Community-oriented Medical Education Research Articles

BARRIERS TO STUNTING PRIMORDIAL PREVENTION THROUGH PROSPECTIVE BRIDE’S ADVISORY SERVICE: A QUALITATIVE STUDY USING SOCIAL ECOLOGICAL MODEL

Since the Faculty of Medicine and Health Sciences, University of Warmadewa, launched community-oriented medical education (COME), the stunting prevalence in Gianyar Residence decreased from 12.1% (2018) to 11.1% (2019). In 2021, it decreased to 5.1% which was lower than Bali province (10.9% in 2021) and much less than the Republic of Indonesia (24.4%). The PentaCOME (Pentahelix Community-Based Medical Education) project, the modification of COME, was the collaboration of the Indonesian Ministry of Education, Culture, Research, and Higher Education, the Warmadewa University, as well as PT. Sido Muncul is implemented to further lower stunting prevalence via the “Stunting Primordial Prevention Through Prospective Brides Advisory Service” initiative in Payangan District. The present study was intended to figure out barriers to implementing such initiatives. This is a qualitative study using in-depth interviews and focus group discussions (FGDs) in obtaining data. Purposive sampling was used to select informants who represented academicians (3), businessmen (2), community (9), government (3), and media (3) (i.e., Penta helix components). Twenty in-depth interviews and two FGDs involving academician, community, government, and media were conducted during the 1 September 2022 – 15 October 2022 period. Two coders transcribed and coded independently. The social-ecological model was used to categorize the codes. Informants described that they never heard about the ELSIMIL application (ELSIMIL stands for Electronic Siap Nikah dan Hamil which means ‘prepared to get married and pregnant application’) at the personal level. The “No pregnancy, no marriage” motto (i.e., social pressure to get pregnant before marriage among Balinese) was found a barrier at the interpersonal level. At the institutional level, key informants stated the prospective bride’s advisory service and ELSIMIL application campaign were not adequate. At the community level, the family support team community has been established, however, they could not fulfill their function properly due to the “no pregnancy, no marriage” motto. At the policy level, the traditional village assembly (i.e., “Majelis Desa Adat”) has not issued regulations regarding the prospective bride’s advisory service. A lack of cross-sector collaboration was also reported as a barrier to this initiative. A well-planned promotion could socialize ELSIMIL application among prospective brides. Advocacy to the traditional village assembly might diminish the “no pregnancy, no marriage” motto. Pentahelix collaboration needs to be established to achieve the “zero stunting for golden generation” goal.

Why the Faculty of Medicine, University of Gezira (FMUG), Sudan has the potential to lead in social accountability: reflections, opportunities and future directions

Social accountability is an essential component for all medical schools as it deals with education, research and services. In this mini-review, we have discussed why the Faculty of Medicine, University of Gezira (FMUG), Sudan, can lead in social accountability in Africa and the Middle East. This critical analysis is based on searching the literature published in PubMed, Medline, Scopus and Google scholar. We added sections about reflection on opportunities and future direction for FMUG on social accountability. Many unique features in the curriculum that led to excellence in teaching, research and service, will qualify FMUG to lead in social accountability. The location in the heart of Sudan and being community-oriented medical education meant that FMUG, over the last 45 years, gained and mastered the art of social accountability. FMUG continues to be a leader in medical education and has a pioneer master's program in medical education. The majority of the graduates who are not staff members continued to support the medical school many years after their graduation (teaching, research and donation) and promote the concept of social accountability at the national and international level. The curriculum meets all of the competencies of social medicine. Hence, graduates are influential leaders in all medical specialties, and most importantly, in addressing the priority health concerns of the community in rural and urban areas. Therefore, through research and innovations, FMUG can establish social accountability alliance for medical schools and consider adding more unique components to the concept of social accountability (promotion of concept health made at home, especially during COVID-19 pandemic). For instance, retention and recruitment of doctors (training and promotion) and brain drain are main challenges to many health authorities in African and Middle East countries. Another area of innovation, is environmental social accountability of medical schools in order to develop environmentally sustainable solutions to address health concerns especially during the COVID-19 pandemic. This of considerable importance as Gezira state has one of the largest irrigation agriculture schemes in the world. We believe that medical schools' concept of social accountability will continue to evolve, likely depending on the community's needs. © Journal of Public Health and Emergency. All rights reserved.

