Madam Chairperson, Prof Goh, Hon. Members of the WONCA Executive, Presidents and Representatives of National Delegations, Colleagues, Friends, Ladies and Gentleman:

I am deeply honoured to have the privilege of addressing such a distinguished congregation in the Opening Ceremony of the 13th WONCA Asia-Pacific Regional Conference in Beijing, and must thank Prof Goh Lee Gan, President of the WONCA Asia-Pacific Region, for his kind invitation to me to be the Speaker in this the Second Wes Fabb Oration. I am particularly delighted to learn that this Oration was expressly created to pay special tribute to and to recognize the sterling contributions of Professor Wesley E. Fabb to the World Organization of Family Doctors during his years as the Secretary/Treasurer and later as the first Chief Executive Officer of WONCA. I reminisce with pleasure and satisfaction of having served in divers capacities in the highest governing body of the World Organization - the WONCA Executive - continuously for 18 years from 1980 to 1998, three of which years (1992-1995) as President. I can therefore claim to be eminently qualified to testify from personal experience the excellent and proficient performance of Prof Wes Fabb during his tenures of office, oftentimes far above and beyond the call of duty. WONCA was indeed fortunate to have enjoyed the services of two first-rate workers for the price of one! Mrs. Marian Fabb also made tremendous contributions to WONCA in her own right, especially in relieving her husband of routine in-house administrative chores and more importantly in the organization and management of international conferences all over the world. This husband and wife team is an unbeatable combination. Prof Fabb's predecessor, Dr David Game, had been unofficially labelled as "Mr WONCA" because of his contributions to WONCA in the early years. On that score, by the same token, and using similar criteria, I would proclaim that Wes and Marian Fabb can justifiably be called "Mr and Mrs WONCA".

It was General Douglas MacArthur who recalled to memory the words of an old American army ballad: "Old soldiers never die, they just fade away". I am glad to inform this audience that the Fabbs, after their well-deserved retirement from their respective WONCA positions, refused "to fade away", but embarked on a totally different course of action to launch the most far-reaching, beneficial, potentially profitable and innovative project ever undertaken by WONCA in its entire history. Two years ago, Wes and Marian Fabb established on the WONCA website a unique service for family doctors worldwide - Global Family Doctor - a journal review that identifies articles that are relevant, informative and interesting for the family doctor, and summarizes them for posting on the website under the heading: "Global Family Doctor (GFD)". This combination of cutting edge research material and comprehensive clinical reviews enables family doctors to keep up-to-date, to stay ahead of their patients, and to keep up with their consultant colleagues.

GFD also offers many other educational and informative programmes for family doctors, including the "Daily Alerts" service that notifies recipients by way of a personal e-mail what has been posted on GFD that day. All items are hyperlinked to the summary of the article - a quick click takes the user directly to the summary. At present, over 2,300 doctors worldwide receive "Daily Alerts". This is a free service with no cost involved; you just click on. To quote Prof Fabb directly: "There is something for everyone on the Global Family Doctor - http://www.globalfamilydoctor.com - a daily visit will pay you rich dividends".

To go through the multitudes of international English-language medical journals relevant to general practice/family medicine is a tedious and painstakingly labour-intensive job for the husband and wife team operating out of their home in Australia - but it is an invaluable and absolutely precious asset to all family doctors around the world. And it could be potentially profitable to WONCA, too. In future, when the number of users multiple and the network expands, pharmaceutical companies and retail enterprises may well be tempted to pay WONCA for the privilege of advertising in the network. For all these reasons, the Regional Council of the WONCA Asia-Pacific Region, under the capable leadership of Regional President Prof Goh Lee Gan of Singapore and his predecessor Prof Zoraydo E Leopando of the Philippines, should be heartily congratulated for having the wisdom and the intellect to establish and launch the "Wes Fabb Oration" at the 12th WONCA Asia-Pacific Regional Conference in Malaysia last year, and I too take pride in being its Second Orator by following the footsteps of Prof Fabb, who delivered the Inaugural Lecture in Kuala Lumpur on Easter Sunday, 31st March, 2002.

