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.

[Should medical schools train students in human rights? An exploratory study among medical students in 46 countries]. / Faut-il former les etudiants en médecine aux droits de l'homme? l'Opinion d'etudiants en médecine de quarante-six pays.

The interest of medical students from 46 countries for human rights issues and training was investigated in a cross sectional study. Training in human rights is demanded by 85,4% of respondents. Nearly 55% consider that such training should be compulsory. Nearly 85% of students consider as specific tasks of a medical practitioner "to prevent actively professional practices that violate basic human rights in the health systems" or "to develop and promote attitudes respectful of human rights in care". Our study suggests that human rights training could be integrated into basic medical curriculum.

[Health and human rights: perceptions of health professionals and human rights defenders]. / Santé et droits humains: perceptions de leurs défenseurs et des professionnels de santé.

A self-administered questionnaire served as the basis for a study carried out between February and June 2003 covering a panel of 125 experts from 33 countries spread over 5 continents. The objective of this study was to identify the human rights problems perceived as having a very negative health impact from approximately fifty proposals. This study also aimed at identifying the variables which could explain the differences in the perceptions observed. At the global level, the threats to physical integrity and attacks on human life, economic problems of a health or social nature, questions of political or democratic origin, as well as a wide spectrum of other problems are perceived as having very harmful effects on health with an average adhesion rate of severity (TMAG) ranging from 90-75%. For the same categories of problems at the national level, the TMAG varies from 67-40%: The observed consensus around the severity of human rights problems is tempered by the differences in perceptions according to profession, sex, and the level of the country's and continent's development. Other than the fact that these results corroborate the shared international concerns with regard to the state of the world's human rights, they suggest that the experts' opinions constitute a complementary source of information necessary for work on the international mechanisms for the surveillance of the implementation of international treaties; while at the same time, they indicate priorities for action in the field of public health and human rights.

Femoral neuropathy: unusual presentation for recurrent large-bowel cancer.

PURPOSE: The recurrence of colon or rectal cancer may be signaled by serial carcinoembryonic antigen assays, patient symptoms, or radiologic tests such as abdominal and pelvic computed tomographic scans. There are unusual clinical presentations of recurrent disease. METHODS: Retrospectively, six patients with recurrent appendix, colon, or rectal cancer had a femoral neuropathy. Their clinical features and results of reoperative surgery were reviewed. RESULTS: All six patients had thigh weakness and atrophy, and four complained of leg pain. Each of the six patients underwent a reoperation, with a complete cancer resection in four. Pain control was excellent, but only one of the six patients, a patient with appendix cancer, demonstrated prolonged survival. CONCLUSIONS: Leg pain, thigh weakness, and atrophy are compatible with femoral neuropathy and are symptoms and signs compatible with recurrent large-bowel cancer. These findings may alert the clinician to the need for further investigation and treatments.