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Nour N, Onchonga D, Neville S, O'Donnell P, Abdalla ME. Integrating the social determinants of health into graduate medical education training: a scoping review. BMC MEDICAL EDUCATION 2024; 24:565. [PMID: 38783280 PMCID: PMC11119707 DOI: 10.1186/s12909-024-05394-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 04/04/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The social determinants of health (SDH) play a key role in the health of individuals, communities, and populations. Academic institutions and clinical licensing bodies increasingly recognize the need for healthcare professionals to understand the importance of considering the SDH to engage with patients and manage their care effectively. However, incorporating relevant skills, knowledge, and attitudes relating to the SDH into curricula must be more consistent. This scoping review explores the integration of the SDH into graduate medical education training programs. METHODS A systematic search was performed of PubMed, Ovid MEDLINE, ERIC, and Scopus databases for articles published between January 2010 and March 2023. A scoping review methodology was employed, and articles related to training in medical or surgical specialties for registrars and residents were included. Pilot programs, non-SDH-related programs, and studies published in languages other than English were excluded. RESULTS The initial search produced 829 articles after removing duplicates. The total number of articles included in the review was 24. Most articles were from developed countries such as the USA (22), one from Canada, and only one from a low- and middle-income country, Kenya. The most highly represented discipline was pediatrics. Five papers explored the inclusion of SDH in internal medicine training, with the remaining articles covering family medicine, obstetrics, gynecology, or a combination of disciplines. Longitudinal programs are the most effective and frequently employed educational method regarding SDH in graduate training. Most programs utilize combined teaching methods and rely on participant surveys to evaluate their curriculum. CONCLUSION Applying standardized educational and evaluation strategies for SDH training programs can pose a challenge due to the diversity of the techniques reported in the literature. Exploring the most effective educational strategy in delivering these concepts and evaluating the downstream impacts on patient care, particularly in surgical and non-clinical specialties and low- and middle-income countries, can be essential in integrating and creating a sustainable healthcare force.
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Affiliation(s)
- Nehal Nour
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland.
| | - David Onchonga
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland
| | - Siobhan Neville
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland.
| | - Patrick O'Donnell
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland
| | - Mohamed Elhassan Abdalla
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland
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Hoffman M, Metzger K, Martinez O. Building a socially accountable medical school: A layered analysis of the Hackensack Meridian School of Medicine. CLINICAL TEACHER 2024:e13775. [PMID: 38699890 DOI: 10.1111/tct.13775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/01/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND If medicine fundamentally exists to care for the wellbeing of individuals and societies, there should be a direct and comprehensive link between a medical school's social mission and its educational programme. We have not found a description of development or reform that utilises social mission to guide the comprehensive development of the educational programme. As a new school, we utilised a systematic mission-driven approach to develop the curriculum, pedagogical methods and structure of the programme. Using layered analysis, this paper demonstrates how a school's mission can drive all aspects of the educational programme. This supports the transferability of this work to other schools so that they can achieve their unique missions. APPROACH Layered analysis is used for reporting an intervention through three tiered lenses: philosophies, principles and techniques. This provides a structure to guide implementation and evaluation. It can also be used to transfer the innovation to other contexts. EVALUATION Each principle guiding the school's development is linked to context specific techniques and drives the focus of programme evaluation. Evaluation approaches using these principles are described, including an example of composite student performance data in a core area of focus. IMPLICATIONS Through layered analysis of a medical school that developed and implemented a mission-driven curriculum, this can enable other schools to transfer this approach to achieve their missions through the design and implementation of their programmes.
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Affiliation(s)
- Miriam Hoffman
- Department of Family Medicine, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
- Office of Medical Education, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Keith Metzger
- Office of Medical Education, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Ofelia Martinez
- Office of Medical Education, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
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Wilmshurst JM, Catsman-Berrevoets C, Gilbert DL, Nagarajan L, Samia P, Serdaroglu E, Triki C, Vidaurre J, Hameed B. Access to Pediatric Neurology Training and Services Worldwide: A Survey by the International Child Neurology Association. Neurology 2023; 101:798-808. [PMID: 37491325 PMCID: PMC10634651 DOI: 10.1212/wnl.0000000000207633] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/30/2023] [Indexed: 07/27/2023] Open
Abstract
Pediatric neurology is the medical subspecialty responsible for diagnosing and managing diseases and disorders of the nervous system in childhood and adolescence. In many, but not all, regions of the world, the discipline of pediatric neurology is recognized as a specialty or subspecialty of either neurology or pediatrics. Significant knowledge and competencies in this area are necessary to be effective in clinical practice. The need for this is driven by the high burden of disease from neurologic conditions in children and the effect on their families. As the first part of a multistaged project under the auspices of the International Child Neurology Association, in collaboration with key stakeholders, a survey was undertaken to establish which countries have practicing child neurologists. For those countries that have child neurologists, the survey established the number of practitioners and which countries have access to in-country child neurology training. Responses were obtained from 177 countries. Worldwide, there is a median of 0.07 and mean of 0.39 child neurologists per 100,000 population. The greatest deficits in child neurology specialists and access to training were evident in countries which fell under the World Bank rating of low-income country status (range of 0-0.008 child neurologists per 100,000 population). Seventy-three percent of low-income countries lack access to child neurologists: The majority are in the African and South-East Asia regions. For the population of 1.37 billion in the continent of Africa, there were 324 child neurologists, equating to a median of 0.01 per 100,000 population in comparison with a median of 0.59 child neurologists per 100,000 across high-income countries. Ninety-four countries had capacity to support in-country pediatric neurology training. Worldwide, there are inadequate numbers of child neurologists and a great need for increased training capacity.
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Affiliation(s)
- Jo M Wilmshurst
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London.
