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The modern firm

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l4173 (Published 13 June 2019) Cite this as: BMJ 2019;365:l4173

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THE NHS HEALTH WORKFORCE CRISIS AND THE MODERN FIRM: CONSIDERING AN ADDITIONAL ROLE FOR ‘MEDICAL SOCIOECONOSOPHY’ IN BASIC MEDICAL EDUCATION CURRICULUM IMPROVEMENT

The ‘NHS Health Workforce Crisis’ with 8% Posts vacant is daunting [1] and inimical to WHO GPW13 ‘1 Billion more people benefitting from the UHC’ and the capacity to build the ‘Critical Mass’ of ‘Strong Health Workforce Working in Teams’ [2]! Global ‘Health Workforce Shortage’ is about 18 million resulting from: failure to train-retain enough Home-trained Staff, inadequate recruitment of Foreign-trained Staff, Staff departure-Early retirements, stressful Rosters/ Overwork, Pension issues, Low morale, etc [1]. ‘The Modern Firm Approach’ is ventilated and suggested to assure a better deal for ‘Health Workforce’ with focus on ‘Attracting, Training, Supporting and Retaining Workforce’. The proposed ‘Modern Firm’ Strategy to solve the ‘Global Health Workforce Crisis’ is laudable but other possibilities need to be explored as other perspectives have been exposed and include ‘Training Issues’: Poor Trainee-Supervisor Relationships, Training Products as ‘Autodidacts’ with too much ‘Self-reliance’ and less ‘Team Work-compliant Formation’; Also less ‘Patient-Doctor Relationships’ with too much reliance on ‘Tele-Medicine’ and ‘Tele-Consultation’.

The ‘Autodidacts’ from ‘Medical Education’ are certainly not formed for complementing the GPW13 ‘Strong Health Workforce Working in Teams’! The training of ‘Medical Doctors’ needs to amplify ‘Fitness-for-Purpose’ and ‘Goodness-of-Fit’ for the GPW13 in relation to the UHC. Attention should shift to ‘Medical Education Improvement (MEI)’. The ‘Arrowhead’ of the imperative for MEI is the ‘Landmark 1910 Flexner Report’ [3] which, in a very detailed and systematic manner, presented gross, diverse and wide-ranging deficiencies in ‘Medical Schools’ and their ‘Basic Medical Education Curriculum (BMEC)’ in USA and Canada! There were ‘Deficiency Issues’ with the Institutions, Categories, Curriculum, Faculty, Training Models, Structure/ Infrastructure, Regulatory Authority, Assessment/ Certification etc! The ‘Flexner Report-denominated Interventions’ did not significantly improve the very bad situation as reflected in the ‘Centenary Post-Flexner Report Audit’ [4]! Several other Reports identified marked deficiencies in the UK and Australia [5-8]!

Another ‘Analytical Treatise’ also identified persistently pervading deficiency of reasonable inclusion of ‘Non-Medical Academic Disciplines (NMADs)’ in the BMEC of the Medical Schools [9]. Our ‘Preliminary Observations’ in the University of Benin/ Teaching Hospital in Nigeria concerning NMADs was very revealing: Most Medical Doctors could hardly list more than seven NMADs relevant to BMEC (Eregie and Osarogiagbon 2013, Unpublished Data)! A ‘Visionary Strategy’ for MEI was, therefore, the inclusion of the relevant aspects of NMADs in BMEC. This amplifies the critical importance of ‘Interdisciplinarity’ to undergird the ‘Robust Formation’ of Medical Doctors who will be ‘Fit-for-Purpose’, demonstrate the desired ‘Goodness-of-Fit’ and be ‘Teamwork-compliant’! The value of ‘Interdisciplinarity’ in ‘Professional Formation’ has been amply distilled [10]! It is, in fact, consistent with the ‘SPICES’ and ‘PRISMS’ Models of BMEC for Medical Training in Medical Schools [11,12].

