6

角井信弘

特集：国際保健における人材養成
Trends in educational development ＊Arie Rotem

Preamble
The education of the health professions is changing
rapidly. The driving forces stem from three major
sources.
・ Exponential growth in knowledge and technology.
・ Dissatisfaction with current educational programs.
・ Developments in education.

Growth leading to fragmentation
The rapid increase in scientific knowledge has led to ahigh level of specialisation. In order to cope with therising complexity, specialists know more and more about
less and less. This is necessary to ensure adequate depthof expertise. As a result new disciplines are being
created and existing disciplines split into more
specialised areas. The undesirable by-product of thisphenomena is fragmentation of knowledge and practice.
It is becoming increasingly difficult to coordinate thecontribution of all the disciplines. Departments often
operate as if they were independent of each other. The
drawing of boundaries around departmental structuresoften trigger parochial attitudes. Departments tend to
set their own agenda and protect their own space,resources, influence and value systems. Whilstcompetition between the different groups may promoteexcellence in individual units it makes it difficult toachieve corporate goals.
The advancement of
information technology has a potential to improve
communication across different groups but in theCentre for Public Health
University of New South Wales
Sydney, Australia＊ Presentation to academic staff of the Japan National
Institute of Public Healthabsence of incentives for cooperation, units tend tooperate within their zone of autonomy rather than as acorporate entity.
Health professions educators working within
departmental boundaries recognise that their courses areoften not adequately integrated. Education delivered bydepartments working in isolation from each other fails tolink theory and practice and to provide a meaningfulcontext for learning around practical experience andprofessional practice. Most public health issues require
multidisciplinary approaches.
The implications for educational institutions are clear.
The different parts of the course need to be integrated
around meaningful issues, reflecting practice andenabling application of knowledge and skills. There is aneed to improve exchange of information, sharing ofvalues and beliefs and improving capacity for negotiation
among the different disciplines. Appropriate forums arerequired for working together in an atmosphere of trustand cooperation.
Furthermore, negotiation among the stakeholders
must eventually lead to determination of priorities. It is
not possible to “cover” everything. The educational
program must be based on careful analysis of what thegraduates need to know. To avoid overcrowding of the
program it is necessary to formulate realistic learning
objectives and activities. Students need to learn how toretrieve and use information and how to study
independently.

Dissatisfaction with the existing educational
programs
The following issues are often raised as expressions ofdissatisfaction of the current educational programs.

J. Natl. Inst. Public Health, 49 (1) : 2000

Arie Rotem

・ It is argued that educational programs often:* do not reflect health priorities - epidemiologicaldistribution of disease and population healthperspective.
* do not emphasis health promotion and disease
prevention.
* do not encourage assessment of cost effectiveness.
* do little to deal with poor rural distribution ofdoctors.
* do not equip graduates to deal with social concernsof patients.
・ Patients complain that doctors are disease oriented
and impersonal.
・ Teachers and students complain about:* the lack of integration* too much content* delay before clinical learning begins* lack of focus on the needs of the graduates
・ Health authorities complain about lack of social
accountability.

Relevance of Education
Interchange between ‘practice’ and ‘education’ iscommonly recognised as an essential process in attaining
relevance in workforce development. Relevance ineducation and training is vital to ensure students areadequately prepared for practice. Educational institutions
have an obligation to pursue relevance given that inmost instances the majority of their operating budget isderived from public sources. Socio-political concerns
such as equity of access according to need, quality ofcare, consumer satisfaction, efficient use of resources,individual versus community rights, environmental
determinants of health, technology assessment and costmust be considered by educational institutions if they
aim to meet this obligation.
The recent Forty-Eighth World Health Assembly, withparticular reference to medical ‘education’ and ‘practice’,urged Member States to collaborate with all bodies
concerned with education, to promote and support
research concerned with enhancing the relevance of‘practice’, and to support educational reform.
The need to improve relevance in public health7

education has also been, made explicit in the first teneton which the Asia Pacific Academic Consortium for
Public Health (APACPH) was founded. Member
institutions are expected to “[r]aise the quality andrelevance of professional education in public health”.
One of the ways in which APACPH is seeking toenhance the relevance of education is through thedevelopment and wide dissemination of competencies forthe public health workforce.

