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The Integration of Primary Care and Public Health in Medical Students' Training Based on Social Accountability and Community-Engaged Medical Education.

ABSTRACT: Objectives: Primary care and public health comprise the bedrock of health systems, but their divergence has produced two groups of practitioners either focused on individual health or population health. We explored how primary care and public health were integrated in medical students' training in Zamboanga Peninsula, Philippines. Methods: Our qualitative study reviewed community health plans in two municipalities and thematically analyzed the perspectives of medical students, faculty, alumni, and community stakeholders through focus group discussions and in-depth interviews. Results: Integration began by operationalizing a curriculum requiring medical students to serve rural communities during most of their training-a departure from the conventional, hospital-based medical education in the Philippines. The medical students' community immersion provided opportunities for integrating primary care and public health activities that influenced their personal orientations and the health situation in communities. Integration continued after training as alumni found themselves serving as primary care and public health practitioners in the region. Conclusion: Social accountability and community-engaged medical education provided the foundation for medical students to integrate primary care and public health in practice to respond to local needs.

SUBMITTER: Punzalan JK

PROVIDER: S-EPMC9908606 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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The Integration of Primary Care and Public Health in Medical Students' Training Based on Social Accountability and Community-Engaged Medical Education.

Punzalan Jaime Kristoffer JK Guingona Monserrat M Punzalan Mary Germeyn MG Cristobal Fortunato F Frahsa Annika A Liwanag Harvy Joy HJ

International journal of public health 20230126

<b>Objectives:</b> Primary care and public health comprise the bedrock of health systems, but their divergence has produced two groups of practitioners either focused on individual health or population health. We explored how primary care and public health were integrated in medical students' training in Zamboanga Peninsula, Philippines. <b>Methods:</b> Our qualitative study reviewed community health plans in two municipalities and thematically analyzed the perspectives of medical students, facu ...[more]

PMID: 36776739

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Project description:BackgroundMany non-communicable diseases are rooted in social factors that determine health outcomes. Complex topics such as the social determinants of health are difficult to teach through traditional didactic methods. Since the introduction of the social accountability of medical schools' framework in 1995 by the World Health Organisation, healthcare education institutions are encouraged to shift their traditional education models towards a socially accountable approach. Community engagement can facilitate a deeper understanding of health inequity, barriers to health care, and the social determinants of health whilst enabling institutions to meet their obligation to the communities they serve. This systematic review aimed to answer the following question: ''What is the impact of community engaged healthcare education on undergraduate healthcare students' empathy and their views towards social accountability?''.MethodsThis is a mixed-methods systematic review. The protocol was registered with PROSPERO (CRD42022306181). The following databases were searched: Scopus, MEDLINE, Embase, CINAHL, ERIC, BEI for primary research studies published from 1995 to September 2024. Grey literature was also searched via EThOS and Google. Studies recruiting undergraduate students of regulated healthcare professions in countries of very high development were included. A convergent integrated approach to synthesis was followed.ResultsOut of the 19,590 papers yielded from the literature search, 76 met the inclusion criteria and were included in the review. The following subthemes were generated under three overarching themes: Social accountability (advocacy for action; giving back to the community; bigger picture-identifying social determinants of health and barriers to healthcare; barriers to social accountability), Empathy (humanise community members-everybody has a story; overcome bias and challenge attitudes, assumptions and stereotypes; cultural competence and sensitivity; empathetic communication and interpersonal skills; feeling sympathy and sadness), and Shaping the future workforce (future professional demeanour; professional interests; interprofessional education and collaboration).ConclusionsCommunity engaged education can help students better understand community needs, social determinants of health, improve empathy and cultural sensitivity, and build advocacy for social justice and change.

Project description:BackgroundRevitalizing primary health care requires that the health workforce, especially doctors, must appreciate the significance of the socio-cultural environment in health. To achieve this objective, training of medical students must emphasize greater understanding of the community and its role in health through community engagement using community-engaged learning. However, research on this learning method applied in a purely community engagement context is lacking. A medical school in Ghana adapted its fourth-year junior clerkship curriculum in Community Health to include a community-engagement programme. This study reports students' perceptions of the said programme as a way of evaluating it and helping to improve upon its implementation.MethodsA cross-sectional survey using a Google form-based questionnaire with open- and closed-ended questions was conducted from May 2022 to December 2023 among 303 current and past medical students of the University of Health and Allied Sciences, Ghana who had experienced the said programme. Based on the first three levels of the Kirkpatrick's four-level model of training evaluation, data was collected on participants' socio-demographics, their assessment of the programme content and delivery, subsequent attitudinal changes and their application to practice. Descriptive statistics were performed on quantitative data and thematic content analysis done for responses to the open-ended questions.ResultsMore than half of participants were males (188/303). The mean (SD) participant age was 23.9 years (2.4). Over 90% indicated the programme was valuable to their training (277/297) and were satisfied with the facilitators (283/297) despite some anxieties expressed at the start of their clerkship. Participants noted that they acquired other skills including teamwork and leadership aside the reinforced academic content. At least 99% of participants noted they could conduct the processes of community entry and engagement with or without assistance.ConclusionAlthough there is room for improvement, the students' community engagement programme may have some utility in the training of medical students to enable them better appreciate community interactions that influence health. Further research incorporating objective assessments of learning and behaviour change is needed to comprehensively assess the programme.

