The Lancet commissions development was accompanied by expansion of tertiary Before the centennial of the Flexner report, a series of hospitals and academic health centres that trained health initiatives have once again heightened national and professionals, did research, and provided care, thereby global attention about the future of education of health integrating these three areas of activity. Pioneered in professionals. We summarise four sets of major reports the 1950s was the idea of graduate medical education that focus on education of the global health workforce, as postgraduate training, which was similar to an nursing education, public health education, and medical apprenticeship, through residency programmes in education. Recommendations in these reports are ea academ increasingly coalescing into a third generation of reforms The major instructional breakthroughs from the second that emphasise patient ar generation of reforms were problem-based learning and competency-based curriculum, interprofessional and disciplinarily integrated curricula In the 1960s, McMaster team-based education, IT-empowered learning, and University in Canada pioneered student-centred learning policy and management leadership skills. These areas based on small groups as an alternative to didactic lecture. we believe, provide a strong base for formulation of style teaching. Simultaneously, an integrated rather than reform initiatives into the 21st century discipline-bound curriculum was experimentally de- Global workforce education has witnessed a major eloped in Newcastle in the UK and Case Western resurgence of policy attention, partly driven by imperatives Reserve in the USA. 5 Other curricular innovations to achieve national and global health objectives as set out included standardised patients-ie, individuals who are by the Millennium Development Goals(MDGs). Three trained to act as a real patient to simulate a set of major reports are noteworthy in terms of education and symptoms or problemsto assess students on practice, training of the workforce: Task Force on Scaling-Up and trengthening doctor-patient relationships through Saving Lives, World Health Report, and the Joint Learning facilitated group discussions, 7 and broadening the Initiative. These reports all underscore the centrality of continuum from classroom to clinical training through the workforce to well performing health systems to achieve earlier student exposure to patients and an expansion of national and global health goals. All the reports draw training sites from hospitals to communities. - In public attention to the global crisis of workforce shortages health, disciplines expanded along with multidisciplinary estimated worldwide at 2.4 million doctors and nurses in work, and in nursing there was accelerated integration of 57 crisis countries. The crisis is most severe in the worlds schools into universities, with advanced graduate poorest nations that are struggling to achieve the MDGs programmes at the master and doctoral levels particularly in sub-Saharan Africa. The shortages also emphasise associated issues, including imbalances of skill Panel 3: Women and nursing in Islamic societies mix, negative work environment, and maldistribution of health workers. The reports cite imbalanced labour market Women and nursing in Islamic societies has a long and rich dynamics that are failing to ensure adequate rural coverage history. In the Middle East and north Africa, higher education hile generating unemployed professionals in capital nursing started in 1955 when the first Higher Institute of cities, and the international migration of professionals or more about Nursing in the region was established in the Faculty of from poor to rich countries Medicine of the Egyptian University of Alexandria. Endorsed These reports recommend vastly increasing investment WHO, the Institute offered a bachelor of nursing degree. The Institute became an autonomous faculty affiliated to the in education and training. They concentrate on basic workers because of the importance of primary health care University in 1994, offering both masters and doctoral and the long time lag and high costs of postsecondary degrees in nursing sciences. During the past 50 years, the education. Consequently, health professionals, although faculty of nursing has produced more than 6000 graduates, acknowledged, do not receive much attention.These many assuming leadership in the region. rts, however, are sparking growing interest in task nother pioneer is the Aga Khan University School of shifting and task sharing-a process of delegating practical Nursing, which was established in Pakistan in 1980, and tasks from scarce professionals to basic health workers. which began offering a bachelor of science in nursing in 1997 All reports propose increased investment, sharing of and the masters of science in 2001. " The school has devised a resources, and partnerships within and across countries unique curriculum adapted to local contexts but based on the Nursing education is the focus of three major reports in curriculum recommended by the American Association of 2010: Radical transformation, by the Carnegie Foundation olleges of Nursings Essentials of Masters Education in Frontline care. a UK Prime minister commission: 2 and the Robert Wood Johnson Foundation Initiative on the future expanded the bachelors and masters nursing programmes to of nursing, at the US Institute of Medicine. "The Carnegie its campus in east Africa In addition to training nurses, report concluded that although nursing has been effective these advanced degree programmes attract high-quality in promotion of professional identity and ethical candidates in Islamic society, showing societal prestige and comportment, the challenge remains of anticipating value for women entering the nursing profession changing demands of practice through strengthening of scientific education and integration of classroom and www.thelancet.comThe Lancet Commissions 14 www.thelancet.com development was accompanied by expansion of tertiary hospitals and academic health