Research to improve the health of communities benefits from the involvement of community members. Accordingly, major federal and foundation funding agencies are soliciting health promotion/disease prevention programme proposals that require active community participation. However, creating such partnerships is difficult. Communities often perceive conventional research as paternalistic, irrelevant to their needs, manipulative, secretive and invasive of privacy. Many institutions and researchers view community knowledge as lacking in value. Community-based participatory research (CBPR) is a collaborative partnership approach to research that equitably involves community members, organizational representatives and researchers in all aspects of the research process. In this article the authors consider the barriers to institutional change and faculty participation in CBPR, and propose some steps for overcoming the barriers and making CBPR an integral part of a medical institution's research agenda. Training and supporting faculty in the philosophy and methods of this approach is the cornerstone of improved community-based research.

Objective: A collaborative campus-community partnership program provided the framework for an intervention to reduce motor vehicle accident fatalities along a rural Appalachian highway. Students from public health, nursing and medicine worked with community members to identify the problem and plan the strategy to address it. Methods: An inquiry-based learning model proved to be an appropriate approach to engage student teams with community leaders in identifying and resolving health needs. Inquiry-based strategies place students in guided learning situations where their investigations lead to working solutions. The inquiry-based model matched the curricular objectives of the Community Partnership Program (CPP) more closely than the classroom oriented problem-based learning approach. Implementation: In the spring of 1994, students, along with citizens and officials of a rural Appalachian county, initiated a community-based prevention project focused on reducing deaths from motor vehicle accidents employing the principles of an inquirybased learning model. Discussion: This project effectively demonstrates the role that students can play in mobilizing diverse elements of the community to address identified health and safety concerns. It provides an illustration that a longitudinal, community-based, servicelearning approach to health professions education is beneficial to both student learners and communities. Conclusions: Through the use of inquiry-based learning methods, students gained real life experience in applied principles of health statistics, epidemiology, community organization, health risk communication, health education planning and program implementation. Outcomes of the project included a measurable reduction in automobile-related fatalities and the initiation by the state department of transportation of a series of investigations expected to pave the way for physical improvements to the roadway.

Introduction: Although the issue of communication skills is now considered crucial for ophthalmology, no previous research has discussed training in this field. This study aimed to discuss the effects of a 16 hour communication skills course for ophthalmologists. In particular the study assessed the interest of participants with respect to the topic and the efficacy on participants' communication skills, at least in a laboratory setting. Materials and methods: Eleven ophthalmologists participated in the course. Learner satisfaction was evaluated using a questionnaire with a six-point Likert scale. Course efficacy was assessed by a comparison between communicative behaviour of ophthalmologists in videoed role playing before and immediately after attending the course. Videoed consultations were coded using the Patient Centred Score Sheet (PCSS) and the Roter Interaction Analysis System (RIAS). The Wilcoxon signed rank test was used for statistical analysis. Findings: The course obtained high satisfaction in participants (mean score 5.1). In the post test role playing, patient centredness increased significantly (p<0.01). Furthermore, ophthalmologists improved their competence in using open ended questions (p<0.02), process categories (e.g. orientation statement) (p<0.05) and social communication categories (e.g. personal statement) (p<0.01). Discussion: According to our findings, ophthalmologists did show satisfaction for the course. Results also indicate that the course positively influenced ophthalmologist communication competence, at least in a laboratory setting. After the course, participants became more attentive to patients' psychosocial needs, both in terms of general quality of consultation (patient centredness) and in terms of using specific interpersonal skills. Present results are considered preliminary, and further research is needed with a larger sample and including an evaluation of the effects on ophthalmologists' communication skills in clinical practice.

Context: At Jimma University educational goals are to apply the concept of community-oriented education through community-based education (CBE) of health students. This study examined the experiences of student nurses on CBE. Objective: The aims of the study were to identify factors that students considered had helped or hindered their learning on CBE and to ascertain if the stated learning objectives were met. Methods: A quantitative, descriptive, survey design was adopted, using a single, anonymous questionnaire. Some qualitative data were gained using open questions. A convenience sample of 95 students participated in the research. Participants represented 90% of all students who had completed their CBE placements. Findings: Participation, mentors' willingness to answer questions and the relevance of the placement were factors that facilitated learning. Factors reported by students that hindered learning were difficulties of self-expression in a group, mentors emphasising mistakes and weakness and the short time-frame due to ongoing lectures during placement. Students said learning objectives most met were sociodemographic assessment, identifying health problems and action planning. Objectives reported to be least met were identifying environmental health problems, planning preventive health interventions and implementing health interventions. Recommendations: These include the need to develop students' group skills, prepare mentors to facilitate learning, organise CBE in spiral phases, avoid concurrent lectures and improve study facilities.