| | - Coriene Catsman-Berrevoets
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Donald L Gilbert
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Lakshmi Nagarajan
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Pauline Samia
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Esra Serdaroglu
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Chahnez Triki
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Jorge Vidaurre
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Biju Hameed
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
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Larkins SL, Cristobal F, Hogenbirk J, Tandinco F, Othman AB, Mbokazi J, Van Roy K, Upadhyay S, Johnston K, Neusy AJ. Mission and role modelling in producing a fit-for-purpose rural health workforce: perspectives from an international community of practice. Med J Aust 2023; 219 Suppl 3:S20-S26. [PMID: 37544007 DOI: 10.5694/mja2.52020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Sarah L Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD
| | - Fortunato Cristobal
- School of Medicine, Ateneo de Zamboanga University, Zamboanga City, the Philippines
| | - John Hogenbirk
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Canada
| | - Filedito Tandinco
- School of Health Sciences, University of the Philippines Manila, Leyte, the Philippines
| | - Abu-Bakr Othman
- Faculty of Medicine, University of Gezira, Wad Madani, Sudan
| | - Jabu Mbokazi
- Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Kaatje Van Roy
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Karen Johnston
- College of Medicine and Dentistry, James Cook University, Townsville, QLD
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McGrail MR, O’Sullivan BG. Increasing doctors working in specific rural regions through selection from and training in the same region: national evidence from Australia. HUMAN RESOURCES FOR HEALTH 2021; 19:132. [PMID: 34715868 PMCID: PMC8555311 DOI: 10.1186/s12960-021-00678-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/15/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND 'Grow your own' strategies are considered important for developing rural workforce capacity. They involve selecting health students from specific rural regions and training them for extended periods in the same regions, to improve local retention. However, most research about these strategies is limited to single institution studies that lack granularity as to whether the specific regions of origin, training and work are related. This national study aims to explore whether doctors working in specific rural regions also entered medicine from that region and/or trained in the same region, compared with those without these connections to the region. A secondary aim is to explore these associations with duration of rural training. METHODS Utilising a cross-sectional survey of Australian doctors in 2017 (n = 6627), rural region of work was defined as the doctor's main work location geocoded to one of 42 rural regions. This was matched to both (1) Rural region of undergraduate training (< 12 weeks, 3-12 months, > 1 university year) and (2) Rural region of childhood origin (6+ years), to test association with returning to work in communities of the same rural region. RESULTS Multinomial logistic regression, which adjusted for specialty, career stage and gender, showed those with > 1 year (RRR 5.2, 4.0-6.9) and 3-12 month rural training (RRR 1.4, 1.1-1.9) were more likely to work in the same rural region compared with < 12 week rural training. Those selected from a specific region and having > 1-year rural training there related to 17.4 times increased chance of working in the same rural region compared with < 12 week rural training and metropolitan origin. CONCLUSION This study provides the first national-scale empirical evidence supporting that 'grow your own' may be a key workforce capacity building strategy. It supports underserviced rural areas selecting and training more doctors, which may be preferable over policies that select from or train doctors in 'any' rural location. Longer training in the same region enhances these outcomes. Reorienting medical training to selecting and training in specific rural regions where doctors are needed is likely to be an efficient means to correcting healthcare access inequalities.
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Affiliation(s)
- Matthew R. McGrail
- The University of Queensland Rural Clinical School, 78 on Canning St, Rockhampton, QLD 4700 Australia
| | - Belinda G. O’Sullivan
- The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba, QLD DC 4350 Australia
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McGrail M, O'Sullivan B, Gurney T. Critically reviewing the policies used by colleges to select doctors for specialty training: A kink in the rural pathway. Aust J Rural Health 2021; 29:272-283. [DOI: 10.1111/ajr.12707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Matthew McGrail
- University of Queensland Rural Clinical School Rockhampton QLD Australia
| | | | - Tiana Gurney
- University of Queensland Rural Clinical School Toowoomba QLD Australia
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Sayek I, Turan S, Batı AH, Demirören M, Baykan Z. Social accountability: A national framework for Turkish medical schools. MEDICAL TEACHER 2021; 43:223-231. [PMID: 33169641 DOI: 10.1080/0142159x.2020.1841889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To define recommendations to the medical schools in Turkey about social accountability which meets the local needs. METHODOLOGY OF THE STUDY The Association of Evaluation and Accreditation of Medical Education Programs (TEPDAD-Turkey) Social Accountability working group planned a study to determine national recommendations for social accountability of medical schools in two-stages. Delphi technique was used to develop the recommendations and finalize the recommendations in the first stage in which 61 members from 30 different institutions participated. Qualitative analysis was used for open questions in the first round and quantitative analysis for the data which is collected with a rating scale in the second and third rounds of the Delphi study. In the second stage, the recommendations were reviewed and finalized in a consensus workshop in which 68 members from 39 different institutions participated. RESULTS In the Delphi study 63 recommendations were classified under five themes: the health needs of the society, health service delivery, institutional structure and management, educational program and implementation and development and evaluation of social accountability. In the consensus workshop, the 63 recommendations were evaluated and of which 54 of 63 recommendations were agreed upon. CONCLUSION A national framework has been developed by including a wide range of experts from different institutions for the social accountability of medical schools in Turkey. Developing recommendations in a local context will enhance the conceptualization of the recommendations of social accountability in the medical schools. As an accreditation body embedding the principles in the national standards will have a further impact on this process.
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Affiliation(s)
- Iskender Sayek
- Department of Medical Education, Social Accountability Working Group TEPDAD *, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sevgi Turan
- Department of Medical Education, Social Accountability Working Group TEPDAD *, Hacettepe University School of Medicine, Ankara, Turkey
| | - A Hilal Batı
- Department of Medical Education, Social Accountability Working Group TEPDAD *, Ege University School of Medicine, Izmir, Turkey
| | - Meral Demirören
- Department of Medical Education, Social Accountability Working Group TEPDAD *, Hacettepe University School of Medicine, Ankara, Turkey
| | - Zeynep Baykan
- Department of Medical Education, Social Accountability Working Group TEPDAD *, Erciyes University School of Medicine, Kayseri, Turkey
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Barber C, van der Vleuten C, Leppink J, Chahine S. Social Accountability Frameworks and Their Implications for Medical Education and Program Evaluation: A Narrative Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1945-1954. [PMID: 32910000 DOI: 10.1097/acm.0000000000003731] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Medical schools face growing pressures to produce stronger evidence of their social accountability, but measuring social accountability remains a global challenge. This narrative review aimed to identify and document common themes and indicators across large-scale social accountability frameworks to facilitate development of initial operational constructs to evaluate social accountability in medical education. METHOD The authors searched 5 electronic databases and platforms and the World Wide Web to identify social accountability frameworks applicable to medical education, with a focus on medical schools. English-language, peer-reviewed documents published between 1990 and March 2019 were eligible for inclusion. Primary source social accountability frameworks that represented foundational values, principles, and parameters and were cited in subsequent papers to conceptualize social accountability were included in the analysis. Thematic synthesis was used to describe common elements across included frameworks. Descriptive themes were characterized using the context-input-process-product (CIPP) evaluation model as an organizational framework. RESULTS From the initial sample of 33 documents, 4 key social accountability frameworks were selected and analyzed. Six themes (with subthemes) emerged across frameworks, including shared values (core social values of relevance, quality, effectiveness, and equity; professionalism; academic freedom and clinical autonomy) and 5 indicators related to the CIPP model: context (mission statements, community partnerships, active contributions to health care policy); inputs (diversity/equity in recruitment/selection, community population health profiles); processes (curricular activities, community-based clinical training opportunities/learning exposures); products (physician resource planning, quality assurance, program evaluation and accreditation); and impacts (overall improvement in community health outcomes, reduction/prevention of health risks, morbidity/mortality of community diseases). CONCLUSIONS As more emphasis is placed on social accountability of medical schools, it is imperative to shift focus from educational inputs and processes to educational products and impacts. A way to begin to establish links between inputs, products, and impacts is by using the CIPP evaluation model.
