IndonesianIndonesian Physician’s Physician’s CompetencyCompetencyin Global Erain Global Era

Prof.Dr.dr.H. Rusdi Lamsudin SpS(K), Prof.Dr.dr.H. Rusdi Lamsudin SpS(K), M.Med.ScM.Med.Sc

Dekan Fakultas Kedokteran Dekan Fakultas Kedokteran UIIUII

Prof.Dr.dr. H. Rusdi Lamsudin, M.Med.ScProf.Dr.dr. H. Rusdi Lamsudin, M.Med.ScSpesialis Saraf (Consultant)Spesialis Saraf (Consultant)

Medical Doctor, Faculty of MedicineMedical Doctor, Faculty of Medicine, UGM, 1971, UGM, 1971 NeurologistNeurologist, Unair-UGM, 1978, Unair-UGM, 1978 Master of Medical Sciences, New Castle Univ, Australia, 1986Master of Medical Sciences, New Castle Univ, Australia, 1986 Head of Executive BoardHead of Executive Board Muhammadiyah Muhammadiyah Hospital, Hospital,

Yogyakarta, 1993-1999Yogyakarta, 1993-1999 Vice DeanVice Dean, , Faculty of Medicine Muhammadiyah Yogyaakarta Faculty of Medicine Muhammadiyah Yogyaakarta

UniversityUniversity, 1993-1999, 1993-1999 PhD, UGM, 1996PhD, UGM, 1996 Short-course, Unit Stroke & Neuro-Intensive, Insburck, Short-course, Unit Stroke & Neuro-Intensive, Insburck,

Austria,Austria,15 July-15 October, 15 July-15 October, 19971997 Head of Stroke Unit, Head of Stroke Unit, SardjitoSardjito Hospital, Yogyakarta Hospital, Yogyakarta, 2001-, 2001-

20052005 Head of Neurology Department Faculty of Medicine, Head of Neurology Department Faculty of Medicine, UGM, UGM,

2001-20052001-2005 Dean of Faculty MedicineDean of Faculty Medicine,, Indonesia Islamic University, Indonesia Islamic University,

Yogyakarta, 2001-2006, 2006-2010Yogyakarta, 2001-2006, 2006-2010

GLOBALIZATIONGLOBALIZATION

We are a part of a Global Village We are a part of a Global Village having “Dual Citizenship”having “Dual Citizenship”

Disease knows no boundariesDisease knows no boundaries Communications revolutionCommunications revolution Terrorism and local conflictsTerrorism and local conflicts Distinction between domestic Distinction between domestic

and international problems is and international problems is losing its usefulness.losing its usefulness.

GLOBALIZATIONGLOBALIZATION

We are a part of a Global Village We are a part of a Global Village having “Dual Citizenship”having “Dual Citizenship”

Disease knows no boundariesDisease knows no boundaries Communications revolutionCommunications revolution Terrorism and local conflictsTerrorism and local conflicts Distinction between domestic Distinction between domestic

and international problems is and international problems is losing its usefulness.losing its usefulness.

Globalization involves multi-Globalization involves multi-dimensional integration of world dimensional integration of world economics, politics, culture, health economics, politics, culture, health and human affairs, facilitated by a and human affairs, facilitated by a scientific revolution in information scientific revolution in information and biotechnology.and biotechnology.

Globalization is a process of broad Globalization is a process of broad social transformation that make social transformation that make national borders more permeable.national borders more permeable.

Trade is the leader and most powerful Trade is the leader and most powerful force of our time.force of our time.

NEW GLOBAL ECONOMIC NEW GLOBAL ECONOMIC ORDER (1945)ORDER (1945)

International Monetary Fund (IMF)International Monetary Fund (IMF) World BankWorld Bank General Agreement on Traffic and General Agreement on Traffic and

Trades (GATT)Trades (GATT) World Trade Organization (1995)World Trade Organization (1995)

Trade-related aspect of International Trade-related aspect of International Property Rights (TRIPS)Property Rights (TRIPS)

General Agreement on Trade in Services General Agreement on Trade in Services (GATS)(GATS)

GLOBAL TRADEGLOBAL TRADE1970 … 25% Global Output1970 … 25% Global Output2002 … 50% Global Output2002 … 50% Global Output2020 … 67% Global Output2020 … 67% Global Output

