Community-based Medical Education Research Articles

The ‘Australian rural health education revolution’

The ‘Australian rural health education revolution’

Community-based medical education: The Nepal experience

Community-based medical education: The Nepal experience

Training Medical Students in the Community - Memoirs and Reflections of the University of Transkei Medical School

Not long after its inception, the undergraduate medical program at the University of Transkei (UNITRA) departed from the traditional hospicentric medical education approach to one tailored around a Community-Based Medical Education (CBME) curriculum adopting the Problem-based Learning (PBL) pedagogy. This article reflects on the experiences of the faculty in establishing and implementing CBME, exploring what it has meant to train medical students in the community. It further appraises CBME by reviewing its impact on students, the faculty, and the community at large.

Expert Preceptor Interactive Curriculum (Out of Print)

Abstract Introduction The challenges of community-based medical education include ensuring the quality and consistency of students' learning experiences and developing a sense of academic community...

Communities' awareness, perception and participation in the Community-Based Medical Education of the university of Maiduguri

Community-based medical education (CBME) is no longer a new innovation in medical education since the establishment of The Network: Towards Unity for Health (The Network: TUFH) 25 years ago. The CBME of the University of Maiduguri medical college is 14 years old and has never been assessed in terms of the population it serves. The study was conducted to determine the level of awareness, perception, and participation of the communities in CBME. A cross-sectional survey was carried out in 11 village units of three Local Government Areas (LGAs) using a 14-item structured questionnaire administered to adults in randomly selected households. The questionnaire was based on guide questions used for focus group discussions held earlier with community leaders. Awareness of students' visits among respondents was 73.7%. Knowledge of the frequency of presence of the students in the communities was 72.2%. "To examine and treat" (33.6%) and "to ask questions" (16.6%) were the most prominent reasons given for the visits. The majority of respondents perceived the visits as beneficial (72.2%). More frequent visits were requested by 54.4% of the respondents. The communities were willing to be more accessible and felt that the LGAs should provide more logistic support to the program. This study revealed that communities were aware of students' visits and knew reasons for the visits, thought visits were beneficial, and were willing to provide more support for these visits.

Mixed metaphors

If a journal such as The Clinical Teacher, aimed as it is at the busy clinical practitioner, is going to hit the spot, the content obviously needs to be varied and interesting enough to hook the unwitting potential reader. Having risen to the bait, once they've read and digested the article that caught their eye, the chances are that something else will interest, then something else, and so on and so on, until the journal has been read from cover to cover. What's more, the reader, by now, will be cajoling their local Education Centre Library to take out a block subscription to the journal whilst enthusiastically encouraging their colleagues to take a look, setting in motion a cascade of interest…soon everyone is reading The Clinical Teacher, and…OK, fantasy over. But the journal content certainly needs to appeal to a range of interests, and I think this issue of The Clinical Teacher is a good example. We have themed the content to reflect three areas of contemporary concern to those involved in clinical education and training: the social responsiveness of medical schools; personal and professional development; and patient safety and simulation. Medical schools have been exhorted to become more socially responsive, the ultimate aim being to produce graduates who are better orientated to the needs of the communities they serve. Papers on cultural competence, community-based medical education, and a report of an innovative approach to widening access through outreach, including a participating student's views, address this important area. Personal and professional development is another aspect of medical training currently exercising educators’ minds. There are two papers in this theme, one on the use of portfolios, the other on the challenge of training the trainers to take on new assessment roles (in this case, assessing Foundation trainees). Patient safety as a distinct subject is a (relatively) ‘new kid on the block’ in medical education, and the first paper in this section gives an overview of what clinical teachers should know about the topic. Inextricably linked with patient safety is the use of simulation, and two papers tackle this, one describing how to bridge the gap between simulation in the classroom and the realities of the clinical environment, the other an overview of the use of simulation in teaching and assessment – the comment by the author of the latter paper, that we are at the start of ‘a very long journey’ suggests this won't be the last time the topic crops up in The Clinical Teacher. Finally, along with the regular features of Digest and In Brief, we have an ‘Airmail’ from Eire, in which the authors describe and discuss new policy developments in medical education, which, although specific to Ireland, have a familiar ring to them, not least the challenges of introducing graduate entry and the sustainability of programmes in the context of increased student numbers and stretched clinical facilities. So that's it for this issue. Hooked? I hope so. Apologies for the mixed metaphors…I appreciate there are more there than you can shake a stick at…

Community-based medical education

Community-based medical education

Learning in teaching hospitals and the community: time to get the balance right

Learning in teaching hospitals and the community: time to get the balance right

How Can GP Teachers be Supported to Make Good Teaching Even Better?

