Enhancing the health workforce will be critical to
transforming health services delivery to better respond to the changing
needs and realities of the 21st century. This article describes new
methods and approaches for facilitating interprofessional education
and training during initial, graduate and continuous professional
education and training of health professionals in Malta. By embracing
the principles of transformative education and training, Malta is
moving towards breaking down boundaries across levels of care and
settings, thereby developing a health workforce that is fit-for-purpose
to address contemporary health challenges.peer-reviewe

Cordina, Maria

OAR@UM

Enhancing the health workforceEurohealth — Vol.22 | No.2 | 201634TRANSFORMING HEALTH PROFESSIONAL EDUCATION AND TRAINING IN MALTABy: Maria CordinaSummary: Enhancing the health workforce will be critical to transforming health services delivery to better respond to the changing needs and realities of the 21st century. This article describes new methods and approaches for facilitating interprofessional education and training during initial, graduate and continuous professional education and training of health professionals in Malta. By embracing the principles of transformative education and training, Malta is moving towards breaking down boundaries across levels of care and settings, thereby developing a health workforce that is fit-for-purpose to address contemporary health challenges.Keywords: Education, Training, Cooperation, Collaboration, Multidisciplinary Teams, People-centredMaria Cordina is Associate Professor in the Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Malta.  Email: maria.cordina@um.edu.mtIntroductionThe health needs and priorities of the 21st century for the World Health Organization (WHO) European Region, documented in Health 2020, aim to ‘significantly improve the health and well-being of populations, reduce inequalities strengthen public health and ensure people-centred health systems that are universal, equitable, sustainable and of high quality’. 1  The European Region has placed non-communicable diseases, chronic conditions, multi-morbidity and other conditions requiring long-term management at the top of its European health policy agenda. 2  Successful management leading to positive patient outcomes of these conditions will require coordinated and integrated inputs across disciplines throughout the individual’s life course rather than through episodic management and isolated services. This also calls for more active participation of the individuals, their families, and communities affected. A health workforce that is focused on facilitating this will be fundamental to improving health outcomes. Transformative models of education and training for the health workforce will be key to achieving these goals. 2  This is by no means a trivial task. It demands dramatic shifts in mind-set both among clinicians and academics. Over the past ten years, leaders in Malta have been embracing transformative education and training in several areas, including the area of safe and effective use of medicines.Transformative education and trainingThe goal of transformative education and training is to foster greater alignment between educational and training institutions and health services. 3  These goals are also important in securing Enhancing the health workforceEurohealth — Vol.22 | No.2 | 201635the pursuit of Universal Health Coverage (UHC) and were endorsed by Member States in Resolution WHA66.23 Transforming Health Workforce Education in Support of Universal Health Coverage. In response to the Resolution, WHO has convened a technical working group on Health Workforce Education and Assessment Tools ‘to enable countries to identify and measure their progress towards developing a transformative approach to health workforce education that will promote and support universal health coverage’. 4 The WHO Regional Office for Europe’s own Expert Group on Health Professionals’ Education and Training also recognised that education and training institutions are often disconnected from the needs of health services, especially when faculty is mainly composed of development of academics theoretically oriented academics with minimal exposure to practice. The working group has discussed development programmes of academics, addressing the evolving health care needs, utilizing a variety of approaches to support the selection of the most suitable methods of health professional education and training. 5  These methods aim to lessen the ‘theory-practice gap’  3  by engaging experienced clinicians from hospitals and primary care who possess the necessary skills to teach in initial education and training institutions and contribute to continuing education and training.Bridging the gaps at the University of MaltaThe University of Malta is the highest publicly funded health professional education and training institution in Malta. While the university is overseen by the Ministry of Education, that ministry shares close ties with the Ministry of Health and supports the Ministry of Health’s goals and objectives: to provide education and training that is relevant to population health needs. The university has applied guidance produced by the above-mentioned steering groups.For example, at the University of Malta the vast number of academics involved in teaching in the Faculties of Medicine and Surgery, Dentistry and Health Sciences are also practitioners in Malta’s state teaching hospitals. The experience and insights they possess help to ensure that health professional education and training is up to date and delivered by academics who are skilful and aware of the most current needs of health services and the patients and populations they serve. A number of these academics are also involved in professional organizations and unions. In Malta, these teachers have been instrumental in introducing modifications and new methods of teaching to better overcome barriers and obstacles faced by services. This places them in a strategic position to promote necessary changes to education and training, but also to services.Interprofessional education and trainingOne means of transforming health professional education and training is through the introduction of interprofessional education and training in both undergraduate and post graduate programmes. 