Transformative scale-up of the school of health sciences, University of the Philippines Manila

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> The School of Health Sciences (SHS), University of the Philippines Manila, established in 1976 offers a one-of-its kind ladder-type, community-based curriculum in health sciences.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study described the SHS curriculum and how it contributed to the transformative scale-up of the education of health professionals in the Philippines.</p><p style="text-align: justify;"><strong>METHODS:</strong> This study is a concurrent transformative mixed method design. Data were collected concurrently through interviews of university officials, faculty, students, alumni, communities, and partners as well as observations of review classes and office activities. Quantitative data were collected from school records and performance ratings of students. From the data emerged the basic principles of primary health care and community-based education and they were juxtaposed to describe transformative learning of SHS students and faculty.</p><p style="text-align: justify;"><strong>RESULTS:</strong> All of the 3,481 students admitted from 1976 came from geographically isolated and depressed areas; more than 95% of the graduates are still in the country and chose to serve the communities. The school's ladder-type, community-based curriculum produced competent midwives, nurses, and physicians. SHS did not just transform its students but also the faculty, communities, its partner local, national, and international agencies, and changed the landscape of community-based education in the region.</p><p style="text-align: justify;"><br /><strong>CONCLUSION</strong>: SHS produced health professionals who chose to serve the communities. It continues to evolve to institutionalize primary health care and community-based education.</p>

Impact of community based training on medical undergraduates skills upgradation regarding infant and young child feeding practices: A mixed method study

Despite various reforms brought in health care service delivery there is always a gap between community and health care providers. Hence there is a need to explore the successful strategies to reorient the medical students towards public health relevant community needs. Objective: This study aimed to assess the feasibility and impact of community based field training imparted among medical undergraduates to identify problems related to infant and young child feeding practices and design appropriate interventions. Material and Methods: This study is a mixed method study where improvement of knowledge were assessed quantitatively through quasi experimental pre-post study design. Difference in cumulative score obtained after training was compared using student's t test. Perception of students and mentor's views on this approach in terms of benefits and challenges were explored during in-depth interviews. Transcripts of qualitative interviews were analysed using manual content analysis. Results: Total of 781 infant and young children from 30 villages were surveyed by 36 medical undergraduates. There was significant improvement in knowledge on feeding practices from the baseline [baseline mean (SD) score: 3.3 (1.5); post training mean (SD) score: 6.5 (1.1), p<0.001]. Mentors of the opinion that this community based approach had facilitated the students to acquire skills on management, communication, team spirit and professional attitude. Students had opportunity to assess spectrum of illness and the co-existing social conditions in their natural setting. Conclusion: Students as well as other stakeholders were more positive and overwhelmingly supporting this approach. This approach is feasible with better planning, institute cooperation and commitment.

Narrativas e memórias de docentes médicos sobre o ensino baseado na comunidade no sertão nordestino / Narratives and memories of professors of medicine on community-based education in the brazilian northeast

O ensino baseado na comunidade trata-se de uma abordagem educacional voltada à inserção de estudantes em cenários de prática real desde os anos iniciais dos cursos, principalmente em comunidades urbanas e/ou rurais e em serviços da atenção primária à saúde, em que o planejamento, a execução e a avaliação das ações desenvolvidas partem das necessidades de saúde local e, idealmente, inclui a participação de pessoas da comunidade, das equipes de saúde e da própria universidade em todas as suas etapas. Este estudo problematizou o processo de implementação de um currículo baseado no ensino em comunidade em uma escola médica criada no âmbito do Programa Mais Médicos, no sertão nordestino. Para isto, trabalhou-se com interlocuções teóricas entre narrativas, memória e currículo. Teve-se por objetivo compreender como docentes médicos vivenciam o ensino baseado na comunidade, tendo em vista suas memórias da formação médica. Trata-se de estudo qualitativo, nos marcos da história oral. Para a produção das narrativas e contextualização dos sujeitos, utilizaram-se observações participantes, questionários socioeconômicos e entrevistas individuais semiestruturadas. As informações foram analisadas pela técnica de codificação temática. Os resultados são apresentados e discutidos por meio de duas categorias temáticas: "eles serão médicos dentro de uma comunidade": currículo, memória e formação médica; e "na hora em que eu cheguei lá, quis ir embora": atuação docente no ensino baseado na comunidade. As narrativas desvelaram as disparidades e incongruências entre uma formação médica modelada nas prescrições do currículo "tradicional" e as expectativas de atuação docente num currículo "inovador", caracterizado pela centralidade do estudante e das necessidades de saúde locais que produzem arranjos pedagógicos diversos próprios do ensino baseado na comunidade. Nesse panorama, imbricam-se desafios, dificuldades e gratificações num movimento ainda amorfo e num espaço ainda com muitos vazios que esperam para serem preenchidos, descritos, narrados com futuras histórias de vida que poderão elucidar como se aprendeu a ser docente nesse horizonte que se espraia a nossa frente. Cumpre destacar a polissemia do termo "comunidade" no contexto estudado e as dificuldades vivenciadas no início da carreira docente, o que evidencia a necessidade de investimentos em desenvolvimento docente nos cursos médicos, em geral, e nos recém-criados, em particular.(AU)

