Design, implementation and evaluation of a community health training program in an integrated problem-based medical curriculum: a fifteen-year experience at the University of Geneva Faculty of Medicine

Developing a responsive model to societal needs in medical education

BACKGROUND

Responsiveness is relevant in the context of treatment and the provision of medical services. However, if we delve deeper into the subject, we must establish and develop responsiveness within the medical sciences education system. This study aims to identify the dimensions that significantly impact responsiveness in the medical education system based on a comprehensive review and expert opinions in healthcare.

METHODS

The present research is descriptive-analytical in terms of its objective and follows a mixed-method approach. This study was conducted in three stages. Initially, we utilized relevant keywords related to education in databases, such as Web of Science, Scopus, ScienceDirect, OVID, CINHAL, EBSCO, Google Scholar, Iranmedex, SID, and Irandoc. Subsequently, in the expert panel session stage, the factors influencing responsiveness were identified in the comprehensive review stage, and with this thematic background, they were conceptualized. Finally, the Confirmatory Factor Analysis (CFA) technique was employed to coherently examine the relationships between variables and present the final model.

RESULTS

We obtained 32 articles from the comprehensive review of studies. Four components in planning, implementation, monitoring and evaluation, and intersectoral cooperation were identified based on expert panel opinions. Based on the standardized coefficients, the components of research-based educational planning, community-oriented education evaluation indicators, and utilization of modern educational methods are statistically significant.

CONCLUSION

The establishment and development of responsiveness in the medical sciences education system involve training specialized and responsive human resources through innovative educational methods that have sufficient familiarity with the multidimensional concepts of health and how to achieve them. This approach allows for practical and responsible steps toward training competent and committed physicians in line with the needs of society. On the other hand, responsiveness in the medical sciences education system can be improved by enhancing research-based educational planning and developing community-oriented evaluation indicators that can assess the number of revised educational programs based on societal needs. Therefore, understanding the critical elements in revising medical education programs, which play the most significant role in addressing societal needs and responding to changing disease patterns and new health priorities, is both a necessity and an important priority.

[Studying Human Medicine at the University of Geneva: An Up-to-Date, Integrated Curriculum]

Studying Human Medicine at the University of Geneva: An Up-to-Date, Integrated Curriculum Abstract. The curriculum of human medicine at the Faculty of Medicine of the University of Geneva has been thoroughly renovated in 1995. It offers an integrated program allowing for a constant adaptation of the content to the explosion of biomedical knowledge and the changes in society. It uses active, student-centred learning methods. In line with the Bologna process since 2006, it has been accredited several times, most recently in 2019. It evolved to strengthen the importance of primary care and to introduce interprofessional training, in particular through its simulation centre. Through early and continuous clinical immersion, students acquire their practical skills in an integrated manner. These conditions are conducive to the introduction of new concepts, such as the Entrustable Professional Activities (EPAs) conveyed by the recent national competence framework PROFILES.

Revolutionized Public Health Teaching to Equip Medical Students for 21st Century Practice

Medical graduates increasingly need public health skills to equip them to face the challenges of healthcare practice in the 21st century; however, incorporating public health learning within medical degrees remains a challenge. This paper describes the process and preliminary outcomes of the transformation, between 2016 and 2019, of a 5-week public health module taught within an undergraduate medical degree in New Zealand. The previous course consisted of a research project and standalone lectures on public health topics. The new course takes an active case-based learning approach to engage student interest and stimulate a broadening of perspective from the individual to the population while retaining relevance to students. A combination of individual- and population-level case scenarios aim to help students understand the context of health, think critically about determinants of health and health inequities, and develop skills in disease prevention, health promotion, and system change that are relevant to their future clinical careers. The new module is based on contemporary medical education theory, emphasizes reflective practice, and is integrated with other learning in the degree. It challenges students to understand the relevance of public health to every aspect of medicine and equips them with the skills needed to act to improve population health and reduce inequities as health professionals and leaders of the future.