With the increase in undergraduate teaching taking place within general practice, it is important that general practice (GP) teachers are offered training and developmental activities to support their educational work. It is also important that this support is well targeted, if it is to be effective in raising teaching quality. This study set out to elicit the views of GP teachers both in terms of the value of current developmental activities being provided by the Centre for General Practice and Primary Care (CGPPC), and action points for the future. A questionnaire was sent to each lead GP teacher at all 108 active teaching practices involved in community-based medical education. The responses indicated that student feedback reports, module specific training, peer observation and, importantly, the opportunity to network with peer tutors in other practices, were regarded as useful activities. The research demonstrates that GP teachers are well able to articulate their own support needs and the results set a clear agenda for working with practices based on a collaborative understanding. Education for Primary Care (2006) 17: 17–23 # 2006 Radcliffe Publishing Limited

Primary Care Physicians' Attitudes to Community-Based Medical Education and the Wave Model as a New Teaching Method in Ambulatory Care Settings

Purpose: In order to expand and improve community-based medical education(CBME), we attempted to delineate the characters of the primary care physicians interested in medical education and their opinions on the new medical teaching method for ambulatory care settings, Wave model. Methods: Through mailed questionnaires, we asked the Seoul members of the family physician association and the internal medicine physician association about their interest and opinions of CBME and the Wave model. Results: We received 186 replies from the total 1088 questionnaires(17.1%) sent out. Many of the primary care physicians(141/186; 75.8%) had no experience with CBME. However, 127 (68.7%) were interested in CBME and 121(65.4%) answered that they were interested in teaching students in their clinic. There were 128(69.2%) affirmative responses to the Wave model, which was much higher than that to the observation-centered method, 53(30.3%)(p＜0.0001). Primary care physicians who have affirmative attitudes to adopting the Wave model would select this model as their CBME program(p＜0.0001). Primary care physicians willing to teach students tend to be males(p=0.0085) and younger in age(p=0.0003), have examination rooms for student-patient contact(p＜0.0001), and possess positive attitude to adopting the Wave model(p= 0.0018). Conclusion: There are many primary care physicians eager to participate in CBME. They view the Wave model as an effective teaching method. Factors associated with the desire to work as a preceptor include being male and younger in age. having examination rooms for student-patient contact, and possessing a positive attitude to adopting the Wave model.

A Pilot Study for Integrating Volunteers With Core Psychiatry Faculty

Among psychiatric educators of medical students and residents are those who are referred to as volunteer faculty. Their unpaid status, limited time to devote to teaching, and isolation from most of the core faculty present us with the challenge of better integrating them with the team of educators. The author describes a faculty development demonstration project in a community-based medical education setting. Attendance information and postworkshop surveys in 2001 and 2003 are presented as qualitative data. On two occasions, one-half day conference with a visiting expert was offered to both core and voluntary faculty. Attendance was satisfactory, and comments of participants demonstrated a new appreciation and application of techniques for clinical teaching and evaluation. Faculty development workshops offered to voluntary and core faculty may encourage collaboration between groups, enhance teaching, and become a meaningful aspect of continuing education. Increased interaction with volunteers may lead educators to reframe the concept of faculty.

The Paradigm Of Community-Based Participatory Epizootiology: A Review

Community-based participatory approach has been used for decades in rural sociology and the humanities in the design, implementation, monitoring and evaluation of development and intervention projects. Community-based medical and health education paradigm has become the accepted standard for undergraduate medical education worldwide since its evolution in the sixties. Its application to veterinary medicine is a recent phenomenon, but is now largely and effectively entrenched in veterinary epidemiology education and practice in East and Central Africa, as well as other third world countries. Within the ongoing Pan African Programme for the Control of Epizootics (PACE) in 32 African countries, the Community-based Animal Health and Epidemiology (CAPE) Unit actively promotes the participatory approaches in pastoral areas of the Greater Horn of Africa region. This paper discusses the application of community-based participatory techniques to epizootiology and seeks to promote its use in Nigeria Keywords : Paradigm, community-based participatory epizootiology. Tropical Veterinarian Vol. 23 (3 &4) 2005: pp. 69-77

Community-based or tertiary-based medical education: so what is the question?

