Prof. Sum-ping LEE, HKU

Reflections on a Medical Education System in Evolution
Prof. Sum-ping LEE
MD, PhD
Dean, Li Ka Shing Faculty of Medicine, The University of Hong Kong


Preamble: Changing Times

Nothing is permanent, and nothing stays perfectly still.
Life and society undergo a dynamic evolution and
changes unfold inexorably onward. So does medical
education. While the need, the mission of fostering
future generations of doctors to serve and enrich this
noble profession have always been the theme of medical
education, the perception, the objectives, the
methodology and instruments of teaching have been
topics of rediscovery, reinvention, as well as
controversial debates. These have been influenced by the
accelerated advances in biomedical science and
exponential proliferation of information; changing
societal and ethical values amongst a background of
fluctuating economic ups-and-downs. There is a fear
that because of the emphasis and reliance on high level
technological devices, that we have been producing
doctors who are more like technocrats and they adopt a
robotic way of prescribing expensive sophisticated tests
and drugs and procedures. These may then erode into
the compassion and idealistic humanitarian qualities
which underpin the basis of the practice of Medicine.
There is also a fear that the delicate balance of
entrepreneurial objectives and altruism has been
perturbed by the zest for materialistic considerations and
that patients might be regarded as tradable commodities.
And in the name of efficiency, we do not listen enough
and care enough any more. What is more alarming is
that ethical standards may so be compromised.
Can a medical education system be improved so that
the medical graduates and ultimately the practitioners
of Medicine will attain an Utopian equilibrium? I think
not. There are many societal forces that determine and
shape the phenotype, choices, and behaviour of the
young men and women after they have graduated from
medical school. But I think we should try. We must try.
Mission and Principles of Medical
Education
The mission of medical education in Hong Kong is to
serve the community by educating and training a
diverse medical workforce capable of meeting our need
for doctors who are engaged in the practice of clinical
medicine and particularly family medicine. Included in
the workforce are doctors engaged in public health
practice, biomedical and health services research,
medical education, and medical administration.
Although numerically small, medical graduates can
have substantial contribution to fields such as ethics,
law, public policy, business, and journalism. The
medical education system has this unique responsibility
to educate and train highly competent medical
practitioners. The design, contents and the process of
medical education ensure that the graduates acquire
and possess throughout their careers the knowledge,
skills, attitudes, and values needed for medical practice
as members of an interdisciplinary health care team.
In order to achieve this goal, the medical education
system must be able to attract and successfully educate
a diverse group of learners; to support the health and
well being of these learners; and to cultivate mentoring
relationships for learners at each stage of their careers.
The medical education system is a vehicle to execute the
will and the trust of the community. Medical education
must be effective, efficient, high-quality and yet
affordable. A good medical education provides
opportunities for learners to engage in different
effective learning experiences throughout their careers.
The medical system must also recognise that learning is
not the antiquated classroom learning but to capitalise on
the remarkable advance in information technology.
Access to information used to be the limiting step in
learning and many generations of learners had
studiously copied, word for word, the lectures of their
professors reading from the notes in a lecture room,
dimmed to accommodate the projection of slides. Now,
with a click of a "mouse", anyone can download
hundreds of papers, reviews and materials which no one
can have the time to deal with, in the current era of
information overload. Therefore, the old paradigm of
teaching must change to include time and information
management. Learning is not the drudgery of
memorising isolated facts, but knowledge is acquired by
guiding a motivated and inspired mind to seek the
appropriate answers. If this skill can be passed on, then
learning will become a life long gift and process, and will
continue after the student has left the medical school.
To produce practitioners of medicine with excellent
competency and professionalism, and who will provide
high quality care to the patients, the medical education
system must promote a humanistic approach to
medicine. In doing so, we should avoid turning the
medical school experience into a vocation training
centre and have students develop a "tunnel vision" view
of their profession and lives. The students must not see
only the leaf but not the tree. They should see the tree,
the forest, and the interrelationship and interdependence
of the forest with the mountains and the streams. To this
end, a broadening of the educational profile including
the humanities and liberal arts will encourage our
learners to adopt a wider visual field. True education
enriches human beings and cultivates a sense of value
and identity for the individual, as well as the
individual's relationship to others and the community
at large. The medical education system should be a
patient-centred approach to medical care. The process
of education embraces an appreciation of the
importance of basic research in the advancement of
medical practice. It also generates an understanding of
the organisation, financing, and the delivery of health
care in Hong Kong, as well as a global perspective on
contemporary health issues. In addition to providing
the best possible curriculum, learning environment,
clinical context and experience, learners are encouraged
to broaden their learning experience as an exchange
student with a different (overseas) medical teaching
institution, preferably in a clinical setting. To
appreciate Medicine at a global scale, they must
experience being a global citizen. During the course of
learning, ethics and legal issue, when appropriate, will
be integrated into the curriculum. As a result, the
graduates will be able to listen and communicate
effectively, weigh quality of life issues appropriately;
assess and use evidence critically; apply resources
efficiently and effectively; use resources and
technologies with sound judgement appropriately.
They will also participate in multi-disciplinary and
team approaches to patient care, contribute to the
elimination of medical errors and improving the quality
of health care, and achieve a balance between
individuals and population health needs when making
patient care decisions.
Medical Educators
In our zest to achieve research recognition, faculty
members of medical schools are often directly or
indirectly encouraged to focus on their research
productivity. As a result, achievements in excellent
medical education may be under-recognised. Passion,
devotion and commitment to teaching must be
rewarded because teaching is a primary mission of the
medical schools. It is important for the leadership of
any university to realise that excellent teachers are to be
recognised and revered.