Community Oriented Medical Education

Abstract not available
 J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 1

Commitment towards a better future for medical education in Saudi Arabia: the efforts of the college of medicine at Qassim University to become socially accountable

ABSTRACT Background: The College of Medicine at Qassim University (COMQU) was founded in 2001 as a problem-based learning and community-oriented medical school in order to strengthen the health system not only in the Qassim region but also in the whole of Saudi Arabia. The aim of the current study was to assess whether the COMQU is a socially accountable medical school and the steps taken to achieve that target. Materials and methods: The study used the social accountability grid published by the World Health Organization (WHO) as a framework to assess the social accountability efforts in the context of three functions of medical schools: education, service and research. Data were collected through the analysis of college documents (2001–2017) and interviews with key informants. Results: The COMQU shows compliance towards social accountability in the three domains of the grid. The indicators related to the education domain demonstrate more compliance than those of research and community service in the grid. Conclusion: The COMQU is based on community-oriented medical education (COME) with strong commitment towards social accountability (socially responsible going towards social responsiveness). More research is needed in order to pave the way to achieve social accountability status. Abbreviations: COMQU: College of Medicine at Qassim University; COME: Community-oriented medical education; WHO: The World Health Organization; MOH: Ministry of Health; SCFHS: Saudi Commission of Health Specialties; PHC: Primary Health Care; HYMS: Hull York Medical School; WFME: World Federation for Medical Education; NCAAA: National Commission for Academic Accreditation and Assessment

Trainees' preferences regarding choice of place of work after completing medical training in traditional or problem-based learning/community-based education and service curricula: a study in Ghanaian medical schools.

Career choices, recruitment and subsequent retention of healthcare professionals in the rural areas are a major worldwide concern and challenge to the health sector, leading to human resource shortages, resulting in poor quality health care for rural communities. Medical education has integrated community-oriented medical education strategies in undergraduate medical training to help address the challenges of health care in rural communities. These strategies are likely to impact the strategies of delivering the content of undergraduate medical curricula. This study explored medical trainees' preferences regarding place of work and choice of specialty after completing training using either the traditional or mixed problem-based learning/community-based education and service (PBL/COBES) curriculum in Ghanaian medical schools. This study was a cross-sectional descriptive design using a questionnaire consisting of 25 open- and close-ended questions. The questionnaire was administered to first-, third- and sixth-year students of two medical schools in Ghana: University of Ghana School of Medicine and Dentistry (UG-SMD) and University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS). UG-SMD uses the traditional method of teaching and learning, whilst UDS-SMHS uses PBL/COBES curriculum in the training of their students. Associations between gender, type of curriculum, choice of specialty and practice location were assessed using the χ2 test. Logistic regression analysis was performed to determine the association between medical school and curriculum type and students' preparation for rural practice while controlling all other factors. Qualitative data analysis of answers to open-ended questions was performed, applying the principles of thematic analysis. Of the students from PBL/COBES track, 64.2% were male, and from the traditional track 52.0%. The majority (74.1%) of students from PBL/COBES track indicated that their medical school curriculum adequately prepared them for rural practice as compared to those from the traditional track (35.1%). The willingness of third-year students at UDS-SMHS to choose to practise in rural areas after graduation decreases as compared to their colleagues in first and sixth years. Students from the traditional track were 80% less likely to state that their medical school curriculum adequately prepared them for rural practice compared to students from the PBL/COBES track (odds ratio=0.19, confidence interval=0.13-0.28, p=0.001). Students following the PBL/COBES curriculum stated that the program was very useful and could influence their choice of future practice location. Students following the traditional curriculum called for the introduction of innovative teaching methodology incorporating rural outreach programs as part of the medical curriculum. Students using the PBL/COBES curriculum indicated that their curriculum adequately prepared them for future rural practice. Students following the traditional curriculum called for the introduction of an innovative teaching methodology incorporating rural outreach programs. This, they believed, would help them cultivate an interest for rural practice and also increase their willingness to choose rural practice after graduation from medical school.

