Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia.
Med Educ. 2019 Jan;53(1):25-31. doi: 10.1111/medu.13630. Epub 2018 Jul 4.
Medical education has not been immune from forces for globalisation in the contemporary world. At the same time the social accountability of medical schools in addressing local health priorities has been emphasised. This paper explores the global-local tension in medical education through a careful selection of key overview papers.
Globalisation in medical education has taken two main forms: economic and altruistic. The former includes licensing curricula, recruiting internationally and establishing 'offshore' schools or campuses. Altruistic collaborations focus on the spread of learning and educational innovations. Both forms bring benefits but have been subject to critique for their differential impact and focus on educational inputs rather than outputs.
Social accountability requires medical schools to direct their activities to local priorities and to serving local health systems. Adoption of the principles of social accountability compels all medical schools to ask questions of their educational programmes and graduate outcomes. However, these are globally interdependent questions and are the intent of some well-known social accountability collaborations. It is naïve to think that adoption of a social accountability agenda by all medical schools would necessarily reduce global health inequity. A recent Australian example shows that workforce maldistribution, for example, is resistant to even high-level intervention.
It is yet too early to fully accept that 'think global, act local can be turned on its head'. There is much research to be carried out, particularly on the outcomes and impacts of medical education. Establishing cause and effect is a challenge, as is determining whether globalisation or localisation can contribute to greater global health equity. If we are ever to resolve the global-local tension in medical education, we need more evidence on the outcomes of what we do, whether globally or locally inspired.
在当今世界，医学教育也未能免受全球化力量的影响。与此同时，医学院校在解决当地卫生重点问题方面的社会责任也得到了强调。本文通过精心挑选的关键概述论文，探讨了医学教育中的全球-本地紧张关系。
医学教育中的全球化采取了两种主要形式：经济和利他主义。前者包括许可课程、国际招聘和建立“海外”学校或校区。利他主义合作侧重于学习和教育创新的传播。这两种形式都带来了好处，但因其对教育投入而非产出的差异化影响和关注而受到批评。
社会责任要求医学院校将其活动指向当地重点和服务当地卫生系统。采用社会责任原则迫使所有医学院校对其教育计划和毕业生成果提出质疑。然而，这些问题是全球相互依存的，是一些著名的社会责任合作的意图。认为所有医学院校都采纳社会责任议程就一定会减少全球卫生不平等，这是幼稚的想法。最近澳大利亚的一个例子表明，例如，劳动力分配不均，即使是高级别干预也难以改变。
目前还为时过早，不能完全接受“全球化思维，本地化行动”的说法。还需要进行大量研究，特别是关于医学教育的成果和影响。确定因果关系是一个挑战，确定全球化或本地化是否有助于实现更大的全球卫生公平性也是一个挑战。如果我们要解决医学教育中的全球-本地紧张关系，就需要更多关于我们所做工作（无论是全球还是本地启发）的结果的证据。
