Lesley Pocock
lesleypocock@mediworld.com.au

Obviously our thirst for knowledge has been linked to our advances as a global population, with technology, art, philosophy, science and medicine contributing to our greater understanding, and the ability to have some degree of authority over our own lives.

Much of this knowledge has extended to the reach of most humans - and the internet, in modern times, has allowed for greater access to repositories of information and education.

There are areas of education however, with a huge financial premium on them and much of this is for the right reasons. Those practising in various scientific, educational and medical fields, need to be properly schooled to ensure that when they put that education into practise, it is achieving the aims of the education.

Unfortunately the price of access to some of this knowledge means that potential scholars in many countries cannot afford it and in the case of postgraduate medical education this is possibly the most problematic and restricted, while being a basic right for all humans - that is, access to proper medical care.

This leaves some countries with few or no trained doctors and even in the wealthiest countries there are shortages. It also means that those in low-income nations who are able to access medical education because of money or luck, use their degrees as a ticket to a better life in a developed country, looking for their skills. On an individual basis you cannot blame people looking for a more advantageous life for themselves and their families but generally it just perpetuates the drain of resources from poor countries to wealthy countries, where the shortages in trained medical personnel also exist.

Now is the time is to look at inequities of access to medical education particularly, in an age when Information and Communications Technology (ICT) does provide for strategies for innovative and strategic means of better and cheaper distribution of, and access to, vital knowledge not just in the interests of individual access for the student, but universal access to the means of making it a better world for all.

Knowledge leads to enlightenment of thought, creativity, compassion and empathy and possibly world peace via better public and academic education.

Attempts have been made, in recent times, to look at the global problem of inequities in medical education and practice.

The dearth of high quality educational resources in some regions is self evident, with many global doctors practising in fields in which they have no formal training whatsoever. These doctors however are filling vital roles and doing the best they can under the 'local' circumstances.

Good global education needs to fit the requirements of a greatly diverse consumer, with diverse values, diverse levels of prior training, and be accurate in all situations.

These problems are magnified when dealing in medical education, particularly primary care, and when dealing with a Multinational approach and a multinational endpoint.

The Applied Sciences of Oncology Distance Education project

The International Atomic Energy Agency (IAEA) and the Regional Cooperative Agreement for Research, Development, and Training Related to Nuclear Science and Technology (RCA) financed a Distance Learning Course on the Applied Sciences of Oncology, to be delivered on multimedia CD ROM. This training course is an outcome of an IAEA Technical Cooperation Project implemented under the (RCA). RCA is an intergovernmental agreement among seventeen Member States of the IAEA in the Asia and the Pacific Region.

Following the identification of the shortage of well qualified radiation oncologists in the region, the Member States of the RCA decided to address this problem through the development of distance learning material. The National Project Coordinators also assisted in the pilot testing of the training material. Three RCA Member States, three AFRA (Regional Cooperative Agreement for the Africa Region) Member States and two ARCAL (Regional Cooperative Agreement for the Latin America Region) participated in the pilot testing of the distance learning material.

The requirement was to 'educate without teaching', for fear that an untrained doctor may follow the instruction by rote, for example, in every case of breast cancer, when it is the lymph nodes that are involved, that indicate appropriate treatment. Any prior level of medical knowledge was also not to be assumed, so the project also involved complementing or reviewing 'basic training'.

Essentially the task was to combine science with socio-economics and to look in depth at the many issues involved. While initially developed as a training aid, it was deemed in 2005 a successful TC by the IAEA and accepted as global curriculum to train 900 oncologists in developing nations every 5 years.

The major challenge in the ASO project was the learning environment. In the case of the ASO project the environment was multimedia CD as it required complex scoring and tracking, access to web based services from the CD itself - video, pfd, and animations plugged in, date stamp recorded on course certificate/report as each module was completed.

To localise content you need to look at both ends of the process. In the case of global medicine the source of the medical education is as important as the endpoint (the global doctor, registrar or medical student). Medical education is usually written for the audience it is going to teach, within a process and with certain facilities, which match the conditions within which the resultant medical graduate will practice.

