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Education And Debate

Continuing medical education: Changes in health care and continuing medical education for the 21st century

BMJ 1998; 316 doi: (Published 24 January 1998) Cite this as: BMJ 1998;316:301
  1. Angela Towle, visiting professor (

    Series editors: Hans Holm and Tessa Richards

  1. a Division of Educational Support and Development, University of British Columbia, Vancouver, BC, Canada V6T 1Z3

    Major trends in health care

    A revolution in health care is occurring as a result of changes in the practice of medicine and in society. These include changing demographics and the pattern of disease; new technologies; changes in health care delivery; increasing consumerism; patient empowerment and autonomy; an emphasis on effectiveness and efficiency; and changing professional roles. These are the challenges which will face the medical profession in the 21st century and to which continuing medical education must respond.

    Demographics and the pattern of disease

    In 20 years' time the proportion of most rich countries' populations aged 65 and over will have doubled to around 20-25%. Old people today consume about a third of total health care spending; if present trends continue, by the year 2000 they will be consuming half.1 The consequences will be a shift in the need for preventive and curative health care in the direction of the chronic health problems of older people and a large increase in demand for care of very frail or ill dependent elderly patients. There will be even greater pressures to cap spiralling healthcare costs.

    Summary points

    The education system must be better able to respond to rapid changes in the outside world and involve employers and users of health services

    The culture of the education system, now largely shaped by performance in examinations and emphasis on factual content, must be changed to one which values self directed learners and problem solvers

    There is a need to improve the effectiveness of continuing medical education, such as developing better programmes on doctor-patient communication and interprofessional continuing education

    No major changes in overall patterns of morbidity are expected, but some health problems will increase. Health loss areas will include the widening of social class disparities, increasing alcohol consumption and drug addiction, and increasing numbers of cases of senile …

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