My association and involvement with the development of General Practice in China since 1986 is well-documented and does not need further elucidation. However, one particular service which WONCA performed for China during my term of office as WONCA President should be placed on record at this point. It was at the 13th WONCA World Conference in Vancouver in May 1992 soon after I assumed office as WONCA President that the Director of Medical Education of the Ministry of Health of PRC, Dr Huang Yongchang, approached me with the request that WONCA send a team of experts to China to conduct an extensive on-the-spot investigation into the system of medical education in China, and to advise his Department on how to incorporate the concept of general practice/family medicine into the curricula for different grades of medical schools in China.

Subsequently, the WONCA Council resolved:

"That WONCA promote not only the Specialty of general practice/family medicine, but also the concept of general practice/family medicine as being applicable to all primary health workers"; and,

"That a Task Force comprising a group of four experts go to China for a month to study the curriculum there, and produce curricula for the four levels of "doctor" which currently exist in China";

and voted the sum of US$10,000 for the project.

The "WONCA Task Force on Medical Education and Development of General Practice/Family Medicine in China" comprised four members - Dr Giora Almagor and Dr Martine Granek-Caterivas, both from Israel, Dr Goh Lee Gan from Singapore and Dr Chau Tang-tat from Taiwan. The members were in China for about a month in late 1992 through early 1993. Each member, accompanied respectively by appropriate senior officials of the Ministry of Health and the Chinese Medical Association, separately toured remote rural villages in four different provinces, and submitted their report to the P.R.C. Ministry of Health and the WONCA Secretariat in March/April 1993. Their valuable and informative report was translated into Chinese and published in both English and Chinese in booklet form, thanks to a generous donation from the Chan Tat-chee Memorial Fund, and was extensively distributed by the Hong Kong College in China and worldwide.

Each and every one of you was given on registration a Booklet printed in both English and Chinese, which I specially brought from Hong Kong. May I request that you to please take out the Booklet and place it in front of you...... Thank you...... You will notice that the Booklet is in three parts:

Going back into history, you will find that most medical educators and policy-makers in medical schools around the world in the 19th and the first half of the 20th Century up to the time of the Pacific War in 1941 firmly believed that the core bundle of medical knowledge they impregnated and infused into the minds of medical students during the 5 or 6 years of undergraduate medical studies should be sufficient and adequate to serve the doctor throughout his entire professional career. The advent of the knowledge explosion and the rapid advance of sciences following the Second World War completely shattered such complacency. Many other factors including the need for more community-based teaching, the need to replace traditional didactic teaching by problem-based learning (PBL), etc., all combined to make the time-honoured system of training medical students completely anachronistic and out of sync with the times. And yet, to this day, many medical schools around the world (and China is no exception) are lamentably still utilizing such out-dated 19th Century methods to teach 21st Century students.

I am glad to inform you that the Medical Faculty of the University of Hong Kong had since early 1990's indulged in a series of extensive curriculum reviews to look into the problems of (1) overcrowded curriculum; (2) compartmentalized teaching with no integration; (3) rigid curriculum with an over-emphasis on didactic teaching, resulting in a passive approach by students; (4) lack of clear educational objectives and monitoring systems; (5) an over-emphasis on hospital-based secondary and tertiary care; and (6) too much emphasis on examinations, etc. There are also a host of other concerns, not the least of which is the need of modern doctors to cope with an ever-increasing knowledge base, and to keep learning throughout their professional life. All these considerations combined to solidify the resolve of the Medical Faculty to completely revamp the curriculum and radically transform the modus operandi of teaching, and to introduce the new style curriculum into the Faculty as from 1997.

As I said earlier, Appendix II is comprised of two articles. The first article by Prof Tony Dixon, the prime-mover of the curriculum reform, gives the theoretical background and rationale for the change. The second article written jointly by Prof Dixon and Prof S P Chow described in detail the new curriculum of the HKU Medical Faculty, as it existed today. I highly recommend that all of you read and re-read these two articles until you can fully understand and truly grasp the significance of the wealth of information therein contained.

