Challenges and opportunities for educating health professionals after the COVID-19 pandemic.

The education of health professionals substantially changed before, during, and after the COVID-19 pandemic. A 2010 Lancet Commission examined the 100-year history of health-professional education, beginning with the 1910 Flexner report. Since the publication of the Lancet Commission, several transformative developments have happened, including in competency-based education, interprofessional education, and the large-scale application of information technology to education. Although the COVID-19 pandemic did not initiate these developments, it increased their implementation, and they are likely to have a long-term effect on health-professional education. They converge with other societal changes, such as globalisation of health care and increasing concerns of health disparities across the world, that were exacerbated by the pandemic. In this Health Policy, we list institutional and instructional reforms to assess what has happened to health-professional education since the publication of the Lancet Commission and how the COVID-19 pandemic altered the education process.

Concurrent Validity and Reliability of a Handheld Dynamometer in Measuring Isometric Shoulder Rotational Strength.

CONTEXT: Measuring isometric shoulder rotational strength is clinically important for evaluating motor disability in athletes with shoulder injuries. Recent evidence suggests that handheld dynamometry may provide a low-cost and portable method for the clinical assessment of isometric shoulder strength. OBJECTIVE: To investigate the concurrent validity and the intrarater and interrater reliability of handheld dynamometry for measuring isometric shoulder rotational strength. DESIGN: Cross-sectional study. SETTING: Biomechanics laboratory. PARTICIPANTS: Thirty-nine young, healthy participants. MAIN OUTCOME MEASURES: The peak isometric strength of the internal rotators and external rotators, measured by handheld dynamometry (in newton) and isokinetic dynamometry (in newton meter). INTERVENTIONS: Maximal isometric shoulder rotational strength was measured as participants lay supine with 90° shoulder abduction, neutral rotation, 90° elbow flexion, and forearm pronation. Measurements were performed independently by 2 different physiotherapists and in 3 different sessions to evaluate interrater and intrarater reliability. The data obtained by handheld dynamometry were compared with those obtained by isokinetic testing to evaluate concurrent validity. RESULTS: The intraclass correlation coefficients for interrater reliability in measuring maximum isometric shoulder external and internal rotation strength were .914 (95% confidence interval [CI], .842-.954) and .842 (95% CI, .720-.914), respectively. The intrarater reliability values of the method for measuring maximal shoulder external and internal rotation strength were 0.865 (95% CI, 0.757-0.927) and 0.901 (95% CI, 0.820-0.947), respectively. The Pearson correlation coefficients between the handheld and isokinetic dynamometer measurements were .792 (95% CI, .575-.905) for external rotation strength and .664 (95% CI, .419-.839) for internal rotation strength. CONCLUSIONS: The handheld dynamometer showed good to excellent reliability and moderate to good validity in measuring maximum isometric shoulder rotational strength. Therefore, handheld dynamometry could be acceptable for health and sports professionals in field situations to evaluate maximum isometric shoulder rotational strength.

Influence of Shoulder Position on Functional Control Ratio During Isokinetic Assessment.

CONTEXT: One of the possible mechanisms leading to secondary impingement syndrome may be the strength imbalance of shoulder rotators which is known as functional control ratio (FCR). The FCR is a ratio dividing the eccentric peak torque of the external rotators by the concentric peak torque of the internal rotators. Previous studies have focused on the reproducibility and reliability of isokinetic assessment, but there is little information on the influence of variable shoulder positions on FCR. OBJECTIVE: To compare shoulder FCR across 3 different shoulder abduction positions during isokinetic assessment. DESIGN: Cross-sectional study. SETTING: Biomechanics laboratory. PARTICIPANTS: Thirty-one healthy young university students (age 22.35 [0.95] y, weight 60.52 [9.31] kg, height 168.23 [9.47] cm). INTERVENTIONS: The concentric peak torque of internal rotators and eccentric peak torque of external rotators of right shoulder were measured on an isokinetic dynamometer. MAIN OUTCOME MEASURES: Concentric peak torque of the internal rotators and eccentric peak torque of the external rotators, measured using an isokinetic dynamometer. RESULTS: The concentric peak torque of internal rotators was significantly lower at 120° shoulder abduction compared with other positions (P < .001). The FCR was significantly higher at 120° shoulder abduction than 90° (P = .002) or 60° (P < .001) shoulder abduction because of the lower concentric peak torque. No significant difference was found in the FCR between the other 2 shoulder positions (P = .14). CONCLUSIONS: Shoulder position variations may influence FCR because of weakness of the internal rotators. Rehabilitation and injury prevention training programs should specifically focus on strengthening the internal rotators at more elevated angles of shoulder abduction.

Prenatal exposure to sand and dust storms and children's cognitive function in China: a quasi-experimental study.