Introduction: Previous investigation has shown that the health sector is a main source of discrimination against people with hepatitis C. This paper examines the perceptions and experiences of people with hepatitis C of their interactions with healthcare workers, particularly examining the implementation of infection control precautions. We contend that rather than applying infection control precautions universally, health care workers make judgements about individual patients and the likelihood that they are infected with hepatitis C. Thus, infection control practices can be used as a tool to discriminate against people with hepatitis C. Social identity theory is used to illustrate these insights and to propose recommendations for education of health care workers. Method: Semi-structured interviews with 19 people who had hepatitis C were conducted. The analysis examines issues of diagnosis, discrimination and disclosure in relation to healthcare workers' use of infection control procedures during clinical interactions. Results: Participants described non-compliance with infection control guidelines by healthcare workers in a range of settings. In some instances, participants expressed disapproval of non-compliance, at other times participants felt vulnerable and discriminated against. Participants felt obliged to disclose their infections, but some decided against future disclosure because of negative reactions from healthcare workers. Infection control procedures were used as a tool to discriminate against some participants. Discussion: Non-compliance with infection control guidelines persists among healthcare workers and can be identified by patients. A minority of workers use infection control as a discriminatory tool against those with hepatitis C. Further intervention is required to ensure infection control guidelines are enacted in the manner intended.

Introduction: The undergraduate curricula of medical schools in King Abdul Aziz University, Saudi Arabia, Umm Al-Qura University, Saudi Arabia and Sana'a University, Republic of Yemen are traditional, like most of the medical schools in the Middle East region. The curriculum in Dundee University Medical School, UK, claims to follow the prescriptions of the UK General Medical Council to be outcome based with three interlocking phases and students encouraged to take responsibility for their own learning. The aim of this study is to measure the educational environment, using the 50-item Dundee Ready Education Environment Measure (DREEM), in each medical school and to compare the educational environment as perceived by the responding students of the traditional medical schools in developing countries with that of the ''modernised'' medical school in Dundee University, UK. Methods: The DREEM was administered to 1072 medical students in the four different universities. Using SPSS, data were expressed as means of scores. Comparisons between schools, years of study and gender were made using non-parametric tests. Results: For all three traditional medical schools, the mean scores of the inventory were lower compared with Dundee Medical School. Students from traditional schools rated their learning and teaching environment significantly lower than their counterparts in Dundee Medical School. Similarly, they rated their academic self-perceptions, social-self perceptions and their atmosphere more poorly than the Dundee students. Conclusion: The DREEM provides useful diagnostic information about medical schools, whether it is in developing or western developed countries.

Background: People experiencing mental health problems have greater contact with health and welfare professionals in generalist settings than with specialist mental health services. Yet the capacity for generalist professionals to respond effectively to mental health problems is often compromised by inadequate mental health training. The Discipline of Psychiatry at the University of Newcastle developed a series of CDRom mental health learning modules for professionals working in non-mental health settings. The paper describes the principles that guided the development of a series and how those principles were applied. Development principles: The following development principles were adopted. The series should: (i) have a multi-disciplinary application; (ii) be adaptable for presentation in multiple educational domains; (iii) be accessible for rural and remote practitioners; (iv) combine structured solutions-focused lessons (directed learning) with elements of problem-based learning; (v) include working problems that are authentic and relevant; and (vi) describe normal, abnormal and cross-cultural manifestations of problems. Application of principles: The model guided the development of a short course series on professional engagement with people who have personality problems. The learning modules provide generic, multi-disciplinary training for a range of practitioners, including nurses, primary care physicians, social workers, psychologists and magistrates. The modules have been adapted for use in undergraduate medical education, postgraduate programs (in population health, nursing, psychology and drug and alcohol studies) and continuing education. Conclusion: In contrast to traditional diagnostic-focussed psychiatry training, the model directly addresses the mental health training needs of health and welfare professionals using a multi-disciplinary, problem-based approach.

Context: Emergence and burgeoning of specialized health care structures have contributed to the diversity in health services. Inadvertently, the separation and resultant independent functioning of health and rehabilitation organizations have impeded opportunities for health care workers to interact with one another. Consequently, providers may lack knowledge on available health services within communities in which they preside. Educational approaches that can assist health professionals improve awareness of services across organizational divides are needed. Objectives: The new International Classification of Functioning Disability and Health (ICF), offers a multidimensional view of health, which can be used in education sessions to increase provider awareness of how health is mediated across health paradigms. This paper explores the conceptual basis of the ICF and its use in promoting a broader view of health essential for treating consumers with complex health problems and enhancing knowledge sharing amongst professionals. Methods: A single case study design is used to demonstrate how the ICF's conceptual framework offers providers a means to promote mutual understanding of differences in health services and to assist them in sharing knowledge on the services provided with others. Conclusion: Conceptually, the ICF can be used as a basis for structuring interorganizational educational initiatives to increase knowledge sharing amongst organizations and health care workers. In addition, introducing health professionals to a multidimensional view of health can assist them to understand the breadth of health services in the community and to consider a more comprehensive set of health determinants and dimensions in caring for consumers.

In many countries, health systems suffer from fragmentation as different health activities conducted by different stakeholders are poorly coordinated, resulting in a mitigated performance to improve quality, equity, relevance and cost-effectiveness in health care. The impact on health would be enhanced if main stakeholders such as health professional schools, service organizations, professional associations, health policy bodies and the general public shared a common vision on how to best meet people's priority health needs. An approach initiated by WHO in 1999 and developed by The Network: Towards Unity for Health endeavours to create a unity of purpose and action among these stakeholders. This article comments on challenges and opportunities in implementing this approach whose pillars are integration and partnerships. The conditions for each stakeholder to become more socially accountable and the role of a teacher, researcher, manager or community representative in contributing to this process are discussed.