Development and Education
Major developments in education, which have evolved
over the past two decades, are increasingly applied inhealth professions education. Better understanding of
the learning process has led to greater emphasis on
active learning and rejection of passive “spoon feeding”.
Much greater emphasis is put on the design of learning
activities. Students learn by practicing skills andapplying knowledge. Teachers design appropriate
learning activities and create supportive conditions forlearning. The role of the teacher in transmitting
information is diminishing in importance. Students areexpected to access information through many sources.
Their capacity to access and manage information isregarded as a core competency required to sustain andupdate knowledge throughout their career.
Hence, advanced educational programs focus on thedevelopment of learning skills which equip the students
for life long self directed learning. Activities aredesigned to help students to learn how to learn, how tosolve problems, how to use information and how to use
their experience and practice as a source of newlearning. They are given opportunities to observe and topractice. Students are expected to reflect on theirexperiences, to explore meanings and to test new ideas.
They are assessed on their ability to apply knowledge
and solve problems rather that merely on their ability torecall facts and bits of information.
In response to dissatisfaction with aspects of thegraduates performance, greater emphasis is put oncommunication skills and interpersonal relations. It is
recognised that personnel maturity and competence inmanaging oneself are important. This includes
management of time, avoiding excessive stress andmaintaining self well being. Understanding and being
able to apply ethical consideration also gains importance.
With the increasing complexity of technology, therequirement to ration health services and the dynamic
interrelations of social, cultural, economical andJ. Natl. Inst. Public Health, 49 (1) : 2000

8Presentation to academic staff of the Japan National Institute of Public Health on Trends in Educational Development

professional issues, health professions are required tomake difficult decisions based on sound ethical andprofessional considerations.
Efforts to improve access to education for people in
the workforce and people in remote areas has led to anincreased use of distance modes of education. With theamount of information technology widely available, many
programs are offered on-line via the internet andsophisticated electronic learning environments.
The social setting for learning has also gained muchattention in recent years. It is increasingly recognisedthat the quality of the learning environment has major
impact on the quality of the learning achieved. The
learning environment is portrayed in terms of theconditions it offers, the opportunities for practice andexposure it provides and the appropriateness of thelearning activities and resources it offers. Hence, theincreasing emphasis on community setting for learning is
associated with the belief that the community provides abetter exposure and opportunity to practice relevant
skills not afforded in highly specialised hospital
departments.
All these developments require a much more
systematic approach to educational planning. Systematicplanning focuses on analysis of what the graduates needto learn and the attributes they need to possess to
succeed in their professional careers. This information isused to formulate educational objectives, learning
activities and assessment procedures which focus on therequired learning.

arrangements, and learning environments. Many
institutions have recognised the need to restructure theirorganisation to remove boundaries between departments
and enable integration across disciplines. The content
which is included in the curriculum is more likely to be
selected and organised around key issues (cases,problems or scenarios) that the graduate will need toaddress. The concepts and information are presented in
the context of and in association with the case problemsaddressed. It is agreed that this approach enables
deeper and more sustainable learning because it offers
meaning and an immediate opportunity for practice andapplication.

Conclusion
In my brief presentation, I highlighted some major
developments in education of the health professions. I
have noted that we need to address and indeed takeadvantage of scientific and technological advancements.
We can no longer expect to teach students everything
they may need to know. Rather we should preparethem for life long learning by cultivating their cognitive
skills. This is achieved though active learning provided
in a meaningful context of practice and education.
The shifts in educational approach has major
implications for the role of teachers in the way weorganise our institutions and programs and in the kind ofresources we use.
The trends identified are gaining momentum and arequite universal. Public health educators need to review
these developments and undertake restructuring of theirprograms in earnest.

The planning process incorporates also a carefulanalysis of required resources, organisational

保健医療従事者の教育は，高度な専門性を目指す技術・知識の進歩，また，疫学や公衆衛生上の優先順位や対費用効果，従事者の配置，患者の意向を十分反映していない現行の教育プログラムへの不満，および学習過程を重視する教育の進歩などから急速に変化しつつある．このため必要とされる全てを教え込むというのではなく，生涯にわたって学び続ける技術を身につけさせるよう保健医療教育プログラムを改善発展させることが望まれる．

J. Natl. Inst. Public Health, 49 (1) : 2000