Project description:ObjectivesTo identify community preceptors' views on the qualities and abilities required of physicians in community medicine, the education to acquire those qualities and abilities, and the factors affecting preceptors' involvement in community-based teaching.MethodsWe conducted semi-structured interviews with 13 male community preceptors in northern Japan who had at least 5 years of experience in community medicine and prior teaching experience with preclinical students. Participants were selected using purposive sampling to ensure diversity in clinical roles and institutional affiliations. A thematic analysis was conducted on verbatim transcripts to identify recurring themes.ResultsParticipants emphasized "communication skills," "understanding the perspectives and backgrounds of patients and their families," and "love for the community and its people" among the essential qualities and abilities for community physicians. They cited deepening relationships with and fostering an attachment to the community as necessary to cultivate these skills. The factors identified as facilitating community-based teaching included "positive emotions felt throughout the teaching experience," "supporting hospitals and the wider community," and "devotion to students." Factors that hindered involvement included "perceived difficulty of teaching preclinical students" and "education-related issues at universities assigning students on placement," such as the lack of opportunities for community-based teaching within the curriculum.ConclusionsIn line with the "social axis" in Worley's four Rs model, deep community involvement is essential to developing communication skills and patient-centered medicine. This study identified the qualities and abilities required for community physicians, as well as the educational activities needed to cultivate them from the early years of medical school. Strengthening collaboration between universities and community preceptors is vital to advancing community-engaged medical education (CEME). Cross-cultural studies could further explore how CEME operates in diverse contexts, contributing to socially accountable and community-responsive medical education.

Project description:IntroductionRecent international consensus statements advocate for the integration of Point-of-Care Ultrasound (PoCUS) into the global undergraduate medical curriculum. Some medical schools outside Saudi Arabia have already incorporated PoCUS into their undergraduate curricula to enhance anatomy, physiology and pathology instruction. However, there are no data on the potential role of PoCUS in the preclinical training of medical students in Saudi Arabia. Given constraints on resources for medical education, a formal needs assessment was conducted to evaluate the potential utility of PoCUS within the basic science curriculum at our institution.MethodsAll final year medical students at our institution were invited to complete a validated online survey. The questionnaire utilized a 5-point Likert scale to assess student perceptions of the potential for PoCUS to improve their understanding of basic sciences and their desire for its incorporation into the preclinical curriculum.ResultsA total of 229 students participated (response rate 76%; male 134/200; female 95/100). Our survey demonstrated good internal consistency (Cronbach's alpha: learning basic sciences 0.81, need for curriculum integration 0.83). The vast agreed that learning PoCUS would enhance their understanding of anatomy (95%) and pathology (75%). While only 52% agreed that learning PoCUS would improve their understanding of physiology, a substantial majority (80%) agreed that all medical schools should incorporate PoCUS into their undergraduate curricula. Furthermore, 62% agreed that offering PoCUS training would make the medical school more attractive to prospective applicants. No significant differences were observed between the responses of male and female students. The results of a confirmatory factor analysis provide strong support for the hypothesized three-factor model. All factor loadings are significant (P < 0.001), CONCLUSIONS: Medical students in Saudi Arabia perceive that PoCUS would be a valuable tool to learn anatomy and pathology, aligning with the recommendations of the consensus conference on PoCUS integration in undergraduate medical education organized by the World Interactive Network Focused on Critical Ultrasound (WINFOCUS) and the Society of Ultrasound in Medical Education (SUSME). Introducing PoCUS training into preclinical medical curricula may also enhance the attractiveness of medical schools to potential applicants.

Project description:BackgroundLimited knowledge, negative beliefs, and lack of sufficient breastfeeding promotion and support by physicians contribute to global suboptimal breastfeeding rates. Formal medical education is well-known to influence future physicians' knowledge, beliefs, and medical practice. However, less understood is the influence of social networks and processes on the exchange and diffusion of knowledge and practices related to breastfeeding.ObjectivesWe selected the underserved and under-supported public medical school in Lebanon to examine the social side of medical education. Our objectives were to assess knowledge, beliefs, and self-efficacy related to breastfeeding promotion and support among interns and residents. We also examined the social ecosystem surrounding these students concerning the exchange of breastfeeding knowledge.DesignAll data were collected during one study visit per participant. First, an interview-administered structured survey was used to assess beliefs, perceived knowledge, basic breastfeeding knowledge, and self-efficacy related to breastfeeding among n = 70 medical interns and residents. Then, social network data were collected during a semi-structured interview and analyzed using an ego-network approach. All interviews were voice-recorded, transcribed, coded, and thematically analyzed. Descriptive statistics were used to analyze quantitative survey and social network results.ResultsAlthough interns and residents had positive beliefs about breastfeeding benefits, they had limited knowledge and low self-efficacy related to the psychosocial and clinical aspects of breastfeeding promotion and support. They did not seem to have a well-connected professional network around breastfeeding knowledge and practices. Several tended to rely on their informal/non-professional network, such as their mothers, partners, and sisters, for knowledge and practice.ConclusionsOur work using breastfeeding as an exemplary case suggests there is a role for better attending to the beliefs of medical students as well as to the social side of medical education. Future studies can use social network theory to help identify and address influences on medical education outcomes.

Dataset Information

The Integration of Primary Care and Public Health in Medical Students' Training Based on Social Accountability and Community-Engaged Medical Education.

Publications

The Integration of Primary Care and Public Health in Medical Students' Training Based on Social Accountability and Community-Engaged Medical Education.

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