In 2013, at the Session on Health, Aging, Nutrition and Nursing of the Oxford Round Table, I made a ‘Twin Presentation’ on ‘Innovative Improvement Interventions’ on ‘Eregie Performance Gap Index (e-PGI)’ as a ‘Development Ranking Tool (DRT)’ and ‘Medical Socioeconosophy (MSE)’ for ‘Medical Education Improvement (MEI)’. The e-PGI was developed as a ‘Computed Multi-Domain Development Ranking Tool’ based on ‘Resource Utilization’ for ‘Sustainable Development’ and consists of 8 Governance-related Domains with 21 Indicators [13]. The 8 Domains are: Resource Endowment and Generation (REG), Leadership (BILBI: Bad Insensitive Leadership with Budgetary Indiscipline), Followership (FRCE: Followership with Responsible Constitutional Expectation), Corruption Level (C), Electoral Credibility (K), Mortality Metrics for Women and Children (M), Inequalities (Q) and Sustainability (S) [13]. The e-PGI was developed by the Author of this ‘Contribution’, a Professor of Child Health and Neonatology and Consultant Paediatrician and Neonatologist, an outcome of ‘Self-directed Capacity-building’ with exposure to, and benefit from, ‘Interdisciplinarity’ and hence the impetus for MSE in MEI!

‘Medical Socioeconosophy (MSE)’ was developed as a ‘New Study Area in Medical Education with the inclusion of relevant aspects of NMADs in BMEC’. It meets the ‘Critical Prescriptions’ of the Carnegie Foundation for the Advancement of Teaching (CFAT): Solution to a ‘High-Leverage Problem’, Initiator-Innovator-Integrator, Engaging-Effective-Efficient, Texts-Tasks-Tests, Alpha-Beta-Gamma Implementation Phases and Activity-Individual-Organizational Level Outcomes’ [14]! It is consistent with ‘Interdisciplinarity’ and the ‘PRISMS Model’ of BMEC. MSE is to be taught by NMADs-Experts as a ‘Single Multi-Discipline Package with defined number of NMADs’ over many years in the BMEC [10]. Just as General Studies Education (GSE) assures University Undergraduate Education produces broadly-informed ‘Graduates’, so also the MSE facilitates the formation of well-exposed and well-informed ‘Medical Doctors’ that will be ‘Fit-for-Purpose’ and ‘Teamwork-compliant’! Such ‘Medical Doctors’ will also be able to cope with discharging ‘Non-Medical Challenges/ Responsibilities’ in a ‘Globalized Borderless World’: ‘Working with People and Professionals without Borders’ and ‘Thinking Outside the Box’! Immediate Past Director-General World Bank Dr Jim Yong Kim is a Medical Doctor as is Syrian President Bashar al-Assad!

The Backronym ‘PRICE’ captures the ‘Groups of NMADs’, in addition to ‘Socioeconomics Plus’, included in MSE and ‘Plus’ addresses ‘Other NMADs’. Some Teasers: P for Professionalism, Politics, Practice, Policy, Principles, Population, Planning, Partnerships, Philosophy, Pedagogy; R: Regulation, Research, Retirement, Reforms, Resources, Religion, Risks Issues, Rights, Rule of Law; I: Interdisciplinarity, Infrastructure, Innovations, Interventions, Investments, Insurance, Immigration, Institutions, Impact; C: Curriculum, Communication, Corruption, Crisis-Conflict, Constitutionality, Collaboration, Conflict of Interest, Culture, Counselling, Career, Cost of Care; E: Evolution, Education, Engineering-Technology, Employment, Empowerment, Ethics, Environment, Entrepreneurship-Ecopreneurship, Evaluation. ‘Plus’ includes: Government, Governance, Human Capital, Management, Leadership-Followership, Migration, Globalization, Travels, Sports, Space Science, Sexuality, Diversity, Sustainable Development, ‘OMICS Technology’, Nanotechnology, etc! MSE is, therefore, the ‘Study of ‘Socioeconomics Plus’ in BMEC’ where ‘Plus’ is ‘PRICE Plus’ and hence MSE is ‘’PRICE Plus’ of Medicine’!

