Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP183

Invited Speakers

Geographical Challenges for Pediatric Training

AryonoHendarto Departmentof Child Health Faculty of Medicine Universitas Indonesia,CiptoMangunkusumo Hospital

In this era of globalization, countries border didn’t matter anymore. There are many migrating workers, one of which is health workers. There has been a 60% rise in the number of migrant doctors and nurses in Organisation for Economic Cooperation and Development (OECD) countries.1 This happen across the globe, especially in the region that already have Free Trade Agreement, such as Europe Union (EU), North America Free Trade Area (NAFTA) and most recently ASEAN Economic Community (AEC). ASEAN Economic Community already start in 2015.2 According to the Mutual Recognition Arrangement (MRA) of this regional movement, physicians, nurses and dentists are among seven professional groups (physician, nurse, dentist, accountant, engineer, architect and surveyor) that can be qualified to practice in another country.2But the evaluation of the physician among Asian countries, especially for pediatrician needs to be evaluated. Until now, evidence relevant to AEC and health services were mostly about graduated health professional but not about medical education and qualification systems.3 Comparable medical qualification systems are important to make sure a fair exchange of physician workforces among countries. Differences will need to be recognized as part of the effort to harmonize the system and to realize the MRA and free flow of medical practitioners. Despite the existence of Professional Medical Regulatory Authority (PMRA) in each country, good analysis on pediatrician qualifications in the ASEAN and globally has been lacking.3 Asia Pacific region is characterized by divergence and inequality. Besides highly disparate levels of wealth, there are also differences in income and human development, health systems and levels of health resourcing.4 Health workers are the important element of health systems. The size, competency, geographic distribution, skill and productivity of the health workforce are factors determining access to high-quality health services.5 There are three factors that mostly important to the Asia Pacific region. First, the size of the health work-force and health spending vary across the region.4 There are disparities between the richest countries in the region and the poorest one. Second, health spending is a critical determinant of adequate health workforce-to-population ratios.5 Third, countries that invest higher levels of healthcare resourcing capacity of sustaining higher worker-population density and higher skilled birth attendance coverage enjoy superior health outcomes.6 In 2008, leaders from the international pediatric education, training and accreditation community recognized this lack of standards across the countries.7 Thus, in 2009 Global Pediatric Education Consortium (GPEC) was born. Its vision was to creating common core standards for training and evaluation of pediatricians as one method of promoting improvement quality of medical care provided to children worldwide. GPEC have synthesized 12 core competencies for pediatric training. These competencies are outlining the knowledge, skills, abilities and behaviors that a pediatrician must obtain during training and maintain throughout his/her career. These 12 competencies are common across pediatrics regardless of geographic locale of training and practice. These competencies are:7 1. Ethics in Practice 2. Collaboration 3. Global Health Awareness 4. Patient Safety and Quality Improvement 5. Research Principles and Evidence-based Practice 6. Scholarly Activity 7. Self-Leadership and Practice Management 8. Communication and Interpersonal Skills 9. Health Advocacy and Children’s Rights 10. Professionalism 11. Assessment, Diagnostic, Procedural and Therapeutic Skills 12. Medical Knowledge and Patient Care To become prepared with this globalization health system era, residents needs to be trained with global health and transnational competence to be globally competent, especially those who desire careers combating worldwide disease. The global health electives improves residents self-perceived skills as clinicians consonant with findings in previous evaluations and in understanding social determinants of health and health systems and improving cultural competency.8Transnational-competence offers a good chance for providing clinicians with the interpersonal skills needed to be effective globally. Transnational-competence skills can improve health-care outcomes in ethnoculturally discordant medical encounters.9

Keywords: