Institutional collaboration and competition in community-based education.

We sought to determine whether competition for community-based training sites exists among health professions schools, and to examine faculty and senior administrators' perspectives on institutional collaboration for community-based education. Eight academic health centers (AHCs) in the USA were selected by objective criteria for their significant community involvement. Chief executive officers, vice chancellors, deans, and the individuals responsible for community-based education, research and community service responded to written surveys. The overall response rate was 79% (n = 91). Responses were subjected to quantitative and qualitative analyses. Leaders of community-based education reported that "competition for community-based training sites" is a barrier to community involvement. "Competition for community-based training sites"was positively related to 'call for increasing percentage of graduates to enter primary care careers' (0.30, p < 0.01) and negative related to "collaboration exists between the community and your school/AHC" ( - 0.28, p < 0.05). Respondents reported that a moderate level of collaboration across schools exists. While medical school respondents reported having collaborative relationships with other health professions schools and with the community, nursing respondents reported medicine's performance at a significantly lower level. Public health and nursing faculty reported that they are competing with medical schools for sites they had traditionally used for their students. Competition for sites is an unintended outcome of the increased emphasis on community-based education in health professions curricula. We recommend AHCs form joint committees across schools to effectively address community-based sites as a limited resource, and to consider a wider range of community-based organizations as training partners.

Forces affecting community involvement of AHCs: perspectives of institutional and faculty leaders.

PURPOSE: To understand the external and internal factors that either facilitated or were barriers to an academic health center's (AHC's) involvement in community-based education, research, and clinical care; community service; and community or economic development activities. METHOD: Eight AHCs in the United States were selected by objective criteria for their significant community involvement. Chief executive officers, vice chancellors, deans, and the individuals responsible for community-based education, research, and community service responded to written surveys. Responses were subjected to quantitative and qualitative analyses. RESULTS: The overall response rate was 79% (n = 91). Public perception, an increased focus on a population health perspective, and an increased call for AHCs to be accountable to local and statewide constituents were cited as the most significant external factors contributing to an AHC's community involvement. Institutional leadership, familiarity with community-based organizations, institutional climate, faculty and student interest, and institutional structures were cited as the most significant internal facilitators of community involvement. Fiscal concerns, competition for community-based training sites, lack of collaboration across health professions schools, and inadequate faculty roles and rewards were viewed as the most significant barriers to community involvement. All respondents reported that their AHCs' orientations towards community service, and community-based teaching, research, and clinical care would increase in the next five years. CONCLUSION: Development of a strategic plan may increase the effectiveness of an institution's community involvement. Central to this plan should be a restructuring of faculty roles and reward polices and an increase in faculty release time to promote community involvement. The importance of involving the community in the planning and implementation of community-campus partnerships should not be underestimated.