Health for all: comparing apprenticeship with traditional classroom learning in community oriented medical education (COME)

Health for all: comparing apprenticeship with traditional classroom learning in community oriented medical education (COME)

Community-based medical education in action: primary care physicians’ perceptions

Introduction and objectives: During the last decade, in response to wide ranging changes in healthcare systems and physicians' roles, the medical curriculum has undergone some modification. To achieve high quality education, 2 strategies are suggested: (1) Community-based medical education and (2) Community-oriented medical education. During the process of curriculum planning, the planners need to identify the potential areas for improvement and to guarantee the quality of instruction. This study aimed to determine the viewpoints of medical graduates from Qazvin University of Medical Science (QUMS), Tehran, on community medicine internship and clerkship programs (CMICP) in order to assist better decision-making by policymakers.Methods: In this qualitative study, the conventional content analysis approach was employed. Data were gathered from 20 primary practitioners of QUMS through individual semi-structured interviews and focus group discussions (FGD) which were continued until data saturation occured. The interviews were transcribed and analyzed immediately after the interviews. To analyze the data, one note was employed and to analyze the qualitative data, inductive method was used. The unit of analysis was selected and labeled using an open coding system. Then, the similar open codes were categorized in subthemes and finally the subthemes were organized into the main themes. Findings: The results of data analysis identified 4 main themes including: planned curriculum, delivered curriculum, hidden curriculum and curriculum evaluation.Conclusion: Many graduates suggest that, in addition to curriculum renewal, curriculum planners should identify mediated factors in CMICP to prepare graduates to practise in healthcare settings.

Community Oriented Medical Education for Learning of Pathobiology

Background: According to the needs of health education, community oriented medical education was recommended. Health students must learn more about prevalent diseases in their communities. Objectives: To introduce community oriented medical sciences education to students learning pathobiology and its effects. Materials and Methods: This study was a quasi-experimental study conducted using the revised curriculum. The pathobiology course was taught with attention to community oriented medical education in group A. The teacher focused on more prominent and prevalent infectious diseases in Khorasan Razavi province, but regular subjects were taught in group B. Student grades or data was then compared and analyzed by SPSS 16, mean, standard deviation, and a t-test with P<0.05 for comparison, and significant levels were determined. Results: The total grade of pathobiology in group A (with community oriented medical education) was 17.58 ± 1.28. In group B (regular education), the total grade was 17.02 ± 1.75 with t = 1.292 and P = 0.202. There were no significant differences. The specific lessons, such as infection of mycobacterium tuberculosis and gastro intestinal infections, were promoted. Mean grades were higher in group A than B. Conclusions: According to the grades, community oriented medical education was helpful in teaching some specific chapters of pathobiology, such as more prominent and prevalent infectious diseases.

Putting communities in the driver's seat: the realities of community-engaged medical education.

"Community" has featured in the discourse about medical education for over half a century. This discourse has explored relationships between medical education programs and communities in community-oriented medical education and community-based medical education and, in recent years, has extended to community-engaged medical education (CEME). This Perspective explores the developing focus on "community" in medical education, describes CEME as a concept, and presents examples of CEME in action at Flinders University School of Medicine (Australia), the Northern Ontario School of Medicine (Canada), and Ateneo de Zamboanga University School of Medicine (Philippines).The authors describe the ways in which CEME, which features active community participation, can improve medical education while meeting community needs and advancing national and international health equity agendas. They suggest that CEME can redefine student learning as taking place at the center of the partnership between communities and medical schools. They also consider the challenges of CEME and caution that criteria for community engagement must be sensitive to cultural variations and to the nature of the social contract in different sociocultural settings.The authors argue that CEME is effective in producing physicians who choose to practice in rural and underserved areas. Further research is required to demonstrate that CEME contributes to improved health, and ultimately health equity, for the populations served by the medical school.

Commitment of medical graduates educated with and without community-based medical education towards community health care: A study from Malaysia.

