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Transforming Medical Education for the 21st Century


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Table of Contents

Foreword. Commentaries by members of The Lancet Commission on Education's Health Professionals for a New Century. Preface. About the author. Acknowledgements. Figures and tables. Introduction. Key drivers of change. Changing demographics and redefining health priorities. Social determinants of health. Obesity: 'a diet to disaster'. Malnutrition: 'the face of worldwide hunger'. Impact of rising costs on healthcare. Improving health literacy. Global health: 'putting families and communities at the hub'. Scientific megatrends in healthcare and information technology. Breaking down inter/trans-professional barriers. The Lancet Commission report and concluding comments. National reviews of medical education. Common issues and concerns in medical education. National reports and the possible need to 'dig deeper'. Balancing primary care and the specialties. Barriers to achieving reforms. Educational priorities in medical education. A synthesis of key educational priorities in medical education. Systemic problems in medical education. Curriculum reform in medical education: returning to first principles? Main purpose of restructuring healthcare education and training. Competencies for the twenty-first century. Refocusing medical education: from teaching to learning. Considering Confucian and Socratic learning philosophies. Educational challenges in implementing 'transformative' learning. Enhancing understanding and acquisition of professional skills. Medical education: learning systems review and development. Rationales for change: a recap. Three approaches to planning and operating educational systems. Reconceptualising healthcare education and training. Mapping population health and competency needs using the DACUM process. Benefits of applying DACUM in healthcare curricula. Case examples: learning systems implementation. The University of the Philippines Manila School of Health Science: 'where health workers are trained to stay and serve.' From competencies to learning outcomes. A case study in curriculum mapping of core medicine. Adapting healthcare curricula to the twenty-first century. Learning outcome components. Learning systems design: ensuring patient safety and learning effectiveness. An example of creating an interprofessional, innovative and engaging learning environment. Learning that lasts: the 'law of cumulative ignorance.' Medical education and the management of change. Improving postgraduate education: lessons from a national study. National Health Service cultures and organisational performance: research findings. The adaptive-generative development model to guide change and innovation. Enacting change: think globally, act locally. Building an action culture. Interactional leadership: valuing emotions and social interaction. Implications of applying the leadership framework in healthcare. Toward professional standards in healthcare education. 'Choosing' to lead. The physician - patient contract. Changing physician - patient relationships. Public perceptions of physicians. Toward a new physician - patient contract. Professional as 'authority': a patient's story. Defining patient rights to good medical practice in the twenty-first century. Professional as 'partner': a junior doctor's story. Realising the aims of medicine in the twenty-first century. Patients in the twenty-first century. Role of medicine: cure illness, extend life or 'medicalise' society? Developed nations: cutting costs - prioritising patients and resources? Developing nations: key ingredients for success? Healthcare by 2020 and beyond: 'back to the future?' From academic centres to academic systems and longitudinal integrated rotations or clerkships. Remote care requirements for NASA and community-based medicine. Reducing costs, yet safer and more efficient treatment? 'What's Past is Prologue': Revitalising Medication Education and training for the 21st Century. Transforming medical education: seizing the moment. Factors underpinning long-term, highly successful organisations. Organisational reorientation: shifting the paradigm. Expanding from local and national to global health systems. Toward new curriculum models for healthcare education and training. Building teamwork, not 'team work.' Future technological advances and healthcare. Managing the change process. Facing limitations and challenges: broadening the field of medicine and medical education in the twenty-first century. Human population growth and global carrying capacity. Finding solutions to emerging needs and problems. International 'beacons of change and innovation' in medical education. Medical and healthcare education at a crossroad. A closing word and the 'pale blue dot.' Epilogue: Leadership in medicine and healthcare for the 21st Century. References. Index.

About the Author

George R Lueddeke Consultant in Higher and Medical Education Development


Of importance is the chapter on the physician-patient contract. The focus on global health is of interest, particularly as there is often an assumption that high-income (western) countries know what is good for the rest of the world, and there is a missionary zeal about it. Of particular interest and importance is the chapter on facing limitations. This is a thoughtprovoking and readable volume that will be of interest to educationalists and students alike.' Dinesh Bhugra, Institute of Psychiatry, King's College London, UK (International Journal of Social Psychiatry) "This book could be transformative and a turning point in medical education specifically and healthcare education generally. It is a step in the right direction and should be required reading for educators, students/trainees and managers in medicine, nursing, public health and other health/social care professions. It is a driver and facilitator in advancing progress in interprofessional education." Professor Afaf I. Meleis, Margaret Bond Simon Dean of Nursing, University of Pennsylvania, United States "Undoubtedly, the book will challenge many to rethink healthcare, health systems and health/medical education in a global context that is changing with unprecedented speed and scope." Dr Catherine Michaud, Consultant, The China Medical Board, Boston, Massachusetts, United States "Global developments set the scene for the radical changes in the education and training of health professionals. Ultimately, it is transformation in how health professionals work, and most fundamental of all, in how they think and how they understand the world that will lead to improvements in health and healthcare." Lord Nigel Crisp, House of Lords, London, United Kingdom " I LOVE IT. This book is amazing and your input is excellent, brilliant and smashing - it is lived and real leadership !!!! Congratulations!" Professor Dr. med. Bjorn Brucher, Professor of Surgery, Medical Director Peritoneal Surface Malignancies Center of Excellence & Chief, Division of Cancer Research, BSNCI Bon Secours National Cancer Institute, United States; Founder of the Theodor-Billroth-Academy(R) University of Tubingen, Germany "This book will be of interest to all because it offers more than just a discussion of changes in the education of health professionals; it offers suggestions to real enabling actions." Professor Patricia J Garcia, Dean, School of Public Health and Administration, Universidad Peruna Cayetano Heredia, Lima, Peru "I've read your book, thoroughly enjoyed it, and have now shared it with others. Thanks for this terrific synthesis and contribution to the field." Dr Joseph Kolars, M.D. Senior Associate Dean for Education and Global Initiatives at the University of Michigan Medical School, United States "I continue to use your book which is excellent...and seminars here would be a good idea." Professor Geoff McColl, Consultant Rheumatologist, deputy dean of Medicine, Dentistry and Health Sciences, and director of Melbourne University's Medical Education Unit, Melbourne, Australia "I have gone through your book and find it very informative as it provides a comprehensive analysis of health/social care issues facing the developed and developing worlds and highlights the need for strengthening medical/healthcare education and training - coping with emerging needs and global developments. I am optimistic that this manuscript will pioneer a new thought process and will be useful in scaling up human resources for health and increasing their productivity in line with the Global Health Workforce Alliance strategy for 2013-2016: 'advancing the health workforce agenda within universal coverage." Dr Muhammad Mahmood Afzal, Head of Country Facilitation Team, Global Health Workforce Alliance (GHWA), Geneva, Switzerland "I have indeed read your new book and recommended it to a number of AMA colleagues. It is an excellent summary of the state of medical/health care education today and issues for the future...I am a fan of your work and it has influenced my thinking as we put this program together." Susan E. Skochelak MD, MPH Vice President, Medical Education, American Medical Association

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