Looking back: twenty years of reforming undergraduate medical training and curriculum frameworks in Switzerland

Introduction: To date, hardly any reports exist that outline the reforms in medical studies in Switzerland from the first partial reforms in the 1970s until today. Methods: This article outlines the recent history of medical curricula, their reforms in the early 1970s and, based on these, the key reasons for the major curricular reforms of the 2000s from the perspective of the authors. Results: The various projects, initiatives and legislative elements at the national level include the introduction of new quality control instruments - federal examination and programme accreditation, the introduction of a national catalogue of learning objectives and its two follow-up editions, as well as the implementation of the Bologna reform in undergraduate medical curricula. Examples of the key new elements found in all medical training in Switzerland include: the interdisciplinary orientation of learning content in organ and functional system-oriented subject areas or modules, the enhanced valorisation of practical clinical training, as well as the introduction of problem-oriented formats and the integration of partly formative, partly summative exams according to the format of the objective structured practical examination (OSCE). Characteristics unique to the four medical faculties and their medical training programme are also highlighted. Discussion: The described projects, initiatives and legislative elements have led to a dynamic, continuous development of medical curricula in Switzerland. The close cooperation between the faculties and the Federal Office of Public Health (FOPH) has also resulted in a redefinition of the roles and responsibilities of universities and the Federal Government according to the new Law on Medical Professions. This guarantees the medical faculties a great deal of autonomy, without neglecting quality assurance.

Analyzing the social aspects of the integrated program of field training, research, and rural development course, Faculty of Medicine, University of Gezira, Sudan

INTRODUCTION

Social factors such as culture, race, education, belief, and living and working environment can be part of the causes of diseases or influence the natural history of a disease.

MATERIALS AND METHODS

We have adopted the Harden's ten questions of curriculum development framework approach to assess the social impact of medical curriculum of Faculty of Medicine, Gezira University (FMUG), among the Integrated Program of Field Training, Research, and Rural Development course. We have assessed the objectives and aims of the course and critically analyzed how these will meet the need for social sciences to be integrated into the curriculum.

RESULTS

The recommendations about social and behavioral sciences are well implemented in the curriculum of FMUG. The curriculum promotes early exposure to the community learning. The ten questions of Harden for curriculum or course assessment are satisfactorily covered in the Integrated Program of Field Training, Research, and Rural Development course at FMUG. In addition, the course is also fitting well with criteria suggested recently for increasing competency in social medicine within the medical school curriculum. Importantly, the course is part of the social sciences that well integrated through the duration of the curriculum.

CONCLUSION

The Integrated Program of Field Training, Research, and Rural Development course at FMUG satisfy most of the competency for social medicine. Therefore, taking all these factors into consideration, it is possible to suggest that further research is needed to establish whether the model of FMUG in social sciences can be exemplary for universities in Africa and the Middle East.

Impact of instructor-provided notes on the learning and exam performance of medical students in an organ system-based medical curriculum

PURPOSE

The present study aimed to explore the impact of instructor-provided notes on the learning and exam performance of medical students.

PATIENTS AND METHODS

The participants involved in this study were the first year medical students who enrolled in the auditory system course in the second semester of the academic years 2012-2016 (N=380, 170 males and 210 females). The medical students were divided into two groups: teaching without guided note-taking approach and teaching with guided note-taking approach. To measure the note-taking process of students, quantity and quality of notes were recorded and scored. At the end of the course, the questionnaire was administered to all students in the experimental group in order to cover student's satisfaction with the instructor-provided notes. Chi-squared tests using SPSS software were performed on categorical variables for comparison of exam score between classes with/without guided note-taking approach. A P<0.05 was considered as statistically significant.

RESULTS

When compared, more females (75%) than males were included in the note-taking process. Females wrote more information in greater detail than males. In the control group, only 58 students from 193 students attempted to take notes, but in the experimental group, all of the students were encouraged to complete guided notes and take notes. When students were provided with guided notes, the structure of their notes reflected more outline, examples, verbatim and words than the control group. The students connected the main idea with their details in the spaces of the guided notes. The course final exam performance for the class with the guided note-taking approach was statistically significantly higher than that for the class without a guided note-taking approach (χ²) = 10.542; P=0.023). Nearly all of the students agreed to receive instructor-provided notes before class.