Context: Community-based medical education (CBME) has become widely accepted as an important innovation in undergraduate medical education. In curriculum featuring CBE, students are acquainted with the community early in their studies however; the impact of this training can be judged best to see them practice the required aspects of CBME. Malaysia is a multiracial country with a very strong community dependant life style. Main national health problems have called for a change in health profession education from traditional hospital based health care to community-based delivery system. There are three major university medical schools that practice either community oriented or community based medical education in undergraduate medical curriculum. Universiti Sains Malaysia (USM) has a community based medical education (CBME) curriculum as compared to a community oriented education curriculum (COE) adopted by Universiti Malaya (UM) and a more traditional curriculum practiced by Universiti Kebangsaan Malaysia (UKM) Objective: To determine whether medical graduates from USM with a community-based medical education in its curriculum for more than 25 years are inspired to have stronger commitment towards community health as shown during their on-job practice of medicine compared to other graduates from UM and UKM, who have adopted community-oriented medical education. Methods: A questionnaire-based pilot study with 12 items (variables) was designed to obtain supervisor’s opinion on commitment of interns towards the health of community they serve. The questionnaire was administered to a randomized group of 85 specialists supervising the internship training program in five major disciplines including internal medicine, surgery, orthopedic, gynecology and obstetrics and pediatric medicine. The data received from 62 respondents from four major disciplines was analyzed utilizing SPSS version 12.0.1. Result: The responses received from 62 supervisors on 9 out of 12 variables were directly related to community commitments of interns. It was shown that the USM graduates who were taught through a CBME curriculum have performed better than the graduates from UM and UKM who followed a COE curriculum. p-value (< 0.001) was highly significant and consistent with higher mean score in those variables. Conclusion: The graduates taught through a CBME curriculum (USM) performed better in community commitments towards patients care compared to graduates from COE curriculum (UM) and a traditional curriculum (UKM).

Advantages of Community-Oriented Education in Postgraduate Surgical Training

Community-oriented medical education (COME) focuses on meeting the health needs of a community by training medical graduates to service those needs. This work seeks to outline the importance of a community-oriented methodology in postgraduate surgical training, as this approach may improve acquisition of generic skills and basic surgical competencies, and could increase learning opportunities for trainees.

Community-Oriented medical education: Bringing perspectives to curriculum planners in Damascus University

The varying health needs in Syria because of the trend of increasing communicable and noncommunicable diseases necessitate new curricula for all health professions schools in which community health needs, socio-cultural aspects of health and disease can be emphasized. There is a need to produce more primary level healthcare professionals who are trained to apply the principles, policies and strategies of the World Health Organization and achieve better health for all. A new perspective in the Faculty of Dentistry in Damascus University has been suggested and is presented here. Graduates generally are not well prepared to provide primary level healthcare in the community. Community-oriented medical education (COME) can produce health-oriented professionals who are equipped with broad skills and able to work for health promotion, disease prevention, and cure. Health orientation is one of the most radical features of COME, wherein the curriculum is appropriate to learners' future practice in the community. Community orientation enables students to become more people focused so that they can work towards people's self-empowerment, change people's attitudes and behaviors, and improve their self-awareness and esteem. This viewpoint addresses the importance of redesigning the dental curriculum and the need to implement COME in Damascus University. It is proposed as an example of changes needed in all health professions schools in Syria. The call to redesign the curricula to serve the health needs of the Syrian population will be difficult to achieve but is vital. Improving our understanding of the concept of COME and having all sectors of government and society commit to it will make the transition possible and will make the COME a reality.

Community-oriented medical education and clinical training: comparison by medical students in hospitals.

