Introduction: Literature suggests that a diverse body of healthcare graduates could extend health service delivery. However, the literature also indicates that the throughput of minority, working class, and historically disadvantaged students is problematic. Poor throughput is attributed to the way that university environments alienate some students. This brief communication highlights lessons learned from exploratory interviews with four first-year oral hygiene students at a university in South Africa. It provides insight into the issues that contribute to academic success and failure. Methods: Semi-structured, individual interviews, to gain information regarding students' university academic experiences were conducted. Enablers and barriers to learning identified in the literature were used to capture themes. Findings: The following three themes emerged: educational identity, language and finances. The analysis showed how a white middle class student recognized practices that are rewarded at university and how three, working-class, black students experienced tension between their expectations and experiences and the university culture. However, far from being victims, these students provided suggestions on how their transition might be facilitated. Conclusion: Evidence suggests that these students wanted both to be apprenticed into the new way of doing things while having their differences acknowledged. A model for education that initiates learners and also challenges the culture of power is suggested.

Background: Understanding the written English language might be a barrier when teaching Evidence-based Health Care (EBHC) to Spanish-speaking physicians. Aim: To quantify the magnitude of this potential barrier. Method: Cochrane Review abstracts in English or in Spanish were randomly distributed among first-year residents at the Pontificia Universidad Catolica of Chile. Residents answered investigator-designed questionnaires to measure their comprehension while the time needed to complete the task was recorded. Results: Groups were similar at baseline. Mean score for those reading in Spanish was 11.9 ± 2.8 (range 5 to 18) compared to 10.5 ± 3.8 (range 1 to 17) for those reading in English (p=0.04). Low scores (£ 9) were twice as frequent for the English group than for the Spanish group (16.7% vs 34.7%; p=0.042). The time to complete the task was also longer for the group reading in English. Conclusion: Language should be taken into account when teaching EBHC to Spanish-speaking physicians.

Context: Traditionally, the structures of health professional education in Canada and elsewhere have been largely based on "silos" in which health professionals are educated in relative isolation to one another. The curriculum content and structure has followed strict disciplinary lines. Recent commissions, committees and policy documents in Canada have identified the importance of reshaping educational preparation and the professional training of health care professionals (Commission on the Future of Health Care in Canada, 2002; Health Council of Canada, 2005). Objectives: This brief communication describes an interprofessional curricular approach that combines characteristics of Barr et al.'s (2005) extracurricular and crossbar models of interprofessional education curriculum. Methods: An interprofessional education curriculum that combines principles of an integrative, continuous, early-to-late and blended learning approach. Discussion: The curricular approach supports exposing students to interprofessional education at an early stage in their training and then to continue with regular reinforcement. Another guiding principle is that interprofessional education is integrative rather than supplementary to the existing core curriculum. Early evaluation results suggest favourable satisfaction amongst students and faculty as well as significant effect on attitudes toward interprofessional teamwork and education. An ongoing evaluation is continuing based upon the various levels of Freeth et al.'s (2002) interprofessional education evaluation framework.

Context: Recent outbreaks of infectious diseases and humanitarian crises highlight the need for an understanding of public health issues in medical progams. However, public health teaching is perceived as peripheral in current Australian university medical programs. Objective: To integrate public health into clinical and biomedical teaching throughout the new medicine program at the University of NSW. Methods: The medicine program has been designed with three phases and with clinical experiences introduced early in the program. The approach is to trigger learning with scenarios and with vertical integration to reinforce lifelong learning. Public health teaching and understanding has been integrated into all the scenarios. Discussion: As the program is only in its 4th year, there has been no summative evaluation of the impact of this approach. However, formative evaluation through Phase 1 student portfolios has demonstrated a good understanding of public health concepts in the satisfactory way students have addressed one of the eight graduate capabilities: Social and Cultural Aspects of Health and Disease. Another indicator of an appreciation of public health issues in medicine has been the choice of social and cultural topics in students' independent learning projects. Conclusion: Summative evaluation will occur when the University's new program graduates work in the existing health care system. It is proposed that they will be followed up to see whether they apply the public health values in their practice.

