Translating medical school social missions to student experiences.

CONTEXT: There is a growing focus on the social missions of medical schools as a way of expressing an institutional commitment to service, responsibility and accountability. However, there has been little exploration of how a social mission translates to student experiences. METHODS: This multicentre study explored how the social missions of eight medical schools (from Australia, Belgium, Canada, the Philippines, South Africa, Sudan and the USA) translated to their medical education programmes, and how their students perceived the mission. The study used a nested case study design involving interviews with final-year medical students. Constructivist grounded theory techniques were used to analyse the data. Cultural-historical activity theory concepts of externalisation and internalisation were used to structure the analyses. RESULTS: The study identified substantial variation in the form, focus and depth of expression of each school's social mission, significant variation in how and to what extent the mission was externalised in the design of each school's undergraduate medical education programme, and significant variation in how students perceived the social mission and its translation to their training experiences. The translation of a social mission to educational outcomes depended on a cascade of externalisation and internalisation processes, each of which could alter or reinterpret the mission. Translation depended to a great extent on sensitising learners to the mission's values and issues and subsequently activating this knowledge in the context of direct clinical encounters that embodied the issues the mission was seeking to address. CONCLUSION: Whether a medical school's social mission is focused on equity of access to the medical profession or on its graduates serving particular community needs, the mission principles need to be translated into practice. This translation process involves a series of externalisation and internalisation steps, each of which determines how much and what aspects of the mission are translated.

Training for impact: the socio-economic impact of a fit for purpose health workforce on communities.

Across the globe, a "fit for purpose" health professional workforce is needed to meet health needs and challenges while capitalizing on existing resources and strengths of communities. However, the socio-economic impact of educating and deploying a fit for purpose health workforce can be challenging to evaluate. In this paper, we provide a brief overview of six promising strategies and interventions that provide context-relevant health professional education within the health system. The strategies focused on in the paper are:1. Distributed community-engaged learning: Education occurs in or near underserved communities using a variety of educational modalities including distance learning. Communities served provide input into and actively participate in the education process.2. Curriculum aligned with health needs: The health and social needs of targeted communities guide education, research and service programmes.3. Fit for purpose workers: Education and career tracks are designed to meet the needs of the communities served. This includes cadres such as community health workers, accelerated medically trained clinicians and extended generalists.4. Gender and social empowerment: Ensuring a diverse workforce that includes women having equal opportunity in education and are supported in their delivery of health services.5. Interprofessional training: Teaching the knowledge, skills and attitudes for working in effective teams across professions.6. South-south and north-south partnerships: Sharing of best practices and resources within and between countries.In sum, the sharing of resources, the development of a diverse and interprofessional workforce, the advancement of primary care and a strong community focus all contribute to a world where transformational education improves community health and maximizes the social and economic return on investment.

Street outreach and shelter care elective for senior health professional students: an interprofessional educational model for addressing the needs of vulnerable populations.

BACKGROUND: University of New Mexico Health Sciences Center (UNMHSC), located in Albuquerque, New Mexico, USA, has an international reputation for developing and implementing curricular initiatives addressing health inequities. The Street Outreach and Shelter Care elective is designed to provide interprofessional service learning opportunities for senior pharmacy and medical students addressing the needs of our nation's most marginalized population-those experiencing homelessness. METHODS: Our institution collaborated with multiple community partners serving the homeless to develop, implement and teach a 4-week senior elective for health professions students. During this elective, senior pharmacy and medical student teams provide individualized health care to men in local homeless shelter facilities. Students also participate in street outreach programs across a continuum of homeless populations. Weekly interprofessional education (IPE) faculty-facilitated sessions allow students to reflect on their experiences and learn from other discipline perspectives. RESULTS: Student evaluations uniformly reflect the transformative nature of the rotation since its inception, April 2009. Our outcomes corroborated the findings of similar service learning models developed to sensitize health professions students to the complex challenges of homeless populations. DISCUSSION: Academic centers can play a central role in health education reform by instituting curricula focusing on the primacy of population welfare and just distribution of resources. Senior year is an opportune time to reinforce social accountability among health professions before graduation. This elective is based on adult principles of learning and can serve as an international educational model for developing interprofessional curricular innovations addressing the healthcare needs of vulnerable populations.

Improving Community Health Using an Outcome-Oriented CQI Approach to Community-Engaged Health Professions Education.

Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement.

Addressing Interpersonal Violence as a Health Policy Question Using Interprofessional Community Educators.

INTRODUCTION: The health effects of intimate partner violence (IPV) not only include physical injury, but can also manifest as posttraumatic stress disorder, anxiety, and others. US medical students report receiving inadequate training about IPV. This case-based tutorial for third-year medical students examines: (1) a clinical encounter with a patient experiencing several complex challenges including IPV and homelessness; (2) the implications of existing policy on the delivery of health care services; and (3) the impact of policies on patient choices. METHODS: This case is completed during a family medicine clerkship. The 2-hour case review moves between small- and large-group sessions led by community interprofessional experts at a local family advocacy center. Optimal group size is three to four students and one or two experts per group. The large-group session should be led by a dynamic moderator who is familiar with the Socratic method of teaching to elicit a variety of responses to ad hoc challenge questions. Materials provided include student resources, student case, facilitator guide, moderator guide, and sample brochure of IPV documentation policies. RESULTS: To date, over 200 students have participated in this session. During the most recent iteration the average response to the question, "As a result of the FAC experience, I feel more empowered to care for persons experiencing IPV," was 4.1 out of 5 (5 = strongly agree). DISCUSSION: Public health, health policy, and clinical topics can be effectively taught by an interprofessional team of community experts and lead to improved student understanding of the importance of health policy to both individual and population health outcomes.

Laying the foundation: a residency curriculum that supports informed advocacy by family physicians.

This is one of six short papers that describe additional innovations to help integrate public health into medical education; these were featured in the "Patients and Populations: Public Health in Medical Education" conference. They represent relatively new endeavors or curricular components that had not been explored in prior publications. Although evaluation data are lacking, it was felt that sharing a description of a longitudinal curriculum focused on the development of basic advocacy skills through practical activities in community assessment and engagement combined with legislative advocacy at the University of New Mexico would be of value to medical educators.

Reuniting public health and medicine: the University of New Mexico School of Medicine Public Health Certificate.

The University of New Mexico School of Medicine (UNMSOM) sought to train medical students in public health concepts, knowledge, and skills as a means of improving the health of communities statewide. Faculty members from every UNMSOM department collaborated to create and integrate a public health focus into all years of the medical school curriculum. They identified key competencies and developed new courses that would synchronize students' learning public health subjects with the mainstream medical school content. New courses include: Health Equity: Principles of Public Health; Epidemiology and Biostatistics; Evidence-Based Practice; Community-Based Service Learning; and Ethics in Public Health. Students experiencing the new courses, first in pilot and then final forms, gave high quantitative ratings to all courses. Some students' qualitative comments suggest that the Public Health Certificate has had a profound transformative effect. Instituting the integrated Public Health Certificate at UNMSOM places it among the first medical schools to require all its medical students to complete medical school with public health training. The new UNMSOM Public Health Certificate courses reunite medicine and public health in a unified curriculum.