To determine the students' comparison of their one month educational trainings in Community-Oriented Medical Education with hospitals clinical education. Observational study. Kermanshah Community-Oriented Medical Education Field, Kermanshah University of Medical Sciences, Kermanshah, Iran, from April 2000 to February 2009. As of 2000, medical interns of Kermanshah University of Medical Sciences spend one month in the field of community-oriented medical education. At the end of the one-month period, the interns filled a questionnaire of 11 questions (based on the Likert scale) to assess the level of education in the field compared to hospital clinics. Data of questionnaires collected and completed from 2000 through 2009 (948 questionnaires) were analyzed on SPSS 18 using descriptive statistics (percentage) and analytic statistics (Chi-square test). The 948 students consisted of 66.4% males (n = 666) and 33.6% females (n = 282). All 11 variables of comparison were rated improved in the field education compared to the hospital training. The greatest difference pertained referring patients to the relevant health units (82% vs. 23.3%); patience in education (84.6% vs. 37.1%); consideration given to the three levels of prevention (77.2% vs. 33.6%) and the attention paid to the presence of students (91.7% vs. 51.8%), all of which were statistically significant (p < 0.0001). According to the interns, the educational status of specialized clinics of the field was superior to the specific clinics of hospitals (p < 0.0001). From the standpoint of medical students, training in community-oriented medical education in the field was better than training in the hospitals' clinics.

Medicine in the community: a unique partnership

Many advantages to community-oriented medical education have already been described. Responding to reforms in undergraduate medical education policy, our medical school reconfigured its clinical curriculum to include a module with a broad community focus, based in primary and secondary care. We describe our initial experience developing, implementing and evaluating this module. The aim of the module was to provide students with an understanding of medicine as practised, and health care as delivered, in the community. The 6-week module is delivered four times annually in the final stage of the medical degree programme, with 40-50 students attending each time. Learning experiences encompass clinical attachments, lectures, workshops, seminars and group presentations, with multifaceted assessment and formal student feedback at the end of the module (Ramsden's Module/Course Experience Questionnaire, and student self-assessment of specified learning objectives, using a five-point Likert scale). RESULTS OF STUDENT FEEDBACK: A total of 104 out of 181 (57.5%) students completed the evaluation. Of these, 69.3 per cent were satisfied with the course (with a mean Likert score of 3.7). More than 75 per cent of the students agreed or strongly agreed that they had attained 12 of 13 specified learning objectives, and 64.6 per cent (95% CI 55.0-74.2%) agreed that they could use common diagnostic/therapeutic equipment. The mean Likert scores for Ramsden questionnaire subscales were: good teaching, 3.5; clarity of goals, 3.1; appropriate assessment, 3.6; appropriate workload, 3.7; and generic skills development, 3.4. The most positive scores were attained for teachers' ability to explain (3.95; 77.5% agreed or strongly agreed) and effort at making subjects interesting (3.83; 73.5% agreed or strongly agreed). Our experience shows a community-based module with a strong combined primary care and elderly care focus is feasible, and enables the achievement of valuable learning objectives.

Community Oriented Medical Education (COME) and Its Application.

For the last 100 years, the role of doctors and healthcare systems are widening and changing due to two factors. First due to new knowledge reaching us as a result of new technology and research, which in turn leading to better understanding of Medicine, individual and community. Second factor changing the role Is societal reorganization of resources and their delivery.Considering these factors, 166 members assembled in 30th world Assembly in 1977, adopting the concept of "Health for All", and issuing following statement: "Attainment of all citizens in the world by the year 2000 of a level of health that would enable them t lead a socially and economically productive life1.This was followed by Alma Ata conference in 1978 where WHO and UNICEF accepted that Health for All can be achieved by Primary Health Care. This was a revolutionary turnaround where it was argued that secondary and tertiary rare should support the primary care with redistribution of resources involving community participation and more stress on prevention than ever before. The global strategy was suggested in detail in34th World Health Assembly in 1981.The cost effectiveness was accepted as an important factor that must be given due importance in every model. As the health workforce in most health systems costs 70% of budget, it is necessary that their training should be appropriate and cost effective2.