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Affiliation(s)
- Cassandra Barber
- C. Barber is a PhD candidate, School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0003-3605-8485
| | - Cees van der Vleuten
- C. van der Vleuten is professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Jimmie Leppink
- J. Leppink is senior lecturer in medical education, Hull York Medical School, University of York, York, United Kingdom
| | - Saad Chahine
- S. Chahine is associate professor, Faculty of Education, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0488-773X
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Johnston K, Guingona M, Elsanousi S, Mbokazi J, Labarda C, Cristobal FL, Upadhyay S, Othman AB, Woolley T, Acharya B, Hogenbirk JC, Ketheesan S, Craig JC, Neusy AJ, Larkins S. Training a Fit-For-Purpose Rural Health Workforce for Low- and Middle-Income Countries (LMICs): How Do Drivers and Enablers of Rural Practice Intention Differ Between Learners From LMICs and High Income Countries? Front Public Health 2020; 8:582464. [PMID: 33194989 PMCID: PMC7604342 DOI: 10.3389/fpubh.2020.582464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 11/13/2022] Open
Abstract
Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points-entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multi-national study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway.
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Affiliation(s)
- Karen Johnston
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Monsie Guingona
- Ateneo de Zamboanga University School of Medicine, Zamboanga City, Philippines
| | | | - Jabu Mbokazi
- School of Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Charlie Labarda
- School of Health Sciences, University of the Philippines, Manila, Philippines
| | | | | | | | - Torres Woolley
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | | | - John C Hogenbirk
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, ON, Canada
| | - Sarangan Ketheesan
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Sarah Larkins
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
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10
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Loyola AB, Palileo-Villanueva LM. A Role-Playing Activity for Medical Students Demonstrates Economic Factors Affecting Health in Underprivileged Communities. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:637-644. [PMID: 32982536 PMCID: PMC7489936 DOI: 10.2147/amep.s259032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Innovative teaching-learning strategies are necessary to promote community orientation and foster awareness of the social determinants of health among millennial learners in the health professions. METHODS The authors designed a role-playing simulation activity that aims to highlight the multidimensional nature of health and develop in students an appreciation of the day-to-day experiences of underserved populations. The current investigation aimed to evaluate the utility of the role-playing activity and guided reflection in terms of the students' appreciation of economic factors that affect health and health-seeking behavior of patients and their recognition of the role of healthcare professionals with respect to issues related to poverty and health. Thematic analyses of the insights and observations of the students immediately after the activity and the anonymized reflection papers were done to identify recurring ideas that made an impression on them. RESULTS The students were able to identify that in a setting with limited employment opportunities and low-income potential, the residents prioritized food and shelter over everything else. They also chose cheaper products over healthier options. Practically everyone forewent out-of-pocket healthcare expenditure in order to minimize its disruptive consequences. In these settings, the students highlighted the role of society and government in the provision of services and in community development. The students also emphasized the necessity for competition among a number of providers of goods and services to reduce prices. When asked if healthcare professionals are contributing to the widening gap between rich and poor, 70% agreed, 9% disagreed, 14% did not give a direct answer, and 7% said that healthcare professionals contributed in some ways and alleviated in other ways. The most commonly cited behavior that contribute to this disparity are the decision to seek highly specialized training, the congregation of practitioners in highly urbanized centers, and inattention to the economic difficulties of most patients. Those who disagreed with the statement cited systemic problems as the driving force that widens the disparity. In particular, these students cited the commodification of healthcare and related services, inappropriate policies, and insufficient funding specifically for services and health human resources. CONCLUSION The evolving landscape in healthcare financing requires more preparation among our medical students and trainees. Innovative strategies such as role-playing activities and guided reflection are useful in demonstrating economic factors that influence health and promote better understanding of externalities that shape the health status of individuals and communities.
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Affiliation(s)
- Aldrin B Loyola
- Department of Medicine, College of Medicine, University of the Philippines – Manila, Manila, Philippines
| | - Lia M Palileo-Villanueva
- Department of Medicine, College of Medicine, University of the Philippines – Manila, Manila, Philippines
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11
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King C, Fisher C, Johnson J, Chun A, Bangsberg D, Carder P. Community-derived recommendations for healthcare systems and medical students to support people who are houseless in Portland, Oregon: a mixed-methods study. BMC Public Health 2020; 20:1337. [PMID: 32878612 PMCID: PMC7466795 DOI: 10.1186/s12889-020-09444-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/25/2020] [Indexed: 11/20/2022] Open
Abstract
Background People who are houseless (also referred to as homeless) perceive high stigma in healthcare settings, and face disproportionate disparities in morbidity and mortality versus people who are housed. Medical students and the training institutions they are a part of play important roles in advocating for the needs of this community. The objective of this study was to understand perceptions of how medical students and institutions can meet needs of the self-identified needs of the houseless community. Methods Between February and May 2018, medical students conducted mixed-methods surveys with semi-structured qualitative interview guides at two community-based organizations that serve people who are houseless in Portland, Oregon. Medical students approach guests at both locations to ascertain interest in participating in the study. Qualitative data were analyzed using thematic analysis rooted in an inductive process. Results We enrolled 38 participants in this study. Most participants were male (73.7%), white (78.9%), and had been houseless for over a year at the time of interview (65.8%). Qualitative themes describe care experiences among people with mental health and substance use disorders, and roles for medical students and health-care institutions. Specifically, people who are houseless want medical students to 1) listen to and believe them, 2) work to destigmatize houselessness, 3) engage in diverse clinical experiences, and 4) advocate for change at the institutional level. Participants asked healthcare institutions to use their power to change laws that criminalize substance use and houselessness, and build healthcare systems that take better care of people with addiction and mental health conditions. Conclusions Medical students, and the institutions they are a part of, should seek to reduce stigma against people who are houseless in medical systems. Additionally, institutions should change their approaches to healthcare delivery and advocacy to better support the health of people who are houseless.