The first batch of medical students who were admitted under the new scheme into the Faculty in 1997 had completed their 5-year course last year (2002). They had just finished their mandatory one-year internship in various hospitals in Hong Kong this (2003) summer. Even though it is still too early to pass judgment on the impact this revolutionary curriculum has on their future professional performance, initial feedback and responses are all very positive and most encouraging. One definite and noticeable result is that without exception, all new medical graduates have very much improved communicative skills.

The main purpose for my bringing to your attention the details of this new development in Hong Kong is to request all of you to bring the highlights of this information back to your respective countries in the hope that your medical schools and universities may be prompted to share or emulate the experience of Hong Kong University's current exercise of breaking away from the anachronistic traditional method of training medical undergraduates. At the dawn of the 21st Century, we should not be afraid to discard the antiquated and the obsolete in favour of modern trends and to do our best to move forward with the times.

From undergraduate education, let us turn our attention to post-graduate education - in other words, let us turn to the main theme of this Conference - "Quality General Practice in the New Century". The Oxford Dictionary defines "Quality" as the "degree of excellence of a thing", or alternatively as "a general excellence". All of us at this Conference may wish to presume that the latter meaning, namely, "a general excellence" is applicable. However, the other meaning could imply that "quality" could be assessed to determine whether it is of "good quality" or "bad quality". This is where "standards" come into play. I wish to make use of the real-life experience of the Hong Kong College of Family Physicians to illustrate my point.

One of the first objectives of the Hong Kong College, when it was founded in 1977, was to work towards improving the ability and skills of members leading to the holding of "Fellowship Examinations" to assess their "quality" or "standards". It was seven years later in 1984 when the College felt it was confident enough to conduct its First Fellowship Examination. >From the very beginning, the College instituted "Quality Control" by inviting renowned academics in general practice/family medicine from around the world to act as "external examiners". In this way, the Hong Kong College managed to achieve "international standards" by getting the Royal Australian College of General Practitioners to agree to hold Conjoint Fellowship Examinations" in 1987, and which has been held annually since. Since the "Australian Fellowship" is recognized by the General Medical Council of England, it implies that the "quality" or "standard" of the "Hong Kong Fellowship" has achieved parity of standards with the rest of the world.

What I have said about the quality or standard of the Hong Kong College Fellowship is to point out that the term "Quality General Practice" in our Conference Theme is only so many empty words if we do not qualify it by proof of excellence. And such proof can only be achieved through assessment or examination using predetermined standards. This Conference is therefore a suitable forum to start discussions on the formulation of an "Asia-Pacific Standard of Family Medicine/General Practice". "Rome was not built in one day". This is as good a time as any to start thinking about the possibility of a common standard of General Practitioners or Family Physicians in the Asia-Pacific Region.

The next priority of the Hong Kong College is to convince the Hong Kong Government to recognize that a hospital-based health delivery system has a disastrous and devastating effect of segregating primary health care from secondary/tertiary care. We must bear in mind that it was universally recognized that hospital-based health care systems which places heavy emphasis on medical technology and expertise have little impact on overall health, but result in an unsupportable drain on human and financial resources. Furthermore, cognizance must be taken of the fact that more than 50% of the graduates will become general practitioners. The effects of dislocation of General Practice and Hospital Specialist care go further than merely to limit the quality of primary care, but the resultant overcrowding of hospital in-patient services adversely affects the efficiency, quality and cost-effectiveness of secondary/tertiary care.

For the record, after 25 years of toil and efforts, the Hong Kong College is glad to witness that Hong Kong is at last progressing in the direction of "Seamless Health Care", which is in fact advocated by Dr E K. Yeoh, the Secretary of Health and Welfare of the HKSAR Government. Because of the change in official government policy, there are at present a total of 450 trainee doctors in family medicine programmes in public hospitals in Hong Kong, out-stripping those of all other specialties in the Hospital Authority, and there are indications that the health delivery system in Hong Kong is gradually shifting from hospital- to community-based.