Rizal, Renaissance and Reform: Reflections on Ophthalmology and Otorhinolaryngology in the Philippine General Hospital

The nineteenth of June 2011 marks a century and fifty years since the birth of José Protasio Rizal in 1861.1 The ninth of November 2011 also marks the Golden Jubilee of the foundation of the Departments of Ophthalmology and Otorhinolaryngology of the Philippine General Hospital (PGH) in 1961, dividing the original Department of Eye, Ear, Nose and Throat that was established a century ago in May 1911. The national hero of the Philippines and Pride of the Malay Race2 is immortalized in countless ways, reflecting his multiple accomplishments that mark a true renaissance individual. The two departments of the national University of the Philippines (UP) have likewise made their mark in pace with the many achievements of their alumni. Rizal was a polyglot and polymath poet, painter, sculptor, sportsman, scientist and patriot, whose writings led to his execution and sparked the Philippine Revolution of 1898.1,3 He was also a physician and an ophthalmologist who insightfully dissected the ills of his patients and society.4 What have the departments and their hospital contributed to health and to humankind?&#x0D; &#x0D; If precedence were the measure of significance, the pioneering “firsts” would have to include the first laryngo-fissure operation by founding department head Dr. Reinhard Rembe in 1913, the first intracapsular cataract lens extraction in the country using a suction erisophake after the technique of Barraquer by the next chair (and nephew of the national hero) Dr. Aristeo Rizal Ubaldo in 1920, the first laryngectomy by Drs. Ubaldo and founding president of the Philippine Academy of Ophthalmology Antonio S. Fernando in 1923 and the first labyrinthectomy by Drs. Ubaldo and Vicencio C. Alcantara in 1927.5 There was a time when the chairs and senior consultants of most departments of otorhinolaryngology - head and neck surgery in the Philippines were alumni of the UP-PGH, as was the leadership of the Philippine Society of Otolaryngology and Bronchoesophagology (later Philippine Society of Otolaryngology Head and Neck Surgery) which separated from the Philippine Ophthalmological and Otolaryngological Society (subsequently Philippine Academy of Ophthalmology and Otolaryngology) in 1956. But those are bygone days, and the folly of resting on one’s laurels becomes all too apparent, as these are quickly eclipsed by the capabilities of newer, better-equipped health care facilities that are manned by experts trained in their respective institutions. Thus the race to super-specialize and sub-specialize, perhaps to regain lost ground and primacy at the expense of tertiary general health care has become the battle cry for some, led by the present administration of the PGH.&#x0D; &#x0D; And yet, the majority of Filipinos still do not have access to primary health care.6 They who do not even have the services of a basic physician much less can avail of special care of their sight, hearing and balance, smell and taste, breathing, swallowing or speaking, nor of the face with which they face the world. Witness the number of adults with unrepaired cleft lips and untreated head and neck tumors roaming the streets of the city.&#x0D; &#x0D; The UP College of Medicine (UPCM) founded in 1905 aims “towards leadership and excellence in community-oriented medical education, research and service directed particularly to the underserved.”5 As the teaching hospital of the UPCM, with whom it shares such academic and clinical departments as Ophthalmology and Otorhinolaryngology, the hundred-year-old Philippine General Hospital and its leadership cannot and must not turn a blind eye or deaf ear to the underserved it is mandated to serve. Its true strength lies in relevance, which is quickly lost if it succumbs to the delusionary glitter of super specialization beyond the reach of most people. Of what benefit is it to be the “first,” if it does not redound to the good of the “many?”&#x0D; Of Rizal, it has been said “to his patients he gave sight; and to his country he gave vision.”7 As the Departments of Ophthalmology and Otorhinolaryngology pursue the arts and sciences of vision, hearing and balance, olfaction and gustation, respiration and deglutition, phonation and facial expression, may they sharpen the sensitivity of health providers in PGH and other loco-regional general hospitals to the real issues of health and humankind in the developing world and embolden us to overcome the apathy to “hear no evil, see no evil, speak no evil.”