3  Interprofessional education and training and collaborative practice can help to address fragmentation of health care services and the unmet needs of the system. 6  Interprofessonal education and training however, can also be quite challenging. A significant amount of coordination between academics and programme developers from different professions/disciplines is necessary to implement it. 3  All academics must be convinced of the need to implement such programmes and must then invest a lot of time in re-designing curricula which can effectively promote teamwork and team learning.Safe and effective use of medicinesThe Department of Clinical Pharmacology and Therapeutics oversees all teaching related to pharmacology and therapeutics for health professional students at the University of Malta. A core group of people in the Department is responsible for coordinating, overseeing and participating in the teaching of all courses. Teaching is provided by clinical pharmacologists, specialised practicing medics and practicing clinical pharmacists and is based on current recommendations. 7   8   9   10  This facilitates the introduction of the same key and general concepts related to safe and effective use of medicines for all health professional students. While all health professional students receive education and training on this topic, traditionally the focus of this education and training has varied depending on the group of students, e.g. medical students tend to focus on prescribing issues, pharmacy students on dispensing and identifying errors, and nursing students focus on administration. This led to a situation where the individual health professions are not able to fully appreciate the entire medicines use process and the contributions of different professions to the process.‘‘ methods that foster more interprofessional learningSince 2010, the Department of Clinical Pharmacology introduced new methods that foster more interprofessional learning. This approach allows all health professional students to continue receiving uniform and consistent knowledge about the safe and effective use of medicines while also allowing them to gain a better appreciation of the entire medicines use process, to identify their place in the process, and to realise how their practice can contribute positively and negatively to the safe and effective use of medicines. Students also get the chance to learn, reflect and improve their skills and work in teams well before entering practice, thereby accelerating their ability to work in teams once they have graduated. It also promotes the use of a common language which enhances effective communication between different professions.The topics addressed are discussed in the context of practice, through both lectures and tutorials, using examples and cases from teaching hospitals and Enhancing the health workforceEurohealth — Vol.22 | No.2 | 201636the community. At times the classes are multidisciplinary and at times, due to logistical restraints, they are taught by discipline. Even when taught to a single discipline of students, discussions on the contribution of other professions to the medicines use process are prioritized. Explicit efforts are made to also give students hands on training in clinical settings, both in hospitals and the community where they will eventually work. The department has received positive feedback, both from the students following the courses as well as from the different faculties. The environment created has been deemed very constructive and the curriculum has been made dynamic through the interactions of experts from various disciplines, academics and students.The Department also offers a Master’s course in Clinical Pharmacology. Individuals from different professions are encouraged to enrol, which provides a very healthy environment for the exchange of ideas and methods for increased collaboration. These individuals then proceed to act as key leaders in their own professions to champion and disseminate the principles of interprofessional work for the safe and effective use of medicines.Student engagement and participationThe university also actively encourages student driven activities that can serve to promote interprofessional learning. Student groups are encouraged to collaborate across disciplines in integrated public health activities as a means for better understanding of each other’s contribution to various conditions. In Malta, health professional student organizations are very active and regularly collaborate in a number of initiatives as well as organize joint educational seminars. For example, recently student health care associations organised a conference entitled, The Multidisciplinary Approach to Health Care, with the aim of promoting communication and teamwork between all health care professionals. 11  The Maltese health care student associations also hosted the first World Medicine and Pharmacy Students Joint symposium. 12  Here again, they learn from an early stage how to engage with each other and appreciate the health-related needs of the community. This effort has been an important means of better positioning students – future clinicians – to understand the meaning of, and contribute to, a people-centred health system.‘‘ instill a culture of engaging in CPD in studentsContinuing professional developmentA fit-for-purpose workforce also needs to be continuously updated with information on emerging new evidence-based practice, innovative technological approaches, knowledge regarding new treatment modalities and various skills. Continuing professional development (CPD), like university-based education and training, can benefit from transformative education and training principles. In Malta, CPD for health care professionals is not mandatory nor is it linked to licensing. It is the individual professional associations, such as the Malta College of Pharmacy Practice, the Malta College of Family Doctors, the Malta Association of Hospital Pharmacists to mention a few, who have undertaken initiatives to provide CPD to their members. In the absence of a national accrediting body, the associations are self-accrediting. Meetings are national and are held in various locations, such