Background: Community-based medical education (CBME) is no longer a new innovation in medical education since the establishment of The Network: Towards Unity for Health (The Network: TUFH) 25 years ago. The CBME of the University of Maiduguri medical college is 14 years old and has never been assessed in terms of the population it serves. The study was conducted to determine the level of awareness, perception, and participation of the communities in CBME. Methods: A cross-sectional survey was carried out in 11 village units of three Local Government Areas (LGAs) using a 14-item structured questionnaire administered to adults in randomly selected households. The questionnaire was based on guide questions used for focus group discussions held earlier with community leaders. Results: Awareness of students' visits among respondents was 73.7%. Knowledge of the frequency of presence of the students in the communities was 72.2%. ''To examine and treat'' (33.6%) and ''to ask questions'' (16.6%) were the most prominent reasons given for the visits. The majority of respondents perceived the visits as beneficial (72.2%). More frequent visits were requested by 54.4% of the respondents. The communities were willing to be more accessible and felt that the LGAs should provide more logistic support to the program. Discussion: This study revealed that communities were aware of students' visits and knew reasons for the visits, thought visits were beneficial, and were willing to provide more support for these visits.

Objectives: To find out whether educational visits by a nurse to specialist physicians improved their self-reporting of smoking cessation activities; whether these visits increased the percentage of physicians who were aware of and recommended a computer-tailored smoking cessation program and who participated in a training workshop on tobacco dependency treatment. Methods: Specialist private practice physicians (n¼523) working in Geneva, Switzerland were randomly assigned to either receiving (n¼261) or not receiving (n¼262) a single 40-minute visit by a trained nurse in 2003. The physicians answered a postal questionnaire 5 months after the visits indicating the percentage of their patients they counselled or treated for tobacco dependency and we recorded whether physicians took part in the workshop. Findings: Only half (53%) of the physicians agreed to receive a visit. At follow-up more physicians in the intervention group than in the control group were aware of the computer-tailored program (73% vs. 39%, p50.001) and more physicians in the intervention group said they recommended the use of this program to more patients (20% vs. 10%, p¼0.009). Among non-smoking physicians only, the proportion of patients who were advised to quit smoking was higher in the intervention than in the control group (69% vs. 54%, p¼0.019, as reported by physicians). The intervention had no impact on physicians' participation in the workshop. Conclusions: Visits by a nurse increased the proportion of physicians who recommended to their patients the use of a computer-tailored smoking cessation program. Among nonsmoking physicians only, the intervention increased the proportion of patients who received the advice to quit smoking, as reported by physicians.

Context: In Community-Based Education (CBE) students are expected to develop problem solving, communication and critical thinking capabilities. Assessment provides an opportunity for students to improve these skills, it helps them to gain increased motivation, high achievement, it reduces anxiety over grading, and it improves communication between learners and teachers. The aim of this study was to develop a common instrument for assessing undergraduate students of Health Sciences in their placements for CBE. Objectives: (1) Identify the skill requirements of students in CBE; (2) Develop a common instrument for assessing undergraduate students in Health Sciences. Methods: The study was based in the Faculty of Community and Health Sciences at the University of the Western Cape. Existing documents relevant to the assessment of CBE were collected and analyzed to provide background information. Focus group discussions were held with lecturers from various departments, key persons from the departments and students were audiotaped and later the data analyzed into emerging themes. This was followed with a workshop by relevant experts in CBE, to identify the essential items to be included in the proposed assessment tool. The instrument was piloted with two departments in various community settings. Results: The participants identified knowledge, transferable skills, professionalism and attitudes as important elements for assessment. The instrument piloted was very comprehensive and suitable for use by students of any profession in a range of communities. Conclusion: It is recommended that the instrument can be used to assess students in any learning experience based in a community setting.

