Supporting the integration of HIV testing into primary care settings.

OBJECTIVES: We examined the efforts of the US network of AIDS Education and Training Centers (AETCs) to increase HIV testing capacity across a variety of clinical settings. METHODS: We used quantitative process data from 8 regional AETCs for July 1, 2008, to June 30, 2009, and qualitative program descriptions to demonstrate how AETC education helped providers integrate HIV testing into routine clinical care with the goals of early diagnosis and treatment. RESULTS: Compared with other AETC training, HIV testing training was longer and used a broader variety of strategies to educate more providers per training. During education, providers were able to understand their primary care responsibility to address public health concerns through HIV testing. CONCLUSIONS: AETC efforts illustrate how integration of the principles of primary care and public health can be promoted through professional training.

Academies in Health Professions Education: A Scoping Review.

PURPOSE: Thirty years ago, academies were conceived as a sociocultural approach to revitalize the teaching mission of medical schools and to promote educators' career advancement. The academy movement has grown rapidly and now reaches a broad range of health professions education organizations. The authors conducted a scoping review to map the literature and describe the evidence that guides the formation of new academies and justifies the continuation of existing ones. METHOD: The authors searched MEDLINE (via Ovid), Embase (via Elsevier and Ovid), CINAHL (via EBSCOhost), and Web of Science (via Clarivate Analytics) from inception through March 6, 2020, for publications regarding academy-like organizations. They mapped the relevant literature using logic modeling as an organizing framework and included the mission, resources, activities, output, outcomes, and impact of the included academies. RESULTS: Of the 513 publications identified, 43 met the inclusion criteria, the oldest of which was published in 2000. Most publications were either case reports or perspective/opinion pieces (26, 57.8%), while studies presenting empirical findings were less common (11, 24.4%). Publications showed that academies were diversifying and increasingly were part of a broad range of organizations, including departments, hospitals, health science campuses, and national organizations. The mission, resources, and activities were similar across academies. Evaluation studies were largely limited to process measures, and rigorous studies examining outcomes (i.e., changes in academy participants) and impact on the organization at large were rare. CONCLUSIONS: The increase in the number of academy-related publications parallels the accelerating speed of the academy movement. To sustain this movement, rigorous studies must provide evidence that academies contribute to the revitalization of organizations' teaching mission and bring about an academic culture where educators thrive and where education is a legitimate career path.

Co-creating a psychiatric resident program with Ethiopians, for Ethiopians, in Ethiopia: the Toronto Addis Ababa Psychiatry Project (TAAPP).

BACKGROUND: Globalization in medical education often means a "brain drain" of desperately needed health professionals from low- to high-income countries. Despite the best intentions, partnerships that simply transport students to Western medical schools for training have shockingly low return rates. Ethiopia, for example, has sent hundreds of physicians abroad for specialty training over the past 30 years, the vast majority of whom have not returned. This represents a highly problematic net transfer of financial and human resources from the Ethiopian people to Western countries that have failed to develop their own adequate health human resource plans. METHODS: With this background in mind, in 2003 Addis Ababa University invited the University of Toronto to collaborate on the first Ethiopian psychiatric residency program to be run entirely in Ethiopia. Called the Toronto Addis Ababa Psychiatry Project (TAAPP), it was established on the principle of supplementing the ability of the small Addis Ababa University Department of Psychiatry to teach, provide clinical supervision, and to help develop educational capacity. Over the last 6 years the model has involved a large number of University of Toronto faculty and residents who have spent blocks of 1 month each in Addis Ababa. RESULTS: This article describes the first three phases of TAAPP (I) Development of a model residency program; (II) Enhancing clinical, educational and leadership capacity; and (III) Sustainability, faculty development, and continuing education. Between 2003 and 2009, the number of psychiatrists in Ethiopia increased from 11 to 34; the Addis Ababa University Department of Psychiatry faculty increased members from three to nine. There are new departments of psychiatry established in four other university hospitals in Ethiopia outside the capital city. Mental health services are now being integrated within the national system of primary care. CONCLUSION: An important issue that underscores such a partnership is the risk of simply exporting Western, America-centric psychiatric training versus creating culturally appropriate models of education.

Canadian residents teaching and learning psychiatry in Ethiopia: a grounded theory analysis focusing on their experiences.

