An interdisciplinary community diagnosis experience in an undergraduate medical curriculum: development at Ghent University

Development of a community orientation program (COP) as a community-based medical education method for undergraduate medical students: an experience from India

BACKGROUND

Intra-regional cultural and linguistic differences are common in low- and middle-income countries. To sensitise undergraduate medical students to the social and contextual determinants of health to achieve the 'health for all' goal, these countries must focus on innovative teaching methods. The early introduction of a Community Orientation Program (COP) as a Community-based Medical Education (CBME) method could be a game changing strategy. In this paper the methods, evaluation, and implication of the COP in an Indian setting are described.

METHODS

The curriculum of the COP was developed based on the analysis, design, development, implementation, and evaluation (ADDIE) model for educational intervention. In this learner-centric and supervised educational program, the key aim was to focus on developing students' communication skills, observation power and enhancing their motivation for learning through collaborative learning. To meet the objectives of the COP, a situated learning model under the constructivism theory was adopted.

RESULTS

Between 2016 and 2019, 557 students were trained through the COP by visiting more than 1300 households in ten villages. To supplement the students' observations in the community, more than 150 small group discussions, a health education programme for the community and summary presentations were conducted. The students' feedback indicated the need to improve the clinical examinations demonstration quality and increase the number of instruments for clinical examinations. More than 80% of students felt that the program would assist them to improve their communication skills, their understanding of the various socio-demographic factors associated with the common diseases, and it will enable them to respect the local culture during their clinical practice.

CONCLUSIONS

Early initiation of the COP as a CBME method in the undergraduate medical curriculum in an Indian setting has shown promising results. Further evidence is required to adopt such a program routinely for under-graduate medical teaching in the low- and middle- income settings.

Experiencing and designing community-based medicine - development and evaluation of an elective based on explorative learning

Objective: To develop and evaluate an elective for the 6^th semester in the medical curriculum at Charité - Universitätsmedizin Berlin. In this elective, medical students could experience and test Community Oriented Primary Care, hence the integration of public health into primary care, by using explorative learning methods. Method: In three consecutive semester, all participants of the elective filled in a questionnaire before and after the elective. The self-developed questionnaire covered socio-demographic features, an evaluation of the elective as well as a self-assessment regarding learning objectives and attitudes. The results were analyzed descriptively; the learning success was measured by mixed model regression. Results: Thirty-one students (100% of the elective participants) took part in the evaluation, 30 of them (96.8%) at both survey dates. The students evaluated the elective and particularly the commitment of the teachers as very positive. The five-level Likert scale showed a significant growth of knowledge by an average of 1.3 points. The attitudes of the students hardly changed. Conclusion: Students can experience Public Health practically by means of Community Oriented Primary Care. In doing so, explorative learning is an appropriate method providing a significant increase in competences.

Community-based educational design for undergraduate medical education: a grounded theory study

BACKGROUND

Community-based education (CBE) is strategically important to provide contextual learning for medical students. CBE is a priority for countries striving for better primary health care. However, the CBE literature provides little curriculum guidance to enhance undergraduate medical education with the primary health care context. We aim to develop a CBE framework for undergraduate medical education (from macro, meso, and micro curriculum levels) to engage students and teachers with better, more meaningful learning, within primary health care settings.

METHODS

We used a grounded theory methodology by interviewing eight medical educationalists and ten CBE teachers, followed with the coding process by sensitizing the concepts of 'medical education' and 'primary care', to explore any new concepts. The primary data originated from a developing country where the paradigm of high-quality primary health care is mostly unfamiliar. Three senior researchers from international associations of general practices from different countries provided validation to the results.

RESULTS

We identified a new framework for a community-based educational program. The micro-curriculum should offer opportunities for small group activities, ranging from simple to complex learning, emphasizing clinical skills, leadership, and teamwork to improve self-directed and collaborative practice. Sufficient role models and constructive feedback within primary care contexts are robust facilitators. For the meso-curriculum, comprehensive coordination on teacher-training and CBE program is needed. To ensure the sustainability of the program, faculty leaders and managers should include the macro-curriculum with a national postgraduate general practice curriculum and provide strong commitment.