Context: There has been an increase in the number of medical schools implementing community-based educational (CBE) programmes. However, there are doubts whether CBE programmes are appropriately implemented. As a case study, the CBE programme of the Medical Faculty of Diponegoro University (MFDU) in Semarang, Indonesia was evaluated. Objectives: To acquire MFDU's students' opinions on their CBE programme as part of a comprehensive evaluation of that programme, and to generate recommendations for improvement of MFDU's CBE programme. Methods: Coles and Grant's model for curriculum evaluation was applied. This model recommends triangulation of data generated from comparison of the programme as designed ''on paper'', as implemented ''in action'' by the faculty, and ''as experienced'' by the students. To assess the curriculum as experienced by the students, direct participatory observation was performed and focus group discussions were conducted to collect students' opinions. Results: Students specifically signalled: (1) frequent overlap of lectures given during the CBE clerkship and in the previous part of the curriculum, (2) mismatch between their activities in the community and the community's felt health needs, (3) greater benefits of the CBE programme for Primary Health Care (PHC) centres and students than for target communities, and (4) incidental defective co-operation between students and health providers or community health workers. Conclusion: Students' opinions yielded more in-depth information on the CBE programme evaluated and facilitated formulation of recommendations for improvement of that CBE programme.

Introduction: A framework for the definition of generic objectives for community-based education (CBE) was developed for undergraduate medical programmes, particularly for developing countries. To probe the validity of the set of CBE objectives generated by this approach, opinions from a wider audience were sought. Method: Questionnaires were sent to 72 medical schools in 36 developing countries. Half of the addressees were randomly drawn from the list of institutional members of The Network: Toward Unity For Health (TUFH) and stratified according to developing countries. Another 36 medical schools were randomly drawn from non-Network: TUFH schools from the same country where the selected Network: TUFH addressee was located, or from a neighbouring country. Results: A total of 43 medical schools responded to the questionnaire (60% response rate), 31 out of the 36 addressed Network: TUFH members (86%) and 12 out of 36 addressed non-Network: TUFH schools (33%). Out of all 43 respondents 39 (91%) had implemented CBE in their curricula. Opinions of Network: TUFH and non-Network: TUFH schools on the framework and the generic objectives were not significantly different. Out of the 21 proposed objectives, 17 were scored as relevant by 75% or over of all responders and one out of the four objectives considered to be less relevant by the responders was deleted. Conclusion: A framework to develop generic CBE objectives and a derived set of 21 objectives were modified based on input by 43 medical schools residing in developing countries distributed all over the globe. The outcome is a validated set of 20 generic objectives for CBE programmes in developing countries.

Context and objectives: Undergraduate medical training program accreditation is practiced in many countries, but information from developing countries is sparse. We compared medical training program accreditation systems in nine developing countries, and compared these with accreditation practices in the United States of America (USA). Methods: Medical program accreditation practices in nine developing countries were systematically analyzed using all available published documents. Findings were compared to USA accreditation practices. Findings: Accreditation systems with explicitly defined criteria, standards and procedures exist in all nine countries studied: Argentina, India, Kenya, Malaysia, Mongolia, Nigeria, Pakistan, Philippines and South Africa. Introduction of accreditation processes is relatively recent, starting in 1957 in India to 2001 in Malaysia. Accrediting agencies were set up in these countries predominantly by their respective governments as a result of legislation and acts of Parliament, involving Ministries of Education and Health. As in the USA, accreditation: (1) serves as a quality assurance mechanism promoting professional and public confidence in the quality of medical education, (2) assists medical schools in attaining desired standards, and (3) ensures that graduates' performance complies with national norms. All nine countries follow similar accreditation procedures. Where mandatory accreditation is practiced, non-compliant institutions may be placed on probation, student enrollment suspended or accreditation withdrawn. Conclusion: Accreditation systems in several developing countries are similar to those in the developed world. Data suggest the trend towards instituting quality assurance mechanisms in medical education is spreading to some developing countries, although generalization to other areas of the world is difficult to ascertain.