Community-based education is an educational approach aimed at integrating students into real practice scenarios from the initial years of the courses, mainly in urban and/or rural communities and in primary health care services, where the planning, implementation and evaluation of actions are developed from local health needs and ideally involve the participation of the community, health team members and the university itself at all stages. This study critically questionned the implementation process of a community-based education curriculum at a medical school created as part of the More Doctors Program in the sertão (dry hinterland) of the Brazilian Northeast. To this end, theoretical dialogues were developed between narratives, memories and the curriculum. The objective was to understand how medical professors experience community-based teaching, given the memories of their medical training. The study was qualitative in nature and developed within the framework of oral history. We used participant observation, socioeconomic questionnaires and individual semi-structured interviews to produce the narratives and contextualize the subjects. The data were analyzed by means of the thematic coding technique. The results are presented and discussed through two thematic categories: "they will be doctors within a community": curriculum, memory and medical training and "the moment I arrived, I wanted to leave": teaching practices in community-based education. The narratives uncovered the disparities and incongruences between a medical training modeled on prescriptions of the "traditional" curriculum and the expectations of teaching practices in the "innovative" curriculum, characterized by the centrality of the student and the local health needs that produce diverse pedagogical arrangements particular to community-based education. In this panorama, challenges, difficulties and gratifications are interwoven in a still amorphous movement and in a space where several gaps still await to be filled, described, narrated with future life histories that might elucidate how one learns to be a teacher on that horizon that expands out in front of us. Finally, it is important to highlight the polysemy of the term "community" in the context studied and the difficulties experienced at the beginning of a teaching career, which demonstrates the need for investments in teaching development in medical courses in general, and in newly created ones in particular.(AU)

Vivência integrada na comunidade: inserção longitudinal no Sistema de Saúde como estratégia de formação médica / Integrated experience in the community: longitudinal health care insertion as medical education strategy / Vivencia integrada en la comunidad: inserción longitudinal en el Sistema de Salud como estrategia de formación médica

Propostas inovadoras para o processo ensino-aprendizagem nos cursos de Medicina vêm sendo desenvolvidas em busca de uma formação profissional generalista, humanista e crítica. A partir da aprovação do Programa Mais Médicos (PMM), novas escolas foram criadas adotando metodologias de ensino ativas e promovendo maior integração ensinoserviço-comunidade. Este artigo é um relato de experiência sobre o desenvolvimento do módulo Vivência Integrada na Comunidade no curso de Medicina da Escola Multicampi de Ciências Médicas do Rio Grande do Norte, que oportuniza ao estudante uma inserção longitudinal no sistema de Saúde em municípios do interior do Nordeste. Essa proposta vem promovendo maior integração entre a universidade, os gestores e os trabalhadores da Saúde. A aposta é a de que este módulo poderá contribuir com a fixação do médico na região e fortalecer o sistema de Saúde no interior do Brasil.

Innovative teaching-learning process proposals for medical courses have been developed for generalist, humanistic, critical professional education. Beginning with approval of the More Doctors Program, new schools were created, adopting active teaching methodologies and promoting further community-service-teaching integration. This paper is an experience report on the development of the Integrated Experience in the Community module in the medical course at the Medical Sciences Multi-campuses College of Rio Grande do Norte, which provides students with longitudinal insertion opportunities in the healthcare system of the hinterland towns of the Northeast region. This proposed module has been promoting further integration between the university managers, and healthcare workers. The goal of this module is to contribute to securing physicians for in the region and strengthening the healthcare system in the Brazilian hinterland.