centres that trained health professionals, did research, and provided care, thereby integrating these three areas of activity. Pioneered in the 1950s was the idea of graduate medical education as postgraduate training, which was similar to an apprenticeship, through residency programmes in hospital-based academic centres.72 The major instructional breakthroughs from the second generation of reforms were problem-based learning and disciplinarily integrated curricula. In the 1960s, McMaster University in Canada pioneered student-centred learning based on small groups as an alternative to didactic lecture￾style teaching.73 Simultaneously, an integrated rather than discipline-bound curriculum was experimentally de￾veloped in Newcastle in the UK and Case Western Reserve in the USA.74,75 Other curricular innovations included standardised patients—ie, individuals who are trained to act as a real patient to simulate a set of symptoms or problems—to assess students on practice,76 strengthening doctor–patient relationships through facilitated group discussions,77 and broadening the continuum from classroom to clinical training through earlier student exposure to patients and an expansion of training sites from hospitals to communities.78–81 In public health, disciplines expanded along with multidisciplinary work, and in nursing there was accelerated integration of schools into universities, with advanced graduate programmes at the master and doctoral levels. Before the centennial of the Flexner report, a series of initiatives have once again heightened national and global attention about the future of education of health professionals. We summarise four sets of major reports that focus on education of the global health workforce, nursing education, public health education, and medical education. Recommendations in these reports are increasingly coalescing into a third generation of reforms that emphasise patient and population centredness, competency-based curriculum, interprofessional and team-based education, IT-empowered learning, and policy and management leadership skills. These areas, we believe, provide a strong base for formulation of reform initiatives into the 21st century. Global workforce education has witnessed a major resurgence of policy attention, partly driven by imperatives to achieve national and global health objectives as set out by the Millennium Development Goals (MDGs). Three major reports are noteworthy in terms of education and training of the workforce: Task Force on Scaling-Up and Saving Lives, 20 World Health Report, 19 and the Joint Learning Initiative. 18 These reports all underscore the centrality of the workforce to well performing health systems to achieve national and global health goals. All the reports draw attention to the global crisis of workforce shortages estimated worldwide at 2·4 million doctors and nurses in 57 crisis countries. The crisis is most severe in the world’s poorest nations that are struggling to achieve the MDGs, particularly in sub-Saharan Africa. The shortages also emphasise associated issues, including imbalances of skill mix, negative work environment, and maldistribution of health workers. The reports cite imbalanced labour market dynamics that are failing to ensure adequate rural coverage while generating unemployed professionals in capital cities, and the international migration of professionals from poor to rich countries. These reports recommend vastly increasing investment in education and training. They concentrate on basic workers because of the importance of primary health care and the long time lag and high costs of postsecondary education. Consequently, health professionals, although acknowledged, do not receive much attention. These reports, however, are sparking growing interest in task shifting and task sharing—a process of delegating practical tasks from scarce professionals to basic health workers. All reports propose increased investment, sharing of resources, and partnerships within and across countries. Nursing education is the focus of three major reports in 2010: Radical transformation, by the Carnegie Foundation; Frontline care, 9 a UK Prime Minister commission;12 and the Robert Wood Johnson Foundation Initiative on the future of nursing, at the US Institute of Medicine.82 The Carnegie report concluded that although nursing has been effective in promotion of professional identity and ethical comportment, the challenge remains of anticipating changing demands of practice through strengthening of scientific education and integration of classroom and Panel 3: Women and nursing in Islamic societies Women and nursing in Islamic societies has a long and rich history. In the Middle East and north Africa, higher education in nursing started in 1955 when the first Higher Institute of Nursing in the region was established in the Faculty of Medicine of the Egyptian University of Alexandria. Endorsed by WHO, the Institute offered a bachelor of nursing degree. The Institute became an autonomous faculty affiliated to the University in 1994, offering both masters and doctoral degrees in nursing sciences. During the past 50 years, the faculty of nursing has produced more than 6000 graduates, many assuming leadership in the region. Another pioneer is the Aga Khan University School of Nursing, which was established in Pakistan in 1980, and which began offering a bachelor of science in nursing in 1997 and the masters of science in 2001.83 The school has devised a unique curriculum adapted to local contexts but based on the curriculum recommended by the American Association of Colleges of Nursing’s Essentials of Master’s Education in Advanced Nursing (1996).84 Aga Khan University has also expanded the bachelors and masters nursing programmes to its campus in east Africa.83 In addition to training nurses, these advanced degree programmes attract high-quality candidates in Islamic society, showing societal prestige and value for women entering the nursing profession. For more about the Faculty of Nursing at the University of Alexandria see: http://www. alexnursing.edu.eg