BACKGROUND: While there is evidence that sand and dust storms can have adverse health effects, the effects of such storms on children's cognitive function has not been explored. We examined whether prenatal exposure to sand and dust storms affects children's cognitive function and, if so, whether harmful effects of sand and dust storms vary by the trimester of exposure. METHODS: This study used nationally representative data from the China Family Panel Studies between 2010 and 2014 and data on sand and dust storms from the national Sand and Dust Weather Almanac. We selected four indicators of children's cognitive function: mathematics test scores, word-recognition test scores, the age the child began speaking in whole sentences, and the age the child began counting from one to ten. Since the annual incidence of sand and dust storms is highly variable and is largely unpredictable, we used a region-and-year fixed-effect model to compare the cognitive function of children born in the same region and year but with varying amounts of prenatal exposure to sand and dust storms. We also investigated whether the effect of sand and dust storms varied by the specific month of prenatal exposure. FINDINGS: We included 1236 observations for the analysis of mathematics and word-recognition test scores, 2693 observations in the analysis of the age the child began speaking in whole sentences, and 1951 observations for the analysis of the age the child began counting from one to ten. Every 10 additional days of prenatal exposure to sand and dust storms was associated with a 0·20 SD (95% CI 0·06 to 0·35, p=0·009) reduction in word test scores, 0·04 (-0·00 to 0·09, p=0·089) additional months to begin speaking in sentences, and 0·14 (0·03 to 0·25, p=0·021) additional months to begin counting, but was not significantly associated with mathematics test scores (reduction of 0·02 SD, -0·19 to 0·15). 10 additional days of prenatal exposure to sand and dust storms in the seventh gestational month was associated with a 0·18 SD (0·10 to 0·25) reduction in mathematics test scores, a 0·34 SD (0·18 to 0·50) reduction in word test scores, an additional 0·33 months (0·07 to 0·59) to begin speaking in sentences, and an additional 0·20 months (0·04 to 0·35) to begin counting. INTERPRETATION: Our results suggest that protecting pregnant women from the effects of sand and dust storms in the critical periods of fetal brain development could generate benefits for the cognitive function of the next generation. FUNDING: None.

China's Silk Road and global health.

In 2013, China proposed its Belt and Road Initiative to promote trade, infrastructure, and commercial associations with 65 countries in Asia, Africa, and Europe. This initiative contains important health components. Simultaneously, China launched an unprecedented overseas intervention against Ebola virus in west Africa, dispatching 1200 workers, including Chinese military personnel. The overseas development assistance provided by China has been increasing by 25% annually, reaching US$7 billion in 2013. Development assistance for health from China has particularly been used to develop infrastructure and provide medical supplies to Africa and Asia. China's contributions to multilateral organisations are increasing but are unlikely to bridge substantial gaps, if any, vacated by other donors; China is creating its own multilateral funds and banks and challenging the existing global architecture. These new investment vehicles are more aligned with the geography and type of support of the Belt and Road Initiative. Our analysis concludes that China's Belt and Road Initiative, Ebola response, development assistance for health, and new investment funds are complementary and reinforcing, with China shaping a unique global engagement impacting powerfully on the contours of global health.

Doctors in China: improving quality through modernisation of residency education.

There is growing recognition that the ultimate success of China's ambitious health reform (enacted in 2009) and higher education reform (1998) depends on well educated health professionals who have the clinical, ethical, and human competencies necessary for the provision of quality services. In this Review, we describe and analyse graduate education of doctors in China by discussing the country's health workforce and their clinical residency education. China has launched a new system called the 5 + 3 (5 year undergraduate and 3 year residency [standardised residency training]), which aims to set national quality standards. To improve understanding for the Chinese model, we present a comparative perspective with systems from the UK and USA. To succeed, the 5 + 3 model will need to overcome major challenges of accreditation and certification, alternative education pathways, and China's unique degree and credentialing system. We conclude by reviewing the challenges of clinical competencies in China, especially the complementarity of specialist training and general practitioner training, which are essential for the quality and equity of China's health-care system.

Identifying the competencies of doctors in China.

BACKGROUND: China adopted a Flexnerian model as its medical institutions developed over the recent past but the political, social, and economic environment has changed significantly since then. This has generated the need for educational reform, which in other countries, has largely been driven by competencies-oriented models such as those developed in Canada, and the United States. Our study sought to establish the competencies model, relevant to China, which will support educational reform efforts. METHODS: Data was collected using a cross-sectional survey of 1776 doctors from seven provinces in China. The surveys were translated and adapted from the Occupational Information Network General Work Activity questionnaire (O*NET-GWA) and Work Style questionnaire (O*NET-WS) developed under the auspices of the US Department of Labor. Exploratory factor analysis and confirmatory factor analysis ascertained the latent dimensions of the questionnaires, as well as the factor structures of the competencies model for the Chinese doctors. RESULTS: In exploratory factor analysis, the questionnaires were able to account for 64.25 % of total variance. All responses had high internal consistency and reliability. In confirmatory factor analysis, the loadings of six constructs were between 0.53 ~ 0.89 and were significant, Construct reliability (CR) were between 0.79 ~ 0.93 respectively. The results showed good convergent validity. The resultant models fit the data well (GFI was 0.92, RMSEA was 0.07) and the six-factor competencies framework for Chinese doctors emerged. CONCLUSIONS: The Chinese doctors' competencies framework includes six elements: (a) technical procedural skills; (b) diagnosis and management; (c) teamwork and administration; (d) communication; (e) professional behavior; and (f) professional values. These findings are relevant to China, consistent with its current situation, and similar to those developed in other countries.

