Hong Kongs Health System: Reflections, Perspectives and Visions
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The public healthcare approach focuses on preventing illness and disability, as well as promoting health and well-being Wilcock, Primary health care, a branch of public health, specifically focusses on preventative health and health promotion measures Leclair et al. Since good health or ill health is a consequence of what people do or don't do every day, health promoting occupational therapy is about enabling people to take control of, and improve their health and well-being through their everyday doing occupations Wilcock, However, the occupational therapy profession has not been very active in the area of public health Hocking, Traditionally occupational therapists worked with clients after a health event occurred, mainly within secondary health care contexts that is, hospital or rehabilitation services Scriven, Finlayson and Edwards argued that occupational therapists need to shift their focus away from care and cure to one of prevention and promotion.
Such a shift could move occupational therapy practice more towards primary health care. A priority of this strategy is to increase the focus on population health, prevention and health promotion, and community involvement Mace, and so primary health organisations PHO were established Ministry of Health, An unknown error has occurred. Please click the button below to reload the page. In Taiwan, for example, scholars report that ten years after the curricula were incorporated into official medical education, consensus on the real meaning of medical humanities has not yet been reached.
The absence of a definition consensus has led to cognitive disparity among the faculty members, resulting in various expectations about curriculum outcomes and barriers to curriculum planning Wu et al, There have been insufficient communication platforms between clinical and humanities teachers.
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Additionally, medical humanities has suffered from exclusion from scholars who have placed more emphasis on clinical research Tsui et al, In China, scholars point out that the development of medical humanities has lagged behind the rapid growth of medical sciences. A major disadvantage to medical humanities is reflected on the disproportionate funding support granted by The National Science Foundation of China or the National Natural Science Fund of China Yun et al, In Hong Kong, as a curriculum initiative, the medical humanities curriculum in the MBBS programme at The University of Hong Kong HKU was envisioned to be an interdisciplinary endeavour and to have its development and delivery reflected in the multi-disciplinary composition and diverse expertise of the curriculum planning group and the teachers.
The leaders of the MH initiative made a deliberate effort to include and recruit interested colleagues from all specialities and departments in the Faculty who were engaged in teaching medical students. Through a curriculum retreat and questionnaire survey, colleagues were identified and nominated by heads of department to be part of the inaugural medical humanities planning group MHPG convened in Colleagues from the university-at-large in the fields of social sciences, fine arts, education and history, who were already known to members, were also invited resulting in a membership of All of the MHPG members had research and teaching expertise in their own fields but none had prior experience teaching or working in medical humanities in an undergraduate medical education context.
This enabled the group to develop fresh ideas from the ground up, bringing diverse perspectives to enrich the syllabus and the classroom learning. Many of the learning activities in the MH curriculum are led concurrently by teachers from both the arts and from medicine which gives the visual impression of the interdisciplinary collaboration that underscores the interdisciplinary exploration of a particular topic. Interdisciplinary perspective emerging from interdisciplinary collaborative teaching remains a key ideal of the MH curriculum.
For example, one of the threads in the MH curriculum examines the history of medicine in Hong Kong as it relates to why we practice medicine the way we do. The historian introduced the concept of crisis, using plague a defining event in the history of medicine in Hong Kong as an example to focus on the various repercussions on doctors and society.
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The public health researcher extended the discussion beyond plague to look at other infectious disease crises to explore patterns in history, how history informs the present and future, and how health care progress also brings forth social and ethical issues. The primary care doctor looked at front line human emotion in times of crisis individual crises as well as global crises and how we experience it, are affected by it and respond to it. Together, the teachers co-created a cohesive and authentic interdisciplinary learning experience for students.
Another thread in the MH curriculum is culture and healing which examines the roles of culture and spirituality in healing. One of the learning activities is a workshop that introduces mindful practice as a means to be fully present and aware of self and surroundings with implications for patient care, as well as a skill to build personal resilience. This is led by a social scientist and a doctor, both of whom are active mindfulness practitioners who are able to bring in the scientific basis of mindful practice, the practical aspects and the relevance to medicine Wong et al, The active engagement of both teachers reinforces the value of what may be perceived to be an irrelevant paedgogical approach performance arts by medical students and makes explicit its relevant to medical practice through a debriefing discussion.