CONCLUSIONS

Findings of the present study indicated that when students are provided with guided notes, their note-taking process develops; consequently improving students' learning and exam performance.

Training medical students in health promotion: twenty years of experience at the Faculty of Medicine of the University of Geneva

Background: In most cases, the work of medical doctors, be they general practitioners or specialists, involves some dimension of health promotion (HP). There is thus ample justification for increasing the awareness of medical students vis-à-vis HP and its relevance for their future practice.

Methods: In the context of a major curriculum reform (problem-based learning [PBL]) at the Faculty of Medicine of the University of Geneva in the mid-1990s, several steps were taken to strengthen HP throughout the curriculum and include HP in its key domains as defined by the Ottawa Charter (OC).

Results: First, the political dimension of HP was developed in a series of first- and fifth-year lectures and third-year workshops; second, community action was strengthened through a third-year one-month community immersion program; third, the development of personal skills was integrated into second- and third-year PBL cases and into fourth-and fifth-year learning activities in clinical settings as well as second- and third-year HP electives; in terms of reorienting health services, the chosen approach included the development of a HP-specific track in the context of a Certificate of Advanced Studies (CAS) in Community Health and a Master of Advanced Studies(MAS) in Public Health. Furthermore, a supportive intra-university environment was created through a collaborative convention with Health Promotion Switzerland, which is in charge of coordinating HP in Switzerland.

Conclusion: In our view, HP teaching for medical students seems all the more relevant given that future medical doctors will have to take care of an increasing number of patients likely to develop chronic non-communicable diseases.

[Teaching infectious diseases in the Medical Degree within the European higher education area]

Durante los estudios de Medicina deben adquirirse competencias básicas en diferentes áreas de conocimiento, una de ellas es la patología infecciosa. La formación en enfermedades infecciosas es imprescindible para la práctica médica general y para la especialización académica o profesional en muchas áreas de la Medicina, tanto médicas como quirúrgicas. La gran cantidad de conocimientos que se genera continuamente sobre las enfermedades infecciosas exige un programa de aprendizaje bien estructurado y enmarcado en un entorno dominado por la globalización. La incorporación de España al espacio europeo de educación superior ha obligado a adecuar los planes de enseñanza de las facultades de Medicina y establecer los contenidos y objetivos docentes de todas las materias de estudio. En este artículo comentamos las implicaciones de la integración del sistema universitario español en el espacio europeo de educación superior («Plan Bolonia») en la docencia de las enfermedades infecciosas en el grado de Medicina, y describimos el programa de aprendizaje de la patología infecciosa en la Universidad Miguel Hernández de Elche (Alicante) basado en resultados y competencias.

Estratégia de Saúde da Família: recursos comunitários na atenção à saúde mental

OBJETIVO: Investigar a percepção de profissionais de estratégia de saúde da família sobre recursos existentes no território para atendimento de demandas em saúde mental. MÉTODOS: Estudo transversal, qualitativo realizado com 27 profissionais da saúde de serviços de atenção primária. Os dados foram coletados utilizando entrevistas, grupos focais e observação. Após a coleta, os dados foram transcritos e submetidos à análise à luz do conceito estruturalista. RESULTADOS: Os enfermeiros referiram dispositivos formais para apoio em saúde mental, enfatizando serviços de saúde. Os coordenadores mencionaram serviços de saúde, universidade e parcerias como conselho tutelar e promotoria pública. Os agentes comunitários demonstraram maior integração com o território e conhecimento abrangente de fontes de apoio social formal e informal. Na observação do território foram identificados recursos sociais não mencionados nas entrevistas. CONCLUSÃO: A percepção dos enfermeiros em relação aos recursos comunitários centrou-se em instituições formais relacionadas à saúde ou ao ensino de cursos na área da saúde. Os coordenadores identificaram outros serviços de saúde e dispositivos de proteção social. Os agentes comunitários têm a maior percepção dos recursos existentes em saúde mental.