OBJECTIVES: The Toronto Addis Ababa Psychiatry Project (TAAPP) is an international collaboration between University of Toronto and Addis Ababa University. University of Toronto psychiatric residents may participate in TAAPP as an elective. The authors explored the Canadian resident experience in a qualitative study of the project. METHODS: Eleven residents were interviewed using a semistructured questionnaire. Grounded theory was employed to organize participants' experiences and highlight emerging themes. The computer software NVivo7 was used to facilitate data analysis. RESULTS: Participants described gaining competency as health advocates, collaborators, scholars, and teachers. They endorsed increased sensitivity to cross-cultural issues and greater awareness of global health issues, including practical and ethical ramifications of working at an intersection of cultures. Residents gained international perspective psychiatric practice. CONCLUSION: The elective provided unique opportunities for acquiring clinical, teaching, collaborative, leadership and advocacy skills. It prompted participants to consider ethical and cross-cultural issues and allowed them to be mentored intensively by Ethiopian and Canadian teachers and peers.

South Carolina Area Health Education Consortium Disaster Preparedness and Response Training Network: an emerging partner in preparedness training.

The South Carolina Area Health Education Consortium (SC AHEC) was funded in 2003 to train healthcare professionals in disaster preparedness and response. During the 5 years of funding, its Disaster Preparedness and Response Training Network evolved from disaster awareness training to competency-based instruction and performance assessment. With funding from the assistant secretary for preparedness and response (ASPR), a project with implications for national dissemination was developed to evaluate 2 aspects of preparedness training for community-based healthcare professionals. The SC AHEC designed disaster preparedness curricula and lesson plans, using a consensus-building technique, and then (1) distributed sample curricula and resources through the national Area Health Education Center system to assess an approach for providing preparedness training and (2) delivered a standardized preparedness curriculum to key influential thought leaders from 4 states to evaluate the effectiveness and acceptability of the curriculum. As a result of this project, the SC AHEC recommends that preparedness training for community-based practitioners needs to be concise and professionally relevant. It should be integrated into existing healthcare professions education programs and continuing education offerings. The project also demonstrated that although AHECs may be interested and well suited to incorporate preparedness training as part of their mission, more work needs to be done if they are to assume a prominent role in disaster preparedness training.

Initiation of farm safety programs in the Arkansas Delta: a case study of participatory methods.

CONTEXT: Outreach to high-risk communities is one of the goals of Area Health Education Centers. One such population is the farm community, which is known to suffer high rates of traumatic events. PURPOSE: To describe a participatory methods initiative by the Arkansas Delta Area Health Education Center and other agencies to address farm-related health hazards in a 7-county region. METHODS: Regional injury and fatality data were gathered from sources including Arkansas Farm Bureau Federation insurance claims, the Arkansas Statistical Service Phone Survey, the National Agricultural Statistics Service, and the Cooperative Extension Service Division of Agriculture at the University of Arkansas. Focus groups were held to assess farmer perceptions and recommendations. FINDINGS AND RECOMMENDATIONS: Accidents involving tractors accounted for 42% of deaths, and accidents with crop-spraying aircraft accounted for 36%. Focus group participants agreed that planting and harvesting seasons were particularly dangerous. Recommendations included educating motorists to be more cautious on agricultural area roads, using local farmers to provide farm safety training, and making safety equipment more available.

The Kansas Health Education Training Center: caring for the underserved.

The State of Kansas was awarded Health Education Training Centers (HETC) DHHS/HRSA, BrHPr Federal funds for the first time in 2002 through 2005. The three-year grant award was under the leadership of the Nurse-Midwifery Education faculty of the University of Kansas (KU) School of Nursing. Federal objectives included: 1. To facilitate interdisciplinary clinical training for health professions students from nursing, medicine, and allied health at targeted underserved communities. 2. To deliver culturally appropriate health care information to underprivileged populations at targeted underserved communities. 3. To conduct continuing education activities for community health workers and health professionals serving vulnerable urban and rural populations. 4. To recruit and mentor high school students from disadvantaged populations to pursue health professions. This three-year state-wide program addressed access to quality health care for underprivileged and underserved populations in select communities to improve health status, through community-based care that is culturally competent, multidisciplinary, sensitive to needs of special populations and augmented by health professions students. This article provides a review of two selected community-based interventions in Sedgwick and Wyandotte counties (addressing BrHPr federal objectives one and two) implemented to enhance care for immigrant pregnant women and underserved patients diagnosed with diabetes, respectively. Also included is a review of literature related to the efficacy and utilization of community based health workers (CHWs) in caring for vulnerable populations.

The evolution and impact of the national AHEC program over two decades.