as the University of Malta, the main public acute hospital, and various private locations.It is important to instil culture of engaging in CPD in students while they are still studying at the undergraduate level. This can increase the probability that they will identify with, master and engage in desirable practices. Various methods of CPD are in use in Malta. Most importantly, what is offered should be responsive to the current and changing health challenges faced by clinicians;  3  for example, the management of a number of chronic diseases, such as diabetes, cardiovascular disease, and dealing with obesity, all of which are highly prevalent in Malta. These are approached from different angles and would include academic updates and practical information, such as efficient ways to access patient services and collaborating with different disciplines to achieve the best possible patient outcomes. Methods of decreasing the burden on the system and the patient are also usually highly debated.Towards this end, various professional organizations organise CPD for their professions. It is not unusual for CPD sessions to be organized jointly by various associations. CPD sessions organized by all professional organizations are sometimes open to undergraduate health professional students, as a means of introducing them to the concept of CPD. In addition, professional associations habitually invite members from other professions to address their educational sessions. For example, the Malta College of Pharmacy Practice regularly invites medical doctors who have specialized in relevant fields to address management of respiratory, cardiovascular and endocrine conditions; nutritionists to address obesity and provide updates on healthy eating practices; and psychiatrists and psychologists to address management of mental health. 13  CPD is offered in the form of in-service training, interactive workshops, seminars, and as a series of talks. Therefore, there has been a very interesting and diverse mix of approaches and methods to give health professionals the opportunity to reflect and improve their team practice.ConclusionDue to the varying structures that exist in different countries, there is no single solution to effectively train undergraduate and postgraduate students to practice efficiently as a team. Multiple modalities need to be used to produce a health workforce that is flexible, multi-skilled, and team-oriented. Academics from different disciplines could shift from the comfort of their traditional approach to education and training and break down barriers between different professions. Collaborations between academics from the different disciplines has been key to drawing on the strengths, identify gaps, Enhancing the health workforceEurohealth — Vol.22 | No.2 | 201637and together build effective programmes to deliver a health workforce that is fit-for-purpose to successfully transform health services and respond to the demanding needs to the 21st century.References 1  Health 2020: a European policy framework supporting action across government and society for health and well-being. Copenhagen: WHO Regional Office for Europe, 2013. Available at: http://www.euro.who.int/en/publications/abstracts/health-2020-a-european-policy-framework-supporting-action-across-government-and-society-for-health-and-well-being 2  Priorities for health systems strengthening in WHO European Region 2015 – 2020: walking the talk on people centeredness. Copenhagen: WHO Regional Office for Europe, 2015. Available at: http://www.euro.who.int/__data/assets/pdf_file/0003/282963/65wd13e_HealthSystemsStrengthening_150494.pdf?ua=1 3  Transforming and scaling up health professionals’ education and training. World Health Organization Guidelines 2013. Geneva: WHO, 2013. Available at: http://whoeducationguidelines.org/sites/default/files/uploads/WHO_EduGuidelines_20131202_web.pdf 4  Development of a WHO evaluation toolkit for health workforce education. Available at: http://www.who.int/hrh/education/dev_who_toolkit_eval/en/ 5  Steinert Y. Staff development. In Dent J, Harden R (eds.) A practical Guide for medical teachers. Oxford: Elsevier Ltd, 2009:391-7. 6  The Framework for Inter professional Education and Collaborative Practice. Health Professions Network Nursing and Midwifery offices within the Department of Human Resources for Health. Geneva: WHO, 2010. Available at: http://www.who.int/hrh/nursing_midwifery/en/ 7  Patient Safety Curriculum Guide: Multi-professional Edition. Geneva: WHO, 2011. Available at: http://www.who.int/patientsafety/education/curriculum/en/ 8  Frank J, Brien S. The Safety Competencies: Enhancing Patient Safety Across the Health Professions. Toronto: Canadian Patient Safety Institute, 2009. Available at: http://www.patientsafetyinstitute.ca/en/toolsResources/safetyCompetencies/Documents/Safety%20Competencies.pdf 9  Clinical Pharmacology in Health Care, Teaching and Research. World Health Organization, International Union of Clinical and Basic Pharmacology, Council for International Organization for Medical Sciences. Geneva: WHO, 2012. Available at: http://www.who.int/medicines/areas/quality_safety/safety_efficacy/OMS-CIOMS-Report-20120913v4.pdf 10  Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug- related problems their structure and function. Annals of Pharmacotherapy 1990;24:1093-7. 11  Students promote multidisciplinary view of health care. The Times of Malta, 8 December 2013. Available at: http://www.timesofmalta.com/articles/view/20131208/education/Students-promote-multidisciplinary-view-of-healthcare.498080 12  Health profession students join forces. The Times of Malta, 23 October 2005, Available at: http://www.timesofmalta.com/articles/view/20051023/education/health-professions-students-join-forces.74301 13  The Malta College of Pharmacy Practice. Activities. Available at: http://www.mcppnet.org/activitiesmain.htmNCD	country	assessments: Challenges and opportunities for health systemsAvailable at: http://www.euro.who.int/en/health-topics/Health-systems/health-systems-response-to-ncds

Transforming health professional education and training in Malta

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Transforming health professional education and training in Malta

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