Richard Murray: Toppling ivory towers

MEDICAL schools are not generally regarded as progressive agents of social change. The truth is that they tend to be bastions of medical establishment and tradition the world over.

Students are mostly the sons and daughters of an urban elite and clinical education remains grounded in tertiary medicine and its tribal institutional cultures.

The pursuit of institutional prestige through expensive biomedical research is the main game — and “impact” in terms of betterment of the human condition is measured, very imperfectly, by international journal citation indices and competitive grant income.

Yet our ageing population, the challenge of non-communicable diseases and cost pressures in health systems demand a different approach.

If communities are to be assured of affordable and effective patient- and population-centred health care into the future, a revolution is needed in the production of doctors and generation of medical knowledge.

“Socially accountable medical education” is the proposition that medical schools accept an obligation to align teaching, research and service activities to jointly identified community needs.

The international movement for socially accountable medical education is gathering momentum. The ideas are also being taken up closer to home with development of a coalition of schools interested in these ideas within the Medical Deans Australia and New Zealand.

One international grouping is the Training for Health Equity Network (THEnet). Working on the principle of “social accountability in action”, this is a consortium of institutions committed to achieving health equity through medical education, research and service that is responsive to the priority needs of communities.

As an authentic community of practice and working in partnership with others, THEnet seeks to transform medical education, build institutional capacity and shape policy to make health systems around the world more equitable.

In Australia, James Cook University and Flinders University are part of this collaboration, as are nine other schools in Belgium, Canada, Cuba, Nepal, the Philippines, South Africa, Sudan and the US.

Despite their disparate contexts, there is much experience in common among these institutions in their struggles to establish innovative programs or challenge conventions from within. The development of an international evaluation framework to assist medical schools seeking to become more attuned to community needs has been an important piece of joint work.

The Training for Health Equity Network institutions embrace values of equity, relevance, quality, efficiency and partnership. Working with — and within — communities and local health systems, they look to recruit students who represent their target populations and to align curriculum and pedagogies with priority community needs.

They also aim to produce graduates who are technically, socially and culturally suited to work in this way. The schools are advocates for change and work with stakeholders to transform health systems to be more relevant to community needs.

Viva la Revolución!

Professor Richard Murray is the dean of medicine and head of school at James Cook University, Queensland and president of the Australian College of Rural and Remote Medicine.

Posted 9 July 2012