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Affiliation(s)
- Caroline King
- School of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Cameron Fisher
- School of Medicine, Oregon Health & Science University, Portland, OR, USA.,School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Jacob Johnson
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Arum Chun
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - David Bangsberg
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Paula Carder
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
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12
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Biswas S, Douthit NT, Mazuz K, Morrison Z, Patchell D, Ochion M, Eidelman L, Golan A, Alkan M, Dwolatzky T, Norcini J, Waksman I, Solomonov E, Clarfield AM. Implementing a Practical Global Health Curriculum: The Benefits and Challenges of Patient-Based Learning in the Community. Front Public Health 2020; 8:283. [PMID: 32766194 PMCID: PMC7379171 DOI: 10.3389/fpubh.2020.00283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/29/2020] [Indexed: 12/26/2022] Open
Abstract
Background: A growing number of medical schools across the world have incorporated global health (GH) into their curricula. While several schools focus GH education on lecture-based courses, our premise is that global health education should embody a holistic approach to patient care and medical education in local communities. Medical students may learn global health by focusing on real patients, their families and communities as part of a practical curriculum. Aims and Objectives: A unique GH curriculum was devised to compare student learning outcomes on a practical vs. lecture-based course. The premise was that learning from patients would result in a greater breadth of coverage of the global health syllabus as compared to that from a lecture-based course. Methods: A teaching and learning program was developed over 3 years to provide medical students interaction with real patients in the community on a first-preclinical-year Introduction to Global Health and Medical Anthropology course. Learning outcomes on the practical vs. lecture-based course were compared using thematic analysis of the written assignments of both courses: global health case reports and literature reviews, respectively. All members of three cohorts of students undertaking the course in successive academic years were compared (Group A: literature review; Groups B and C: case reports; n = 87). Results: Case reports provided evidence of a greater breadth of learning outcomes when compared to the literature review (p < 0.001). The writing of the case report was enhanced by completion of a field journal and family health needs assessment tool (p < 0.001). Students demonstrated a closeness to their patients that added depth, understanding and motivation to assist patients in health activities and advocate for their needs. Discussion: Placements with patients in the community provided students with a rich learning environment and facilitated the formation of relationships with patients to better understand the social determinants of health and advocate for improvements in their living and working conditions and access to healthcare. Conclusions: Global health may be better learned experientially by following patients rather than from frontal lectures. Patient-based learning inspires a commitment to the individual and facilitates medical schools in meeting their obligations to the communities they serve.
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Affiliation(s)
- Seema Biswas
- British Medical Journal Group, BMJ Case Reports, London, United Kingdom
| | - Nathan T Douthit
- Brookwood Baptist Health, Medical Education, Birmingham, AL, United States.,British Medical Journal Group, BMJ Case Reports, London, United Kingdom
| | - Keren Mazuz
- Hadassah Academic College, Jerusalem, Israel
| | - Zach Morrison
- Department of Surgery, Marshfield Medical Center, Marshfield, WI, United States
| | - Devin Patchell
- Department of Emergency Medicine, Mercy Health, Cincinnati, OH, United States
| | - Michael Ochion
- Department of Social Work, Municipal Health, Be'er Sheva Municipality, Be'er Sheva, Israel
| | - Leslie Eidelman
- Clalit Health Services, Gastroenterology Unit, Ambulatory Specialist Center, Ashkelon, Israel
| | - Agneta Golan
- Department of Neonatology, Soroka University Medical Center, Be'er Sheva, Israel.,Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Michael Alkan
- Department of Medicine, Ben Gurion University of the Negev, Be'er Sheva, Israel.,Medical School for International Health, BGU Faculty for Health Sciences, Be'er Sheva, Israel.,P.H.R. Open Clinic, Volunteer Physician, Tel Aviv-Yafo, Israel
| | - Tzvi Dwolatzky
- Geriatric Unit, Rambam Health Care Campus and Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - John Norcini
- Foundation for Advancement of International Medical Education and Research, Philadelphia, PA, United States.,Psychiatry Department, Upstate Medical University, Syracuse, NY, United States
| | - Igor Waksman
- Department of Surgery, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Evgeny Solomonov
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.,Department of General and Hepatobiliary Surgery, Ziv Medical Center, Safed, Israel
| | - A Mark Clarfield
- Department of Geriatrics, Soroka University Medical Center, Be'er Sheva, Israel.,Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Department of Geriatrics, McGill University, Montreal, QC, Canada
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13
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Abbott PA, Brooker R, Hu W, Hampton S, Reath J. "I Just Had No Idea What It Was Like to Be in Prison and What Might Be Helpful": Educator and Learner Views on Clinical Placements in Correctional Health. TEACHING AND LEARNING IN MEDICINE 2020; 32:259-270. [PMID: 32064934 DOI: 10.1080/10401334.2020.1715804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Phenomenon: Correctional health services can provide quality learning experiences for medical students and graduate medical trainees, including through motivating learners to work with people involved with the justice system, and promoting understanding of the social determinants of health. Approach: We conducted 38 semi-structured interviews to examine the views of learners and educators on how to promote high quality clinical learning in correctional settings, with a focus on the Australian context. Participants included medical students; general practitioners who had undertaken graduate trainee placements; clinical staff involved in teaching and clinical supervision; and graduate program medical educators and university teachers from Australia, New Zealand, and Canada. Data were analyzed thematically. Findings: Clinical placements in correctional settings provided learning about the health of people involved in the justice system, but also beneficial clinical learning for working with a wide range of patients with complex health needs. Valued learnings included managing complex consultations, mental health and substance use disorders, and overcoming anxiety related to interacting with people in prison. Learner concerns included limited patient contact time, apprehension prior to placements, and stress related to experiences during the placements. This apprehension and stress could be mitigated by orientation and debriefing, and by appreciating healthcare professionals in correctional settings as advocates for their patients. Clinical supervision was perceived to be demanding in this context. Independent patient interaction was not usually possible for students and there could be short windows of time in which to provide direct patient care, making pauses for teaching difficult. Insights: Clinical placements in correctional health services provide experiential learning of direct relevance to medical student, and potentially to general practice trainee, curricula which is valuable even when learners do not have particular interest in correctional health. Furthermore, these placements may increase the capacity of the medical workforce to provide skilled care to other underserved populations. High quality learner and clinical supervisor experiences, and program scale and sustainability, require enhanced learning support systems through partnerships between correctional health services and education institutions. Required supports for learners include orientation to security arrangements, debriefing sessions which assist learners to distill their learning and to reflect on challenging experiences, and alternative learning opportunities for when direct patient consultations are not accessible. Supervisor teaching supports include shared teaching approaches in the correctional health clinics and added student support from university-based staff.
