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of costly medical technologies and services that may have little relevance to
the most pressing health needs of the nation's population (Sitthi-amorn 1989).
Increasing attention has been paid to how best to use fixed or shrinking
resources to maximize their health impact.
Medical graduates in Thailand are often ill-prepared to deal with the health
realities of their own country. This problem received wide attention at the
latest Thai National Medical Education conferences (in 1979 and 1986), with
particular focus on how to incorporate the primary-health goals set out in
national strategies into Thai training institutions (Sitthi-amorn 1989). Graduates
of medical schools were seen to lack a population perspective on health
and were thought to have an insufficient appreciation for the social and
behavioural determinants of health relevant to their own country. Many are
unprepared for the realities of the communities and health-care facilities in
which they are destined to work. Although providing curative care is their
primary task, health promotion and disease prevention have been neglected.
As a consequence there is little chance of effecting change in the overall status
of health or the underlying causes of morbidity and mortality.
At question also is how the curriculum and training can promote the attributes
necessary for health graduates to interact effectively with the community and
to assume the diverse roles of educator, health-care manager, and researcher.
For this, it is essential to develop the capability of physicians to formulate
relevant research questions and use national data and resources to improve
the effectiveness of their activities.
Recognizing these deficiencies, medical education reform aims to develop
students' capacity for critical thinking; appraisal of basic health data; defining,
measuring, and evaluating community-health needs; and acting as agents of
change in their role as both physician and responsible community leader. In
Thailand and elsewhere, these objectives have led to the development of
community-targeted, problem-based (CTPB) learning methods (Neufeld
1989).
The CTPB initiative in medical education in Thailand is an example of the
larger movement among health-science educational institutions taking place
on an international scale. In 1979, the Network of Community-Oriented
Educational Institutions for Health Sciences was established with the support
of the World Health Organization (WHO) and the Pan-American Health
Orgnization (PAHO). The network's objectives include strengthening community-oriented
learning in institutions and the development of approaches
and methods that contribute adequately to community-health needs (Neufeld
1989). The number of participating institutions has grown from the original
group of fewer than 30-43 full-member and 75 associate-member institutions.
A network task force on priority health problems in medical education has
been developing an approach to education planning based on the health
problems of populations served by the institutions (Neufeld 1989). Out of this
effort, institutions have adopted CTPB programs. The relevance of a given
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