Jan Tato

Postpy wiedzy i wspczesnej informatyki jako nowe wyzwania dla Uniwersytetw Medycznych, ich edukacyjnych celw i metod gorca potrzeba nowej pedagogicznej reformy
Progress of sciences and of contemporary informatics challenges the Medical Universites, their educational aims and methods the hot need of new pedagogical reform
Warsaw Medical University Association of Therapeutic Education, Warsaw

New educational aims: impact of progress in science

The accelerating pace of progress in science and technology transforms the life ot the contemporary men more profoundly than ever before. The forthcoming future appears more and more different than the present. This general principle deeply involves the patterns of medical profession and - at the first place - the aims, means, technological and social aspects of the formation of the new physician (1, 2). Science and technology transforms the whole structure of medicine - new physiological information, methodology in diagnosis and therapy, new ways in prophylactics and in psychosocial dimension of health and disease enforce the changes in medical education. This is a natural and positive process. It looks however, that this process develops not in a linear fashion, it has turning points acutely increasing the dynamics of change to a new quality of education. They are many indices pointing to the fact, that the medical profession and institutions reached now such acceleration.

New educational obligations educational science translation

In formulation of educational aims one may delineate several, important perequisites (1, 3).

1. The specific objectives of education are strongly influenced by the rapid accumulation of the amount of biological and social knowledge and by new qualities of the knowledge and also technology. This fact enforces also the compartmentalization and the specialization in medicine. It is enough to mention, that the number of medical and paramedical periodicals mounted up to 100.000. These phenomena are naturally connected with the progress of medicine. They are continuously imposing new educational aims. The postgraduate teaching process therefore is not any more only the transmission of some quantity of knowledge and skills. Therefore the first prerequisite of this process should be the creation of the ability to select the scientific information, to compose it logically, to use it creatively. This capacity would enable the physican to discriminate between the important and useful body of knowledge and the dispensable information. It means also emphasis on the need to unite the process of the knowledge assimilation with the practical elaboration of the capacity to apply them in action. The process of teaching should influence formatively the ability of intelligent observation, collection of data, the skills in plannig and performing the experiments, the capacity of detection and evaluation of internal logic relations between the phenomena (4).

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2. The postgraduate medical education should strength the formation of the proper structure of professional thinking. The most important way of organizing the effective structure of thinking is the proper presentation of the logic and dynamic structure of medicine and specialty. This could be regarded as a second perequisite in formulation of educational aims. 3. Medical education should be a continuous, integrated learning experience stretching from college years through medical school, postgraduate hospital training and throughout the years of medical practice. Each stage should be a preparation for the next, but requirements for progression should be adaptable to individual motivation and needs. 4. This suggested continuum is not confined to the training of doctors of medicine but makes room for all the occupations that relate to health care. Flexibility to allow individual choice of studies leading to a wide variety of health careers should be the keynote of the system. It would require new patterns of give and take between the medical school and its parent university, the hospital, and the surrounding community, and would allow both vertical and lateral mobility through its curricula for both, with the aim of making the most economical and efficient use of university teaching facilities and of abolishing rigid course requirements that serve no really useful purpose (1, 5). Continuity, flexibility and individual choice of health careers would guide cach students course of study in college, in medical school, in postgraduate education, and in life. The aim of such an educational continuum would not be to inculcate large bodies of knowledge, but to teach the student to think, to solve problems, and to find and apply new information when necessary. 5. The uniwersity is the logical institution to exercise the responsibility for the education of health professionals as well as medical students. It should also take the lead in the planning, designing and operation of health care systems and in creation of new knowledge essential to progress in health.

-day they become more close to the biology, to the general physics, chemistry and mathematics. The basic medical sciences departments are to-day less preclinical, than ever before. Many clinicians didnt notice these changes. They manifest only their opinions that the young physicians arriving to the ward are not as well prepared as before. Prepared for what? The answer to this question is quite different in the departments of basic medical sciences and in the wards. Mathematics, physics, chemistry are the disciplines moving the biology forward. But the assimilation of the new biology in clinical medicine is not always efficient. It is well known, that the loosening of the union between the biology and medicine always resulted in decreasing the scientific value of the latter, medical teaching is then transformed into the second-class activity and the wards in the technological stations. Therefore the educational programmes should be aimed at the preservation of the continuity between the premedical, preclinical and clinical teaching. By the term continuity one should understand the correlation in the matters, in the methodology and in the manner of thinking taught through all periods of teaching. Such attitude and performance is saving very substantial amount of effort, investment, materials increasing in the same time beneficial effects of physician or the health team activity in terms of priceless human. values.