Speed of globalization is exceptionalSpeed of globalization is exceptional Good economic policiesGood economic policies Structured reformsStructured reforms

Most Governments are ill equipped to Most Governments are ill equipped to manage problems that transcend their manage problems that transcend their bordersborders

Global bodies are too weak to provide Global bodies are too weak to provide monitoring of commerce, environment, monitoring of commerce, environment, social development, health, and educationsocial development, health, and education

GLOBALIZATION: GLOBALIZATION: OPPORTUNITIESOPPORTUNITIES

““A RISING TIDE A RISING TIDE WILL LIFT ALL WILL LIFT ALL

BOATS”BOATS”

Reduction in Reduction in povertypoverty

Exchange of ideasExchange of ideas Infusion of Infusion of

scientific scientific knowledgeknowledge

Improvement in Improvement in health statushealth status

Social Social developmentdevelopment

GLOBALIZATION:GLOBALIZATION:RISKSRISKS

““A FAST RISING A FAST RISING TIDE WILL LIFT TIDE WILL LIFT

BIG YACHTS BUT BIG YACHTS BUT WILL CAPSIZE WILL CAPSIZE SMALL BOATS”SMALL BOATS”

Spread of diseaseSpread of disease Hazardous Hazardous

materialmaterial DisparitiesDisparities Negative Negative

behavior changebehavior change CorruptionCorruption

CURRENT STATUSCURRENT STATUS

1 Billion People in the Developed 1 Billion People in the Developed WorldWorld

United States, Europe, JapanUnited States, Europe, Japan Increase in disposable incomeIncrease in disposable income Enhanced social injusticeEnhanced social injustice Improved standard of livingImproved standard of living

CURRENT STATUSCURRENT STATUS

3 Billion People in Developing 3 Billion People in Developing Countries areCountries are integrated into the integrated into the global economy, i.e.global economy, i.e. China, India, China, India, Thailand, TaiwanThailand, Taiwan Stable governments (good economic Stable governments (good economic

policy)policy) Human capitalHuman capital InfrastructureInfrastructure Visionary leadershipVisionary leadership

CURRENT STATUSCURRENT STATUS

2 Billion People in poor countries have 2 Billion People in poor countries have been leftbeen left behindbehind Political instability (poor economic Political instability (poor economic

policies)policies) Poor or no infrastructurePoor or no infrastructure Lack of human capitalLack of human capital No natural resourcesNo natural resources

Their participation in world trade is Their participation in world trade is less than it was 20 years ago, with less than it was 20 years ago, with income falling and poverty increasing.income falling and poverty increasing.

FIVE GAINS IN GLOBAL FIVE GAINS IN GLOBAL HEALTHHEALTH

Reduction in vaccine preventable diseasesReduction in vaccine preventable diseases Reduction in childhood morbidity and Reduction in childhood morbidity and

mortality leading to increased life mortality leading to increased life expectancyexpectancy

Tremendous advances in biomedical Tremendous advances in biomedical research; new drugs, new vaccines, research; new drugs, new vaccines, geneticsgenetics

Reduction in fertility ratesReduction in fertility rates Public private partnerships adding Public private partnerships adding

additional resources to solve public health additional resources to solve public health problemsproblems

FIVE MISSED FIVE MISSED OPPORTUNITIESOPPORTUNITIES

Dealing effectively with HIV/AIDS Dealing effectively with HIV/AIDS epidemicepidemic

Imbalance in resource allocations Imbalance in resource allocations between prevention and medical carebetween prevention and medical care

Environmental degradationEnvironmental degradation Donor-driven need of quick and time Donor-driven need of quick and time

limited results, did not allow for limited results, did not allow for development of integrated health development of integrated health infrastructureinfrastructure

Missed gender recognitionMissed gender recognition

MISSED GENDER MISSED GENDER RECOGNITIONRECOGNITION

Failure to recognize gender Failure to recognize gender dimensions of healthdimensions of health

Maternal morbidity still very Maternal morbidity still very highhigh

Failure to have family planning Failure to have family planning services available to all womenservices available to all women

Gender based violence remains Gender based violence remains un-addressedun-addressed

Exploitation of women Exploitation of women

SYSTEM IS RUN BY SYSTEM IS RUN BY COMPETITION FOR PROFITSCOMPETITION FOR PROFITS

Creates conditions in which powerful Creates conditions in which powerful controlcontrol