Se han desarrollado propuestas innovadoras para el proceso enseñanza-aprendizaje en los cursos de medicina a la búsqueda de una formación profesional generalista, humanista y crítica. A partir de la aprobación del Programa Más Médicos se crearon nuevas escuelas, adoptando metodologías de enseñanza activas y promoviendo una mayor integración enseñanza-serviciocomunidad. Este artículo es un relato de experiencia sobre el desarrollo del módulo "Vivencia integrada en la comunidad" en el curso de medicina de la Escuela Multicampi de Ciencias Médicas de Rio Grande do Norte que proporciona al estudiante una inserción longitudinal en el sistema de salud en municipios del interior del Nordeste de Brasil. Esta propuesta ha promovido una mayor integración entre la Universidad, los gestores y los trabajadores de la salud. La apuesta es que este módulo podrá contribuir con la fijación del médico en la región y fortalecer el sistema de salud en el interior de Brasil.

Efectos de la educación comunitaria sobre factores de riesgo en adultos mayores prediabéticos / Effects of community-based education on the risk factors in prediabetic older adults

Introducción: la educación es piedra angular en la prevención, atención y tratamiento de la diabetes mellitus. Promueve efectos positivos en la salud de los enfermos y sus familiares a través del conocimiento, con la finalidad de prevenir o retardar las complicaciones de la diabetes, por lo que ningún grupo etario debe ser excluido de este beneficio. Objetivo: determinar el efecto de la educación comunitaria sobre el sedentarismo, los hábitos alimentarios y la glucemia, en adultos mayores con prediabetes. Métodos: estudio cuasi experimental en 20 adultos mayores de ambos géneros, con glucemia capilar de 100 mg/dL a 125 mg/dL, derechohabientes del Instituto Mexicano del Seguro Social, adscritos a la Unidad de Medicina Familiar No. 17 del Instituto Mexicano del Seguro Social, en Villa Juárez, Sonora, México. Resultados: el promedio de edad fue 67 ± 6 años, con predominio del género femenino (60 %) y escolaridad baja. El 72 % de la población tenía familiares directos con diabetes mellitus. Luego de la estrategia educativa, mejoraron los conocimientos sobre diabetes, y hubo cambios significativos antes-después en la evaluación global (p= 0,0001), glucemia capilar (p= 0,0001) y hemoglobina glucosilada (p= 0,003). Así mismo, mejoraron los hábitos dietéticos y de ejercicio físico. Conclusiones: la estrategia educativa tiene un efecto benéfico sobre variables metabólicas y favorece cambios en el estilo de vida(AU)

Introduction: education is the milestone in the prevention, care and treatment of diabetes mellitus. It promotes positive effects for the patient's and the relatives' health through acquisition of knowledge for the purpose of preventing or delaying the diabetes complications, so any age group should be excluded from this benefit. Objective: to determine the effect of community-based education on sedentary and feeding habits and glycemia in pre-diabetic older adults. Methods: quasi-experimental study of 20 older adults of both sexes with capillary glycemia of 100 mg/dL a 125 mg/dL, rightful owners of the Instituto Mexicano del Seguro Social and ascribed to the family medicine unit no. 17 of Instituto Mexicano del Seguro Social in Villa Juarez, Sonora, Mexico. Results: the average age was 67 ± 6 years, females (60 percent) and low schooling prevailed. Seventy two percent of the population had first-line relatives with diabetes. After the educational strategy implementation, knowledge on diabetes improved and significant changes occurred when comparing before and after this intervention in terms of global assessment (p= 0.0001), capillary glycemia (p= 0.0001), and glycosylate hemoglobin (p= 0.003). Feeding habits and physical exercising showed some improvement. Conclusions: educational strategy has beneficial effects on the metabolic parameters and encourages lifestyle changes(AU)

Cambios curriculares basados en la enseñanza por problemas y entrenamiento en la comunidad: experiencia cubana en Suráfrica / Curricular changes based on problems-based learning and community-based education: the cuban experience in south Africa