Objective: To determine if undertaking regular Formative Assessment (FA) in the setting of our medical school enhanced the students' learning experience. Methods: An FA intervention was designed and implemented with clinical students during their clerkship in the academic year 2003/04. FA was administered as structured verbal comments on daily clinical case presentations. Evaluation of the intervention included pre- and post-surveys exploring the perceptions of students and teachers on the quality of the learning experience. Focus group discussions with students and with teachers were held at the start and conclusion of the intervention to identify strengths and weaknesses of FA. Findings: All participating teachers perceived that students were interested in learning before the intervention. Teachers who perceived that students achieved the set learning objectives increased from 0% before to 28% after the intervention. Most teachers (71%) and students (86%) perceived FA to enrich students' learning experience. Students appreciated the positive change in teachers' attitudes during the FA intervention. Both students and teachers recommended that FA become a regular and routine activity. Conclusions: Students and teachers viewed FA as a positive, feasible intervention. They thought it enriched the learning process and recommended it be a routine learning activity.

Context: A central recommendation from the Pew Health Commission to educators has been to empower future care providers to function effectively as teams. Administrators and faculty members within a school of allied health sciences thus established an interdisciplinary program where students would learn to function as team members and demonstrate competencies required for practice in diverse, demanding, and continually changing health care environments. Students from five disciplines have participated in featured events, mentored activities and capstone projects, earning credit in an interdisciplinary course of study that complements offerings in their home disciplines. Goal: This follow-up article reports on the progress and development since 2002 of an interdisciplinary program known as Team IDEAL. Formative evaluation measures used to assess satisfaction with the program are presented alongside a discussion of new directions. Conclusion: Team IDEAL will move forward in a streamlined form that reflects its central aim. IDEAL leadership will remain cognizant of the effects of discipline-specific curricular changes, complex programming, and student perspectives on the process interdisciplinary education.

Context: The necessity of learning skills through "integrated skills training" at an undergraduate level has been supported by several studies. The University of Antwerp implemented undergraduate skills training in its renewed curriculum in 1998, after it was demonstrated that Flemish students did not master their medical skills as well as Dutch students who received "integrated skills training" as part of their undergraduate medical course. Aim : The aim of this study was to compare the skill outcome levels of two different student populations: students who had been trained in basic clinical skills mainly through clinical internships in year 7 with students who had learned these skills through an integrated longitudinal programme in a special learning environment in years 1-5 prior to their internship experience. Study sample: Students of the traditional curriculum learned skills through a 75 hour programme in years 4 and 5, through plenary sessions followed by a 12 month period of internships during which skills could be further practiced. We tested this group right after completion of their internships. Students from the renewed curriculum followed a 200 hour intensive small group skills training programme offered in years 1-5. This group was tested before starting their internships. Results: On global OSCE-scores, renewed curriculum students had significantly higher overall scores (p<0.001) and they scored significantly higher at 6 of 15 stations. There was no significant difference at 8 stations, while traditional curriculum students scored better at station 1. Discussion: 5 years and 200 hours of integrated undergraduate skills training is more effective as a method of learning basic clinical skills, compared to learning these skills through 75 hours of traditional skill training and reinforcement of these skills in 12 month clinical internships, when measured by means of an OSCE.

Background: Finding evidence for the link between capacity building in medical education and improved health outcomes in developing countries is an important challenge. We describe the Foundation for Advancement of International Medical Education and Research (FAIMER) Institute, a two year, part-time fellowship in medical education methodology and leadership and its evaluation as a model to bridge this gap by collecting quantitative and qualitative data on intermediary outcomes. Methods: FAIMER has used the following framework of human capacity building programs: 1) identify young and talented individuals with potential to become agents for change; 2) organize and deliver an effective learning intervention that is relevant for the environment; 3) facilitate the opportunity for real-life application of acquired knowledge and skills with support; and 4) promote development of a sustainable career path with opportunities for growth and advancement. Results: Twenty-three percent of curriculum innovation projects were directly related to community health. Of the 35 fellows in the first three classes of the Institute, there have been 11 promotions, 9 peer-reviewed publications and 14 international poster presentations, indicating development of the medical education field. Other qualitative and quantitative program evaluation data are presented. Discussion: The link between capacity building in medical education and improved health can be demonstrated in several ways: align curriculum with local health needs, place learners in community clinical settings, teach basic healthcare workers, become involved in national policy development and develop the field of medical education. Conclusion: While experimental models may not be possible to evaluate the effect of capacity building, methods described may help support the connection between improved medical education and health.

