ABSTRACT
CONTEXT: Community-based education (CBE) was developed thirty years ago in response to the maldistribution of physicians and subsequent inequity of health care services across geographical areas in developed and developing countries. Several medical schools in Nigeria report adopting CBE. This study seeks to identify and describe the CBE programs in accredited Nigerian medical schools and to report students' assessments of the knowledge and skills gained during their community-based educational experience. METHODS: Researchers developed a questionnaire that was distributed to student representatives at 19 of the 20 accredited medical schools. Student representatives distributed the questionnaire to 20 final year medical students and returned the completed questionnaires to the researchers. Quantitative data were entered into SPSS 14. RESULTS: Most students from CBE schools participated in CBE experiences of 4 to 8 weeks duration during their fifth or sixth year and paid for their food and transportation costs. Medical school personnel supervised the students who were also often assisted by community personnel. Students' rated highest their learning about environmental-related health risks and how to identify community health problems. They rated lowest what they learned about how to train health workers and how to implement and analyze results of community health interventions. DISCUSSION AND CONCLUSION: CBE teaches future physicians how to function as health care providers in underserved communities. CBE curricula in Nigeria are addressing most, but not all, of the validated CBE generic objectives. Most notably, the curricula are not providing adequate education in the implementation and analysis of results of a community health intervention.
Subject(s)
Community Health Services/organization & administration , Community Medicine/education , Education, Medical, Undergraduate/methods , Students, Medical , Community-Institutional Relations , Consumer Behavior , Education, Medical, Undergraduate/organization & administration , Female , Humans , Male , Nigeria , Preceptorship/methods , Preceptorship/organization & administration , Schools, Medical , Surveys and Questionnaires , WorkforceABSTRACT
Nursing home reimbursement systems which do not adjust payment levels to patient care needs lead to access problems for heavy-care patients. Unnecessarily long and costly hospital stays may result. A patient-based nursing home incentive reimbursement system has been designed and is being evaluated in a controlled field experiment in 36 California skilled nursing facilities. Incentives are paid for admitting heavy-care patients, meeting outcome goals on some patients, and discharging and maintaining some patients in the community. This article describes a nursing home reimbursement system which is intended to simultaneously mitigate problems of restricted access, inefficient use of beds, and nonoptimal care. It also discusses the approach to evaluating this broad social intervention by application of a controlled experimental design.
