University managers: We need to educate human beings, not poor search engines
DEBATE: How do we prepare the students to function in a world that is constantly changing? This is the question that the healthcare study programmes should ask themselves, writes Charlotte Ringsted, Lars Bo Nielsen and Per Höllsberg, who are the vice-dean for education, the dean of Health and the director of studies for the medical degree programme at Health, Aarhus University, respectively.
By Charlotte Ringsted, Lars Bo Nielsen and Per Höllsberg
In the educational sector, we measure and register lots of figures to do with the students and discuss how the figures can say something about quality. Unfortunately, in the case of the healthcare study programmes this is done at the expense of a debate that should actually be the most important of all: How do we best prepare the students to function in a healthcare system that will be in a state of constant change throughout their entire working life?
The healthcare sector is very much on the agenda in connection with the regional and municipal elections of 2017. Journals, reports and conferences are falling over each other in the rush to describe future trends. There will be more elderly people and more people with chronic diseases.
We must prepare for changeability
Diagnostics, treatment and post-treatment will increasingly take place outside of the hospital system and will place great demands on the collaboration between hospitals, general practitioners, municipalities and various health professionals.
Danes in general and the patients will have ever greater co-responsibility for their health and for handling their disease, while at the same time having increased expectations of welfare and quality of life. Technological developments will alter the work tasks of the healthcare professionals, and IT technologies will contribute to large volumes of data and thereby provide an opportunity for finding new strategies to take care of the patients. Knowledge in the field of gene technology will to a higher extent make it possible to tailor preventative measures and treatment of the individual.
The question is: How do we best prepare our health science students to function in these rapid developments and not least to be able to themselves have an influence on them. With the present rules, a newly qualified medical doctor can look forward to a working life that will last almost fifty years. In half a century, the demands at a workplace will look very different from today.
Out to work as quickly as possible
However, that is not exactly what takes up space in the debate in the educational sector; rather, it is more a question of quality goals that look very much like the targets in the hospital system: out as quickly as possible, in work as quickly as possible and satisfaction among the system’s users.
Large quantities of data are collected in the educational sector, both for ourselves and for central authorities, on application figures, drop-out rates, study progress, well-being and here and now labour market relevance. No one disagrees with the importance of well-being and the relevancy of work.
Of course, the students should thrive, and it is also quite natural to closely manage the finances and to focus on value for money. But in both the healthcare and educational sectors, this performance management can easily come to get in the way of developing visions for the future and specific strategies for how public institutions can contribute to society's development, growth and welfare.
In Denmark, we are happy to have a public healthcare and educational system and emphasis that everyone has equal access. But it is expensive, and it is therefore high time for us to consider how these sectors can contribute to economic growth.
Predictions point to the considerable potential that the life science industry has for Denmark. But when it comes to the healthcare sector, unfortunately the situation has become such that worries about the impartiality of healthcare professionals who get involved in the industry overshadows the debate about the possibilities for collaborating on the development of new technologies and about economic benefit for both parties – both the industry and the public sector. Other countries – for example Israel – have succeeded to a greater extent in allowing this collaboration function.
In our efforts to get the students to complete their studies quicker and to safeguard quality, perhaps we forget to focus on the big questions about what it is a university education can and should contribute? What tools can a university degree provide that Google or the Watson supercomputer cannot do better?
Anyone can easily search for information about their health and illnesses on the internet, and to some extent people do so before meeting the healthcare sector. The Watson technology can suggest examinations and treatment faster than humans can on the basis of large volumes of data. How can the university study programmes ensure that our young people get the long-lasting competences that enable them to further develop their field, so they do not rush to keep up with progress, but instead are able to influence the development of the subject, the healthcare system and the new technology?
Looking into the crystal ball with hospitals, industry and researchers
These are some of the questions that the healthcare programmes at Aarhus University are now taking up. To begin with, we have started to formulate overarching visions and strategies for our degree programmes, so that they are characterised by a perspective that both looks into the future and at the world around us.
Together with representatives from the hospitals in the Central Denmark Region and municipalities, patients, the pharmaceutical and medical technology industry, students, lecturers and researchers, we have put our heads together to find out how the individual degree programmes can contribute to continuous development, growth and welfare.
In the case of the medical degree programme, this has led us to a mutual realisation that core expertise is absolutely central. The clinical picture of the patient and the clinical reasoning for dealing with the patient’s problem must be based on scientific evidence and a deep understanding of basic principles and mechanisms regarding the body’s structure and function and the various examination and treatment options.
Just as important is the ability to place this core expertise in context. This applies to each individual patient, each of whom has a unique life situation that calls for empathy and care. But context is also about striking a balance between consideration for the individual and the professional responsibilities for groups of patients and the healthcare system.
Finally, it is important to be able to see the big picture, society, the academic subject and the global context. Professionals in the field must contribute on all levels to developments.
Reflection, overview and collaborative skills
The degree programme should support the students in being able to constantly find things puzzling and ask questions about the current practice. They must be able to look critically to the way in which we handle the individual and the way in which we have organised our healthcare system – and be able to contribute with suggestions for improvements.
Solving this type of task requires reflection, overview and collaborative skills. What we need are degree programmes that build up the students' independence and which contain sufficient flexibility and time for in-depth study and project work.
In this context, the degree programme must also support the students in thinking creatively and innovatively and in becoming aware of the possibilities for working together with the industry and its companies on the development of technologies. The purpose of the medical degree programme is primarily to train medical doctors and to a lesser degree to educate graduates for the industry.
But awareness of the collaboration with the industry is important for the development of technologies that will continually be relevant for medical doctors and the healthcare system. This perspective must therefore be incorporated in the degree programmes.
Students need to be able to challenge our world picture
The ability to ask questions, explore and challenge our current world picture is part of the university's DNA. On the medical degree programme, we have extraordinarily bright, talented and hard-working students, and in Aarhus alone we have close to four tons of the very finest brains.
The question is whether we are utilising the potential we have sufficiently – the fresh eyes, the as yet still well-preserved authentic indignation, the resourcefulness and creativity – for the benefit of society.
The challenges facing the healthcare system show that the ability to reflect critically and an academic, systematic and analytical approach towards developing the subject, the system and the technologies is more important than ever. The same is true of an interdisciplinary orientation towards problems and issues that presupposes a strong core expertise in the individual healthcare degree programmes.
In our eagerness to quickly get the students out and to collect data on this and that so we can check the quality of the degree programmes, we risk forgetting development and visions.
In a society that must live off of knowledge and which produces young graduates who can look forward to lifelong learning in a field that is being transformed more quickly than ever, we believe that visions in a perspective that looks both into the future and at the world around us deserve to be part of the discussion.
This op-ed was originally published in Danish in Altinget on 23 November 2017: https://www.altinget.dk/digital/artikel/sundhedsdekanat-vi-skal-uddanne-mennesker-ikke-daarlige-soegemaskiner (in Danish only).