|Year : 2011 | Volume
| Issue : 1 | Page : 662
Co-Editors' Notes 24:1
D Pathman, M Glasser
Co-Editors, Education for Health
|Date of Web Publication||15-Dec-2012|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pathman D, Glasser M. Co-Editors' Notes 24:1. Educ Health 2011;24:662
This issue's eleven Original Research Papers, two Brief Communications, five Letters to the Editor, an Interview and an In The News! reflection article together create as full an issue as Education for Health has ever enjoyed. Our authors have been busy. To orient you to these many papers, we briefly describe them here.
In "An International, Multidisciplinary, Service-Learning Program: An Option in the Dental School Curriculum," Martinez-Mier and co-authors from Indiana University in the U.S. describe a semester-long class and service-learning experience in Mexico for students of five of their health professions schools. Evaluation finds that through the experience, students perceived that they gained greater cultural awareness, better cross-cultural communication skills and better appreciation for the difficulties Latinos in the U.S. face when accessing care.
Nendaz et al., in "Bringing Explicit Insight into Cognitive Psychology Features during Clinical Reasoning Seminars: A Prospective Controlled Study," assess an intervention of small group, case-based clinical reasoning seminars for medical students of the University of Geneva in Switzerland. Tutors for half of the students introduced concepts from cognitive psychology and asked students to reflect on the psychological processes underlying their diagnostic reasoning as they worked through cases. Students with this modest exposure to cognitive psychology more often listed the correct diagnosis on their list of differential diagnoses, but did not more often arrive at the correct final diagnosis.
Molinuevo and Torrubia, in "Validation of the Catalan Version of the Communication Skills Attitude Scale (CSAS) in a Cohort of South European Medical and Nursing Students" test a Catalan translation of the well-known CSAS with nursing and medical students of the Universitat Autònoma de Barcelona. They demonstrate internal consistency and test-retest reliability, as well as some measures of external validity for the translated instrument, supporting its use with students of southern Europe who speak Catalan.
In "General Population and Medical Student Perceptions of Good and Bad Doctors in Mozambique," Dr. Pfeiffer and colleagues explore attributes of good and bad doctors as perceived by first-year medical students and by community members in Beira, Mozambique. Through survey rankings of the most important attributes, the groups showed some similarities and some differences in their opinions. Both groups felt good doctors had good diagnostic skills and were calm and patient, and that bad doctors could discriminate, act contemptuously and be dishonest. Community members more often identified good listening as a trait of a good doctor whereas medical students more often indicated that good doctors were dedicated and concerned for their patients.
Mu, Shroff and Dharamsi of the University of Toronto, in "Inspiring Health Advocacy in Family Medicine: A Qualitative Study," speak to the importance of all physicians, and certainly family physicians, serving as advocates for the health of their patients, communities and the society more broadly. Learning how to serve the role of health advocate is included among essential competencies for physicians in Canada. The authors interviewed family medicine residents, faculty and practicing family physicians that were identified as health advocates, to learn what inspires and motivates them to engage in advocacy. Subjects spoke of the importance of having a sense of empathy and compassion for people of marginalized groups, of feeling a need to affect positive social change, and the influence of parents, role models and experiences outside of medicine. They voiced mixed and complex views about how best to include health advocacy training in their residency education.
A piece by Ramanathan and colleagues entitled "Mixed Methods Evaluation of an International Internet-Based Continuing Medical Education Course for Pediatric HIV Providers in Pune, India" evaluates the effectiveness of a six-week CME course for providers in Pune on care for children who are HIV positive. The course, consisting of 29 online streaming videos and weekly case discussions, was designed and led by faculty in pediatric infectious disease at the Center for Clinical Global Health at Johns Hopkins University in the U.S. Their evaluation included pre-post knowledge assessments, interviews and focus groups with participating physicians, nurses and others. It found that participants' knowledge increased in some areas of HIV care but not all areas, and participants identified barriers to the course's full success, which included participants' lack of regular and easy access to the Internet and the lack of relevance of some of the U.S. developed curriculum to their own patients and resources in Pune.
Professor Aja and colleagues, in "Developing Culturally-oriented Strategies for Communicating Women's Health Issues: A Church-based Intervention," discuss the challenges of teaching women about health issues in developing countries where not all are literate and there is a strong oral tradition. The authors describe activity-oriented workshops with women in Nigeria who were brought together to learn how to create dialogue, dramas, songs, stories, quizzes and posters to teach other women in their own churches about adolescent health, nutrition, violence against women and other health topics. The Women and Health Learning Package guided the program.
A qualitative study by Bail and Morrison, "Interprofessional Communication of Prognosis: Teaching to Bridge the Gaps," assesses how healthcare teams communicate among themselves about patient prognosis. They gathered interview data about team interactions around three patients with hematological malignancies in a large hospital in Australia. The authors focus their discussion on the theme that clinicians often do not share information on prognosis with other team members. This sometimes happened because some providers view it as unnecessary for other team members' jobs and it is difficult to share this information when members variably approach prognosis from a biomedical versus psychosocial perspective. The educational implications are discussed in detail, with several helpful teaching approaches presented.