If such a session was led by a teacher from only one or the other discipline, the learning would not be nearly as compelling Chen et al, In , the hiring of a historian to join the core team under the medical humanities programme at The University of Hong Kong became the first cross-disciplinary academic appointment in a medical faculty in Hong Kong.
In , the first cohort of students under the compulsory and longitudinal medical humanities curriculum recently graduated from the six-year programme. The formation of an interdisciplinary group and subgroups for curriculum planning and teaching enabled powerful learning experiences for both teachers and students. However, the tendency was for these interactions to be rather superficial as most of the teachers are engaged in one-off teaching sessions. All the members of the MHPG are committed and enthusiastic volunteers in the MH program but are compelled by external academic pressures to limit the extent and depth of their involvement.
The potential for true interdisciplinarity in the HKU context is truly promising but as yet unfulfilled. Moreover, the challenges of medical humanities education are observed at another three levels. First, regarding the content, scholars have argued about the problems that might occur in implementing the Western style of medical education, including medical humanities, as a neo-imperialist product in the global context Bleakley ; Hooker et al, Whilst it might be easier to implement this style of teaching and learning, such as problem-based learning, it takes more effort to contextualise the content of medical humanities in response to local needs.
Owing to the undergraduate degree structure, students generally do not recognise the significance of medical humanities until they enter their senior year. However, when they finally become aware of the curriculum relevance, they have no more time left for recollection or reflection. Second, concerning the maintenance of interdisciplinary teamwork, the number of participants from other faculties in the Medical Humanities Planning Group have varied over the years.
Therefore, this situation requires efforts to maintain the connection between the medical humanities programme and scholars from other faculties. Few of them deliver lectures or conduct workshops on a regular basis. Third, as for faculty development, the teaching team has to rely on community partners and volunteer clinicians to undertake teaching and learning activities for more than 1, students. In April , at the Annual Science, Technology and Society Conference in Tainan, Taiwan, humanities and social science scholars from various medical schools in Taiwan reflected on the challenges in designing and offering courses related to medical humanities.
In the specially curated session, they brainstormed on their work from three aspects: the perpetually vague definition of medical humanities, the confused identities of non-scientific scholars working for medical schools and the difficulties in cross-disciplinary collaboration.
Whilst communicating with clinical teachers, they found that special skills are needed, particularly the ability to connect teams, to work across boundaries and to work in the environment they are not familiar with. Sadly, it was observed that few clinicians become the same communicators. However, with their new identity, the participants also perceived these crises as avenues to exercise their agency to inspire the design and the delivery of medical education, as well as take further steps to influence policy making.
Nevertheless, a larger problem lies in how higher education is imagined, operated and manipulated in the institutions where the scholars work.
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In the same session, they reflected on the tensions regarding the impartiality of performance reviews or criteria for promotion on the tenure tracks of humanities and social science scholars working in a biomedical-oriented environment. Such patterns have resulted in the enlarged size of the science faculties, gradually edging out the space for humanities and social sciences. For example, teaching releases and sabbatical leaves are less likely to occur in medical schools, but these breaks provide the important research support required for time-consuming article writing.
Without such support, it is difficult to conduct in-depth and contextualised research and transform the results into teachable content.
In terms of research, humanities scholars and social scientists still have to focus on their original research output since it is less likely to publish interdisciplinary works. Regarding teaching, relying on non-contextualised materials is therefore inevitable. Teachers can only reduce lengthy debates on medical history and anthropology to the most basic concepts, without being able to upscale their teaching from the level of reflection to critical thinking Wu, Likewise, the pursuit of increasingly stringent metric-based performances in different university departments creates barriers to academic exchange among scholars who are not yet tenured.
The resources are thus limited in supporting immeasurable programmes. In , philosopher Ivan Illich commented on the restricted function of professions in society. They then treated the chart, they changed its parameters. This is the image of a physician whom medical humanities has been attempting to critique. In other words, this is the product that medical humanities education has been avoiding to create. The book meets the critical need of students, academics, health care professionals, government officials, politicians, and the general public who have been struggling with how best to approach and understand the context and the need for change.
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Embarking on health reform to achieve the ideal is the prerogative of most governments. Driven by data and supported by sound evidence, this book offers a tailor made vision for health reform in Hong Kong. It is a recommended compendium for all stakeholders in the health system. However, as this excellent book shows, it is also one from which the rest of the world can learn.