Innovation, ideology and innocence.
Innovative solutions are required to deal with the inadequacies of existing medical education programmes, in both the developed and developing countries, if we are to promote the evolution of more acceptable, more efficient and more effective health care. The newly formed Network of Community-oriented Educational Institutions for Health Sciences is attempting to promote a series of educational and organisational innovations, aimed at the preparation of health professionals who will be better equipped and better motivated to meet the real health needs of the populations they are to serve. Such innovations encounter many obstacles, of which ideologically-based inflexibility of thought is the most important. Ideologies are here defined, in Barnett's words, as "patterns of belief ... quasi-conceptual, quasi-affective sets assumed to be true", having the power to prohibit "rigorous or experimental examination of novel experience." Such systems of thought have 'negative, restrictive and pathological effects' on the development of innovative solutions to complex problems. A particularly destructive and inhibiting stereotype has flowed from an ideological commitment to the achievement of 'international excellence'. A state of what in this paper is called 'innocence' is regarded as mandatory for the implementation of studies based on a commitment to the empirical approach, to the null hypothesis and above all to the evaluation of the process and outcome of educational and other interventions in the health care system.