Outreach Centres Research Articles

Proposed Career Pathway for Clinical Academic General Dental Practitioners

The Modernising Medical Careers framework provides the opportunity for both medical specialists and general medical practitioners to follow training pathways that lead to appointments as National Health Service (NHS) consultants and to senior academic posts. Similar opportunities are available for dentists who wish to specialise. However, they are not available to dentists working in primary dental care who wish to become NHS consultants or senior academics in general dentistry. An alternative pathway is required that does not force committed primary care dentists who wish to become NHS consultants or senior academics down a path of specialisation. In this paper, the authors explore the situation in some detail and propose a career pathway with appropriate competencies for primary care dentists who aspire to become NHS consultants or senior academics. They justify why such posts should be created. The competencies have been developed using key guidelines and documents from the European Bologna Process and the Association for Dental Education in Europe, the Curriculum for UK Dental Foundation Programme Training, and the General Dental Council monospecialty curricula. It is hoped that the proposed pathway will produce highly trained generalists who will: (a) encourage and undertake research in primary dental care, where over 90% of dentistry is delivered, (b) support and lead outreach centres so that teaching and clinical cases reflect primary dental care, where students will spend their working lives post-qualification, and (c) provide a means of increasing the numbers of clinical dental academics, which have been in decline over the last 10 years.

An evaluation of student, patient and practitioner experience of general dental practice placements

Modern undergraduate dental curricula strive to provide meaningful clinical experiences for their students. Outreach learning is now well established in most UK dental schools and provides an additional clinical environment in which the whole dental team can develop their skills. This paper evaluates student, patient and practitioner experiences of a general dental practice placement scheme. A number of practices in the Yorkshire region hosted senior undergraduate dental students. All parties were very positive about the experience. The students found the experience in general dental practice to be very different from that in outreach centres, with the experiences of working in well established teams being seen as very beneficial. Practitioners and their teams reported a number of unforeseen benefits and the patients found their experiences to be overwhelmingly positive. Some students reported positive perceptions of their clinical experience, when being interviewed for their vocational training and general professional training posts.

Cardiac rehabilitation in the Northwest

To audit the cardiac rehabilitation (CR) service in the Northwest. Patients were identified on the CR Information System. Indications, rate of uptake, demographics and complications were all recorded. Cardiovascular risk factors and exercise capacity before and after CR were compared. Systems for referral and phases I-IV were analysed. Three hundred ninety-two patients were offered CR in 2006. 151 patients completed phase III. One-fifth attended outreach centres. Mean age was 62.9. 22% were female. No serious adverse events occurred during exercise training. A smoking quit rate of 26% was achieved. Mean blood pressures pre and post CR were 141/76 and 131/73 mmHg, respectively. The mean increase in exercise capacity was 2.85 mets. CR in the Northwest provides a modern evolving programme. Enhanced referral rate, reduction in the duration of phase II, increased participation by women and improved accessibility will consolidate its contribution to cardiovascular disease management in this region.

Blended problem-based learning for widening participation: a case study

AbstractThis paper discusses some issues involved in a model of delivery adopted for widening participation at outreach centres for Liverpool Hope University and explores the rationale for using blended Problem-based learning (PBL) as a means of addressing the issues and improving learning.A number of principles are proposed for the effective use of blended PBL and the paper analyses a case study, explaining the design and organisation of the module, together with the research methodology adopted. It provides some initial guidelines for other practitioners who wish to pursue similar activities.

Mulu Muleta: Ethiopian surgeon working to end fistula

Working for 16 years with impoverished fistula patients in Ethiopia has made Mulu Muleta a world renowned fistula surgeon and a passionate supporter of the global campaign to end fistula. The moving tales of young girls and women who are abandoned by their husbands and ostracised by their families because of fistula have strengthened her resolve to contribute to the eradication of obstetric fistula. "Recently we carried out a national survey on public perceptions about fistula. We found that many people especially in rural areas think fistula is a curse or a punishment for sinning. They think it cannot be treated" she says. Muleta says fistula is an issue in almost every developing country where emergency obstetric care is scarce. In Ethiopia fistula is most prevalent in rural communities where access to health-care facilities is difficult because of the mountainous terrain with poor often non-existent roads. Moreover the custom of early marriages in some parts of the country exacerbates the problem. (excerpt)

HYPOXIC ISCHEMIC ENCEPHALOPATHY. STILL HAUNTING!

