Biomedical professions need a One Health approach in HE

One Health is an inclusive concept which denotes the holistic integration of health for humans, animals and the environment. As such, it has important implications for how we prepare biomedical professionals for daily practice.

Its implementation requires multidisciplinary knowledge and intersectoral collaboration to bring biomedical professionals (doctors, veterinarians, pharmacists, agronomists and environmental scientists) together to advance knowledge and science.

Such cross-sectoral collaboration is fundamental if we are to effectively tackle global challenges, such as the prevention, preparedness for and crisis management of existing, and emerging, health threats.

A 2018 pan-European survey of 41 veterinary education organisations in the European Union and the European Free Trade Area showed there is a consensus among veterinary academics about the benefits of interdisciplinary education.

This model of teaching provides a different educational experience and helps to create a common understanding of One Health, by widening students’ horizons, offering new opportunities and promoting ‘thinking outside the box’.

In so doing, it better prepares students and professionals to cope with complex healthcare problems in their daily practice. Education has a crucial role to play in formulating the necessary attitudes and aptitudes of future biomedical professionals and preparing them for their important role in ensuring One Health.

Barriers to One Health education

The survey shows that, while the benefits of interdisciplinary education for the students, the professionals and society are undisputable, the interdisciplinary model is still difficult to implement at undergraduate level and remains rather underexplored.

Although the results are limited to one discipline – veterinary medicine – they provide some good insights and food for thought. It is evident that changing educational culture to encompass One Health requires a complete switch in the way health professionals approach all aspects of biomedical practice, from observation, examination and diagnosis to prevention, control, treatment and research.

Academic education should therefore offer interprofessional teaching at a university level to facilitate a horizontal change in attitudes, to inspire more openness and to promote interdisciplinary collaboration throughout people’s professional careers.

The survey revealed that different regulations are the most important factors hindering innovation and openness when it comes to teaching methods in Europe.

European laws, national legislation, academic and structural regulations and implementation of different accreditation systems are often obstacles to the development of any new learning process.

The paradigm of veterinary training in Europe, which is regulated at EU level by the Professional Qualifications Directive (Directive 2005/36/EC as amended by Directive 2013/55/EU), promotes discipline-based education and makes it difficult to integrate a One Health culture at universities.

Even in the European Union, a region which is subject to a common legislative framework, education remains a policy area which comes under the subsidiarity principle. Important variations are still present in policies and regulations from country to country and between higher education institutions.

Additionally, there are challenges at the level of teaching and the curriculum. Creating a course which works across disciplines requires particular attention when it comes to the composition of the class in order to identify the appropriate level of knowledge necessary for students coming from different backgrounds.

Additionally, it requires the proper design of learning outcomes as well as assessment methods in a way that is appropriate for all students.

Core competencies and quality assurance

These considerations, along with international policy recommendations from the World Health Organization (WHO) (Transforming and Scaling Up Health Professionals’ Education and Training: WHO Guidelines, 2013), the World Organisation for Animal Health (Fourth OIE Global Conference on Veterinary Education: Final recommendations, 2016) and other similar bodies, have led to further reflection on how to facilitate the implementation of an open, holistic approach towards professional education and training in order to increase multisectoral and intersectoral interactions, allowing the introduction of a true One Health culture in education.

There is a need for policy reform when it comes to the regulation of professional qualifications for everyone in the biomedical sciences in the EU. This would include a framework which outlines One Health core competencies, which could then be incorporated within the different curricula, irrespective of the scientific area they cover.

Establishing a list of One Health day-one competencies would help academic institutions, irrespective of their area of expertise, to identify the subjects in their curriculum where interdisciplinary training could be introduced as an important teaching tool.

One Health core competencies should integrate knowledge, skills and attitudes, which will enable health professionals to think about, design and apply their healthcare skills holistically.

Apart from the need for a new regulatory framework, teaching needs to encompass a range of professionals from different backgrounds with a common understanding of One Health, who could join forces to prepare programmes which are fit for purpose for different students.

Academic institutions should encourage and train educators to widen the learning process by partnering with experts from other disciplines. Academic leaders should champion discussions on intersectoral collaboration and measures to facilitate interdisciplinary mobility for both educators and students.

There is also the need for another policy reform to endorse the implementation of a harmonised approach to quality assurance in the European Higher Education Area, which will facilitate the development of a common perception of One Health across disciplines.

So far, very few European-wide, profession-specific accreditation systems exist in the EU; for instance, when it comes to veterinary training there is the European System of Evaluation of Veterinary Training. Such initiatives need to be formally embraced and legally endorsed and promoted.

It is evident that the time has arrived for an open global dialogue on how to re-design academic education with a view to preparing health professionals to be able to implement a holistic approach and to be innovative and more effective.

Dr Despoina Iatridou is a senior policy officer at the Federation of Veterinarians of Europe and general secretary of VetCEE (Veterinary Continuous Education in Europe), Professor Jimmy Sanders is VetCEE president and Professor Ana Bravo is president of the European Association of Establishments for Veterinary Education.