Attracting and retaining doctors in rural Nepal

In Nepal, a number of private sector medical schools have opened recently; although sufficient numbers of doctors are graduating there continues to be a doctor shortage in rural areas. This article analysed the rural doctor shortage in Nepal and reviewed the international literature for strategies that may be suitable for use in Nepal. Original research articles, reviews, magazine articles and project reports dealing with Nepal and other developing countries during the period 1995 to 2010 were sourced via Google, Google Scholar and Pubmed. Full text access was obtained via WHO's HINARI database. The health workforce in Nepal is unevenly distributed resulting in doctor shortages in rural areas. The recent introduction of mandatory rural service for scholarship students was aimed to reduce the loss of medical graduates to developed nations. High tuition fees in private medical schools and low Government wages prevent recent graduates from taking up rural positions, and those who do face many challenges. Potential corrective strategies include community-based medical education, selecting rural-background medical students, and providing a partial or complete tuition fee waiver for medical students who commit to rural service. Traditional healers and paramedical staff can also be trained for and authorized to provide rural health care. A range of strategies developed elsewhere could be used in Nepal, especially community-oriented medical education that involves rural doctors in training medical students. The reimbursement of tuition fees, assistance with relocation, and provision of opportunities for academic and professional advancement for rural doctors should also be considered. Government investment in improving working conditions in rural Nepal would assist rural communities to attract and retain doctors.

Education for health professionals in the emerging market economies: a literature review

Along with economic growth and social reforms, the emerging market economies (EMEs) are undergoing restructuring of their health care systems. There is now an increased focus on disease prevention and primary care, along with a patient-centred approach to health care delivery. However, these changes need to be complemented by alterations in the health care education system. A review of the published literature, limited to the last 10 years, was conducted to include recent updates on medical and nursing education. This was done by systematically searching appropriate databases using keywords. This review covers only the common issues related to education and training in EMEs. Issues identified included: the mismatch between the health needs of the population and education curricula; outdated curricula and teaching methods; growing numbers of medical schools; the quality of education, and inadequate career guidance for students to help them make decisions about choosing a health profession as a career and, later, about choosing a field of specialisation. The literature provides evidence of innovative approaches adopted in several EMEs, which include: outcome-based education; community-oriented medical education; problem-based learning; initiatives to improve quality, and initiatives to resolve the shortage of skilled educators for medical and nursing schools. The health care systems in EMEs are undergoing changes imposed by economic, political and social transition. Reforms in health systems will need to be complemented by educational reforms. Education systems require to be updated through needs-based comprehensive curriculum design and innovative teaching methods. The challenges imposed by the growth in the number of public and private institutions and the need for a standardised accreditation system for quality assurance demand attention. The profiles of both family medicine and community health care will need to be raised and their status enhanced to attract high-calibre students to these specialties.

Community-oriented medical education

Community-orientated medicine is a topical area for debate in the current discussions about medical education, but it can be agued that medical education has always been in the community because medical practice is located therein. It is widely accepted that community settings provide a wealth of learning opportunities for students and trainees and can help address some of the problems being experienced in the hospital settings in relation to the expansion of the sector. This paper seeks to offer a personal viewpoint on community and community-oriented medical education and then considers different models of community medical education and the resource implications for such approaches.

Curricular Trends in Malaysian Medical Schools: Innovations Within

Various curricular innovations were adopted by medical schools worldwide in an attempt to produce medical graduates that could meet future healthcare needs of society locally and globally. This paper presents findings on curricular approaches implemented in Malaysian medical schools, in trying to meet those needs. Information was obtained from published records, responses from various questionnaires, personal communication and involvement with curricular development. Curricular innovations tended to be implemented in new medical schools upon their establishment. Established medical schools seemed to implement these innovations much later. Curricular trends appear to move towards integration, student-centred and problem-based learning as well as community-oriented medical education, with the Student-centred learning, Problem-based learning, Integrated teaching, Community-based education, Electives and Systematic programme (SPICES) model used as a reference. The focus is based on the premise that although the short-term aim of undergraduate medical education in Malaysia is to prepare graduates for the pre-registration house officer year, they must be able to practise and make decisions independently and be sensitive to the needs of the country's multiracial, multi-religious, and often remote communities. In most cases, curricular planning starts with a prescriptive model where planners focus on several intended outcomes. However, as the plan is implemented and evaluated it becomes descriptive as the planners reassess the internal and external factors that affect outcomes. A common trend in community-oriented educational activities is evident, with the introduction of interesting variations, to ensure that the curriculum can be implemented, sustained and the intended outcomes achieved.