The 1993 World Congress on Medical Education held in Edinburgh had as its theme a very topical subject: "The Changing Medical Profession"; and came to the conclusion that the medical profession had indeed changed. Arising out of this, the World Health Organization (WHO) and the World Organization of Family Doctors (WONCA) decided to join forces to review the current state of medical education around the world and to make recommendations on how to tailor medical education to meet community needs. In June 1993, the WONCA Executive, under my chairmanship as WONCA President, approved the proposal to co-sponsor with WHO a Strategic Action Forum entitled: "Making medical practice and education more relevant to people's needs: the contribution of the family doctor".

After two years of hard work, the 60 invited participants from the two World Bodies, meeting first in Hong Kong and again in London, Ontario, tabled the Final Report of the Strategic Action Forum to the World Health Assembly of WHO and the World Council of WONCA in May and June respectively of 1995. The Final Report was unanimously adopted and hence became a formal joint WHO/WONCA Working Paper, which was disseminated world-wide. The essence of this Working Paper is to send a strong message to all medical schools to provide more opportunities for medical students to learn in community settings and to allocate more resources for the teaching of family medicine in the undergraduate curriculum. This was exactly what Hong Kong University had done by the revamping of its medical curriculum in 1997, as I have reported earlier on.

Academic excellence is the bulwark of any professional discipline, and the Discipline of General Practice/Family Medicine is no exception. For this reason, I do not need to apologize for the lengths I have gone through to relate to you the evolution of Academic General Practice/Family Medicine in Hong Kong. However, hand-in-hand with the development of Academic General Practice/Family Medicine is the need to provide funding for General Practice/Family Medicine Research. Of course we need biomedical research to continue to unravel the mysteries of the microcosm. But that is not enough. We need to pay as much attention to behavioural research in the promotion of health, to research about the family, the social and environmental determinants of disease, to research on health services. First and foremost, we need research into behavioural change, since changes in behaviour of individuals, families and the community are more likely to improve the overall health of the society than is biomedical research, so much of which is directed towards finding ways of patching up people AFTER disease has began. This is why general practice/family medicine is so crucial to the future of medicine. Family medicine's global view, its operative paradigm, its approach to health and illness, are not-to-be-missed signposts as medicine enters the 21st Century.

The October 2003 issue of the Public Health & Epidemiology Bulletin (Volume 12 Number 5) published by the Department of Health of the Hong Kong Government released findings of the Department's recent survey on "Child Behaviour Problems vis-à-vis Parental Response". The conclusion was that "the high prevalence of child behaviour problems and dysfunctional parental practices as well as high parental stress level among a fair proportion of parents pose significant public health problems. There is evidence supporting links between conduct problems in children and anti-social behaviour in adults. Ineffective parenting, child behaviour problems and further increase in parenting difficulties form a vicious circle". I quote this passage from the Public Health & Epidemiology Bulletin to give you an example of the abundance of good raw material in our midst within the community for General Practice/Family Medicine research projects provided we care to look around us.

It can therefore be said that Academic General Practice/Family Medicine is the essential source of nutrients on which the health and well-being of the Discipline of General Practice/Family Medicine depends, and General Practice/Family Medicine Research and Experimentation is the soil on which Academic General Practice/Family Medicine grows and is nurtured. For these reasons, there is no better way to enhance "Quality General Practice in the New Century" than to bolster Academic General Practice/Family Medicine and Research. It is therefore imperative that every medical school or university must have strong departments of General Practice/Family Medicine with well-funded and well-organized research projects.

All I have said so far is on the importance of learning - by medical students, by doctors and by everybody in the profession. ¡u¾ÇµL¤î¹Ò¡v. There is no "stop" in the acquisition of knowledge, and I cannot overemphasize the need and the importance of all doctors to be committed to "Life-long Learning". There are many ways to achieve this aim, but to my mind, the simplest and easiest way is to make good and full use of what Prof and Mrs Fabb have been offering on the WONCA website - the "Global Family Doctor". May I take this opportunity to once again thank Wes and Marian Fabb for their wonderful and most valuable contribution to the World Organization of Family Doctors.

