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      Design, implementation and evaluation of a community health training program in an integrated problem-based medical curriculum: a fifteen-year experience at the University of Geneva Faculty of Medicine

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          Abstract

          Background

          In the literature the need for relevance in medical education and training has been stressed. In the last 40 years medical schools have been challenged to train doctors competent to respond to community health needs. In the mid-90s the University of Geneva Faculty of Medicine introduced an integrated medical curriculum. In this initiative a particular emphasis was put in introducing a 6-year longitudinal and multidisciplinary Community Health Program (CHP).

          Objectives

          The aims of the present article are to describe the conception, elaboration and implementation of the CHP as well as its evolution over 15 years and the evaluation of its outcomes.

          Methods

          The CHP was at its origin elaborated by a small group of highly motivated teachers and later on developed by a multi-disciplinary group of primary care physicians, epidemiologists, public health and bio-ethics specialists, occupational health professionals, lawyers and historians. Evaluation of the program outcomes included educational innovations, new developments of the curriculum and interactions between students and the community.

          Results

          The CHP learning objectives and teaching modalities were defined by the multi-disciplinary group in consensus meetings which triggered a collaborative spirit among teachers and facilitated further developments. The evaluation procedures allowed the monitoring of students’ satisfaction which remained high over the years, students’ active participation which decreased over time and success at certifying exams which was globally as good as in basic life sciences. The evaluation also assessed outcomes such as educational innovations, new developments of the curriculum and interactions between students and the community.

          Conclusion

          As suggested in the literature, our experience shows that the students’ direct exposure and practice in the community health environment is an effective training approach to broaden students’ education by offering them a community perspective of health and disease.

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          Most cited references 39

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          Changing face of medical curricula.

          The changing role of medicine in society and the growing expectations patients have of their doctors means that the content and delivery of medical curricula also have to change. The focus of health care has shifted from episodic care of individuals in hospitals to promotion of health in the community, and from paternalism and anecdotal care to negotiated management based on evidence of effectiveness and safety. Medical training is becoming more student centred, with an emphasis on active learning rather than on the passive acquisition of knowledge, and on the assessment of clinical competence rather than on the ability to retain and recall unrelated facts. Rigid educational programmes are giving way to more adaptable and flexible ones, in which student feedback and patient participation have increasingly important roles. The implementation of sustained innovation in medical education continues to present challenges, especially in terms of providing institutional and individual incentives. However, a continuously evolving, high quality medical education system is needed to assure the continued delivery of high quality medicine.
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            What can experience add to early medical education? Consensus survey.

            To provide a rationale for integrating experience into early medical education ("early experience"). Small group discussions to obtain stakeholders' views. Grounded theory analysis with respondent, internal, and external validation. Problem based, undergraduate medical curriculum that is not vertically integrated. A purposive sample of 64 students, staff, and curriculum leaders from three university medical schools in the United Kingdom. Without early experience, the curriculum was socially isolating and divorced from clinical practice. The abruptness of students' transition to the clinical environment in year 3 generated positive and negative emotions. The rationale for early experience would be to ease the transition; orientate the curriculum towards the social context of practice; make students more confident to approach patients; motivate them; increase their awareness of themselves and others; strengthen, deepen, and contextualise their theoretical knowledge; teach intellectual skills; strengthen learning of behavioural and social sciences; and teach them about the role of health professionals. A rationale for early experience would be to strengthen and deepen cognitively, broaden affectively, contextualise, and integrate medical education. This is partly a process of professional socialisation that should start earlier to avoid an abrupt transition. "Experience" can be defined as "authentic human contact in a social or clinical context that enhances learning of health, illness or disease, and the role of the health professional."
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              A taxonomy of community-based medical education.

              The authors propose a classification of community-based education (CBE) as it is implemented all over the world. To create this taxonomy, they used reports in the literature of 31 active programs in many locations. A CBE program is an instructional program carried out in a community context, outside the academic hospital. The authors distinguish between programs that are developed primarily to provide services to an underserved community; programs that have a research focus; and programs that have as their primary goal the (clinical) training of students. These three major types can be subdivided in six minor types, among them community development programs, health intervention programs, and simple community-exposure programs. The ultimate goal of creating the taxonomy is to contribute to the development of a theory of CBE and provide a more systematic way to study CBE. In addition, the proposed taxonomy clearly demonstrates the various ways in which medical schools, their staffs, and their students can become involved with the communities served. CBE is not a unitary concept but a set of attempts to contribute to the quality of life in a particular community and, at the same time, create conditions for students to acquire hands-on understanding of the nature of the problems to be faced in future professional practice, and to develop relevant skills. The taxonomy also enables those involved in the development of CBE programs in their medical schools to see alternative approaches, which will help them choose the approaches that fit their particular educational goals. Last, it demonstrates the intricacies involved in the implementation of CBE, in particular the complexity of building a learning environment that is productive for students and, at the same time, responsive to community needs.
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                Author and article information

                Journal
                Med Educ Online
                Med Educ Online
                MEO
                Medical Education Online
                Co-Action Publishing
                1087-2981
                29 June 2012
                2012
                : 17
                Affiliations
                [1 ]Unit of Development and Research in Medical Education, University of Geneva Faculty of Medicine and Geneva University Hospital, Geneva, Switzerland
                [2 ]Institute of Social and Preventive Medicine, University of Geneva Faculty of Medicine and Geneva University Hospital, Geneva, Switzerland
                [3 ]Department of Community and Primary Care Medicine, University of Geneva Faculty of Medicine and Geneva University Hospital, Geneva, Switzerland
                [4 ]Department of Neurosciences, University of Geneva Faculty of Medicine and Geneva University Hospital, Geneva, Switzerland
                [5 ]Vice-dean's Office for Medical Education, University of Geneva Faculty of Medicine and Geneva University Hospital, Geneva, Switzerland
                Author notes
                [* ] Emmanuel Kabengele Mpinga, Institute of Social and Preventive Medicine, Centre Médical Universitaire, Michel Servet 1, 1211 Geneva 4, Switzerland 4. Email: emmanuel.kabengele@ 123456unige.ch
                Article
                MEO-17-16741
                10.3402/meo.v17i0.16741
                3387672
                22778541
                © 2012 Philippe Chastonay et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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