Pieper and MacFarlane, in "I'm worried about what I missed": GP Registrars' Views on Learning Needs to Deliver Effective Healthcare to Ethnically and Culturally Diverse Patient Populations, explore Irish general practitioner postgraduate trainees' view and experiences delivering care to ethnically and culturally diverse patients. Through focus groups, registrars of the postgraduate general practitioner Western Training Programme in Galway reported that their formal training in how to care for patients of diverse populations was inadequate. In particular, they felt they were left with less than adequate factual knowledge of the customs, expectations, health needs and effective ways to communicate with patients of other cultures and sometimes different languages. Few participants spoke of difficulties in their own attitudes towards or inabilities to adequately communicate with patients of other cultures. The registrar-subjects noted that this is a difficult area to teach, but various better ways to do so were discussed.
A thoughtful paper by Reid, "Pedagogy for Rural Health," seeks to provide a conceptual and theoretical framework within which to set rural education. A "critical pedagogy of place" is proposed, where education is closely linked to the values, issues and resources of rural communities and where the community context is central to learning. It is offered in contrast to the more traditional assumption of health sciences education that the biomedical approach to disease and its cure are universal and placeless. All rural practitioners are well aware of how the local context-local customs, the environment, resources, travel times and distances, the range of clinicians locally available and their skills and idiosyncrasies, and the referral resources available-influence nearly every aspect of rural care.
Drs. McGrath, Wong and Holewa, in "Canadian and Australian Licensing Policies for International Medical Graduates: A Web-based Comparison," use information from Internet websites of relevant licensing authorities to compare how Australia and Canada are alike and dissimilar in their licensure requirements and processes for international medical graduates. Among the important differences, the authors conclude that Canada has a challenging process for IMGs with stringent up-front requirements, but when these hurdles are met IMGs enjoy the same standing and rights as Canadian-trained physicians. In contrast, in Australia the authors conclude that it is relatively easy for IMGs to earn a conditional license, but then IMGs are generally restricted in where they can practice and the type of position, never earning full parity with Australian-trained physicians.
In a Brief Communication entitled "Human Trafficking: An Evaluation of Canadian Medical Students' Awareness and Attitudes," Wong and colleagues at the University of Toronto assess pre-clinical medical students' awareness of human trafficking and its appropriateness as a topic within their curriculum. Over 90% of students admitted to having limited or no knowledge about human trafficking and almost the same number were not aware of the clinical signs of trafficked persons when they present for healthcare. Most students felt these things were important for medical students to learn.
Afghani et al., in a second Brief Communication "Medical Students' Perspectives on Clinical Empathy Training," point to the need for studies specifically addressing the barriers to empathy training in medical education. Their study evaluated the attitudes of 3rd and 4th year medical students regarding their training in clinical empathy at a public teaching hospital and medical school. When asked about specific barriers for learning empathy, the majority of respondents indicated time pressure and lack of good role models. The study highlights the need for innovative methods to address student concerns regarding barriers to practicing empathy, as well as the need for more training in how to demonstrate empathy in challenging clinical situations.
In his In the News! essay, Jan van Dalen, an associate editor of Education for Health, explores the application of the work of Philip Zimbardo to the roles that health professions faculty and students assume. In Zimbardo's most famous experiment, students participating in a prison simulation experiment unexpectedly took on their assigned roles with too much enthusiasm, with "guards" using sadistic approaches with "prisoners", and "prisoners" becoming dependent in their roles. Van Dalen reflects on how similar, socially defined roles guide the expectations and behavior of faculty and students, sometimes in ways counter to effective learning and individual freedoms.
There are also five thought-provoking Letters in this issue of EfH. Therese Svan Åström, a senior medical student from Sweden, reflects on interprofessional teamwork in patient care, looking back at her training and evolving appreciation for the value of teams. In a second letter, Berg and Harris report survey results from pre-clinical students who were less sanguine about their exposure to healthcare teams through their early clinical experiences. Students reported they were uncertain who team members were, uncertain of everyone's expertise and skills and felt that the physicians dominated the team. In a third letter, Shankar and Piryani describe a medical humanities curriculum at their new medical school in the Kathmandu Valley of Nepal in South Asia, a region where they note medical humanities are not commonly taught. In a fourth letter, Stern et al. study the problem of poor attendance at weekly grand rounds conferences in academic departments of medicine. They find that the likelihood of attendance by the faculty of the various divisions of medicine at their institution is closely related to whether their division chief had attended. In the final letter, Dongre describes how using a photo-elicitation process engages medical undergraduates to facilitate discussion between students, community members and faculty on public health problems.
This issue also features a Making a Difference interview by EfH co-editor Michael Glasser with Sister Jeanne Devos: "Promoting Social Justice for the Underserved." Sister Jeanne relates a life devoted to service that led to the establishment of the National Domestic Workers Movement in India. Sister Jeanne discusses the philosophy and objectives of her life's work. She is truly a pioneer who has made a difference for liberation of the poor.
Last in this issue, but certainly not least, there is a listing of the scholars who served as Reviewers for Education for Health, with a note of gratitude from the Editorial staff. It is these Reviewers who identify the papers that warrant publication and help shape the published articles you read. They do this work without pay. Without them, there would be no journal.
As always, learn and enjoy!
Donald Pathman, MD, MPH
Michael Glasser, PhD
Co-Editors, Education for Health