The launch of MMU aims to extend the concept to family medicine, with the major aim to bring top quality, affordable medical education to where it is most needed.

The MMU courseware therefore concentrates on the global family doctor/family phsycian. The Masters and Graduate Diploma provides a …..

The pragmatic approach extends to the research components and we are asking participating doctors in developing nations to identify real research needs in their own country so that all work undertaken addresses real problems and needs in the country where the doctor practises.

The education itself is written by university based medical educators, in western countries, and is also quality assured.

Additionally it has been reviewed for a variety of international requirements, including best practice, respect for all cultures and religions, and includes education on those areas not well addressed in western education, e.g. malaria and other tropical diseases.

As most family doctors in developing nations also perform minr ir general surgery, a special feature of MMU is the Department of Surgery, which teaches basic principles and real surgery skills, via interactive video of complete surgical procedures.

The course also reviews basic anatomy and undergraduate surgery, with a view to covering the full requirements for a Diploma in Surgery. All aspects of general surgery are covered initially in the courseware, and eventually neurosurgery and cardiac surgery will be introduced.

It is know that most family doctors in developing nations by necessity have to perform all such proedures, so MMU provides top level tar8inig material, nit even found in modern postgardaue surgical education.

All courseware is hosued on CD ir DVD, and each orogram is tracked and self-reporting. Particpants print out their rersukts from the CD once completed and forward to MMU for verification and awarding of diplomata.

Access to global medical education involves three basic issues, and the first is the content and the focus of that education. It is the experience of the authors that medical education currently tends to stop at borders and that education within national boundaries can have a focus that depends on the wealth of that country. In wealthy counties there is much education and focus on diseases of wealth, cardiovascular disease, diabetes and type 2, but little focus or need for the same on malnutrition, malaria, typhoid, cholera and other even preventable disease.

This can disadvantage both ends of the spectrum.

The global community misses out on the contribution to real education needs as well as the wealthy community through the medicalisation of what is often lifestyle or cultural or media induced trends. With emphasis and money spent on cure and amelioration, there is less emphasis on self-help and discipline.

The second aspects are affordability and accessibility. With few quality education facilities within a country, or with poor access due to war, famine, national catastrophe or other ignorance, the potential scholar has to finance their own solution. This is not as big a problem to the wealthy in the community, but the wealthy have greater access to all forms of education and therefore choice. If we focus on those who have the commitment and the ability but not the money, or the required gender, that is the vast majority of international medical students, then both accessibility and affordability are the major problems, but in the solving of this conundrum, it provides a great solution to the inequities of the healthcare of the global population. And it is good economics and good epidemiology, as pockets of illness and disease have an even greater ability these days to affect the global population, such as our experience with SARS, avian flu and HIV-AIDS

Issues of affordability

Even giving that the individual developing nations medical student could afford the course at an overseas institution (not withstanding the high degree of variability of quality in institutions even within countries) there is also travel, accommodation, cost of bureaucracy, cost of personal support and issues of loneliness, isolation, cultural differences and other compounding factors.

And affordability must always have a national perspective. If a doctor practising in a developing country, earns the equivalent of $US 200 year, most sources of outside education are immediately placed out of reach.

The reverse of the national exchange rate however, can be put to good use. Spending 'outside' money within a developing country however sees costs greatly reduced, or a solution taking advantage of existing infrastructure is even better.

Information and communication technology however, has given us the means of global public and professional education. Even in developing countries most educated people would have email and access to a PC . Using these as mass distribution tools, in a strategic and focused

The global acceptance to these pragmatic approaches to delivery education at affordable rates to each c has shown the vision of the people in these countries involved and not just to use the approach to catch up to world standards but to provide a more enhanced learning environment using professional ICT based interactive medical education.

MMU provides three levels of payment based on World Bank designated purchasing price parity ppp (2005) of countries and provides a three tier approach to payment. Costs are one off and no travel or accommodation is required. Research activities may involve some small further cost, but if set up to benefit the country and practice of the participant, this can be offset.

For further details visit www.MultimediaMedicalUniversity.com