Medical Education: The Need for an Interconnected, Person-Centered, Health-Focused Approach

Medical Education: The Need for an Interconnected, Person-Centered, Health-Focused Approach

Joachim Sturmberg (Newcastle University, Australia)
DOI: 10.4018/978-1-4666-4615-5.ch002
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Abstract

The notion that the medical professions are grounded in sound social and philosophical commitments to human well-being and advancement is the very foundation of medicine since time in memoriam. Caring is the essential work of all health professionals, since most patients have no medical condition explainable by the mechanistic biomedical model. Health, illness, and disease, and biomedically defined disease distributions in the community follow a Pareto distribution (aka the 80/20 split) (i.e. only a minor percentage require tertiary hospital interventions). This chapter unravels important failures inherent in current medical education approaches – the misconceptions about science, the limitations inherent in the prevailing worldviews, the shaping of attitudes and behaviors resulting from social interactions in health professional institutions, and the impact of the lack of flexibility within health professional institutions. Positing that health is a personal dynamic balanced state, represented through a somato-psycho-socio-semiotic model, is the basis on which principles for a patient-centered educational approach are developed. Such a new curriculum would embrace the complex adaptive systems principle – focusing on the interdependencies between teachers and learners, allowing the curriculum to emerge over the course based on learners’ clinical exposures and experiences, fostering a critical engagement with the multifaceted knowledge base of the disciplines, and most importantly, building the necessary resilience for handling, individually and collectively, the emotional demands of caring.
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The Underpinnings Of Health Care Make Healthcare A Social Endeavour

The notion that the medical professions are grounded in sound social and philosophical commitments to human well-being and advancement is the very foundation of medicine since time in memoriam (Illich 1976; Pellegrino and Thomasma 1981; Sturmberg 2007). It should not be frowned upon, rather it should be the starting point of re-thinking the purpose, meaning and operation of care. Caring in fact should be the imperative work since most patients we care for have no medical condition explainable by the mechanistic biomedical model (Green, et al. 2001; White, et al. 1961). These studies show that the epidemiology of health, illness, dis-ease and disease in the community follows a Pareto distribution (Figure 1), with only a minor percentage requiring tertiary hospital interventions (Sturmberg, et al. 2011). A point important to take into consideration when thinking about health professionals’ education!

Figure 1.

Pareto distribution of health, illness and disease in the community

These findings result in the need to re-frame health as an evaluative complex-adaptive state (Sturmberg 2013; Sturmberg 2009b). The somato-psycho-socio-semiotic model of health describes health as a dynamic balanced state between the bodily, emotional, social and cognitive or sense-making dimensions of personal experience. Not surprisingly patients and doctors may markedly differ in their views about the nature of this personal evaluative state, especially since health and dis-ease can be experienced as much in the presence as absence of identifiable diseases (Figure 2).

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