This edition of Medical Teacher brings to our attention another insightful article from the Flinders University Rural Clinical School, led by Professor Paul Worley (Worley et al., 2004), enquiring as to what students actually do on their clinical rotations. Beginning with the premise that there is little published material exploring the learning activities undertaken by students in different learning environments, Worley and colleagues conducted a study that was able to compare three groups of students. These students were exposed to the same curricula material in three different environments, namely an urban teaching hospital, a remote secondary referral hospital and a rural community-based programme. Although Worley et al. admit to the small numbers of students within the study, and the generalisability of their results, the community students reported greater and more valuable patient contact, more effective time spent in clinical settings and an increased time being supervised by experienced clinicians, compared to the secondary and tertiary based students. The secondary hospital based students reported more time spent in lectures and tutorials than the tertiary or community-based students and the time spent in their clinical settings was valued less than the time spent learning at home. The impact is that this is yet another paper that demonstrates the value of communities as a credible alternative to the traditional teaching hospital. However it does raise other questions regarding medical education and community learning.“If we want things to stay as they are, things will have to change”Guiseppe di Lampedusa (1957)

University of South Carolina School of Medicine.

University of South Carolina School of Medicine.

Parallel Rural Community Curriculum: is it a transferable model?

The chronic shortage of doctors in rural Australia has been well documented. Enabling medical students to undertake positive rural experiences during their undergraduate course is a well-supported long-term strategy to provide a sustainable solution to this problem. The Parallel Rural Community Curriculum (PRCC) was developed by Flinders University, South Australia, in 1997 to enable senior medical students to undertake an entire clinical year based in rural general practice in the Riverland region of South Australia. The academic success of this program has been widely acknowledged. Many institutions are planning to use this model as a basis for their own curriculum reform. However, questions have been asked as to how well this program would translate into another region. Due to the success of the Riverland program, Flinders University decided to commence a second PRCC program in 2002, this time in the Greater Green Triangle (GGT) region of South Australia and Victoria, Australia. This new program was developed collaboratively by the GGT University Department of Rural Health and the Flinders University Rural Clinical School. The mean student rank improved by an average of 17 places out of a class of 90 students. Partnership development took time. General practitioners (GPs) initially showed significant anxiety particularly in regard to their teaching capacity, time commitment of students and the infrastructure demands on their practices. Specialists' engagement was a challenge, requiring a significant change to their teaching paradigms. Horizontal and vertical integration of teaching was complex and required ongoing effort to maximize efficiency. The community had high expectations of the workforce outcome and these needed to be tempered with realistic expectations about the length of time required to train doctors, and an understanding of workforce mobility. The initial evaluation of the GGT PRCC suggests that the Riverland PRCC is translatable. Successes, including student performance, GP acceptance and community ownership have been replicated in the GGT community-based medical education program. A key to the success has been the recognition of the crucial role of partnerships in an environment where, for clinicians, clinical service provision and other personal needs take precedence over teaching roles and responsibilities.

Charles W. Dohner, PhD: an evaluator and mentor in medical education.

As one of the first generation medical education pioneers, Charles W. Dohner, PhD established the ninth office of medical education at the University of Washington (UW) where he served as chairman from 1967-1996. With a background in education and measurement, he focused his work on evaluation of educational programs and faculty development. The Department of Medical Education went through three distinct stages of development: pathfinding 1967-1972 focused on developing working relationships with the faculty and clarifying identity, integration into academic affairs 1972-1980, and direct leadership by department faculty 1980-1996. Dohner helped to create and evaluate the WAMI program, a regional medical education program for the states of Washington, Alaska, Montana, and Idaho. He served as a consultant to a specialty board, the founding president of the Society of Directors of Research in Medical Education, and a frequent consultant in international medical education. Dohner identified three important innovations in medical education: educators in academic medicine, simulations and performance assessment, and community-based medical education. Success factors for professional education include technical competence in education, interpersonal communication and collaboration skills, a plan for personal growth, and use of mentors. Future trends in medical education will involve information technology, professionalism, wellness and complementary medicine, and performance assessment. He has been a passionate spokesman for excellence in medical education and most noted for his roles as an evaluator, program developer, and mentor of academic leaders.

Integrity: the key to quality in community-based medical education? (Part two).

