EDITORIAL

The Edinburgh Declaration, 25 years on!

Declaración de Edimburgo, ¡25 años!

Arcadi Gual, Jesús Millán Núñez-Cortés, Jordi Palés-Argullós and Albert Oriol-Bosch

Correspondence

In August 1988 the World Federation for Medical Education (WFME) held a World Conference on Medical Education in Edinburgh under the watchful eye of the then-president of the WFME, Professor Henry Walton. One outcome of that meeting, attended by a good number of experts from the area of medical education, was the approval of a document that, 25 years later, continues to be a reference in medical education: the 'Edinburgh Declaration' [1,2].

That world conference was the culmination of a series of regional meetings in which countless experts were mobilised with the aim of redefining the challenges that should be set in medical education in order to keep up with the times.

The following, among others, were identified as improvements that faculties of medicine could and should carry out:

- Incorporating community resources into training programmes beyond just those of hospitals.

- Ensuring that the curricular content reflects national healthcare priorities.

- Promoting the continuity of lifelong learning by introducing the active learning methodology and tutorial systems that foster self-directed learning.

- Bringing the curriculum and the assessment systems into line in order to achieve professional competence.

- Training teachers as educators and not just as experts in contents, and acknowledge both teaching and research, as well as service or management.

- Incorporating training in disease prevention and health promotion.

- Integrating clinical practice into basic training by incorporating learning based on problems and community settings.

- Selecting candidates on the basis of their personal qualities rather than just their intellectual capabilities or academic achievements.

To be able to reach these goals it was agreed that there was an urgent need to get both healthcare and educational authorities involved so that they could establish policies and make suitable decisions. But not only the authorities were being urged to play a part. Calls were also being made for the professional associations and the organisations that use and provide health services to become more committed and to make their much-needed contribution with a view to fulfilling the objectives.

The same year as the 'Edinburgh Declaration', another reference document was signed, the so-called 'Lisbon Initiative' [3]. At the request of the World Health Organisation, this European capital hosted a meeting attended by the Ministers of Education and Health and other delegates from 25 European countries, including Spain. The 'Lisbon Initiative' took the principles of the 'Edinburgh Declaration' as its own and proposed the implementation of international cooperation programmes with the intention of reorienting medical education.

A quarter of a century later, it is easy to see how the Edinburgh conference opened up a conceptual pathway that was to make it easier for faculties of medicine to adapt to a future that, in Europe, would be summed up in the term 'Bologna Plan' (1999), that is, the processes of change needed to adapt to the European Higher Education Area.

Nevertheless, 25 years later the analysis of the repercussions of the 'Edinburgh Declaration' on our system for training doctors in particular, and health science professionals in general, shows that in the best of cases we have only come a short way along the path [4,5]. Our educational system, and more specifically the part of training that falls under the responsibility of universities, has again missed the opportunity to carry out real changes and has limited itself to making just superficial alterations. We have been more concerned with getting lots of things done instead of doing them well. Over these past 25 years many voices have been heard over and over again alerting us to the fact that we were treading the path very slowly, when not in the wrong direction. A short time after the 'Edinburgh Declaration', Gallego [6] analysed the situation of medical education in Spain within the international context and warned that the changes that were needed were not taking place. In the publication Learning to become a doctor: Shared social responsibility [7], the Fundación Educación Médica (FEM) recently insisted on the need for the institutions involved in and responsible for the training of doctors to sit down and discuss the changes that citizens are calling for. In this respect, the FEM proposed a series of actions for each of the agents involved that could be seen as a plagiarism of the 'Edinburgh Declaration'. Calling attention to something so many times and seeing how everyone turns a deaf ear is both surprising and profoundly worrying.

Correspondence:
Fundación Educación Médica
Departamento de Ciencias Fisiológicas I
Facultad de Medicina
Universitat de Barcelona
Casanova, 143
E-08036 Barcelona
E-mail: agual@fundacioneducacionmedica.cat

References

1. World Federation for Medical Education. The Edinburgh Declaration. Med Educ 1988; 22: 481-2.         [ Links ]

2. Walton HL. Proceedings of the World Summit on Medical Education. Med Educ 1993; 28 (Suppl 1): 140-9.         [ Links ]

3. World Health Organization. Ministerial consultation for medical education in Europe. The Lisbon Initiative; 1998. Med Educ 1989; 23: 206-8.         [ Links ]

4. Oriol-Bosch A, Pardell H. La formación de los profesionales médicos en la profesión médica: los retos del futuro. In Oriol-Bosch A, Pardell H, eds. La profesión médica, los retos del milenio. Monografías Humanitas 2004; vol. 7. p. 69-84.         [ Links ]

5. Palés J, Rodríguez de Castro F. Retos de la formación médica de grado. Educ Med 2006; 9: 159-72.         [ Links ]

6. Gallego A. La reforma de la educación médica en España (discurso de inauguración). Madrid: Real Academia Nacional de Medicina de España; 1991.         [ Links ]

7. Gual A. Aprender a ser médico: responsabilidad social compartida. Barcelona: Fundación Educación Médica; 2012.         [ Links ]