Gun violence in K-12 schools in the United States: Moving towards a preventive (versus reactive) framework.

Intentional shootings in K-12 schools in the U.S. persist as a public health problem. The number of shootings in K-12 schools has increased precipitously since 2017. And with approximately 100,000 K-12 public schools nationally serving 51 million children, investing in a comprehensive gun violence prevention strategy is critical. Unfortunately, our current school gun violence prevention approach almost exclusively centers reactive strategies that are in place to respond to acts of gun violence in the moment, rather than preventive strategies that would prevent them from occurring at all. Reliance on these strategies alone, however, is not sufficient. In line with the core tenets of public health prevention and the Whole School, Whole Child, Whole Community model, we present a more expansive school gun violence prevention framework that broadens the spectrum of what constitutes "school gun violence prevention." Our work highlights how enhancing basic neighborhood and school structures-including investments in public libraries, affordable housing, and universal school-based violence prevention programs-are key to both preventing gun violence and promoting well-being. We also highlight the role of stricter gun laws, reasonable school security efforts, bystander interventions, building awareness within school communities, and meaningful investments in early interventions and mental health services. Children, who have been tragically exposed to any number of adverse experiences in the wake of the COVID-19 pandemic, deserve more reasoned choices and large-scale investments in understanding and cutting off the root causes of school gun violence; not just a reliance on strategies that focus on what to do in the moment of a violent act. As gun violence in K-12 schools persists, we must reframe the discourse about school gun violence around prevention, not reaction.

Does community health care require different competencies from physicians and nurses?

BACKGROUND: Recently competency approach in Health Professionals' Education (HPE) has become quite popular and for an effective competency based HPE, it is important to design the curriculum around the health care needs of the population to be served and on the expected roles of the health care providers. Unfortunately, in community settings roles of health providers tend to be described less clearly, particularly at the Primary Health Care (PHC) level where a multidisciplinary and appropriately prepared health team is generally lacking. Moreover, to tailor the education on community needs there is no substantial evidence on what specific requirements the providers must be prepared for. METHODS: This study has explored specific tasks of physicians and nurses employed to work in primary or secondary health care units in a context where there is a structural scarcity of community health care providers. In-depth Interviews of 11 physicians and 06 nurses working in community settings of Pakistan were conducted along with review of their job descriptions. RESULTS: At all levels of health settings, physicians' were mostly engaged with diagnosing and prescribing medical illness of patients coming to health center and nurses depending on their employer were either providing preventive health care activities, assisting physicians or occupied in day to day management of health center. Geographical location or level of health facility did not have major effect on the roles being expected or performed, however the factors that determined the roles performed by health providers were employer expectations, preparation of health providers for providing community based care, role clarity and availability of resources including health team at health facilities. CONCLUSIONS: Exploration of specific tasks of physicians and nurses working in community settings provide a useful framework to map competencies, and can help educators revisit the curricula and instructional designs accordingly. Furthermore, in community settings there are many synergies between the roles of physicians and nurses which could be simulated as learning activities; at the same time these two groups of health providers offer distinct sets of services, which must be harnessed to build effective, non-hierarchal, collaborative health teams.

Competence, commitment and opportunity: an exploration of faculty views and perceptions on community- based education.

BACKGROUND: Community-Based Education (CBE) is an instructional approach designed and carried out in a community context and environment in which not only students, but also faculty and Health Professionals' Education (HPE) institutions must be actively engaged throughout the educational experience. Despite the growing evidence of CBE being an effective approach for contemporary HPE, doubts about its successful implementation still exist. This study has explored HPE structure, policies and curriculum from the point of view of faculty members to gain understanding about the prevailing practices and to propose recommendations that nurtures and promotes CBE. METHOD: A purposive sample was drawn from three major cities of Pakistan- Karachi, Rawalpindi and Islamabad. Out of twelve HPE institutions present in these cities we selected six, which provided a sound representation of medical and nursing colleges around the country. At each institution we had two Focus Group Discussions; in addition we interviewed registrars of medical and nursing councils and two CBE experts. RESULTS: The factors effecting implementation of CBE as perceived by study participants are categorized as: preparation of faculty members; institutional commitment and enthusiasm; curricular priorities and external milieu. Within each theme, participants recurrently described structural and curricular deficiencies, and lack of commitment and appreciation for community based teaching, service and research permeating at all levels: regulatory bodies, institutional heads and faculty members. CONCLUSIONS: The factors highlighted by our study and many others suggest that CBE could not perpetuate effectively within HPE. To enhance the effectiveness of CBE approach in a way that mutually benefits local communities as well as HPE institutions and health professionals, it is important that reforms in HPE must be strategized in a holistic fashion i.e. restructuring and aligning its polices, curriculum and research priorities.

Competencies for undergraduate community-based education for the health professions--a systematic review.

BACKGROUND: Community-based education (CBE) along with competency approach is increasingly becoming popular. However, there appears to be lack of evidence on CBE competencies for undergraduate curriculum, therefore this systematic review attempted to identify and categorize CBE competencies to determine the ones used frequently. AIMS: The systematic review aimed at identifying and categorizing CBE competencies implemented in nursing and medical schools to inform all stakeholders of health professional's education. METHOD: A systematic review of electronic databases including MEDLINE, CINAHL, and ERIC and manual search of four medical education journals was carried out. Search was restricted to original research, published in English language between January 2000 and December 2009. RESULTS: Nineteen studies fulfilled the search criteria. The competencies identified were categorized under six themes: Public Health; Cultural Competence; Leadership and Management; Community Development; Research; and Generic Competencies. Moreover, a number of clinical competencies were also found to be overlapping with CBE. CONCLUSIONS: The literature on CBE competencies is limited in number and in its geographical span as most of the studies found was from developed countries; to expand the efforts to other institutions and countries, core competencies for CBE must be recognized and disseminated widely for its integration in health professionals' curriculum.

Online role-playing for faculty development.

BACKGROUND: There has been a rapid growth of online teaching in the past few years, yet the implementation of role-play for formal educational activities in an online setting is growing more slowly. The use of online role-playing for the development of health professions educators is virtually un-documented in the literature. INNOVATION: In the project reported here we use role-playing as a method to motivate and increase active participation in an online web-based discussion on community-based medical education (CBME). The Foundation for Advancement of International Medical Education & Research (FAIMER(®) ) Institute hosts virtual group discussions for fellows as part of its fellowship programmes, in order to deepen their knowledge base in health professions education and research. In June 2008, a group of seven FAIMER(®) fellows and faculty members moderated an online discussion on CBME using an online role-play exercise with other fellows and faculty members. RESULTS: Out of a total of 102 fellows, 36 (35.3%) participated actively, which exceeded the typical percentage of list server participation. In addition, a rich discussion resulted in a comprehensive report on the goals, challenges, logistical components, role of Health Ministry policy and the possible ethical mandate of CBME in developing countries. CONCLUSION: Online role-play encouraged distributed participation among a highly diverse international group of participants, supporting the conclusion that role-playing can be used effectively with mid-career health professional faculty members in the online environment.