The national Area Health Education Center (AHEC) program began in 1972 with the purpose of addressing problems of the shortage of physicians and the maldistribution of health professionals. The 40 projects of the program have involved 37 states, 55 medical schools, numerous other health professions schools, and 117 local community AHECs. This 19-month study (1988-1990) was undertaken to systematically assess and clarify the organization, functions, activities, and effects of the national AHEC program over two decades. Data sources were mainly 263 interviews of persons representing the full spectrum of those associated with and participating in AHECs. The findings describe a national network of school and community partnerships that were engaged in planning and implementing educational activities and were responsive to changing needs of health care. The individual AHECs differ in structure and activities as a function of the era in which each began, legislative requirements, and the specific community's needs for health professionals. As organizations, AHECs have unique functions that appear to have benefited the target communities or regions, participating schools, students, and medical school residents. Viability of AHECs in the future will depend on their ability to maintain a focus on health professions education in spite of state or community pressure to provide direct services--both clinical services and public education. At the same time, success will depend on the AHECs' capacity to respond effectively to changing needs of the community and the health care delivery system.

A primary care preceptorship for first-year medical students coordinated by an Area Health Education Center program: a six-year review.

In 1991, the University of Florida College of Medicine established a required primary care preceptorship coordinated by the Area Health Education Center (AHEC) Program for all students in the first semester of medical school. Six years' experience with this course, which is entirely community-based and taught by community physicians, provides evidence of the success of the preceptorship. Over the first six years, 97% of students and 92% of preceptors felt strongly that this was an appropriate and valuable experience for students in the first semester of medical school. All believed that the students were capable of interacting with patients in a meaningful fashion and that the course allowed students to gain confidence as health care providers. The course also reinforced the importance of the basic science curriculum and initiated the process of professional development by affirming students' decisions to pursue a career in medicine. The use of content analysis to further evaluate attitudes and behaviors indicated that the students were highly satisfied with their experience and were active participants in the preceptors' practices. Students' approach to patients as people, rather than cases, was positive, and increased from the first to the last day of the preceptorship. After six years, this preceptorship has been demonstrated to have a positive and meaningful impact on medical student education and development.

Diabetes service management training and the need for a patient perspective: a 10-year evolution of training strategies and goals.

In 1977, the Swedish National Board of Health and Welfare published guidelines for comprehensive care of patients with diabetes. The Stockholm County (1.6 million inhabitants) responded and opened a Diabetes Education and Training Centre, LUCD, in 1979. The goal was to reduce the impact of long-term complications. The centre should translate available knowledge about diabetes care into clinical practice, promoting a shift of patients and resources to the primary health care sector. Follow-up studies and new knowledge have changed the short-term training strategies; the long-term goal has remained unchanged. Current work is concentrated on training of staff, improving methods to support better patient learning, aiding organisational changes, and supporting large-scale interventions aimed at both patients, staff and the public. The patient can realize the goals. Knowledge and demands expressed by persons with diabetes are necessary for improvements of diabetes care. The skilled patient is also a guarantee for continuity of care. Regular follow-up of diabetes services was an important impetus for progressive change of short-term training strategies.

Urban AHECs: a comparison with rural AHECs.

The first generation of projects in the Federal Area Health Education Center (AHEC) Program was funded in 1972. Those AHEC projects, located in predominantly rural areas, focused on problems that resulted from the geographic maldistribution of health professionals, especially primary care physicians. Education programs for health professionals, students, and practitioners were used to influence the geographic distribution of health professionals and to improve access to and quality of health care for underserved populations. In 1976, the Congress redrafted the law authorizing the expenditure of funds for AHECs and emphasized that improving access to health care in urban underserved areas also was to be addressed by the program. During the early years of urban AHEC development, it was not clear which lessons learned from rural AHEC experiences could be applied to urban communities and what would be the best focus for AHEC activities in the complex urban environment. Some said that urban areas were so different from rural areas--in economic, racial, and cultural terms and in the subtlety of barriers to health care--as to make the rural AHEC experience largely irrelevant. Others maintained that basic AHEC principles could be applied, regardless of setting, with changes only in tactics to address the problems of the urban inner city. Now that 18 of the total 53 AHECs nationally are urban, and a decade of experience in developing them has been accumulated, it is appropriate to compare the types of educational interventions supported by AHECs in urban and rural environments and the relative priorities of such programs. In this report we examine the experiences of the California AHEC System, which includes 17 urban and rural centers and the 9 medical schools with which they are affiliated. Although the AHEC Program concept was found to be equally applicable to both urban and rural settings, significant differences in implementation were noted. Those differences were evidenced both by relative budgets,such as the large expenditures for undergraduate medical education in urban areas and for nursing in rural areas, and by subtler differences in the types of programs developed within budget categories

Development of clinical education sites in an area health education system.