CONCLUSIONS

We designed a 'CBE-tree' model for the undergraduate medical curriculum. By using the CBE framework developed in this study, students and teachers may better comprehend the essential of primary health care.

Training for impact: the socio-economic impact of a fit for purpose health workforce on communities

Across the globe, a "fit for purpose" health professional workforce is needed to meet health needs and challenges while capitalizing on existing resources and strengths of communities. However, the socio-economic impact of educating and deploying a fit for purpose health workforce can be challenging to evaluate. In this paper, we provide a brief overview of six promising strategies and interventions that provide context-relevant health professional education within the health system. The strategies focused on in the paper are:1. Distributed community-engaged learning: Education occurs in or near underserved communities using a variety of educational modalities including distance learning. Communities served provide input into and actively participate in the education process.2. Curriculum aligned with health needs: The health and social needs of targeted communities guide education, research and service programmes.3. Fit for purpose workers: Education and career tracks are designed to meet the needs of the communities served. This includes cadres such as community health workers, accelerated medically trained clinicians and extended generalists.4. Gender and social empowerment: Ensuring a diverse workforce that includes women having equal opportunity in education and are supported in their delivery of health services.5. Interprofessional training: Teaching the knowledge, skills and attitudes for working in effective teams across professions.6. South-south and north-south partnerships: Sharing of best practices and resources within and between countries.In sum, the sharing of resources, the development of a diverse and interprofessional workforce, the advancement of primary care and a strong community focus all contribute to a world where transformational education improves community health and maximizes the social and economic return on investment.

A scoping review of undergraduate ambulatory care education

BACKGROUND

Since a disproportionate amount of medical education still occurs in hospitals, there are concerns that medical school graduates are not fully prepared to deliver efficient and effective care in ambulatory settings to increasingly complex patients.

AIMS

To understand the current extent of scholarship in this area.

METHOD

A scoping review was conducted by searching electronic databases and grey literature sources for articles published between 2001 and 2011 that identified key challenges and models of practice for undergraduate teaching of ambulatory care. Relevant articles were charted and assigned key descriptors, which were mapped onto Canadian recommendations for the future of undergraduate medical education.

RESULTS

Most of the relevant articles originated in the United States, Australia, or the United Kingdom. Recommendations related to faculty development, learning contexts and addressing community needs had numerous areas of scholarly activity while scholarly activity was lacking for recommendations related to inter-professional practice, the use of technology, preventive medicine, and medical leadership.

CONCLUSIONS

Systems should be established to support education and research collaboration between medical schools to develop best practices and build capacity for change. This method of scoping the field can be applied using best practices and recommendations in other countries.

Evaluation and assessment of social accountability in medical schools

Social accountability as an outcome must be measured at institutional (evaluation) and individual (assessment) level. The definitions used in the measurement will be dependent on the social setting of the medical school being scrutinised. A formal framework is needed so that comparisons can be made and progress measured. The World Health Organisation suggests that there are four principles that delineate social accountability--relevance, quality, cost-effectiveness and equity. Medical schools are evaluated according to their planning, doing and impact in relation to these principles. Boelen and Woollard have clarified the ideas of planning, doing and impact into Conceptualisation, Production and Usability. THEnet group of medical schools use a shortened version of Boelen and Woollard's framework with 20 criteria to evaluate their programmes. At the individual level, there is considerable overlap between the concepts of 'social accountability' and 'professionalism'. Attempts are being made to define and measure professionalism, however, if the behaviour and attitudes of individual graduates is a significant component in defining social responsibility new methods of assessment need to be developed. Factors such as the available resources and the structure of the health services have a very large effect on doctors' attitudes and behaviour. As a result, the task of evaluating and assessing the extent to which medical schools are socially accountable is complex. Judgments on how well a school is meeting the standards will have to make allowance for the local political and economic environment.