Lastly, I wish to conclude my lecture by introducing you to a new concept of learning - Work Based Learning Studies (WBS). Work Based Learning Studies is centred on the principle that learning takes place in all areas of life, NOT JUST in the classroom. WBS recognizes learning from practical experience, helping individuals to gain internationally-recognized academic qualifications from a combination of work experience, research and project work. Much more than distance learning; WBS can help students achieve a university award based on the projects they actually undertake in their jobs.

Each WBS programme is as unique as the person who creates it, and that person is the student! Flexibility is the key - qualifications are available at undergraduate and postgraduate degree level and always take into account the individual circumstances and preferred methods of study of the student. WBS is also an opportunity for employers to improve competitiveness by retaining the interest and enthusiasm of staff, enabling them to develop their skills on the job and to enhance their effectiveness. It is designed to meet the needs of both employers and employees - and offer many tangible benefits.

WBS degree programmes are tailor-made and customized according to needs of the individual and his working environment, and involves three parties, the employee (the student), the employer and the University. This concept was pioneered by the Middlesex University in England and had been in operation for over 10 years. Partnered with Middlesex University, the Hong Kong University School for Professional and Continuing Education (HKU SPACE) launched Work Based Study (WBS) Courses in Hong Kong in 2000 and has since achieved some measure of success.

WBS is much more than Adult Education or Distance Learning. For the first time ever in the history of tertiary education, academics from an Institute of Higher Learning (the University concerned) will meet with the employer (of the potential student) in the workplace to assess the academic value of actual work done by the employee in the work area itself, and the academic worth of training programmes provided by the employer (if any), before formulating with the student the curriculum and course structure accordingly. All programmes are tailor-made and customized in this way. Such innovative approach to tertiary learning is unique and may prove to be the educational trend for the future.

It is highly recommended that you take this idea back to your respective countries for serious consideration. If you want, you may contact Prof Stephen Li, the person in charge of the Middlesex University East Asia Regional Office in Hong Kong.

Tel.: (852) 2503-0111 or
E-mail: admission@mdxu.com.hk.

Delivering this public address in Beijing this morning brings back fond memories of a pleasant train-ride across the picturesque Irish countryside after the WONCA Council Meeting in the quaint and scenic resort town of Killarney on the way to attend the 15th WONCA World Conference in Dublin in June 1998. Amongst the many WONCA delegates and officials on the train, my traveling companions included Dr Stephen Foo, the then President of the Hong Kong College of Family Physicians and Dr Dai Yu-wei, the then President of the Chinese Society of General Practice. Quite naturally the conversation drifted to WONCA business, in the course of which Dr Dai extended invitations on the spot to Dr Foo and myself to go to Beijing to explore with the Chinese Society the possibility of holding WONCA conferences in China.

The upshot of this fortuitous encounter saw the two of us in Beijing on October 15, 1998 for a one-day meeting. A consensus was reached at subsequent discussions that whilst WONCA conferences should be held in China, it would be prudent to host a regional conference in the first instance to gain experience before bidding for a WONCA World Conference. It was also agreed that November 2003 would be the most suitable and optimal time to hold the Regional Conference. So, here we are at the 13th Asia-Pacific Regional Conference, and I must congratulate Dr Dai and her colleagues in the Chinese Society of General Practice for having the foresight to decide on this Conference five years ago. At the same time, I take this opportunity to thank Dr Wu Zhenglai, the Chairperson of the Host Organization Committee, and everyone involved, for the superb arrangements and the choice of this fine venue for the Conference.

I have spread out in front of you a whole array of annotations and suggestions that I believe is relevant to the Theme of this Regional Conference. If I were to be asked which opinion or opinions therein expressed would be most deserving of immediate or urgent implementation, I would counsel "uniform standards for general practice" and "revamping of medical curricula and teaching methods in all medical schools" in China, and hopefully also in those countries in Asia-Pacific which have not yet attained these ideals. So, I leave you with plenty of "Food for Thought", which I am sure would be more than amply compensated by an abundance of "Food for Gastronomic Delights" provided by the Host Organizing Committee.