Global health security: the wider lessons from the west African Ebola virus disease epidemic.

The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security--its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? In the context of the governance of global health, including WHO reform, it will be important to distil lessons learned from the Ebola outbreak. The Lancet invited a group of respected global health practitioners to reflect on these lessons, to explore the idea of global health security, and to offer suggestions for next steps. Their contributions describe some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed. Their common goal is a more sustainable and resilient society for human health and wellbeing.

Profesionales de la salud para el nuevo siglo: transformando la educación para fortalecer los sistemas de salud en un mundo interdependiente / Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

Hace 100 años, diversos estudios sobre la educación de los profesionales de la salud dieron lugar a reformas innovadoras. Los nuevos retos del siglo xxiobligan a rediseñar nuevamente la educación profesional en salud. La Comisión sobre la Educación de los Profesionales de la Salud para el Siglo XXI se reunió para desarrollar una visión compartida y una estrategia común para la educación en medicina, enfermería y salud pública. Esta comisión ofrece una visión que llama a una nueva era de la educación profesional que promueva un aprendizaje transformativo y domine el poder que genera la interdependencia en la educación. Así como las reformas de principios del Siglo XX se apoyaron en la teoría microbiana de la enfermedad y las ciencias médicas modernas, esta comisión cree que el futuro será moldeado por la adaptación de competencias a contextos específicos basándose en el poder de los flujos globales de información y conocimiento. Materializar esta visión requerirá de reformas en la instrucción y el desarrollo institucional, guiadas por los dos resultados que se persiguen: el aprendizaje transformativo y la interdependencia en la educación. Sobre la base de estas nociones esenciales, la comisión ofrece diez recomendaciones específicas. La puesta en práctica de estas reformas requerirá de acciones que faciliten su implantación, entre las que destacan la movilización del liderazgo, la expansión de la inversión en educación profesional en salud, el alineamiento de los procesos de acreditación y el fortalecimiento del aprendizaje global. La implantación de estas recomendaciones deberá contar asimismo con el impulso de un movimiento global que involucre a todos los actores como parte de un esfuerzo concertado para fortalecer los sistemas de salud

100 years ago, a series of studies about the education of health professionals sparked groundbreaking reforms. The challenges of the 21st century demand a new redesign of professional health education. The Commission on Education of Health Professionals for the 21st Century came together to develop a shared vision and a common strategy for postsecondary education in medicine, nursing, and public health. The Commission provides a vision that calls for a new era of professional education that advances transformative learning and harnesses the power of interdependence in education. Just as reforms in the early 20th century were advanced by the germ theory and the establishment of the modern medical sciences, so too the Commission believes that the future will be shaped by adaptation of competencies to specific contexts drawing on the power of global flows of information and knowledge. Undertaking of this vision requires a series of instructional and institutional reforms, which are guided by the two expected outcomes, transformative learning and interdependence in education. On the basis of these core notions, the Commission offers 10 specific recommendations. The implementation of these recommendations require a series of enabling actions, including the mobilization of leadership, the enhancement of investments in health education, the alignment of the accreditation processes, and the strengthening of global learning. These recommendations also demand the support of a global movement engaging all stakeholders as part of a concerted effort to strengthen health systems

China's distinctive engagement in global health.

China has made rapid progress in four key domains of global health. China's health aid deploys medical teams, constructs facilities, donates drugs and equipment, trains personnel, and supports malaria control mainly in Africa and Asia. Prompted by the severe acute respiratory syndrome (SARS) outbreak in 2003, China has prioritised the control of cross-border transmission of infectious diseases and other health-related risks. In governance, China has joined UN and related international bodies and has begun to contribute to pooled multilateral funds. China is both a knowledge producer and sharer, offering lessons based on its health accomplishments, traditional Chinese medicine, and research and development investment in drug discovery. Global health capacity is being developed in medical universities in China, which also train foreign medical students. China's approach to global health is distinctive; different from other countries; and based on its unique history, comparative strength, and policies driven by several governmental ministries. The scope and depth of China's global engagement are likely to grow and reshape the contours of global health.

Transformation of the education of health professionals in China: progress and challenges.

In this Review we examine the progress and challenges of China's ambitious 1998 reform of the world's largest health professional educational system. The reforms merged training institutions into universities and greatly expanded enrolment of health professionals. Positive achievements include an increase in the number of graduates to address human resources shortages, acceleration of production of diploma nurses to correct skill-mix imbalance, and priority for general practitioner training, especially of rural primary care workers. These developments have been accompanied by concerns: rapid expansion of the number of students without commensurate faculty strengthening, worries about dilution effect on quality, outdated curricular content, and ethical professionalism challenged by narrow technical training and growing admissions of students who did not express medicine as their first career choice. In this Review we underscore the importance of rebalance of the roles of health sciences institutions and government in educational policies and implementation. The imperative for reform is shown by a looming crisis of violence against health workers hypothesised as a result of many factors including deficient educational preparation and harmful profit-driven clinical practices.