The effect of training in primary health care centers on medical students' clinical skills

Medical students' effective clinical skills training are an important goal of any medical school. When adequate, graduate doctors will have sufficient skills to consult a patient by taking proper history and conducting appropriate physical examination. The question under scrutiny is the optimal place for providing such training. Since the aim is to graduate general physicians, many literatures highlighted the importance of implementing such training in the primary health care centers. A special clinical skills training program was developed for the Year 4 pre-clerkship medical students of the Arabian Gulf University during the academic year 2011-2012. It was important for these students to acquire certain skills before transferring to the clerkship phase where they deal directly with patients. For the 130 students involved in this study, a self-assessment and clinical exam were conducted at the beginning and end of the program. The study showed that students benefited greatly from this training program with significant differences between their preexisting known skills and clinical skills acquired by the end of the program. Primary care centers are ideal places for optimal training because of small group training setting that is one tutor to two students and of the advantage that students face real patient environment.

Development and evaluation of a community immersion program during preclinical medical studies: a 15-year experience at the University of Geneva Medical School

BACKGROUND

Significant changes in medical education have occurred in recent decades because of new challenges in the health sector and new learning theories and practices. This might have contributed to the decision of medical schools throughout the world to adopt community-based learning activities. The community-based learning approach has been promoted and supported by the World Health Organization and has emerged as an efficient learning strategy. The aim of the present paper is to describe the characteristics of a community immersion clerkship for third-year undergraduate medical students, its evolution over 15 years, and an evaluation of its outcomes.

METHODS

A review of the literature and consensus meetings with a multidisciplinary group of health professionals were used to define learning objectives and an educational approach when developing the program. Evaluation of the program addressed students' perception, achievement of learning objectives, interactions between students and the community, and educational innovations over the years.

RESULTS

The program and the main learning objectives were defined by consensus meetings among teaching staff and community health workers, which strengthened the community immersion clerkship. Satisfaction, as monitored by a self-administered questionnaire in successive cohorts of students, showed a mean of 4.4 on a five-point scale. Students also mentioned community immersion clerkship as a unique community experience. The learning objectives were reached by a vast majority of students. Behavior evaluation was not assessed per se, but specific testimonies show that students have been marked by their community experience. The evaluation also assessed outcomes such as educational innovations (eg, students teaching other students), new developments in the curriculum (eg, partnership with the University of Applied Health Sciences), and interaction between students and the community (eg, student development of a website for a community health institution).

CONCLUSION

The community immersion clerkship trains future doctors to respond to the health problems of individuals in their complexity, and strengthens their ability to work with the community.

Design, implementation and evaluation of a community health training program in an integrated problem-based medical curriculum: a fifteen-year experience at the University of Geneva Faculty of Medicine

BACKGROUND

In the literature the need for relevance in medical education and training has been stressed. In the last 40 years medical schools have been challenged to train doctors competent to respond to community health needs. In the mid-90s the University of Geneva Faculty of Medicine introduced an integrated medical curriculum. In this initiative a particular emphasis was put in introducing a 6-year longitudinal and multidisciplinary Community Health Program (CHP).

OBJECTIVES

The aims of the present article are to describe the conception, elaboration and implementation of the CHP as well as its evolution over 15 years and the evaluation of its outcomes.

METHODS

The CHP was at its origin elaborated by a small group of highly motivated teachers and later on developed by a multi-disciplinary group of primary care physicians, epidemiologists, public health and bio-ethics specialists, occupational health professionals, lawyers and historians. Evaluation of the program outcomes included educational innovations, new developments of the curriculum and interactions between students and the community.

RESULTS

The CHP learning objectives and teaching modalities were defined by the multi-disciplinary group in consensus meetings which triggered a collaborative spirit among teachers and facilitated further developments. The evaluation procedures allowed the monitoring of students' satisfaction which remained high over the years, students' active participation which decreased over time and success at certifying exams which was globally as good as in basic life sciences. The evaluation also assessed outcomes such as educational innovations, new developments of the curriculum and interactions between students and the community.

CONCLUSION

As suggested in the literature, our experience shows that the students' direct exposure and practice in the community health environment is an effective training approach to broaden students' education by offering them a community perspective of health and disease.