Priority for medical education should be based on the emerging health needs of the community. Our medical graduates should carry the mission to ensure the health of our future population. They must be well aware of the emerging health burden not only within their own localities but also globally as we are now living in globalised world.  They must not only know the current health burden and associated risk factors, but also be forward thinking of the future health of our population. Paper by Lopez et al reported that an estimated 45% of global mortality and 36% of global disease burden were attributable to the joint hazards of the 19 selected global risk factors including risk factors for non-communicable diseases and injuries, unsafe sex, indoor smoke, and unsafe water and hygiene.¹ The advancement of medical technology does not replace the comprehensive and holistic approach to personalised health care.  Paper by Kitsios and Kent in BMJ pointed out that despite the advancement of pharmcogenomics with identification of numerous gene-drug associations, few have been incorporated into clinical practice, and the reality of personalised medicine is beyond our genes.² It is no longer a debate which branch of health science should be given more emphasis. One should call for integration of biomedical, clinical and population science for better population health.  The BMJ editorial on ensuring the health of future populations by Graham has highlighted the importance of social determinants of health to be set within the wider biophysical environment.³  She drew on the concerns of recent published review of health in Europe by Marmot that most published research and policies are concerned less with environment than lifestyle, and more with current risks at individual level rather than population level, calling for boarder mission of public health.⁴  All these provide us foresights of future medical education with more coherent integration of different perspectives of science affecting human health and development. 

The health care system will need to be transformed towards integrated care meeting the emerging needs of our contemporary society.  The failure of transformation would lead to inefficiency of health care delivery system not only creating greater burden to the society but also the workload of health care professionals.  Although the merits of integrated care is beyond argument, BMJ editorial by Godlee has pointed out that it is still a tough journey with opposition from skeptical, suspicious and unwilling colleagues including clinical staff who are needed to drive the change.⁵ The argument for integrated medical education would still face great obstacles unless transformation of health care system has taken place.  This would be chicken and egg situation.  However if we would equip our graduates the skills and competencies to deliver quality health care conducive to the needs of the contemporary society, this would facilitate the process of system transformation.

For integrated health care, the clear line of demarcation between hospital and community settings is no longer applicable as patient management requires medical professionals to adopt clinical pathway approach to ensure seamless health care.  Community based teaching is not only intended for graduates going into primary care  and graduates need to possess the basic skills in handling common health issues in both hospital and ambulatory settings. The generic skills should be the ability to handle clinical conditions at different stages of development and identify which clinical specialty would be most appropriate at different stages of disease development.  A conference in revisiting the mission of medical schools in 2008⁶ has pointed out that all medical schools should ensure students becoming familiar with critical subject matter if not yet incorporated sufficiently in the typical curriculum, for examples:

• Knowledge and skills for improving the quality and safety of patient care
• Application of information sciences and system thinking
• Principles of public health and prevention
• Role of non-biological determinants of illness
• Health implication of cultural diversity
• Organisation, financing and performance of health care system
• Creation and impact of health policy

The conference report also suggests that medical schools should adopt promising pedagogical innovations to enrich students’ learning with extensive community as well as hospital based experiences, and underscoring the relevance of basic science topics by integrating preclinical and clinical education.

Medical education needs to enable students to zoom their lens at the level of patient and family, and population and society as well at cellular and molecular, and bodily organs and systems level.  Teaching in primary health care would enhance the capability of students in ‘zooming their lens’ as primary care model combines the effort of upstream, midstream and downstream approaches to improve population health and reduce health inequities.^7,8  Paper by Lam and Poon discusses review on skills in undertaking continuing professional education by primary care physicians.⁹ The transformation of learning skills of primary care physicians in practice will add synergistic effect in transforming medical education as well as health care delivery system.

This article is based on the Visiting Professor Seminar for Faculty of Medicine, University Sains Malaysia on 19 June, 2014