Why is it taking so long for healthcare professional education to become relevant and effective? What can be done?

For about a half century the World Health Organization (WHO), supported by the literature in the field of health personnel education, has argued for the benefits of a learner-centered and community-oriented approach to professional education. Nevertheless, change has not happened in the vast majority of schools and countries. This paper describes the obstacles and constraints to change in health professional education: Obsolete administrative rules, the low profile of public health, the lack of real decision power of faculty, a dearth of faculty trained in the field of education, the arbitrary separation between so-called basic sciences and clinical practice, the disciplinary orientation of learning objectives, a lack of explicit definition of desirable professional competencies, and, above all, too little value placed on the evaluation of educational programs. The recent literature continues to argue for change but action does not follow. Only very few training institutions currently put newer approaches into practice. The university culture remains an environment that stifles change.