Hypoxic Ischemic Encephalopathy is not an un-common health problem in Egypt. It is one of the direct causes of infant mortality rate ranking only second to sepsis the number one cause of mortality. It tops the list for morbidity because of its significant health and social burden. The sequels of the hypoxia so early in life affects neuro-development and contribute to physical and mental handicap in a society that is still un-prepared to deliver optimal health and social care to the special needs children. There are different factors that ally to the persistence of such a problem in an era that witness its distinction in other parts of the world. The under-utilization of proper antenatal care, the un-resourceful outreach centres, the late seek of medical care, the under qualified nurses and unavailable doctors for neonatal resuscitation, the lack of a global therapy for neonatal hypoxia-despite extensive randomised clinical trials for head and total body cooling and numerous drugs- all steers the wheel to the importance of prevention rather than intervention. Also, attention had been directed to the care of the increasing numbers of surviving infants with motor deficits. Close support and follow-up is mandated with the use of national standards that suites the Egyptian and regional standards utilised for neuro-developmental assessment. Efforts are being made to establish interventional programs to reach every child regardless of their socio-economic status. There is still a great need for international and national support for child-neurology facilities establishment for follow-up and services for the hypoxic ischemic encephalopathy victims to parallel the serious efforts for health education and propagation of preventive practices nationwide.

An Assessment of the Academic Achievement of Students in Two Modes of Part-time Programme in Nigeria

<p>This study analyses the academic achievement of students enrolled in part-times studies at on-campus and outreach centres at three dual-mode Nigerian universities, during the 1996/97 to 1998/ 99 academic years. Research subjects in this study were examination and record officers employed by on-campus and outreach institutions. A checklist was prepared to collect students’ grades; these checklists were then transcribed into grade points (GPAs) for data collection purposes. Simple percentage mean (x) and t-test statistic were used for data analysis. Interviews were also conducted with key stakeholders to add qualitative context to the quantitative data collected. This study shows that there was significant difference in the academic performance of students enrolled in the on-campus versus outreach-based, part-time programmes in selected disciplines. Also the average mean (x) performance of students enrolled in the on-campus programme was higher than those students enrolled in the outreach centres. Based on the findings of this study, it is recommended that the government provide adequate funding to increase access individuals seeking higher education in Nigeria. The establishment of functional Open University system is also recommended to provide students with distant learning opportunities and likewise increase access. Several quality improvements are likewise recommended: the use of modern information technology for instructional delivery, recruitment of skilled teachers, improved teaching/ learning facilities, and strict adherence to standardized student admission requirements as specified by the National Universities Commission (NUC). We wrap up with practical suggestions, such as providing orientation sessions for outreach students to learn practical skills such as how to access library materials.</p> <p> <b>Keywords:</b> academic achievement, part-time programmes, on-campus, outreach, distance education, quality assurance, Nigerian universities, students </p>

BES Spring Scientific Meeting 2005 Research Poster

SummaryAim To evaluate the impact of European Society of Endodontology curriculum guidelines on undergraduate teaching in the UK.Methodology A postal questionnaire was designed by two authors (WPS, GB) in 2003. This included open and closed questions relating to endodontic curricula and the impact of curriculum guidelines. This was sent with a cover letter to the thirteen UK undergraduate schools. Data harvest was completed a year after the initial questionnaires were sent. Responses were collated and analysed qualitatively and quantitatively.Results Eight (62%) questionnaires were returned. Analysis revealed divergence from aspects of curriculum guidelines. Guidelines were applied by seven schools. Four schools had not applied guidelines related to endodontic surgery as this was taught by Departments of Oral Surgery. One respondent stated that the established curriculum was too inflexible to allow application. There was wide variation in curriculum structure with combinations of outcome, competency and problem‐based learning. No schools had a separate department of Endodontology. All schools felt graduates should be competent at de‐novo treatment of single and multi‐rooted teeth. In general, competence was expected in single canal re‐treatment but not multi‐rooted teeth. Patient recruitment proved a major barrier to meeting guidelines. Number of cases to be completed by graduation ranged from 6 to 14 in total. Three schools felt that guidelines were not achievable citing lack of time, funds and appropriate staff.All schools provided operative techniques classes prior to clinical treatment. These ranged from 20 to 120 hours (mean 43, S.D. 35.24.). Cases completed in these classes varied. For single rooted teeth this ranged from one to six (mean 2.57). For multi‐rooted teeth this ranged from one to three (mean 2.14). Most schools had at least one faculty member with a special interest in Endodontology. In seven schools however, teaching was also carried out by staff with no special interest. Five schools did not have a separate endodontic clinic. Five respondents had undergraduate learning in outreach centres. Trauma teaching was mainly carried out by in Departments of Paediatric Dentistry.Conclusions There is wide variation in the delivery of endodontic curricula in the U.K. Whilst curriculum guidelines are available, there are barriers to delivering these. Consideration should be given to revision of guidelines in light of their evident inapplicability in some areas.

