Education for Capability – a key for values based system change

PRIME’s mission is to restore person-centred values (God’s values) to the way healthcare is taught and practised around the world, based on the understanding that every person bears the image of God, and following the example of Jesus, the perfect physician and teacher. As a result our main focus naturally tends to be on the teaching of professional values, aspects of communication and the doctor patient-relationship, a holistic approach, empathy and compassion, and other factors that are important in the interaction between health-care professional  (HCP) and patient. Our regular international emails generally address aspects of these things, as they are at the core of what we are seeking to do.

There are, however, wider aspects of good healthcare practice that we also need to consider, as they can influence the context of the HCP/patient interaction very profoundly. One example would be equity of access to healthcare – how does this work in your system? How do patients get to see the doctor/nurse? Do they have to pay, offer bribes, wait in long queues?  Are the rich better able to access health-care than the poor? All these things have an influence on what happens in the consulting room. A recent AMEE guide from Medical Teacher ¹ considered how the capability approach offers a theoretical and practical framework to both implement and evaluate educational interventions that are designed to increase social justice, such as widening equity of access to health-care. (Education for capability means helping learners to adapt to change, generate new knowledge, and continue to improve their performance. It is enhanced through feedback on performance, the challenge of unfamiliar contexts, and the use of non-linear methods such as story telling and small group work. Education for capability must focus on process [supporting learners to construct their own learning goals, receive feedback, reflect, consolidate] and avoid goals with rigid and prescriptive content.) ²

The authors of the guide state that the capability approach, with its origins in economic and human development work, has a focus on the freedom of students to make choices about how they wish to lead a valued life. There is great potential for the capability approach to offer medical education a creative way of changing and challenging established norms, with an emphasis on the teacher facilitating students to achieve their potential by recognising their aspirations and challenging the constraining factors to achieve their aspirations. So students whose values lead them to question inequality of access to health-care would be encouraged to practically consider how they can change this, and to work out how they can integrate their values with the way they want to practice.

Much of medical education is aimed at making students competent (giving them the knowledge, skills and attitudes to be able to do the things outlined in the extant curriculum). Whilst this is undoubtedly necessary, it is not sufficient. To enable learners to be agents for change and to take initiatives in improving health-care, education for capability is also required. This has the potential to produce HCP’s who will not only demonstrate good values in the way they consult with patients, but also bring those values to bear on improving the health-care systems in which they work, to make them more just and equitable for all.  Are you helping your students to become more capable?

Huw Morgan

1. http://informahealthcare.com/doi/abs/10.3109/0142159X.2015.1013927

2. Fraser SW, Greenalgh T. Educating for Capability, Coping with Complexity BMJ 2001;323:799-803