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Affiliation(s)
- Penelope A Abbott
- Department of General Practice, Western Sydney University, Campbelltown, Australia
| | - Ron Brooker
- Department of General Practice, Western Sydney University, Campbelltown, Australia
| | - Wendy Hu
- Department of Medical Education, Western Sydney University, Campbelltown, Australia
| | - Stephen Hampton
- Justice Health and Forensic Mental Health Network, Matraville, Australia
| | - Jennifer Reath
- Department of General Practice, Western Sydney University, Campbelltown, Australia
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14
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McKivett A, Hudson JN, McDermott D, Paul D. Two-eyed seeing: A useful gaze in Indigenous medical education research. MEDICAL EDUCATION 2020; 54:217-224. [PMID: 31958361 DOI: 10.1111/medu.14026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Medical education has a role in preparing future health care practitioners to have the skills to meaningfully address health disparities while providing effective clinical care considerate of diversity in our societies. This calls for medical education researchers to approach their craft in ways that prioritise and value inputs from a broader range of perspectives and worldviews in an effort to redress the negative impacts of social, political and structural forces on health outcomes. METHODS Given the entrenched health inequities experienced by Indigenous populations across the globe, this paper details an approach to medical education research put forward by Canadian Mi'kmaw Elders Murdena and Albert Marshall and named 'two-eyed seeing'. This approach provides the opportunity for medical education researchers to address the ongoing impacts of colonisation, racism and marginalisation on health outcomes by prioritising Indigenous worldviews in medical curricula. The need for researchers and medical academies to critically consider Indigenous governance and processes of respectful knowledge sharing within the wider institutional and societal contexts is addressed. CONCLUSIONS The benefits of two-eyed seeing in the context of better preparing the future workforce to effectively meet the needs of those most vulnerable, and to action change against health inequities, situate it as a promising research approach in medical education.
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Affiliation(s)
- Andrea McKivett
- School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia
| | - Judith N Hudson
- School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia
| | - Dennis McDermott
- Office of Indigenous Strategy and Education, La Trobe University, Melbourne, Vic, Australia
| | - David Paul
- School of Medicine Fremantle, University of Notre Dame Australia, Fremantle, WA, Australia
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15
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Reeve C, Johnston K, Young L. Health Profession Education in Remote or Geographically Isolated Settings: A Scoping Review. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520943595. [PMID: 32754648 PMCID: PMC7378721 DOI: 10.1177/2382120520943595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
Remote health has been differentiated from rural health in Australia and defined as isolated, with poor service access and a relatively high proportion of Indigenous residents, necessitating different models of care. Educational strategies for remote health practice are often needs driven and the characteristics of remote health may be used to categorise remote health professional education. This scoping review aims to identify the purpose of health professional education for remote settings, the type of educational strategies implemented and the reported outcomes. A broad search of published literature available in online bibliographic databases was conducted. A total of 33 articles met the review inclusion criteria. A further 7 articles were identified for inclusion in the review through citation searches and the authors' networks giving a total of 40 articles. Six primary themes were established based on the educational purpose: (1) cultural competency; (2) social accountability; (3) rural and remote skill development for the general workforce; (4) remote specialisation; (5) specialist skills required for a remote workforce; and (6) remote teaching. These themes also reflect the philosophical change over time recognising remote health as a separate discipline and its value as a distinctive and efficacious learning environment. The concept of education for remote practice is proposed to describe this unique leaning environment which encompasses critical pedagogy to develop a sense of agency and social accountability, embedding the delivery of primary health care through service learning and developing relationships in a context which is transformative.
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Affiliation(s)
- Carole Reeve
- James Cook University General Practice
Training, College of Medicine and Dentistry, Anton Breinl Research Centre for Health
Systems Strengthening, James Cook University, Townsville, QLD, Australia
| | - Karen Johnston
- College of Medicine and Dentistry, Anton
Breinl Research Centre for Health Systems Strengthening, James Cook University,
Townsville, QLD, Australia
| | - Louise Young
- College of Medicine and Dentistry, Anton
Breinl Research Centre for Health Systems Strengthening, James Cook University,
Townsville, QLD, Australia
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16
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Askew DA, Lyall VJ, Ewen SC, Paul D, Wheeler M. Understanding practitioner professionalism in Aboriginal and Torres Strait Islander health: lessons from student and registrar placements at an urban Aboriginal and Torres Strait Islander primary healthcare service. Aust J Prim Health 2019; 23:446-450. [PMID: 28807104 DOI: 10.1071/py16145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/27/2017] [Indexed: 11/23/2022]
Abstract
Aboriginal and Torres Strait Islander peoples continue to be pathologised in medical curriculum, leaving graduates feeling unequipped to effectively work cross-culturally. These factors create barriers to culturally safe health care for Aboriginal and Torres Strait Islander peoples. In this pilot pre-post study, the learning experiences of seven medical students and four medical registrars undertaking clinical placements at an urban Aboriginal and Torres Strait Islander primary healthcare service in 2014 were followed. Through analysis and comparison of pre- and post-placement responses to a paper-based case study of a fictitious Aboriginal patient, four learning principles for medical professionalism were identified: student exposure to nuanced, complex and positive representations of Aboriginal peoples; positive practitioner role modelling; interpersonal skills that build trust and minimise patient-practitioner relational power imbalances; and knowledge, understanding and skills for providing patient-centred, holistic care. Though not exhaustive, these principles can increase the capacity of practitioners to foster culturally safe and optimal health care for Aboriginal peoples. Furthermore, competence and effectiveness in Aboriginal health care is an essential component of medical professionalism.
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Affiliation(s)
- Deborah A Askew
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Health, Qld 4077, Australia
| | - Vivian J Lyall
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Health, Qld 4077, Australia
| | - Shaun C Ewen
- Melbourne Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Vic. 3010, Australia
| | - David Paul
- Aboriginal Health, School of Medicine Fremantle, University of Notre Dame, WA 6959, Australia
| | - Melissa Wheeler
- Centre for Ethical Leadership, University of Melbourne, Vic. 3010, Australia
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17
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McGrail MR, Russell DJ, O'Sullivan BG, Reeve C, Gasser L, Campbell D. Demonstrating a new approach to planning and monitoring rural medical training distribution to meet population need in North West Queensland. BMC Health Serv Res 2018; 18:993. [PMID: 30577775 PMCID: PMC6303935 DOI: 10.1186/s12913-018-3788-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the health of rural populations requires developing a medical workforce with the right skills and a willingness to work in rural areas. A novel strategy for achieving this aim is to align medical training distribution with community need. This research describes an approach for planning and monitoring the distribution of general practice (GP) training posts to meet health needs across a dispersed geographic catchment. METHODS An assessment of the location of GP registrars in a large catchment of rural North West Queensland (across 11 sub-regions) in 2017 was made using national workforce supply, rurality and other indicators. These included (1): Index of Access -spatial accessibility (2); 10-year District of Workforce Shortage (DWS) (3); MMM (Modified Monash Model) rurality (4); SEIFA (Socio-Economic Indicator For Areas) (5); Indigenous population and (6) Population size. Distribution was determined relative to GP workforce supply measures and population health needs in each health sub-region of the catchment. An expert panel verified the approach and reliability of findings and discussed the results to inform planning. RESULTS 378 registrars and 582 supervisors were well-distributed in two sub-regions; in contrast the distribution was below expected levels in three others. Almost a quarter of registrars (24%) were located in the poorest access areas (Index of Access) compared with 15% of the population located in these areas. Relative to the population size, registrars were proportionally over-represented in the most rural towns, those consistently rated as DWS or those with the poorest SEIFA value and highest Indigenous proportion. CONCLUSIONS Current regional distribution was good, but individual town-level data further enabled the training provider to discuss the nuance of where and why more registrars (or supervisors) may be needed. The approach described enables distributed workforce planning and monitoring applicable in a range of contexts, with increased sensitivity for registrar distribution planning where most needed, supporting useful discussions about the potential causes and solutions. This evidence-based approach also enables training organisations to engage with local communities, health services and government to address the sustainable development of the long-term GP workforce in these towns.