Introducción: la escuela de Medicina de la Facultad de Ciencias de la Salud de la Universidad Walter Sisulu (antigua Universidad de Transkei), realizó tres grandes cambios del plan de estudios de la Carrera durante los últimos 15 años. Objetivo: hacer una valoración sobre el cambio de paradigma para la implementación exitosa del nuevo modelo de médico comunitario; Analizar las formas de enseñanza utilizadas (basada en problemas y en la comunidad) durante dicho periodo de estudio y comentar los hechos más relevantes. Material y métodos: se realizó un estudio longitudinal descriptivo de los cambios del plan de estudio de la Carrera de Medicina, y el total de estudiantes matriculados en el tercer año de la Carrera en particular (MB ChB 3), desde 1998 hasta 2011; en la Escuela de Medicina de la Facultad de Ciencias de la Salud de la Universidad Walter Sisulu. Se describieron los retos originados y la dinámica de los cambios en los planes de estudio; así como los ajustes paralelos utilizados para mantener los estándares cualitativos. Resultados: la Enseñanza Basada en Problemas {Problem Based Learning:PBL, siglas en inglés) y servicios basados en la comunidad (Community-Based Education:COBES, siglas en inglés) son la piedra angular de la enseñanza de las Ciencias de la Salud en la Universidad Walter Sisulu. Conclusiones: el trabajo en equipo y la integración de los miembros del colectivo de todas las disciplinas involucradas cada año es crucial para lograr resultados exitosos en la Carrera de Medicina en general y su tercer año en particular.

Introduction: the school of medicine of the Faculty of Health Sciences at Walter Sisulu University (former University of Transkei) performed three major changes in the medical curriculum during the past 15 years. Objectives: to analyze the teaching and learning approaches (Problem-Based Learning and Community-Based Education) during the timeframe of the study and comment on the most remarkable aspects. Material and methods: a longitudinal, descriptive study of the curricular changes of the MB ChB programme, as well as the number of students enrolled in the MB ChB 3 programme per academic year since 1998 up to 2011 were performed. The challenges raised as well as the bases of the changes in the curriculum were describes, as well as the parallel adjustments used, in order to preserve the qualitative standard obtained already. Results: problem-Based Learning (PBL) and Community Oriented Based Education and Services (COBES) are the cornerstone of the teaching and learning health sciences at Walter Sisulu University. Conclusions: integration and working as team among the staff of all involved disciplines per academic year is crucial to reach successful results within the medical curriculum in general and MB ChB 3 in particular.

What Rural Physicians Need to Engage in Community Based Education: A Qualitative Interview Survey / Journal of Rural Medicine

There is systematic evidence that community-based education is effective in the recruitment of rural physicians to remote communities. However, various obstacles may exist that prevent rural physicians from sustaining their mentoring activities. The aim of this study was to explore ways for rural physicians to overcome such adversities and continue their mentoring activities. We interviewed four nominated physicians (all male, mean age 48 years) based in Hokkaido, Japan, who practiced in an area with less than 10,000 inhabitants. Semi-structured interviews of approximately 60 minutes were performed and focused on topics rural physicians’ found necessary for their teaching activities. All interviews were tape-recorded and transcribed, the verbatim transcripts were analyzed and repeated themes were identified. Three themes that emerged as needs were 1. sustained significant human relationship, including the formation of a network between students and university faculty, as well as developing partnerships with many community relationships, or other medical professions; 2. intrinsic motivations and satisfaction, including pleasure in mentoring the younger generations; and 3. rewards, including financial compensation. Rural physicians as preceptors require nonremunerative, intrinsic motivational factors, such as a sense of satisfaction regarding the education of medical students and being able to relate to residents and others health-care professions, when pursuing their educational activities. To support them, focusing only on monetary facets may be unsuccessful in encouraging them to continue their educational work.

The effects of off–campus classes for students in a school of health sciences / 医学教育

In Japan, community–based education remains uncommon in undergraduate programs for students in schools of health sciences. The purpose of this study was to examine how students are affected by their participation in off–campus classes, which are considered as a main course of community–based education at the School of Health Sciences, Gunma University.<br>1)Reports submitted by students after participating in off–campus classes were broken down into sentences (with care being taken that each sentence made sense). The extracted sentences were carefully consolidated by means of the Kawakita Jiro method (affinity diagram).<br>2)A total of 972 sentences were extracted and were categorized into 3 categories: "enjoy going out to the community," "increased activity through experiences," "awareness of what one wants to be and one's insufficient abilities." Five middle–sized categories and 10 small categories were obtained.<br>3)Experiences in off–campus classes are expected to increase the activity of students and to have synergic effects with on–campus classes.<br>4)Community–based education might be effectively included in undergraduate programs for students in schools of health sciences.

