A New Year challenge: medical education and …..politics?

As usual, I have to confess that the latest interesting thought about medical education was a link I saw on Twitter. It actually distracted me from the post I was in the middle of writing. The piece is worth a read https://www.statnews.com/2018/01/05/politics-medical-school-education/

Although bear in mind that it is written in the American and undergraduate context. It notes the importance of politics to health systems and delivery and the lack of relevant teaching in medical schools.  Examples it quotes include issues such as prescribing an epi-pen to a child when the family can’t afford to buy it.  In the UK context the parallel question might be “what’s the point of prescribing something if the NHS can’t afford it?”  And the equivalent in Australia?  Somehow, many of these issues come down to the problem of money – and who pays.  Implementing access and interpreting fairness in this context is a political question.

The article points out that it is felt by many that politics should be kept out of medicine. The important thing is for the individual to be a good doctor.  It also comments on the naivety of this view.  Ironically, it is much more likely that there will be discussion of religious values than of political views even though personal and social ethics are involved in both spheres.  When I was a social worker I gravitated initially to the non-political, one-on-one casework approach but age, experience (seeing the limits of what an individual approach can do) and what I read in my early undergraduate studies led me to acknowledge the crucial relevance of politics. As a GP this is apparent on a daily basis.

Politics and health

It’s obvious that Public Health is inherently political. However, domestic violence and its consequences are a political matter.  As are issues in Aboriginal and Torres Strait Islander health and refugee health.  There were some challenging sessions on racism and “equity pedagogy” at the AMEE medical education conference in Helsinki, as shown by these tweets at the time.

   

The informative plenary by Catherine Lucey https://amee.org/getattachment/Conferences/AMEE-2017/AMEE-2017-APP-DATA/Plenary-6b.pdf opened up new concepts that definitely included a broadly political component.  Here is a tweet about it at the time.  Of course some medical schools were established on the basis of social and political issues – specifically located in disadvantaged areas or focussed on the community.

When to learn about it

It works better for all concerned if students learn at the point of need. Motivation is high. In addition, learners also prioritise their learning needs. These are strongly influenced, in post graduate time, by both the need to pass the exam and the need to cope clinically.  “Softer”, non-medical subjects are not rated highly.  So perhaps it is best to put in the groundwork in medical school and have courses that broaden these bright students’ view of the world.  In post-graduate training it is probably more appropriate to include these aspects as discussion points situated in case-based learning.

However, as noted, politics does not just influence health status and health care systems. It also influences health care education.  This can be seen in length of training, cost of training (and hence the way it is delivered), who delivers it, who gets in, the definition of outcomes and even the content of training.  Should educators, therefore, pay more attention to politics and medical education?  What you do is not just led by pure educational theory. So let me leave you with this new year challenge to reflect on how political decisions have affected the way you as educators are now teaching. I have a few opinions myself but in good teaching style I’ll just leave you with the question – and what you might then do about it.

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