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Affiliation(s)
- Matthew R McGrail
- University of Queensland, Rural Clinical School, 78 on Canning Street, Rockhampton, QLD, 4700, Australia.
| | - Deborah J Russell
- Northern Territory Medical Program, Flinders University, PO Box 41326, Casuarina, NT, 0815, Australia
| | - Belinda G O'Sullivan
- Monash Rural Health, Monash University, 26 Mercy Street, Bendigo, VIC, 3550, Australia
| | - Carole Reeve
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, QLD, 4811, Australia
| | - Lee Gasser
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, QLD, 4811, Australia
| | - David Campbell
- Australian College of Rural and Remote Medicine, GPO Box 2507, Brisbane, QLD, 4001, Australia
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18
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Yeung S, Bombay A, Walker C, Denis J, Martin D, Sylvestre P, Castleden H. Predictors of medical student interest in Indigenous health learning and clinical practice: a Canadian case study. BMC MEDICAL EDUCATION 2018; 18:307. [PMID: 30547790 PMCID: PMC6295008 DOI: 10.1186/s12909-018-1401-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Including content on Indigenous health in medical school curricula has become a widely-acknowledged prerequisite to reducing the health disparities experienced by Indigenous peoples in Canada. However, little is known about what levels of awareness and interest medical students have about Indigenous peoples when they enter medical school. Additionally, it is unclear whether current Indigenous health curricula ultimately improve students' beliefs and behaviours. METHODS A total of 129 students completed a 43-item questionnaire that was sent to three cohorts of first-year medical students (in 2013, 2014, 2015) at one undergraduate medical school in Canada. This survey included items to evaluate students' sociopolitical attitudes towards Indigenous people, knowledge of colonization and its links to Indigenous health inequities, knowledge of Indigenous health inequities, and self-rated educational preparedness to work with Indigenous patients. The survey also assessed students' perceived importance of learning about Indigenous peoples in medical school, and their interest in working in an Indigenous community, which were examined as outcomes. Using principal component analysis, survey items were grouped into five independent factors and outcomes were modelled using staged multivariate regression analyses. RESULTS Generally, students reported strong interest in Indigenous health but did not believe themselves adequately educated or prepared to work in an Indigenous community. When controlling for age and gender, the strongest predictors of perceived importance of learning about Indigenous health were positive sociopolitical attitudes about Indigenous peoples and knowledge about colonization and its links to Indigenous health inequities. Significant predictors for interest in working in an Indigenous community were positive sociopolitical attitudes about Indigenous peoples. Knowledge about Indigenous health inequities was negatively associated with interest in working in an Indigenous community. CONCLUSIONS Students' positive sociopolitical attitudes about Indigenous peoples is the strongest predictor of both perceived importance of learning about Indigenous health and interest in working in Indigenous communities. In addition to teaching students about the links between colonization, health inequities and other knowledge-based concepts, medical educators must consider the importance of attitude change in designing Indigenous health curricula and include opportunities for experiential learning to shape students' future behaviours and ultimately improve physician relationships with Indigenous patients.
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Affiliation(s)
- Sharon Yeung
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario Canada
- School of Medicine, Queen’s University, Kingston, Ontario Canada
| | - Amy Bombay
- Department of Psychiatry and School of Nursing, Dalhousie University, Halifax, Nova Scotia Canada
| | - Chad Walker
- Department of Geography and Planning, Queen’s University, Kingston, Ontario Canada
| | - Jeff Denis
- Department of Sociology, McMaster University, Hamilton, Ontario Canada
| | - Debbie Martin
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia Canada
| | - Paul Sylvestre
- Department of Geography and Planning, Queen’s University, Kingston, Ontario Canada
| | - Heather Castleden
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario Canada
- Department of Geography and Planning, Queen’s University, Kingston, Ontario Canada
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Larkins S, Johnston K, Hogenbirk JC, Willems S, Elsanousi S, Mammen M, Van Roy K, Iputo J, Cristobal FL, Greenhill J, Labarda C, Neusy AJ. Practice intentions at entry to and exit from medical schools aspiring to social accountability: findings from the Training for Health Equity Network Graduate Outcome Study. BMC MEDICAL EDUCATION 2018; 18:261. [PMID: 30424760 PMCID: PMC6234627 DOI: 10.1186/s12909-018-1360-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/25/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions. METHODS The Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet's Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent. RESULTS Findings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds. CONCLUSIONS These findings, from a diverse range of schools with social accountability mandates in different settings, provide preliminary evidence for the selection and training of a medical workforce motivated to meet the needs of underserved populations. These respondents are being followed longitudinally to determine the degree to which these intentions translate into actual practice.
