Development and evaluation of a community immersion program during preclinical medical studies: a 15-year experience at the University of Geneva Medical School.

BACKGROUND: Significant changes in medical education have occurred in recent decades because of new challenges in the health sector and new learning theories and practices. This might have contributed to the decision of medical schools throughout the world to adopt community-based learning activities. The community-based learning approach has been promoted and supported by the World Health Organization and has emerged as an efficient learning strategy. The aim of the present paper is to describe the characteristics of a community immersion clerkship for third-year undergraduate medical students, its evolution over 15 years, and an evaluation of its outcomes. METHODS: A review of the literature and consensus meetings with a multidisciplinary group of health professionals were used to define learning objectives and an educational approach when developing the program. Evaluation of the program addressed students' perception, achievement of learning objectives, interactions between students and the community, and educational innovations over the years. RESULTS: The program and the main learning objectives were defined by consensus meetings among teaching staff and community health workers, which strengthened the community immersion clerkship. Satisfaction, as monitored by a self-administered questionnaire in successive cohorts of students, showed a mean of 4.4 on a five-point scale. Students also mentioned community immersion clerkship as a unique community experience. The learning objectives were reached by a vast majority of students. Behavior evaluation was not assessed per se, but specific testimonies show that students have been marked by their community experience. The evaluation also assessed outcomes such as educational innovations (eg, students teaching other students), new developments in the curriculum (eg, partnership with the University of Applied Health Sciences), and interaction between students and the community (eg, student development of a website for a community health institution). CONCLUSION: The community immersion clerkship trains future doctors to respond to the health problems of individuals in their complexity, and strengthens their ability to work with the community.

[Need for health and human rights training: survey in six French-speaking African countries]. / Besoins de formation en santé et droits de l'homme: une enquête dans six pays d'Afrique Francophone.

The purpose of this study was to assess the need of healthcare and non-healthcare professionals for training in the field of health and human rights as a basis for developing relevant education programs. In 2007 a self-administered survey questionnaire was sent to 360 health professionals and human rights activists in Chad, the Democratic Republic of the Congo, the Republic of the Congo, Mali, Burkina-Faso, and Ivory Coast. The response rate was 67% (242/360). The most common training needs involved planning tools (87%), types of human rights violations in health systems (85%), risk factors for human rights violations (80%), and human rights monitoring tools (74%). The preferred training approaches were mixed and participative methods (60%) and practical applications as a means of validation (65%). There was a high degree of homogeneity between the needs expressed by the healthcare and non-healthcare professionals. The findings of this survey indicate that healthcare and non-healthcare professionals wish to obtain the knowledge and skills necessary to prevent and/or identify human rights issues in healthcare systems and to provide adequate responses. Training programs dealing with human rights in healthcare systems should reflect these needs.

Hydrocephalus therapy: reduction of shunt occlusions using a peel-away sheath.

In order to avoid shunt occlusions through particles of brain parenchyma a new procedure was used. Conventionally during ventricle puncture brain tissue may intrude into perforating holes of the ventricular catheter and subsequently shunt dysfunction may occur. By using a peel-away sheath the ventricular catheter can be protected during puncture. The conventional technique (n=90) was compared with the peel-away sheath technique (n=20) in a retrospective analyses in regard to shunt revisions during a 1-year period. Shunt revision was done in 18% (16/90) within 1 year using the conventional technique, respectively, 5% (1/20) using the peel-away sheath technique. Although criteria for statistical significance were not reached these data are worth to be mentioned. A randomised prospective study is initiated and the key features are presented.

Dimensional complexity and power spectral measures of the EEG during functional versus predicative problem solving.

Electroencephalograms were recorded in 22 men while solving tasks of visual-pattern completion and during mental relaxation. They were primed (by foregoing trials) to solve these tasks either in a predicative or functional mode of thinking. Predicative thinking required that in order to complete the pattern the subject had to get involved with the logic of the static structure of the pattern and therefore had to recognize the recurrence of certain features of the elements (e.g., shape, color, and size). Functional thinking required involvement in a dynamic reading of the logic of the pattern and therefore to search for operations and actions to be performed on the pattern elements (e.g., pushing, mirroring, and rotating). The EEG complexity during predicative thinking decreased in comparison to functional thinking and mental relaxation, with this reduction being most pronounced over the right parietal cortex. A reduction in dimensional complexity during functional thinking as compared to mental relaxation, which was concentrated over the left central cortex, although significant, was less clear. The reduced EEG complexity during predicative thought, dominant over the right hemisphere, could reflect increased competitive inhibition among respective cortical neuron assemblies in association with the visual analysis of static element features, converging upon those predicates relevant for the solution.