Inequitable access to immunization and vitamin A capsule services: a case of ethnic minorities in three hill districts of Bangladesh

Avoidable geographic ethnic and socio-economic disparity in immunization coverage has been a serious concern for Bangladesh. However this dimension has not been systematically investigated by independent researchers in the Chittagong Hill Tracts (CHT) of Bangladesh due to political inconveniences stemming from a 20-year armed struggle for autonomy which ended following a peace agreement in December 1997. The CHT has over 974455 people spread over three districts— Khagrachari Rangamati and Bandarban. The major ethnic (adivasi) groups of CHT are Bangali Bawm Chak Chakma Khumi Khyang Lushei Marma Mro Pangkgua/Pankho Tanchangya and Tripura. The Government has been implementing the Expanded Programme on Immunization nationally since 1985 through over 100000 outreach centres to vaccinate children below 2 years of age and women of reproductive age. (excerpt)

Caring in Calcutta — utlising resources in the developing world

ABSTRACT This paper presents an outline of the role of a visiting speech and language therapist with children with special needs in a developing country. Observations on the teachers' current practice with children in an educational environment are discussed before describing the aims of a voluntary worker running subsequent courses in communication skills for staff and parents. The results from a follow‐up study on the skills attained during the courses are presented, with implications for the future role of voluntary workers.In November 1993, the charitable organisation, Action Health, began a three‐year project in Calcutta, India, based at a school for children with special needs. The aim of the project is to provide support in developing the expertise of teachers of children with special needs in communication skills. Training as trainers is also provided for selected staff so that they may facilitate future courses for organisations in and around Calcutta. Although speech and language therapy is continually developing in India, there are still an estimated 12 million children with physical or mental disability — with only 60,000 children enrolled in general or special schools, and only c. 800 practising speech and hearing pathologists in the whole subcontinent. Existing educational services reach only 4% of the physically disabled and 0.2% of the developmentally delayed. Any resources available require careful distribution in order to make them as effective and productive as possible. The most important beneficiaries of the Action Health/REACH project will be the children attending both special schools and outreach centres in and around Calcutta. In order to establish and maintain such a service, the development of varied and innovative teaching methods among the staff is required. This calls for a recognition of the existing skills among the teachers and social workers involved, and how these may be used to good effect. The extent to which this can be achieved will act as an important guideline for the future involvement of visiting speech and language therapists in developing countries — not only in what they can offer to new projects but also how they can utilise what is already in operation. This creates an opportunity for reciprocal exchange of ideas, giving the visiting therapists a chance to learn how to adapt their own skills to meet the diverse and complex needs of a different culture within strict financial, social and geographical constraints. This will have valuable benefits for the therapists on their return, for their future invovlement in meeting the needs of their own community in the UK.

Canadian cancer care: organizational models.

Canadian cancer care has evolved under systems of provincial and federal fiscal control and aims to optimize the management of patients within each province. In Manitoba, patients are initially assessed at one centre but can subsequently receive chemotherapy at an outreach centre closer to home. In British Columbia, two outreach mechanisms exist: consultative clinics provide consultative and follow-up care by radiotherapists and medical oncologists who travel to outreach centres, and community-based regional oncologists provide diagnostic and treatment services in small communities. In Ontario, peripheral clinics are staffed by oncologists from the two provincial cancer institutions, but efforts have been made to find newer outreach models that will better serve certain communities in that province. Two basic models of cancer care organization in the community presently exist in Canada: one stresses the extension of resources outward to the community from major cancer centres, and the other stresses the support of already established resources in the community. Efforts to coordinate these activities are being initiated.