Using area health education centers to promote interest in rural practice.

INTRODUCTON: In the USA, area health education centers (AHECs) work to recruit and educate students to serve in medically underserved communities, primary care, and rural settings. One important aspect of their work is connecting students with rural clinical experiences. Within these experiences, AHECs incorporate a community health/socioeconomic experience within the family medicine clerkship that may not be as prevalent in the standard family medicine clerkship experiences. The purpose of the study was to assess the relationship between AHEC-sponsored family medicine clerkships with a self-reported intent to practice in a rural setting upon graduation. METHODS: The study compared third-year medical students with the Indiana University School of Medicine, which participated in AHEC-sponsored family medicine clerkships to the standard family medicine clerkship. Following the 4-week clerkship, students were asked to report their intent to work in a rural setting using a five-point Likert scale. A χ2 test was used to determine the association of AHEC sponsorship, clerkship site location (rural/urban) and intent to practice in a rural setting. RESULTS: The study consisted of 587 students. There was a statistically significant association between self-reported intent and rural clerkship site, χ2 (1, N=587)=6.542, p=0.01. Furthermore, 21.6% (n=25) of students with a rural clerkship experience reported a greater intent compared to 12.3% (n=58) of students with non-rural clerkship experience. CONCLUSIONS: The study confirmed a significantly positive association between participation in medical clerkship experiences in a rural primary care setting and the intent to practice in a rural setting upon graduation. The results also support the potential value-added benefits through academic-community partnerships with AHECs, family medical and other primary care specialty clerkship programs may perhaps succeed in increasing student interest in pursuing a practice serving in rural communities upon graduation.

A educação interprofissional e o Pró PET-Saúde USP-Capital 2012/2014: a percepção de tutores, preceptores e estudantes / Interprofessional education and the Pró PET-Saúde USP-Capital 2012/2014: the tutors, preceptors and students perception

Nos últimos trinta anos, pesquisadores da área da saúde tem dado especial atenção ao tema da educação interprofissional (EIP), por esta estar relacionada com uma maior satisfação dos usuários e a oferta de uma assistência em saúde mais resolutiva e satisfatória. A necessidade de adotarmos a EIP como uma ferramenta para a formação de profissionais da saúde surge a partir do momento que percebemos que nosso sistema de saúde presta cuidados fragmentados e pouco resolutivos. Atualmente, estudos científicos comprovam que a prática colaborativa e um cuidado ofertado com qualidade é facilmente alcançável se os profissionais trabalharem em equipe com objetivos comuns, sendo imprenscindível o desenvolvimento de habilidades de comunicação interprofissional e prática colaborativa desde o início da graduação. Desta forma, este estudo tomou como objeto de investigação a educação interprofissional, no contexto da atenção primária a saúde e na perspectiva da integração do ensino com os serviços públicos de saúde, por meio do programa Pró PET-Saúde USP-Capital 2012/2014. A escolha do programa para o presente estudo foi devido a natureza interprofissional do projeto, visto que engloba estudantes, preceptores e tutores de diversos cursos da área da saúde e por este ter constituído um espaço privilegiado de aprendizado e aperfeiçoamento na formação

em saúde, dando origem a outras iniciativas interprofissionais na Universidade de São Paulo (USP). A coleta de dados ocorreu de duas formas, sendo a primeira por meio de questionários individuais destinado aos profissionais de saúde (preceptores) e estudantes, com trechos da obra de Lewis Carroll "As Aventuras de Alice no País das Maravilhas", e por meio de um roteiro de entrevista destinado aos docentes (tutores) participantes do programa. Os dados obtidos foram analisados através da análise temática proposta por Minayo. Os resultados mostram que assim como a personagem Alice do livro de Carroll, muitas vezes ficamos confusos sobre quais opções escolher para aperfeiçoar a nossa formação em saúde. Se não soubermos onde queremos chegar, qualquer caminho se torna o certo, porém as evidências comprovam que a escolha por oportunidades de educação interprofissional na graduação e na pós graduação em saúde podem minimizar estereótipos e preconceitos formados pelos estudantes em relação as outras categorias profissionais e desenvolver habilidades de comunicação interprofissional e resolução de conflitos que contribuirá para uma prática colaborativa e a melhor assistência em saúde. Como produto do mestrado profissional foi elaborado um plano de aula destinado aos estudantes da USP com a finalidade de problematizar e permitir uma breve experiência da educação interprofissional.