Uneven enforcement of economic orderUneven enforcement of economic order Short term focus on return (profits)Short term focus on return (profits) No transparencyNo transparency Create competition vs. collaborationCreate competition vs. collaboration

20% of world’s population receives more 20% of world’s population receives more than 80% of the world’s incomethan 80% of the world’s income

DisparitiesDisparities

WEAKENING THE NATIONAL WEAKENING THE NATIONAL GOVERNMENTSGOVERNMENTS

Power shift to multi-national Power shift to multi-national corporations, influence of money in the corporations, influence of money in the political processpolitical process

Weakening of occupational and Weakening of occupational and environmental standardsenvironmental standards

Less investment in health and social Less investment in health and social sectors sectors

Privatization of health and social sectorsPrivatization of health and social sectors Russia, China, PakistanRussia, China, Pakistan

Weakening of safety net institutionsWeakening of safety net institutions Increase of corruptionIncrease of corruption

SOCIAL CHANGE IN SOCIETYSOCIAL CHANGE IN SOCIETY

Rapid change creates Rapid change creates uncertainty, which leads to uncertainty, which leads to polarization of a societypolarization of a societya)a) Unable to keep pace with change Unable to keep pace with change

leads to: leads to: SmokingSmoking Drug/alcohol abuseDrug/alcohol abuse Child abuseChild abuse Violent crimeViolent crime STD/HIVSTD/HIV Unhealthy dietsUnhealthy diets

SOCIAL CHANGE IN SOCIETYSOCIAL CHANGE IN SOCIETY

b)b) Unable to keep pace with changes, Unable to keep pace with changes, individuals react and become individuals react and become fundamentalists, and struggle to overthrow fundamentalists, and struggle to overthrow the government systemthe government system

IndiaIndia RussiaRussiaPakistanPakistan ChinaChinaEgypt Egypt United StatesUnited States

c)c) Most people try to keep pace with change Most people try to keep pace with change

““Stress in individual and society”Stress in individual and society”““More material things but no happiness”More material things but no happiness”

HUMAN VALUES OF SOCIAL HUMAN VALUES OF SOCIAL JUSTICE, EQUITY, COMPASSION JUSTICE, EQUITY, COMPASSION

ARE REPLACED BY A SINGLE FOCUS ARE REPLACED BY A SINGLE FOCUS ON PROFITSON PROFITS

Investment in community slows Investment in community slows downdown

Institutions such as schools look Institutions such as schools look to outside helpto outside help

Further power shifts to wealthy Further power shifts to wealthy people and now the anti human people and now the anti human rights activists have legitimacyrights activists have legitimacy

ENVIRONMENTAL ENVIRONMENTAL DEGRADATIONDEGRADATION

Rapid exploitation of natural resources = Rapid exploitation of natural resources = rapid profits = rapid environmental rapid profits = rapid environmental

degradationdegradation

Global warmingGlobal warming CO2 accumulationCO2 accumulation Ozone depletionOzone depletion

Many gains of the past may even be Many gains of the past may even be lostlost

SUSTAINABLE DEVELOPMENT SUSTAINABLE DEVELOPMENT BECAME AN EMPTY DREAMBECAME AN EMPTY DREAM

Development that meets the needs of Development that meets the needs of the present without compromising the the present without compromising the ability of the future generation to ability of the future generation to meet future needs.meet future needs.

Human beings are the center of Human beings are the center of concern for sustainable development. concern for sustainable development. They are entitled to healthy and They are entitled to healthy and productive life in harmony with productive life in harmony with nature.nature.

Absolute Poverty is Still the Major Absolute Poverty is Still the Major Risk Factor of Poor HealthRisk Factor of Poor Health

The path leading from poverty to poor The path leading from poverty to poor health goes through inadequate health goes through inadequate nutrition, inadequate housing, lack of nutrition, inadequate housing, lack of education and lack of access to health education and lack of access to health services.services.

