Generation (AssociaMed Tunisia)
Established Activity
Based on a peer-to-peer youth education that uses a combination of experiential learning methods, ‘edutainment’ and social media, this workshop consists of delivering one or a series of sessions in different high/ middle schools around the country to teenagers aged between 15 and 20 years old about maternal health and access to safe abortion, gender based violence, and sexually transmitted infections (STIs), including HIV to enable young people to exercise their sexual and reproductive rights.
Global Priorities in Medical Education
25
IFMSA
International Federation of Medical Students’ Associations
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Senegal (FNESS)
Ecuador (AEMPPI)
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Serbia (IFMSA-Serbia)
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Luxembourg (ALEM)
Sierra Leone (SLEMSA)
Malawi (UMMSA)
Singapore (SiMSA)
Aruba (IFMSA-Aruba)
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Slovakia (SloMSA)
Australia (AMSA)
Estonia (EstMSA)
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Malta (MMSA)
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(IFMSA NL)
Taiwan - China (FMS)
Nigeria (NiMSA)
Tajikistan (TJMSA)
Norway (NMSA)
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Paraguay (IFMSAParaguay)
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Hungary (HuMSIRC)
Canada – Québec (IFMSA-Québec)
Iceland (IMSA)
Peru (IFMSA-Peru)
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Peru (APEMH)
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Catalonia - Spain (AECS)
Indonesia (CIMSA-ISMKI) Iran (IMSA)
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