EDITORIAL

Social responsibility of institutions in the training of doctors and healthcare professionals

Responsabilidad social de las instituciones en la formación de los médicos y profesionales de la salud

Arcadi Gual

Director de FEM

Correspondence

The Fundación Educación Médica has recently presented a book entitled Learning to become a doctor: Shared social responsibility¹, in which the social responsibility of the institutions involved in the training of doctors is discussed. We will leave it up to each reader to rate the publication as well as to decide the extent to which he or she agrees with the opinions expressed therein. Yet, it seems fitting at this point to highlight three issues that, perhaps because they appear too obvious, are not considered:

- The training of healthcare professionals has a specific aim that is none other than to provide citizens with the best possible care.

- Society changes and hence its needs and demands change too.

- Training healthcare professionals (not just doctors) and keeping them trained (i.e. competent) is not the responsibility of just one particular institution but is instead the shared responsibility of all the different institutions involved in the training processes.

The first point, caring for citizens, is not always borne in mind to the same extent in the training of healthcare professionals, especially in the early stages corresponding to undergraduate studies. As we advance along the educational continuum, the patient's role becomes increasingly more significant and, accordingly, so does the importance of focusing training on his or her needs. But the university, which is furthest away from professional practice, may not give priority to this fundamental aim but rather to other more characteristic and relevant responsibilities such as research and the development of science.

Today, all sorts of changes are taking place in society and as a result the rules of the game are being modified, but not all the players have known how to assimilate, understand and accept them. These changes affect different aspects, like the aims of medicine, the demographics, epidemiology, the organisation and structure of the healthcare services, technological advances in general (biomedical instruments) and the information and communication technologies in particular, the management of resources, which for some time we had forgotten are limited, and finally the empowerment of patients. Having more informed patients gives rise to social movements that call for a new profile of healthcare professional, who provides clear information and gets patients involved in the decisions that are made about their illness. This change increases the risk of breaching the tacit social contract between society and the medical profession. The alterations in each of these factors condition, to a greater or lesser extent, the training needs of healthcare professionals and consequently it must be said that it is neither socially justifiable nor ethical for healthcare professionals to be trained using methods from the previous millennium.

For a long time now this publication, like many others, has been observing that the so-called educational continuum - degree-specialisation-continuous - is in fact a paradigm of discontinuity between the different links responsible for the training of healthcare professionals. Training doctors and other healthcare professionals and keeping them trained, that is to say competent, is not the exclusive responsibility of any particular institution: rather it is the shared responsibility of all the institutions involved in the training processes. And to implement this shared responsibility they must act in a coordinated manner, by complementing each other and optimising resources, and establishing synergies that allow citizens in general to receive the best healthcare and patients to be looked after as well as possible.

The crisis we are experiencing today is not just a question of economics but also of values. It should therefore encourage the institutions that to some extent and at some time or other are responsible for the learning, training and upkeep of doctors' competence to reflect on matters and ask themselves whether they have incorporated the concept of social responsibility into their mission and into their practice, whether they have updated their institutional mission to keep pace with the social changes, and whether they have modified their processes to achieve the new goals. If they have, then they deserve our acknowledgement and praise, and if not, then they must make amends as soon as possible.

¹The book is available in Spanish, English and Catalan and can be examined at www.fundacioneducacionmedica.org; alternatively, a hard-copy version can be ordered at educacionmedica@ub.edu.

Correspondence:
Arcadi Gual Sala
Departamento de Ciencias Fisiológicas I
Facultad de Medicina
Universitat de Barcelona
Casanova, 143. E-08036 Barcelona
E-mail: agual@ub.edu

Conflict of interests: None declared.