Table 1. Categories of difficulties identified in medical and health professions’ education.

Issues identified	Identified circumstance	Examples	Strategies and solutions
Global	Unsafe, dangerous situations •Natural disasters; climate change •War and conflict •Epidemics and outbreaks (e.g. Ebola, foot and mouth) Political/economic issues •Neoliberalism (commodification) •Populism	•Earthquakes, floods, fires •Shortages of doctors and other HPs •Doctors being killed in conflict •Difficulty in recruitment (also a general issue) •Accreditation standards, lack of regulation •Expenditure cuts	No specific solutions were provided for any of these issues. Suggestions were made mainly about raising awareness and coping strategies. Broad strategies: •Postpone or abandon the programme •Deal with the issue in the short- or long-term - adaptation, collaboration •Mitigate damage, normalise the situation
Health and education systems	•Low resource or remote settings •University funding models •Competing values; role conflict •Quality of education •Multiculturalism	•Difficult to recruit doctors: Leads to a low doctor: patient ratio, e.g. In the Congo, 77 ophthalmologists for 80 million people so preventable diseases (e.g. cataract) prevail •Also affects clinical supervision •CPD and faculty development not offered •Declining health care systems •Fees (e.g. student unrest in South Africa) •Country/regional needs vs. individual needs •Education vs. service delivery •Education vs. research •Private vs. public education •Low staff: student ratio •Traditional paradigm; resistance to change •Accreditation standards, lack of a national exam •Non-inclusive curriculum •Conflict of beliefs and values •Inequality	Suggestions: •Use of telemedicine •Students need to undertake volunteer work to develop a sense of patient advocacy General suggestions (for a range of circumstances): •Just doing something (action) •Plan (reflection)- implement- evaluate-reflect (Kolb’s experiential learning cycle) •Make slow but sure changes •Celebrate small successes •Change the system or develop flexible systems •Plan for the long-term (requires patience) •Develop a sense of ownership (through good leaders) •Identify champions •Positive role models •Collaborate and share good practice with like-minded individuals •Transcultural competence training •Use narratives, stories and conversations •‘Fit for purpose’ curriculum
Organisational; teamwork	Medical hierarchy; lack of group or institutional cohesion	•Conflict amongst health professionals •Working with individual purpose and/or power •Gender, race, religious, etc. discrimination	•Interprofessional training •Unconscious bias training •Institutional sense of purpose •Clear, effective leadership
Individual or personal	Uncertainty	Lack of student support systems	•Development and empowerment of the student body •Develop resilience by exposing students to change