Three Generations of educational reforms First: Science based curriculum. Scientific foundation into the medical education.

Doubling of life span. Development of Medicine. Second: Problem-based instructional innovations Third: Systems-based to improve health systems performance

New Context, new Challenge: we are talking about the world health and the students life. The actual and, principally, the new students will encounter a world with 2 basic characteristics: 1st: the innumerous gaps and inequities around the world and within our own country. 2nd: new health challenges are been present. New demands on health need to be attended. The university has a important mission in provide those students and future professionals, colleagues in profession, a health universe to practice medicine.

Its been no easy to act outside. Even more is been more difficult to practice medicine. Its a role of the institutional, either before attend its own wishes, construct, maintain and take care of the profession and allows the professionals formed by it a certain of good formation and no doubts about competencies. The new focus claims not to forget the evolution of medicine and the science below the evolution. It ask for a new target objective in guarantee this certain of success in medical practice, which passes over the completing need for the 21st century health professional and a role well defined in the health system. (Better conditions not only for the students, but for the medical teachers too!) Gaps and inequities: need to share the dramatic health advances. Conditions of the past century. Continuity of diseases a long time controlled in more affluent populations: infections, malnutrition, maternity-related health risks. New health challenge: new infections, environmental and behavioral risks, at a time of rapid demographic and epidemiological transitions, threaten health security of all. Health systems worldwide are struggling to keep up, as they become more complex and costly, placing additional demands on health workers. Chronic diseases more proactive in health-seeking behavior. Unprecedented teamwork need for a actual patient management, coordinated across time and space.

Slow burning-crises is emerging because of the problems in the actual medical formation: Even time is passing, ill-equipped graduates are been formed. General problems identified: mismatch of competencies to patient and population needs; poor teamwork; persistent gender stratification of professional status; narrow technical focus without broader contextual understanding; episodic encounters rather than continuous care; predominant hospital orientation at the expense of primary care; quantitative and qualitative imbalances in the professional labor market; and weak leadership to improve health-system performance. Professionals become mere technological managers, difficult to serve marginalized rural communities. Lack in effective leadership to transform health systems. Contributes of this process: Professional silos Static pedagogy Curricula rigidities Insufficient adaptation to local context Commercialism in the professional.

Laudable efforts to address these deficiencies have mostly floundered, partly because of the so-called tribalism of the professionsie, the tendency of the various professions to act in isolation from or even in competition with each other.

Good health is at least partly knowledge based and social driven. Role of health professional

Face of the health system: knowledge brokers, link people to technology, information and knowledge. They are also caregivers, communicators, educators, team members, managers, leaders and policy makers. Needs: Technical competence, service orientation, driven by ethical commitment and social accountability. Professional workers. Lengthy period of education and substantial investment by both the student and society. Importance of medical education.

Actual education reform is attempting to developed professional competences that are responsive to changing health needs, overcome professional silos through interprofessional education, harness information technology-empowered learning, enhance cognitive skills for critical inquiry and strengthen professional identity and values for health leadership.
Many countries are attempting to extend essential services through the deployment of basic health workers, even as millions of people resort to providers without credentials, both traditional and modern.

Consequently, in many countries, postsecondary professional education is absent from the policy agenda and is overtaken by emergency or urgent action projects and is regarded as too costly, irrelevant, or long term.

Education revolution Alongside the explosive increase in total volume of information need for the 21st health professional, there is a equivalent increase in ease of access to it. the role of universities and other educational institutions needs to be rethought. Universities and educational institutions are broadening their traditional role as places where people go to obtain information (eg, by consulting books in libraries or listening to expert faculty members) to incorporate novel forms of learning that transcend the confines of the classroom. The next generation of learners needs the capacity to discriminate vast amounts of information and extract and synthesise knowledge that is necessary for clinical and populationbased decision making. These developments point toward new opportunities for the methods, means, and meaning of education

Transformative learning -> instructional reform Three successive levels Three fundamentals shifts Fact memorization -> searching, analysis and synthesis for decision making Achieving core competencies Creative adoption of global resources and educational models. Interdependence -> institutional reform Three fundamentals shifts

Harmony between education and health systems Networks of institution Global preoccupations: flows of education content, teaching resources and innovations. Relevance of these thoughts Improve of population health and quality of life Role of FMUSP and Medicine in the 21st century and Brazil politics This revolution will happens. The FMUSP need to be a leader in this process.