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Affiliation(s)
- Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland Australia
- James Cook Drive, James Cook University, Townsville, 4810 Australia
| | - Karen Johnston
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland Australia
- Training for Health Equity Network, New York, NY USA
| | - John C. Hogenbirk
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario Canada
| | - Sara Willems
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Salwa Elsanousi
- Community Medicine, Department of Family and Community Medicine, University of Gezira, Gezira, Sudan
| | - Marykutty Mammen
- Teaching and Learning Centre, University of Fort Hare, East London, Eastern Cape South Africa
| | - Kaatje Van Roy
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Jehu Iputo
- Department of Medical Education, Walter Sisulu University, Mthatha, South Africa
| | | | | | - Charlie Labarda
- School of Health Sciences at the University of the Philippines, Manila, Philippines
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Brooker R, Hu W, Reath J, Abbott P. Medical student experiences in prison health services and social cognitive career choice: a qualitative study. BMC MEDICAL EDUCATION 2018; 18:3. [PMID: 29291725 PMCID: PMC5748951 DOI: 10.1186/s12909-017-1109-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/17/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND One of the purposes of undergraduate medical education is to assist students to consider their future career paths in medicine, alongside the needs of the societies in which they will serve. Amongst the most medically underserved groups of society are people in prison and those with a history of incarceration. In this study we examined the experiences of medical students undertaking General Practice placements in a prison health service. We used the theoretical framework of the Social Cognitive Career Theory (SCCT) to explore the potential of these placements to influence the career choices of medical students. METHODS Questionnaire and interview data were collected from final year students, comprising pre and post placement questionnaire free text responses and post placement semi-structured interviews. Data were analysed using inductive thematic analysis, with reference to concepts from the SCCT Interest Model to further develop the findings. RESULTS Clinical education delivered in a prison setting can provide learning that includes exposure to a wide variety of physical and mental health conditions and also has the potential to stimulate career interest in an under-served area. While students identified many challenges in the work of a prison doctor, increased confidence (SCCT- Self-Efficacy) occurred through performance success within challenging consultations and growth in a professional approach to prisoners and people with a history of incarceration. Positive expectations (SCCT- Outcome Expectations) of fulfilling personal values and social justice aims and of achieving public health outcomes, and a greater awareness of work as a prison doctor, including stereotype rejection, promoted student interest in working with people in contact with the criminal justice system. CONCLUSION Placements in prison health services can stimulate student interest in working with prisoners and ex-prisoners by either consolidating pre-existing interest or expanding interest into a field they had not previously considered. An important aspect of such learning is the opportunity to overcome negative preconceptions of consultations with prisoners.
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Affiliation(s)
- Ron Brooker
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Griffin B, Porfeli E, Hu W. Who do you think you are? Medical student socioeconomic status and intention to work in underserved areas. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:491-504. [PMID: 27812820 DOI: 10.1007/s10459-016-9726-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Abstract
A frequently cited rationale for increasing the participation of students from low socioeconomic status (SES) backgrounds is that it will create a workforce who will choose to work in low SES and medically underserviced communities. Two theoretical arguments, one that supports and one that contradicts this assumption, are proposed to explain the practice location intentions of medical students which we examine in a longitudinal analysis. SES background and future intentions of 351 applicants to an undergraduate medical degree were assessed at Time 1, with intentions re-assessed one year later for 96% of those who were enrolled as medical students. Students from very low (and very high) SES backgrounds indicated lower intention to practice in low SES or medically underserviced areas than those from mid-range SES backgrounds. Males and students from non-English speaking backgrounds indicated less desire to work in low SES areas, perhaps explained by high aspirational motivation. SES accounted for a relatively small amount of variance in practice intentions. Alternate predictors of practice location, including individual values and training effects, and their implications for selection practice, are discussed.
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Affiliation(s)
- Barbara Griffin
- Department of Psychology, Macquarie University, Sydney, 2109, Australia.
| | - Erik Porfeli
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - Wendy Hu
- Western Sydney University, Sydney, Australia
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Puddey IB, Playford DE, Mercer A. Impact of medical student origins on the likelihood of ultimately practicing in areas of low vs high socio-economic status. BMC MEDICAL EDUCATION 2017; 17:1. [PMID: 28056975 PMCID: PMC5215143 DOI: 10.1186/s12909-016-0842-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 12/14/2016] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Medical schools are in general over-represented by students from high socio-economic status backgrounds. The University of Western Australia Medical School has been progressively widening the participation of students from a broader spectrum of the community both through expanded selection criteria and quota-based approaches for students of rural, indigenous and other socio-educationally disadvantaged backgrounds. We proposed that medical students entering medical school from such backgrounds would ultimately be more likely to practice in areas of increased socio-economic disadvantage. METHODS The current practice address of 2829 medical students who commenced practice from 1980 to 2011 was ascertained from the Australian Health Practitioner Regulation Agency (AHPRA) Database. Logistic regression was utilised to determine the predictors of the likelihood of the current practice address being in the lower 8 socio-economic deciles versus the top 2 socio-economic deciles. RESULTS Those who were categorised in the lower 8 socio-economic deciles at entry to medical school had increased odds of a current practice address in the lower 8 socio-economic deciles 5 or more years after graduation (OR 2.05, 95% CI 1.72, 2.45, P < 0.001). Other positive univariate predictors included age at medical degree completion (for those 25 years or older vs those 24 years or younger OR 1.53, 95% CI 1.27, 1.84, P < 0.001), being female (OR 1.26, 95% CI 1.07, 1.48, P = 0.005) and having a general practice versus specialist qualification (OR 4.16, 95% CI 3.33, 5.19, P < 0.001). Negative predictors included having attended an independent school vs a government school (OR 0.77, 95% CI 0.64, 0.92, P < 0.001) or being originally from overseas vs being born in Oceania (OR 0.80, 95% CI 0.67, 0.96, P = 0.017). After adjustment for potential confounders in multivariate logistic regression, those in the lower 8 socio-economic deciles at entry to medical school still had increased odds of having a current practice address in the lower 8 socio-economic deciles (OR 1.63, 95% CI 1.34, 1.99, P < 0.001). CONCLUSION Widening participation in medical school to students from more diverse socio-educational backgrounds is likely to increase the distribution of the medical workforce to ultimate service across areas representative of a broader socio-economic spectrum.
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Affiliation(s)
- Ian B. Puddey
- School of Medicine and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Level 4 RPH MRF Building, Rear 50 Murray St, Perth, WA 6000 Australia
| | - Denese E. Playford
- School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009 Australia
| | - Annette Mercer
- Faculty Office, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009 Australia
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Preston R, Larkins S, Taylor J, Judd J. Building blocks for social accountability: a conceptual framework to guide medical schools. BMC MEDICAL EDUCATION 2016; 16:227. [PMID: 27565709 PMCID: PMC5002162 DOI: 10.1186/s12909-016-0741-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 08/15/2016] [Indexed: 05/10/2023]
Abstract
BACKGROUND This paper presents a conceptual framework developed from empirical evidence, to guide medical schools aspiring towards greater social accountability. METHODS Using a multiple case study approach, seventy-five staff, students, health sector representatives and community members, associated with four medical schools, participated in semi-structured interviews. Two schools were in Australia and two were in the Philippines. These schools were selected because they were aspiring to be socially accountable. Data was collected through on-site visits, field notes and a documentary review. Abductive analysis involved both deductive and inductive iterative theming of the data both within and across cases. RESULTS The conceptual framework for socially accountable medical education was built from analyzing the internal and external factors influencing the selected medical schools. These factors became the building blocks that might be necessary to assist movement to social accountability. The strongest factor was the demands of the local workforce situation leading to innovative educational programs established with or without government support. The values and professional experiences of leaders, staff and health sector representatives, influenced whether the organizational culture of a school was conducive to social accountability. The wider institutional environment and policies of their universities affected this culture and the resourcing of programs. Membership of a coalition of socially accountable medical schools created a community of learning and legitimized local practice. Communities may not have recognized their own importance but they were fundamental for socially accountable practices. The bedrock of social accountability, that is, the foundation for all building blocks, is shared values and aspirations congruent with social accountability. These values and aspirations are both a philosophical understanding for innovation and a practical application at the health systems and education levels. CONCLUSIONS While many of these building blocks are similar to those conceptualized in social accountability theory, this conceptual framework is informed by what happens in practice - empirical evidence rather than prescriptions. Consequently it is valuable in that it puts some theoretical thinking around everyday practice in specific contexts; addressing a gap in the medical education literature. The building blocks framework includes guidelines for social accountable practice that can be applied at policy, school and individual levels.