Need for actionNeed for action We need sustainable development in We need sustainable development in

globalizing the economyglobalizing the economy We need monitoring of unhealthy We need monitoring of unhealthy

policiespolicies Change in global economic policiesChange in global economic policies

Advocacy for healthy economic policies Advocacy for healthy economic policies to narrow the gap between the need to narrow the gap between the need and the services availableand the services available

Effective dissemination of global health Effective dissemination of global health knowledgeknowledge

WFPHAWFPHA Global Health CouncilGlobal Health Council

Necessary to move beyond health for all Necessary to move beyond health for all to consider all of the other dimensionsto consider all of the other dimensions

Global good “one world, one people”Global good “one world, one people” New research in social sciencesNew research in social sciences

Global EraGlobal Era

6 millions physicians worldwide 6 millions physicians worldwide serving over 6 billion inhabitantsserving over 6 billion inhabitants

Over 1800 medical schools Over 1800 medical schools throughout the worldthroughout the world

Health services and medical practice Health services and medical practice are undergoing profound changes are undergoing profound changes forced by economic difficulties in forced by economic difficulties in financing healthcare systemsfinancing healthcare systems

Global EraGlobal Era

Increasing cost of health interventions are Increasing cost of health interventions are

related cost-containment policies could related cost-containment policies could threaten physician’s humanism and valuethreaten physician’s humanism and value

Rapid advances are occurring in biomedical Rapid advances are occurring in biomedical sciences, information technology and sciences, information technology and biotechnologybiotechnology

New ethical, social and legal challenges for New ethical, social and legal challenges for profession of medicine and call for profession of medicine and call for preservation of a balance between science preservation of a balance between science and the art of medicineand the art of medicine

Global EraGlobal Era

Medical StandardsMedical Standards

Medical standards in use: Medical standards in use: the world’s overviewthe world’s overview

USAUSA The National Board of Medical Examiners The National Board of Medical Examiners

(NBME) (1915)(NBME) (1915) The Federation of State Medical Boards (1993)The Federation of State Medical Boards (1993)

EuropeEurope Maastricht Agreement (1993)Maastricht Agreement (1993)

AustraliaAustralia The Accreditation Committee of the Australian The Accreditation Committee of the Australian

Medical Council (1985, 1991)Medical Council (1985, 1991)

Medical standards in use: Medical standards in use: the world’s overviewthe world’s overview

Latin AmericaLatin America AsiaAsia The World Federation for Medical The World Federation for Medical

Education (WFME) (1999)Education (WFME) (1999)

Medical standards in use: Medical standards in use: the world’s overviewthe world’s overview

The Institute for International The Institute for International Medical Education (1999)Medical Education (1999)

WHOWHO Five Stars DoctorFive Stars Doctor

IndonesiaIndonesia National Competencies of Primary Care National Competencies of Primary Care

Physicians (2005)Physicians (2005)

Global Standard on Basic Global Standard on Basic Medical Education (WFME, Medical Education (WFME,

2003)2003) 9 Area9 Area 36 Sub-areas (Criterias)36 Sub-areas (Criterias) STANDARDSTANDARD

Basic -- Basic -- mustmust Quality development--Quality development--shouldshould

Institute for International Institute for International Medical Education (seven Medical Education (seven

broad educational outcome-broad educational outcome-competence domains)competence domains)

Professional Values, Attitudes, Professional Values, Attitudes, Behaviour, and EthicsBehaviour, and Ethics

Scientific Foundation of MedicineScientific Foundation of Medicine Clinical SkillsClinical Skills Communication SkillsCommunication Skills Population Health and Health Population Health and Health

SystemsSystems Management of InformationManagement of Information Critical thinking and researchCritical thinking and research

The Five Stars Doctor The Five Stars Doctor (WHO)(WHO)

CommunicatorCommunicator Care providerCare provider Care managerCare manager Decision makerDecision maker Community leaderCommunity leader

National Competencies of National Competencies of Primary Care Physicians Primary Care Physicians

(2005)(2005) Effective communicationEffective communication Performing basic clinical skillsPerforming basic clinical skills Application of Principle from Biomedical, Clinical Application of Principle from Biomedical, Clinical

and Behavioral Sciences and Epidemiology in the and Behavioral Sciences and Epidemiology in the Practice of Family MedicinePractice of Family Medicine

Management of health problems in the individual, Management of health problems in the individual, family and communityfamily and community

Accessing, critical appraising and managing Accessing, critical appraising and managing informationinformation

Self awareness. Self-care and personal Self awareness. Self-care and personal developmentdevelopment

Professional, moral and ethics contexts of practiceProfessional, moral and ethics contexts of practice