Introduction of community-based education for physical therapy students in Japan / Монголын Анагаах Ухаан

Background: Physical therapists need to work not only in hospitals but also in the communities. So it has been said that community-based education should be essential for physical therapy education. In Gunma University, community-based education program was implemented from 2010 for physical therapy stu¬dents. Purpose. The purpose of this report is to introduce our challenging program and search for how this program af¬fected students, community staffs and elderly people. Methods: Third-year students collaborated to exercise classes for community dwelling elderly people with teach¬ers and community staffs (public health nurses and civic volunteers). Two classes were provided separately, so students were divided into two groups and each group was assigned to one class. After classes, reports were written by participants (60 persons), community staffs (9 persons) and students (24 persons). Reports consisted of five-grade evaluation of this program and students for elderly people and community staffs, evaluation using visual analogue scale (VAS) of this program and contact with elderly people for students, and impressions described in freely written sentences for all subjects. Results and Discussion: Results of elderly people’s five-grade evaluation were “5 (very good)”-50 persons, “4 (good)”-10 persons to this program and “5”-41 persons, “4”-19 persons to students. Results of community staffs’ five-grade evaluation were “5”-7 persons, “4”-2 persons to this program and “5”-6 persons, “4”-3 persons to stu¬dents. Results of students’ VAS evaluation were 86.5±13.3 (100 extremely good~0 minimum) to this program and 91.6±9.9 to contact with elderly people. It was expected there were good feelings elderly people, community staffs and students have. There was a possibil¬ity that an interchange between elderly people and students would bring different learning from on-campus classes to students and motivation to elderly people. Take-home message: It is thought that community-based education should be included in undergraduate pro¬grams for physical therapy students.

Needs for Population-based Medicine and Innovation of Education in Social Medicine / 医学教育

1) Needs for PBM education were pointed out with relation to clinical research, medical care and health administration<BR>.2) The meaning of population and PBM was discussed in historical context of health supervision and medical care.<BR>3) Discussions were made on problems of undergraduate and postgraduate education in social medicine, importance of PBM education in the community, co-operative specialized training in relevant institutions and the role of thespecialists.

Effect of a Community-based Interprofessional Education Program for Healthcare Students in Japan / 医学教育

To provide appropriate healthcare services to all patients, strong interprofessional partnerships are essential. We have developed a voluntary community-based interprofessional education (IPE) program for medical students and other healthcare students. In this program, students from different healthcare fields conduct fieldwork together in small groups. The purpose of this study was to determine what participants learned through the IPE program.<BR>1) Five researchers with different healthcare backgrounds analyzed all (63) participants' postprogram reports (collected since 2002) and extracted and categorized items describing what the participants had learned.<BR>2) The categories of items learned included the roles of healthcare professionals, cooperation among healthcare professionals, the meaning of “community medicine”, the difficulty and the importance of communication, and a sense of fellowship with participants of other backgrounds.<BR>3) These items indicate our IPE program helps students learn about interprofessional cooperation by observing actual examples of cooperation in the community and by working with students from different healthcare fields.

Healthy Cities and Communities Projects as the Undergraduate Medical Education / 医学教育

We presented here an overview of the international innovation of public health and introduced our community-based educational practice of public health. We also reported it was effective for public health education to let students participate together with teachers in the cooperative movement developing healthy community and let them learn community dynamics, skills of participatory action research and the process of policy making. Today, the under-and post-graduate education of new public health will be effctively performed by participating in the practical healthy community project, which is performed cooperatively by communities, social resources and the university.

The Development of a Community-Based Educational Model in Public Health / 医学教育

Medical education in Japan has undergone dramatic changes, but nothing less than a paradigm change is required for the educational model for social medicine. In the 23 years since 1978, we have developed a community-based public health education program. The curriculum consists of a core of family health practice, student lectures, systematic teachers' lectures, participatory research on community health, and health policy-making. The community-based educational model was effective in developing students' active problem-based learning, abilities in health communication, and understanding of community needs as a biologic-psychologic-cultural-geographic complex; the empowerment of students and the community; and a comprehensive approach to the community care management which integrates health promotion and social welfare. We evaluated the community-based curriculum design, which exposes students to a wide variety of medical, social, and psychological problems in a community as a useful public health educational strategy.