The ‘Modern Firm’ Intervention is proposed for the ‘NHS Health Workforce Crisis’ [1]! This can be complemented with MEI with the inclusion of MSE in BMEC in Medical Schools. Addressing the ‘Robust Complete Formation’ of Medical Doctors has the ‘Twin Benefits’ of:

i. Assuring an increasing ‘Pool of Teamwork-compliant Medical Doctors’ for UHC
ii. Assuring an increasing ‘Pool of Code- and IYCF-compliant Medical Doctors’ with ‘Robust Personality Formation’ who can diagnose and avoid the ‘POTENTIALITY’ of the ‘COIs Monstrosity’ inherent in ‘Health Professionals-Industry Funding’ and such ‘Relationships’ [15].
The ‘Landmark 1910 Flexner Report’ [3] and the ‘Centenary Post-Flexner Report 2010 Audit’ [4] are instructive in directing our attention to the imperative of MEI; This ‘Contribution’ proposes MSE as an ‘Improvement Intervention’ in BMEC!

REFERENCES
1. Godlee F. The Modern Firm. BMJ 2019; 365:l4173
2. Eregie C.O. The 13th General Programme of Work (GPW13) of World Health Organization; The WHO Director-General Keynote Speech to the 72nd WHA: A Missing Major Programmatic Matter. https://www.bmj.com/content/365/bmj.l4173/rr-1 of 18th June 2019
3. Flexner A. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. New York City. 1910
4. Cooke M, Irby D.M., O’Brien B.C. A Summary of Educating Physicians: A Call for Reform of Medical School and Residency. 2010
5. Worley P et al. Emperical evidence for symbiotic medical education: a comparative analysis of community and tertiary programs. Medical Education 2000; 40:109-116
6. Illing J et al. How prepared are medical graduates to begin practice? A comparison of three UK medical schools, final summary and conclusions for the GMC Education Committee 2008; http//gmc-uk.org/about/research/REPORT
7. General Medical Council (UK). Undergraduate medical education: reports from schools and publications. London: General Medical Council, 2009
8. McKimm J. Current Trends in Undergraduate Medical Education: Program and Curriculum Design. Education and Training 2010
9. Wikipedia. Medical Schools. Wikipedia.com, Wikipedia, the free encyclopedia.htm. 2012
10. Wikipedia. Interdisciplinarity. Wikipedia.com, Wikipedia, the free encyclopedia.htm. 2012
11. Harden R.M, Sowden S, Dunn W.R. Educational Stratefies in Curriculum Development: The SPICES Model. Medical Education 1984; 18:284-297
12. Bligh J, Prideaux D, Parsell G. PRISMS: New Educational Strategies for Medical Education. Medical Education 2001; 35:520-521
13. Eregie C.O. Eregie Performance Gap Index (e-PGI): An Innovative Computed Multi-Domain Tool for Development Ranking of Nations based on Resource Utilization for Sustainable Development. Forum on Public Policy 2014; http//forumonpublicpolicy.com/Vol2014no1Health/Eregie.pdf
14. Carnegie Brochure. A Networked Organization Learning through Doing. Carnegie Foundation for the Advancement of Teaching. 2011
15. Eregie C.O. More Talk on the ‘Health Professional Associations-Industry Conversation’; Conflicts of Interest are better avoided: A Proactive Role for ‘Medical Socioeconosophy’. https://www.bmj.com/content/365/bmj.l2093/rr-3 of 22nd May 2019

Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria,
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria,
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.

Competing interests: No competing interests

26 June 2019
CHARLES OSAYANDE EREGIE
MEDICAL DOCTOR
Professor of Child Health and Neonatology, University of Benin and Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria. Also, UNICEF-Trained BFHI Master Trainer and ICDC-Trained in Code Implementaion. Also a Technical Expert/ Consultant on FMOH-UNICEF-NAFDAC Project on Code Implementation in Nigeria
Institute of Child Health, University of Benin, PMB 1154, Benin City, Nigeria