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Affiliation(s)
- Robyn Preston
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Jenni Judd
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
- Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
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Larkins S, Iputo J, Sen Gupta T. Fit for purpose? Selection processes should consider aptitude in terms of skills, personal characteristics and context. MEDICAL EDUCATION 2016; 50:389-391. [PMID: 26995475 DOI: 10.1111/medu.12978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Ray RA, Young L, Lindsay DB. The influences of background on beginning medical students' perceptions of rural medical practice. BMC MEDICAL EDUCATION 2015; 15:58. [PMID: 25889114 PMCID: PMC4375927 DOI: 10.1186/s12909-015-0339-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 03/09/2015] [Indexed: 05/23/2023]
Abstract
BACKGROUND Access to health care is an ongoing problem for underserved populations in rural and remote regions of Australia and North America. Despite medical schools educating more medical doctors, this maldistribution continues. While students entering medical programs with a rural focus purport to have an interest in rural medicine, their understanding of possible future rural practice is unclear. This study explored the differences in perception of rural practice between beginning medical students from rural and urban backgrounds to gain an indication of the usefulness of our selection process to meet the rural workforce mandate. METHODS Beginning medical students completed a writing exercise about the life and work of a rural medical doctor as a test of their academic writing skills. After completing the task and receiving feedback, students were invited to submit their work for analysis. Template analysis using themes from a study of rural medical registrars was used to analyse 103 scripts. RESULTS Students demonstrated foundational insight into some of the realities of rural life and practice. However, differences were noted in perspectives between rural background students and urban background students. Rural background students used everyday language to describe the practicalities of rural life, medical practice and the implications for families and communities. Urban background students generally used complex language and more negative descriptors. CONCLUSIONS Beginning medical students from urban and rural backgrounds differ in their perceptions and expression of rural practice. These outcomes are important for medical schools that use interviews in their selection process. Rural background applicants' suitability may be overlooked because of the interviewer's expectations of language, while urban background applicants may score higher related to complex language and use of key phrases. Interviewer training should address this likely bias thereby increasing the potential to recruit rural background students.
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Affiliation(s)
- Robin A Ray
- College of Medicine and Dentistry, James Cook University, Townsville, 4811, Australia.
| | - Louise Young
- College of Medicine and Dentistry, James Cook University, Townsville, 4811, Australia.
| | - Daniel B Lindsay
- Department of Psychology, College of Health Care Sciences, James Cook University, Townsville, 4811, Australia.
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Larkins S, Michielsen K, Iputo J, Elsanousi S, Mammen M, Graves L, Willems S, Cristobal FL, Samson R, Ellaway R, Ross S, Johnston K, Derese A, Neusy AJ. Impact of selection strategies on representation of underserved populations and intention to practise: international findings. MEDICAL EDUCATION 2015; 49:60-72. [PMID: 25545574 DOI: 10.1111/medu.12518] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/07/2014] [Accepted: 04/28/2014] [Indexed: 05/03/2023]
Abstract
CONTEXT Socially accountable medical schools aim to reduce health inequalities by training workforces responsive to the priority health needs of underserved communities. One key strategy involves recruiting students from underserved and unequally represented communities on the basis that they may be more likely to return and address local health priorities. This study describes the impacts of different selection strategies of medical schools that aspire to social accountability on the presence of students from underserved communities in their medical education programmes and on student practice intentions. METHODS A cross-sectional questionnaire was administered to students starting medical education in five institutions with a social accountability mandate in five different countries. The questionnaire assessed students' background characteristics, rurality of background, and practice intentions (location, discipline of practice and population to be served). The results were compared with the characteristics of students entering medical education in schools with standard selection procedures, and with publicly available socio-economic data. RESULTS The selection processes of all five schools included strategies that extended beyond the assessment of academic achievement. Four distinct strategies were identified: the quota system; selection based on personal attributes; community involvement, and school marketing strategies. Questionnaire data from 944 students showed that students at the five schools were more likely to be of non-urban origin, of lower socio-economic status and to come from underserved groups. A total of 407 of 810 (50.2%) students indicated an intention to practise in a non-urban area after graduation and the likelihood of this increased with increasing rurality of primary schooling (p = 0.000). Those of rural origin were statistically less likely to express an intention to work abroad (p = 0.003). CONCLUSIONS Selection strategies to ensure that members of underserved communities can pursue medical careers can be effective in achieving a fair and equitable representation of underserved communities within the student body. Such strategies may contribute to a diverse medical student body with strong intentions to work with underserved populations.
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Affiliation(s)
- Sarah Larkins
- School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
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Long JA. Accountability in the Medical Profession. Patient Saf Surg 2014. [DOI: 10.1007/978-1-4471-4369-7_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mitchell RD, Jamieson JC, Parker J, Hersch FB, Wainer Z, Moodie AR. Global health training and postgraduate medical education in Australia: the case for greater integration. Med J Aust 2013; 198:316-9. [PMID: 23545029 DOI: 10.5694/mja12.11611] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Global health (GH) training is well established overseas (particularly in North America) and reflects an increasing focus on social accountability in medical education. Despite significant interest among trainees, GH is poorly integrated with specialty training programs in Australia. While there are numerous benefits from international rotations in resource-poor settings, there are also risks to the host community, trainee and training provider. Safe and effective placements rely on firm ethical foundations as well as strong and durable partnerships between Australian and overseas health services, educational institutions and GH agencies. More formal systems of GH training in Australia have the potential to produce fellows with the skills and knowledge necessary to engage in regional health challenges in a global context.
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Affiliation(s)
- Rob D Mitchell
- Emergency Department, Townsville Hospital, Townsville, QLD, Australia.
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29
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Yore D, Parker EL, Pendrey CGA. Medical schools as agents of change: socially accountable medical education. Med J Aust 2012; 197:333. [DOI: 10.5694/mja12.11095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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