Though they share a common goal of improving health, the fields of medicine and public health differ in their approach—one is focused on individuals and treatments, the other on populations and prevention. In an address to approximately 80 HSPH alumni at the Harvard Club of Boston on June 20, Iskender Sayek, dean of the Faculty of Medicine at Hacettepe University, Ankara, Turkey, argued that an understanding of public health should be inherent in the education of future doctors.

The talk was hosted by the HSPH Office of Alumni Programs and the Alumni Council, in collaboration with the Fogarty International Center-funded Mental Health and Developmental Disabilities Program at Children’s Hospital Boston. The Fogarty program is directed by HSPH graduate Kerim Munir (MPH ‘84, ScD ‘93) and is coordinated by alumna Verda Tunaligil (MPH '01).

Sayek is a senior in-country advisor for the Fogarty mental health program, which collaborates with Hacettepe.

Elsbeth Kalenderian (MPH ’89) moderated the discussion.

Sayek spoke frankly about current challenges in Turkey’s medical education system. As in many European countries, Turkey boosted the number of its medical students in the past decade and now has a surplus of doctors who need to find work.

In addition, most medical schools in Turkey have begun to present full professors the option of doing part-time work, a system that Sayek believes distracts them from devoting enough time to teaching. He noted that this problem is not unique to Turkey: medical schools in the U.S. are also looking for ways to make education a priority for faculty members who are busy seeing patients and conducting research. While health care and research are important missions, “the first priority of medical schools under all circumstances should be education,” he said.

Progress has been made. With the rapid growth of medical schools in Turkey, the average teacher-to-student ratio has dropped. A new core curriculum is helping to standardize education in the country, and problem-based learning methods—a model Hacettepe was first to adopt in Turkey—are becoming more popular.

Sayek argued for further fundamental reforms. For one, the medical curriculum can no longer be expected to keep pace with knowledge in many fields, he said.

“The information is growing so fast that medical education has to be changed in a way that we teach how to learn rather than giving the information to our students,” he said.

That means asking students to solve clinical problems and hunt for information on their own instead of listening to lectures all day.

Incorporating more of a public health perspective, medical students need to learn to think broadly about health, rather than simply focusing on individuals and their diseases, he said. Considerations of environmental influences, health promotion, epidemiology, disease prevention, and social contexts should help guide treatment, Sayek said.

For Hacettepe, a plan for medical education reform is in some ways a step into the past. The history of the university dates back to 1958, with the establishment of the Institute of Child Health in Ankara. The institute was modeled on Children’s Hospital Boston and emphasized traditional public health values, such as community health and disease prevention. International training was valued, as promising young faculty were encouraged to pursue postgraduate training in the U.S. and elsewhere.

In 1963, the Faculty of Medicine was established and a general teaching hospital was built. By 1967, Hacettepe University was chartered, folding the Faculty of Medicine into the larger university.

Over time, Hacettepe lost some of its community health focus, said Sayek. His vision includes restoring that focus, and Hacettepe is now collaborating with community health centers.

The university also offers a four-week course devoted to topics such as environmental health, health economics, preventive medicine, and medical anthropology. The school has pioneered a two-month rural practice rotation that is now mandatory in all medical schools in the country.

For Sayek, medical education reform, “should be more than updating the curriculum.”

Sayek’s lecture was one of several events organized by the HSPH Office of Alumni Programs throughout the year. For more information about the office, visit the web site available at http://www.hsph.harvard.edu/alumni/.