Practical connection
The postgraduate educational needs are very much intensified by the rapid development of medical technology. The scientific workers are employed eagerly by non-university hospitals and by other medical care institutions. At the same time and in the relation to the educational assumptions discussed earlier the need of the participation in the post-graduate teaching process of the talented practitioners is felt more intensively by many schools. The difference between the scholar, scientific environment and the professional groups is on the way down (9). Therefore the necessity of correlating the educational methodology and matters between the school and the regional, medical groups in practice emerged. In many countries the post-graduate clinical teaching is firmly supported by the out-patient and in-patients not-university centers. The institutions of the prophylactic medicine, public health services, extra scholar clinical centers are very much advanced in developing such professional atmosphere and scientific methodology that they can be easily used in the extra mural programmers of the education in action. The integration of the intramural and extra school programmes became an important way of forming the student`s professional thinking and its verification in the

Mixing basic and clinical knowledge

The medicine of to-day became enforced to integrate also with many scientific and technologic disciplines traditionally not-medical. It integrates then not only within the historical limits of medicine but also has to assimilate new contents and new methodology (6). These circumstances exert a strong influence on the patterns of activity and on the content or so-called basic medical sciences taught during the preclinical period, and also on the clinical teaching (7). In the recent past the basic medical sciences departments were really medical, to-

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real practical situations and circumstances. It serves the same goal as the teaching of the comprehensive medical care which is already established in many schools.

Adaptation of the post-graduate education methodology to the contemporary needs

It is generally assumed, that every physician during 50% of the average professional activity time uses the information and tools, prescribes drugs completely not known during his undergraduate education. Morever he has to diagnose and treat the new diseases, perform new operations, use new preventive and psychosocial methods. He is obligated to handle the diseases, drugs, operations, prophylactic actions, which were completely not know to his medical school professors. It could be easily concluded, that the whole process of education undergraduate and postgraduate, should train the motivation for self-perfectioning, the individual creative ability to define and solve the new problems based on proper methodology and evaluation. The quantity of information is much less important, than formation of motivated attitude and methodology. The fundamental aim of the post graduate medical educations is not only to teach medicine but to improve skills of the professional man. Such professionalist should be capable to carry out all practical tasks originating from the actual and forthcoming responsibilities as presented to medical profession by the individual and society. The most important single criterion in the evaluation of the corresponding to this goal teaching organization and methodology is its direct efficacy in transmitting to the physicians all scientific information and skills aimed at new possibilities in medicine as practiced to-day and also tomorrow (1, 2, 3). Biomedical research in postgraduate education may increase the cost of training. This is true, but also - in the same time - by the whole cascade of indirect effects-very effective and rewarding. The final balance also from financial point of view is always very positive. Research oriented postgraduate teaching enables the physician not only to highly effective performance in new situations but also strongly stimulates his motivation for improvements, perfectioning, preventing the errors, for innovation. Also the decentralization of the post-graduate training program, out the hospital into the field would be in accord with the aim described above. It may reverse the centripetal tendency of the past two or three generations, which brought about the dominance of the great medical practice and teaching centers and to substitute in their place the spread of knowledge and resources to the periphery. This is essential if we are to train physicians who are dedicated to patient care. Todays specialization programs

create doctors who look at patients as a disease, not as a person. A wider base of training, a combination of which includes both in-office and along with it responsible in-hospital care of the private patient, instead of total in-hospital teaching, should be than the important perequisite.

Teaching technology
The changing objectives of education require the qualitative innovation and intensification of the didactic transmission. One could differentiate 3 types of this transmission. 1. Verbal transmission. It enables the student to contact the teacher directly. It is still a valuable way if the teacher works with a small group of students. 2. Printed transmission provides the student with the possibility of reflection and of individual adjustment in the way of the assimilation of knowledge. The contents of the printed materials should be continuously actualized and programmed. 3. Technotronic transmision radio, television, movies, teaching electronic machines - unite the verbal, visual and moving stimuli. This manner of transmission is dynamic, it facilitates then the formation of the dynamic thinking. The objectives of education as discussed earlier require the renovation in the use of the different didactic transmission techniques. The teaching - learning process has to enclose much more of the individual and direct verbal contacts, of programmed printed transmission media, and especially of call technotronic methods (9).