For the last thirty years, healthcare researchers were giving special attention to the interprofessional education subject (IPE), for it being related to a more positive feedback from the user and a more accurate and satisfactory health care assistance. The need to adopt the IPE as a tool for the formation of professionals on the health area comes from moment where we realize that our health system is delivering a fragmented and less accurate health care. Nowadays, scientific studies show that collaborative practice and the quality of the offered care is more likely if professionals work in a team with common aim, being necessary to develop interprofessional communication skills and collaborative practice since the beginning of the course. Thus, this study took as investigation object the interprofessional education, in the context of the primary health care and the perspective of the integration between education and the public health services, through the program Pró PET-Saúde USP-Capital 2012/2014. The choice of the program for this study was due the interprofessional nature of the project, since it includes students, preceptors and tutors from many healthcare courses and for it being structured in a privileged space for learning and improvement in health training, promoting development to other interprofessional initiatives at Universidade de São Paulo (USP). Data collection

occurred in two ways, the first one being through an individual questionnaire with quotes from the book of Lewis Carroll "Alice in Wonderland" designed for the students who attended to the program, another individual questionnaire intended for health professionals (preceptors) and an interview script destined the professors (tutors) who participated on the program. The data collected were analyzed by the researcher using the thematic analysis proposed by Minayo. Results show that likewise the character Alice from "Alice in wonderland", often we get confused about which options should we chose in order to improve our health training. If we don't know where we want to get to, any path would suffice, however, evidences show that a choice for an opportunity in interprofessional education while in health training could minimize the stereotypes and prejudices formed by students in relation to other professional categories and develop interprofessional communication abilities and conflict management, which will contribute to a collaborative practice and a better health care. As result of the professional master's degree, it was developed a class plan for the students at USP in order to problematize and allow a brief interprofessional education experience.

Does an AHEC-Sponsored Clerkship Experience Strengthen Medical Students' Intent to Provide Care for Medically Underserved Patients?

The mission of Area Health Education Centers (AHECs) is to recruit and educate students to serve as practicing health care professionals in rural, primary care, and medically underserved communities. We sought to determine if participation in an AHEC-sponsored family medicine clerkship experiences during medical school are significantly associated with a self-reported intent to practice primary care in a medically underserved environment upon graduation. The study was a prospective cohort study comparing third-year family medicine students with the Indiana University School of Medicine who participated in either an AHEC-sponsored family medicine clerkship to those who completed their required family medicine clerkship outside of the AHEC setting. Following the 160-h clinical clerkship, all students completed a mandatory, electronic survey and were asked to self-report their intent to the following question: "Which of the following statements best describes the impact of the family medicine clerkship on your intention to provide care to underserved patients when you complete residency training?" The question was integrated into a mandatory post-clerkship evaluation form required by the Indiana University School of Medicine, Department of Family Medicine. A Chi square test of independence as well as a multivariate logistic regression analysis was used to determine the independent association of AHEC clerkship participation and reported intent. A total of 1138 students completed the survey. There were not significant differences in age, gender, race, and ethnicity between students that completed an AHEC clerkship and those that did not. After adjusting for gender, race, and ethnicity, AHEC participants were significantly more likely to report an intention to practice primary care in a medically underserved setting upon graduation. Female students were found to be 1.2-3.4 times as likely to report increased intent compared to male students (95 % CI 1.241-3.394). Participation in an AHEC-supported clerkship was associated with a significant increase in self-reported intent to practice primary care in a medically underserved setting. Additional research is required to determine if participation and/or reported intent are predictive of practice selection after graduation.

A study on the correlation between program contact hours and the successful matriculation into college.

Area Health Education Centers (AHECs) play an important role in the recruitment and training of students to serve as practicing health care professionals in rural, primary care, and medically underserved communities. To analyze the relationship between the accumulated contact hours of past students in AHEC programs and their known matriculation into college. 5,189 students, whom participated in Indiana AHEC Network programs, were grouped into eight categories based on accumulated contact hours and matched against two college matriculation databases. The relationship between the number of accumulated contact hours and known college matriculation was statistically significant. The analysis of the data suggests two significant break points in which the number of accumulated contact hours appears to be correlated with increased known college matriculation. The findings indicate accumulated contact hours are significantly correlated with known college matriculation. Furthermore, two significant break points in contact hours at the 5 and 20 contact hours demonstrated increased correlations between program contact hours and known college matriculation. The results of this analysis between participation in area health education center programming and matriculation into higher education may be transferable to other areas of health education.

Interdisciplinary delivery of oral health care student-training components.

The purpose of this study was to identify the interdisciplinary nature of oral health care components within Area Health Education Centers (AHECs). A questionnaire was designed to elicit descriptive information from AHEC program directors. The questionnaire surveyed the entire population of 37 AHEC project directors identified by the National AHEC Program Office. A total of 23 of 37 questionnaires were returned, for an overall response rate of 62%. Results indicate that dental and dental hygiene students are learning alongside other student health care professionals in an interdisciplinary environment. These oral health care components incorporate a variety of classroom delivery methods, such as problem-based learning, interdisciplinary learning, and reflective sessions. The survey also revealed numbers of students and programs involved in current interdisciplinary activities.

Providing consumer health information via health professionals.

The Health Education Center in Pittsburgh, a community-based health promotion agency which provides library services to health professionals, students, and the lay public, received a resource grant in 1981 from the National Library of Medicine to study professionals' awareness of consumer health information (CHI) materials for their patients and clients. A survey of telephone patrons and on-site library patrons provided details on health professionals' use of the CHI resource center: their areas of interest, the material formats they preferred, and the intended use of the materials. Health professionals' demand for information about consumer-oriented materials and their satisfaction with the HEC library suggest that such a resource can be a valuable asset to a community.