Relationships do matter! In fact, medicine cannot be learned without them, and community-based medical education (CBME) curricula that ignore them or take them for granted do so at their students peril! Could these assertions provide a key to quality in CBME curricula? In a previous paper, I provided evidence for a simple model of four key relationships, the four Rs, to act as a framework to analyse CBME. These four Rs are the relationships between (1) clinicians and patients, (2) health service and university research, (3) government and community, and (4) personal principles and professional expectations. In this paper I describe a key to discerning quality in this model. This key is integrity - that coalition of soundness and interdependence that enables the quality of the whole to be greater than the sum of the parts. I will also discuss the implications of this model for CBME with particular reference to reform of student selection, curricular goals, course structure, and assessment. Whilst further research based on this model is needed, as a result of this synthesis of the current medical education literature, I propose that it is its capacity to produce clinical, social, institutional and interpersonal integrity in its graduates that makes community-based medical education such an attractive alternative. Relationships do matter!

Relationships: A New Way to Analyse Communitybased Medical Education? (Part One)

Relationships do matter! In fact, medicine cannot be learned without them, and community-based medical education (CBME) curricula that ignore them or take them for granted do so at their students' peril. As CBME is becoming more popular, there is a need to develop appropriate frameworks for describing quality in CBME to ensure that it remains a principle-driven, not format-driven, initiative. In this paper, I provide evidence for a simple model of four key relationships, the four Rs, in which the medical student must be immersed to facilitate high quality learning. These four Rs are the relationships between (1) clinicians and patients, (2) health service and university research, (3) government and community, and (4) personal principles and professional expectations. As a result of this synthesis of the current medical education literature, I propose that this model of clinical, social, institutional and interpersonal relationships is a valid framework for articulating the important principles in CBME, and that it describes why community-based medical education is such an attractive alternative. Relationships do matter!

Evaluation of an innovative approach to community-based medical undergraduate education in Nigeria.

Although innovative, community-oriented and PHC-focused medical education programmes have been in operation in some medical schools in Nigeria for over a decade, they are yet to be comprehensively evaluated. This study therefore aimed at evaluating some impacts of the programmes on medical education in the country. The study was conducted in three innovative medical schools in South-Western Nigeria. Two traditional medical schools were selected as control. Questionnaires were used for the collection of data from random samples of 44 final year medical students in the innovative medical schools (SIMS) and 40 final year medical students in the traditional medical schools (STMS). Forty (40) medical graduates of the innovative medical schools (GIMS) and 33 graduates of the traditional medical schools (GTMS) also participated in the study. In addition, in-depth interviews of key stakeholders of the programmes and focus group discussions of selected members of the communities were conducted. Findings revealed that the graduates of the innovative schools were better exposed to PHC education than those in the traditional schools. Their perceptions of the objectives of, and functions during, the PHC education were significantly different. Methods of learning during the programmes appear to be more experiential and inductive. Attitudes of members of rural communities were also favourable to the programmes. The innovative programmes appear to have impacted positively on medical education in the country. A major deficiency of the programmes is inadequacy of human and material resources for their effective functioning.

Perceptions of how well graduates are prepared for the role of pre-registration house officer: a comparison of outcomes from a traditional and an integrated PBL curriculum

Most medical schools in the UK have been engaged in major curriculum reform based on their premises of what might improve undergraduate medical education. In 1994 the course at the medical school of the University of Manchester changed to an integrated course using problem-based learning throughout and with increased emphasis on community-based medical education. This study explores whether the new curriculum has produced any differences in perceptions of how well graduates are prepared for the role of pre-registration house officer. A postal questionnaire was used to survey 1998 Manchester graduates (traditional course) and 1999 Manchester graduates (new course), three months into their first pre-registration house officer placement. A similar questionnaire was sent to the educational supervisors who were supervising the graduates. The questionnaire was designed to measure perceptions of levels of preparedness for the role of pre-registration house officer, using a list of broad areas of competence and specific skills listed in the General Medical Council's 'The New Doctor'. Graduates rated the new course significantly more effective for 12 of the 19 broad competences and eight of the 13 specific skills that were listed. The 'new' graduates rated their understanding of disease processes lower than the 'traditional' graduates, but there was no difference in the ratings given by the educational supervisors for this. Overall the educational supervisors rated the new course as better preparing graduates in five of the competences. Overall, the evaluation shows that a major change in curriculum approach has changed the profile of the perceived preparedness of graduates for entering professional practice.