In 1974 the University of Kentucky was faced with two problems: 1) overburdening of local clinical facilities by students and 2) a large exodus of graduates from the state. The advent of the Area Health Education System offered the opportunity for the clinical education program to develop nontraditional clinical sites across the state. The development and use of these nontraditional sites in predominantly rural areas has become an integral part of the clinical education program. Local facilities are no longer inundated with students. The retention rate of graduates has improved in the seven years of the program from 36 percent to 1972 to 81 percent in 1979.

The national Area Health Education Center program and primary care residency training.

The Area Health Education Center (AHEC) program was established in 1972 to improve the supply, distribution, retention and quality of primary care and other health practitioners in medically underserved areas. Through academic/community partnerships, regional AHECs offer a broad array of educational programs for students, residents and practicing health professionals. With primary care medical education a core part of AHEC programs, AHECs have been involved in decentralized residency training from the outset, with particular attention to family medicine. This paper provides an overview of the national AHEC program, its core components and its support for primary care residency training. Although AHECs have achieved considerable success in training primary care physicians for their respective states, continued refinements of programs are needed to address the needs of the most rural and underserved communities.

AHEC in West Virginia: a case study. Area health education centers.

This case study describes the area health education centers (AHEC) program in West Virginia, spanning 30 years from a first-generation project at Charleston in 1972 (AHEC 1) to a newly funded statewide program (AHEC 2). The outcome is an evolving university-community partnership designed to meet changing work-force and community health needs in the heart of rural Appalachia. West Virginia University's (WVU's) application of the original Carnegie Commission AHEC recommendations (1970) resulted in the Charleston AHEC, now part of the Robert C. Byrd Health Sciences Center of WVU. AHEC today trains more than 135 residents and interns, and one-third of the third-year and fourth-year WVU medical students. Charleston offers clinical and continuing education for nurses, dentists, pharmacists, and allied health professionals. A health sciences library, distance learning, and a network of primary care clinics help define Charleston's unique AHEC role. This AHEC hub continues to meet the classic Carnegie goals of recruiting and retaining health professionals, and providing access to care in the original service area and statewide. Based on the Charleston experience, four new federally funded AHECs are being developed to link rural primary care residencies with the state-funded West Virginia rural health education partnerships. These rural consortia AHECs are applying the concept of community competency, a performance-based methodology, to integrate learning while achieving the goals of Healthy People 2010.

Hard-to-reach providers: targeted HIV education by the national AIDS education and training centers.

A national system of AIDS Education and Training Centers (AETCs) has received federal funding since 1987 to provide education to health care personnel (HCP) about HIV infection. The purpose of this study is to describe how AETC program personnel define and recognize HCP who are hard to reach and educate about HIV and to clarify the issues that make providers hard to reach. Twenty-three semistructured telephone interviews were used to collect data from AETC faculty and staff. Respondents were asked to identify the types of HCP who are hard to reach and to discuss why they are hard to reach. Themes identified to establish which HCP are hard to reach include specific professional groups (especially physicians and dentists) as well as providers who treated less than 10 HIV-infected clients and some HIV-expert clinicians. Themes identified to establish why they are hard to reach include convenience, isolation, and attitudes. Analysis posits that hard-to-reach HCP fall into identifiable categories: "already know the information," "don't know they don't know the information," "don't think they need to know the information," or "don't want to know the information." Respondents also identified innovative ways to approach hard-to-reach providers.

The North Carolina AHEC Self-Paced RN Refresher Program: an evaluation of the first two years.

The North Carolina Area Health Education Centers (AHEC) Self-Paced RN Refresher Program was designed to promote reentry into practice for inactive nurses. The program consists of a didactic self-study correspondence course and a clinical practicum whereby the refresher nurse works one-on-one with a nurse preceptor. At the end of the first two years, the program was evaluated to determine its effectiveness in terms of participant satisfaction and return to nursing practice and to describe the nurse refresher population demographically. Participants reported a high degree of satisfaction; 69% of nurses who completed the program returned to nursing practice. The typical refresher student is a female Caucasian in her forties, married, and graduated from a diploma nursing program.