Summary
Summing up the impact of scientific and technological developments on postgraduate education one may formulate the folloving needs: 1. priority of individual programmes and elastic methodology, coordination of individual requests with social expectations, 2. development of sell-dependent education based on prepared pre-programmed, informative materials as requested by trainee or suggested by the teacher. This creates new obligations for teaching centers, 3. increase of the role of methodology of evaluation that is educational diagnosis and self-diagnosis, monitoring and self monitoring of educational progress and final assesment, 4. stimulation of criticism and selective attitude toward the information by teaching the research methodology, scientific thinking, experimentation, organization of research during educative process,

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5. implementing research and scientific methodology in every educational effort, in every place and time also in non-academic hospitals and out-patient institutions, 6. development of new didactic methods with application of better technical instrumentation, rational use of professional television and new audiovisual aids, assistance computers and long-distance internet relations, 7. based on such technics long distance monitoring of education, increase the role of consultations and summatizing discussions.

5. 6. 7.

8.

9.

Bibliography
1. 2. 3. 4. Holsinger JW jr, Beaton B: Physician professionalism for a new century, Clin. Anat., 2006, 19, 473-9. Stern D (ed.): Measuring Medical Professionalism, Nev York, Oxford Iniversity Press, 2006. Ende J (ed.): Theory and Practice of Teaching Medicine, ACP Press, Philadelphia, 2010. Humprey HJ: Mentoring in Academic Medicine, ACP Press, American College of Physicians, Philadelphia, 2010.

Pangaro L (ed.): Leadership Careers in Medical Education, ACP Press, Amer. College of Physicians, Philadelphia, 2010. Tato J: Filozofia w medycynie, Wyd. Lekarskie PZWL, Warszawa. Finkenstein JA, McMahon GT, Peters A i wsp.: Teaching population health as a basic science AT Harvard Medical School, Acad. Med., 2008, 83, 332-7. Majkowski J (ed.): Wyzwania XXI wieku. Ochrona zdrowia i ksztacenie medyczne, wyd. Federacja Polskich Towarzystw Medycznych, Warszawa, 2010 tom 1. Majkowski J (ed.): Wyzwania XXI wieku. Ochrona zdrowia i ksztacenie medyczne, wyd. Federacja Polskich Towarzystw Medycznych, Warszawa, 2012 tom 2.

Adres do korespondencji: Jan Tato ul. Pocka 15C/73 01-231 Warszawa e-mail: j.taton@interia.pl Nadesano 26.08.2013 Zakwalifikowano do druku 05.10.2013.

Oczekiwania praktykw na postpy naukowych bada Poniej przytoczono fragment z obrad American Diabetes Association, 9-11.06.2006, Waszyngton. Dr Robert Rizza, Prezydent ADA, 66 Sesje ADA (por. osobiste), komentuje dane z programu Archimedes. By to matematyczno-statystyczny model umoliwiajcy wirtualne obliczenie zmian stanu zdrowia i nakadw finansowych w zalenoci od rozwoju opartej na postpach naukowych opieki diabetologicznej w perspektywie 30 lat. Model wylicze zosta sprawdzony w farmakologiczno-epidemiologicznych badaniach wielu populacji. Zastosowano go do 3 perspektywicznych zada American Diabetes Association. l. Cure - pene wyleczenie Jakie skutki zdrowotne i korzyci finansowe w USAprzyniosaby moliwo wyleczenia cukrzycy. Obrazuje to ponisze zestawienie.
Stan lecznictwa cukrzycy Perspektywa 30 lat, liczba przypadkw 35 mln zawau serca 13 mln udaru mzgu 6 mln schykowej niewydolnoci nerek 8 mln lepoty 2 mln amputacji 6,7 mln zgonw Eliminacja powika i zgonw z powodu cukrzycy Eliminacja kosztw powika i utraty produktywnoci - okoo 70 mld USD rocznie Moliwo wyleczenia cukrzycy

2. Optimal Care - 100% osb z cukrzyc w USA osiga cele leczenia sformuowane przez ADA (perspektywa 30 lat): redukcja przypadkw pnych powika cukrzycy o 18 mln. zmniejszenie liczby zgonw z powodu cukrzycy do 4,2 mln. redukcja kosztw z 132 do 50 mld USD rocznie. 3. Committment- poprawne leczenie; 80% osb z cukrzyc w USA uzyskuje cele sformuowane przez ADA (perspektywa 30 lat): redukcja przypadkw pnych powika cukrzycy do 14 mln. zmniejszenie liczby zgonw z powodu cukrzycy do 3,l mln. redukcja kosztw z 132 do 60 mld USD rocznie. W skojarzeniu z wyej zobrazowanymi zadaniami dla diabetologii w USA powstaje pytanie: jak schemat tych wylicze odnosi si do Polski?
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