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The question is, why should we aspire for excellence 
in HPE? Are the current standards of medical 
education not par excellence? What is excellence in 
medical education? To understand this, we need to 
understand the historical narrative of health 
professions education.
Flexner presented a report in 1905 which brought a 

1
major change in the delivery of medical education.  
Before Flexner, teaching and learning were 
d e c e n t r a l i z e d .  L e a r n i n g  w a s  b a s e d  o n  
apprenticeship. Flexner report brought the 
centralized system of teaching in universities and 
hospitals. It promoted a system which was teacher 
centred, emphasized factual knowledge, autonomy 
of the disciplines and hospital based teaching. This 
a p p r o a c h  w a s  c h a l l e n g e d ,  w h e n  m e d i c a l  
educationists presented new theories and strategies 
of learning. Benjamin Bloom presented the 

2 3
taxonomy of cognition  and attitude and Dave  gave 
the taxonomy of psychomotor skills. In early 1986 
Harden published the SPICES model of learning 

4
strategy  which was in total contrast to the teacher 
oriented strategy. In the 80's, Burrows presented the 
idea of problem based learning.Newer teaching 
methods, assessment tools and instruments have 
since been devised. Newer curricula have emerged.  
Problem based learning, competency based 
curriculum, OSCE, OSLER, OSTE, miniCEx , DOPS, CBL, 
CBD; the list is very exhaustive. 
There is a tremendous change occurring in medical 
education globally. Geographic distribution of many 
diseases is changing. There have been dramatic 
shifts in the health care delivery and healthcare 

5
professionals are more accountable now.  The 
effects of this global change are evident in the 
national scenario as well. There is a need to produce 
health professionals that provide better care to 

patients.This has led to rapid increase in the 
educational institutions for health professionals, and 
hence for the curricular changes and adoption of 
newer teaching learning methodologies to equip the 
graduates with desirable outcomes.
Medical education is an on-going process which 
must adapt to the profession's changing dynamics 
with respect to technology, patient needs, and 
service-delivery. To produce medical graduates that 
provide excellent health care, we need defined 
standards of excellence in delivery of medical 
education to these professionals. This needs change 
in curriculum, in assessment methodology and 
r e q u i r e s  i n t e n s i v e  f a c u l t y  d e v e l o p m e n t .  
Implementing these changes is an uphill task. 
Change management is a science. In case of health 
professionals, it requires changing the mind-set and 
training them in these new methods and techniques. 
In the good old days, a doctor would get a basic 
degree in his profession and could join academia on 
these grounds. He would then, with passage of time, 
learn the art of teaching and assessment. But in this 
era and age, this seems difficult without formal 
training in the art of teaching. This need was 
recognized long ago, when in formal education, a 
graduate had to have a licence to teach, that is to 
obtain a degree in teaching which could be a 
certificate, diploma or master in education. But in 
health professions, this need was recognized a little 
late. The first medical education department was set 
up in Chicago Illinois in 1950's. Till 1997, only 7 MHPE 
registered programs were delivering masters in 
medical education. This number went up to 76 in 

6
2012.  According to the data available on FAIMER's 

7
website, the number has reached up to 113.  In 
addition to that, 24doctoral programs are now 

8
offering PhD in medical education.  This is leading to 
the concept of Professionalization of Health 
professions education defined as the process of 
giving a professional character, identity, or status to 
HPE as a profession. It involves establishing a suitable 
and accreditable qualification, satisfying both 

EDITORIAL

-------------------------------------------------

Aspiring for Excellence in Health Professions Education (HPE)
Rehan Ahmed Khan

Correspondence:
Dr. Rehan Ahmed Khan
Associate Professor, Surgery
IIMC-T, Pakistan Railway Hospital, Rawalpindi
E-mail: surgeonrehan@gmail.com



2

national and international needs of medical 
9

education.  
It is very important to understand how the change 
was brought in Flexner's time. Teaching and training 
were based on apprenticeship system before 
Flexner. The system was not centralized and there 
were no uniform standards, to give a doctor the 
license to treat a patient. This change took few 
decades to be fully implemented. It was difficult for 
the apprenticeship system to be completely 
abolished. Now, when we are moving away from the 
traditional system to integrated system, with 
learning and assessment methods more suitable for 
student centred learning, the history is repeating 
itself. Medical education is a continuing process. 
Curriculum is a race track by definition, which needs 
to be revisited regularly. To achieve excellence we 
have to move forward and accept the change.
Pakistan has also seen the impact of this global 
change. Before 2009, there were only few medical 
schools, who were delivering their curricula 
according to the global demands and changing 
international accrediting standards. However as a 
test run, PMDC awarded the responsibility of 
designing and implementing an integrated 
curriculum according to the changing needs of 
medical education. Islamic international medical 
college stands out in this respect to be one of the few 
medical schools to develop MBBS curriculum which 
it has successfully implemented. The process needs 
to be understood nationally. It has been discussed in 
numerous meetings and conferences of medical 
education that after 2021 medical schools will be 
accredited based on delivering medical education 
according to the newer philosophies and demands of 
the professions which target excellence.
Till not very late, only CPSP (College of Physicians and 
Surgeons) was awarding a diploma in HPE. Now there 
are 07 programs in Pakistan which are delivering 
masters in HPE. The change is written very clearly on 
the wall. We have to move from traditional to 
integrated curriculum with the newer learning 

strategies and assessment tools across the national 
front. The clock is ticking fast. The world accrediting 
bodies are aiming at excellence in medical 
education.WFME, FAIMER and ASPIRE are setting the 
standards globally. We need to realize this and adapt 
to the new system in time.
In the beginning of the article we asked, what was 
excellence? Excellence is defined as “the quality of 
being outstanding or extremely good.”Excellence in 
medical education aims at producing best health 
professionals, so excellent health care is provided to 
the patients and eyes are no more set on standards 

10
of minimal acceptable quality.  In essence, we have 
to realize that we cannot provide our patients the 
best healthcare, if we don't aspire for excellence in 
medical education.

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