Witnessing the globalisation of medical education first‐hand

I, Kevin W Eva, couldn’t sleep. Only those of you who know me personally will know just how startling a sentence that is. I am the guy many travellers love to hate as I usually don’t worry about how I’ll cope with travelling long hours or crossing many time zones. Give me a seat in a sardine can of a turbulent plane or a bed in a noisy part of the city, allow me to close my eyes, and the amount of time it takes me to fall asleep can usually be counted in seconds. I consider it my one and only superpower. Yet here I am, sitting up in bed at 4.00 am in Islamabad, Pakistan without so much as a cricket’s chirp to blame for my restlessness. I’ve slept no more than 10 of the past 80 hours, but I still can’t seem to drift into slumber. I’m not a poet, a journalist, nor a philosopher, so I probably won’t be able to adequately capture the feelings that have my mind racing. Nor do I anticipate that the thoughts I’m going to express in this editorial will be considered particularly novel by the journal’s readership. In fact, I’m dreadfully worried about turning this editorial into a ‘tired’ cliché, but I hope you’ll allow me an editor’s prerogative to use this space on occasion to simply share a personal experience that I consider relevant to the Medical Education community. I was brought to Pakistan by my good friend and colleague Ara Tekian, Associate Professor, and Director of International Affairs for the Department of Medical Education at the University of Illinois at Chicago. Ara has been working over the past year with Professor Dr Umar Ali Khan, Associate Dean of the Riphah Academy of Research and Education at Riphah International University, to create a new International Conference on Medical Education. Today I heard Ara variously described by Umar and his colleagues as a pacemaker, a prod and a rope as he has played a major role in making this conference a reality while proving yet again that his personal reputation for being tireless is well deserved. It is clear, though, that the entire team here, including the administration, staff, students, government and the Pakistani Medical and Dental Council are equally dedicated to making this conference a success that will live beyond this first meeting. I can imagine many readers at this point thinking, ‘Yet another conference, you say?’ and drifting off to sleep themselves, but this one is different, not necessarily for its content or format, but for what it represents. We live in a world plagued by strife, a fact that is as apparent here as anywhere. At dinner tonight my colleagues (Ara, John Norcini from the Foundation for the Advancement of International Medical Education Research, and Brownie Anderson from the Association of American Medical Colleges) and I were repeatedly praised for the courage we showed in coming to this meeting. Attending and speaking at a conference like this is one of the last things I would consider courageous, but I do have to admit that the numerous people who doubted the wisdom of travelling to this part of the world at this point in history (myself included) and the vast number of vehicle barriers, armed guards, bomb checks and metal detectors we’ve encountered around the city make it clear that this is not a normal trip. I’m a sceptic, both by nature and by training. So, although I would never understate the very real conflict that’s gripping the region in and around Pakistan [which seems to have worsened since this editorial was written], I do think a degree of scepticism about the images portrayed in the media is healthy. Living near Toronto during the 2003 SARS outbreak allowed me to see first hand how different newsworthy stories can be from day-to-day life. The media cannot be blamed for that (at least, not all the time) as it’s their job to report on unusual happenings, but we can be blamed for forgetting that the images that typically make the news are by definition counter to the norm. The irony in this instance is that when we arrived in Pakistan we were bombarded by various media pundits covering the conference, all of whom wanted to know why we had come to Pakistan, what the conference would be able to achieve, and how the medical educators in the various countries represented could so easily overlook potential ideological or political barriers to share knowledge and ideas. As is his wont, John was most eloquent in answering such questions by pointing out that health professional education may be the ideal context within which to find common ground as, at a fundamental level, all societies strive for better health and that an obvious way to do that is to seek better selection, training and assessment strategies for those who provide health care. Throughout the 2-day meeting and pre-conference workshops, it became clear that many more similarities than differences exist between the issues facing Pakistani medical educators and those that challenge their international colleagues. Naturally, the order of priority is variable and we do need to guard against the dangers of globalising medical education,1 but at its root we all seem to be working toward the same goals, many of which arise from the same frustrations. Although I have been fortunate to attend many international meetings around the globe, my experience in Pakistan gave me a stronger appreciation of why medical education and medical education research have become so global in scope. Being a relatively small field that depends to a large extent on enthusiasm, dedication and innovation, it is essential that we prioritise co-operation and collegiality over and above competition. There is too little to be gained and too much to be lost by building walls between our countries, our institutions, or the various disciplines and professions working to improve health care through education. In 2007 this journal received submissions from 61 countries and it is my hope that this figure will continue to grow as more groups like the medical educators in Pakistan mobilise to strengthen the efforts of the entire country and, by doing so, strengthen medical education around the globe. The timing for doing so could not be better as there are so many new and exciting initiatives in medical education underway worldwide. In this issue alone, no less than four articles speak of issues of direct relevance to the global nature of medical education, highlighting challenges of communication,2, 3 the availability of resources,4 and the universality of issues such as abuse and harassment.5 To nurture and promote further efforts in sharing ideas, challenges and solutions globally, Medical Education has recently partnered with conferences in North America (the Canadian Conference for Medical Education), Europe (the Association for the Study of Medical Education) and Asia (the Asia Pacific Medical Education Conference) to enable the lessons learned through the work of medical educators to be disseminated more readily at a global level. Those who are not fortunate enough to attend each conference can, as of 2009, read the proceedings of those meetings in online supplements produced by our journal by visiting http://www.mededuc.com. One of the more exciting announcements made during the Pakistani conference I attended was that the Pakistani Medical and Dental Council will now begin to recognise medical education as a medical specialty, immediately raising the profile of medical educators and providing further incentive for them to engage in a deep level of scholarship. Less than 24 hours after that announcement was made, I sit here in my hotel room personally excited by the opportunity to witness and support such awakenings to the value of medical education and medical education research. And, with a timing that could not be more fitting, my alarm has just come on, indicating that it is now time for me to ‘wake up’ and go and enjoy another day of friendship and learning with and from our international colleagues.

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