Context: Online learning (referred to as e-learning throughout this article) has proved to be a useful tool for delivering accessible and convenient education to busy clinical healthcare workers. The ABS Management Company specifically designed a program to provide nurses and caregivers with the necessary knowledge and skills to improve the quality of care and the quality of life for the geriatric population in long-term care (LTC) facilities. Objectives: The purpose of the "Online Solutions: Quality Education for Quality Care in Long-Term Care" program is to use new educational pedagogies and innovative ways to conceptualise and deliver healthcare education to meet the complex issues and concerns of caregivers in LTC facilities. Methods: During the one-year period that data were collected for this study, 881 caregivers completed the eight (one-hour) modules in the program. Of these, 753 (85%) completed the optional assessment (both the pre and post tests) for one or more of the eight modules. Therefore, of the 881 employees who reviewed all eight modules (881x8 = 7048 modules), 1046 modules (15%) had both pre-post test data upon which to build the analysis. Findings: Information from the evaluation revealed learner improvement in pre-post test scores in excess of 10%, suggesting an increase in new and relevant skills and knowledge related to abuse and neglect, elopement, infection control, nutrition and hydration, pressure ulcers, provision of basic care and restraints. Moreover, the data indicated a reduction in the use of restraints and occurrence of pressure ulcers, suggesting that learners applied new knowledge and skills in the workplace. Finally, staff turnover rates decreased more than 20% suggesting greater job satisfaction after participating in the program. Conclusions: The research findings point to an urgent and unmet need to provide more accessible just-in-time, just-for-you education programs for caregivers in LTC facilities to ensure quality and efficient services to residents and their families.

Context: Service-learning programs are reported to benefit students, faculty, higher education institutions, community agencies and the relationships among these groups. An interprofessional service-learning paradigm may strengthen these benefits. Community settings can expose students to social and cultural determinants of health, in addition to those biomedical determinants more commonly addressed in health sciences curricula. These experiences can also enhance student understanding of the complexities underlying treatment and prevention of modern health problems, particularly chronic diseases. Objective: The purpose of this initiative was to create and deliver interprofessional service-learning innovations that would enhance student learning and addictions recovery. To address this initiative, the University of Washington's Health Science Partnerships in Interdisciplinary Clinical Education (HSPICE) and the Salvation Army Adult Rehabilitation Center (ARC) began a community-campus partnership in 1997. Innovations took into account student educational objectives established by HSPICE which included: participation in interdisciplinary teams, in conjunction with community partners to identify and reduce population based health issues, realization and articulation of biases regarding issues faced by the participating community, acquiring an understanding of the broader determinants of health and developing an understanding of why the complexity of population health requires interdisciplinary strategies for cost effectiveness. Discussion: Findings are reported from evaluations, needs assessments and ongoing feedback of men recovering from addictions, as applied to health education materials and presentations developed for the ARC. Future directions are highlighted, including the need for further research and evaluation efforts aimed at rigorously assessing cost savings and student knowledge, skills and cultural sensitivity, among others.

Context: Pakistan lags far behind most developing countries in women's health and gender equity. Appropriateness of health care services vis-à-vis the gender specific cultural norms that influence clients' needs are not very visible and are more difficult to monitor. Programs and services need to be sensitively designed to facilitate women's access to physical and social needs. This paper narrates the experience of working with health providers from public and private sectors, community, local government representatives and community-based organizations. Through transformative learning, this endeavour focused on initiating a process of sensitization on gender related health issues for women. Approach: The initiative was primarily based on the use of the following two standardized tools: 'Health Workers for Change' for working with health providers and 'Initiating Women Empowerment for Health' for interacting with the community. Both tools focus primarily on women's health and social issues affecting their health status. The research methodology used was predominantly qualitative, using focus group discussions, participatory rural appraisal and interactive workshops. Implications: This approach endeavours to sensitize the health service providers to the health needs of female clients and encourages behavioural changes. Simultaneously, it creates an opportunity to raise awareness among women and the community in general regarding appropriate health-seeking behaviour and the timely use of health services. The information collected is evidence for policy makers regarding the gender-based problems faced by women who are seeking health care and it suggests how to overcome these problems.

Objectives and context: This paper describes the preliminary outcomes of a collaborative capacity-building initiative performed in Mali to strengthen the immunization program. Methods: We conducted baseline assessments, training and post-training assessments in four programmatic areas: vaccine management, immunization safety, surveillance, and vaccine coverage, using adapted World Health Organization (WHO) tools. Impact assessment was done by evaluation of trainee performance, programmatic impact and sustainability. Results: Qualitative and quantitative improvement of trainee performance was seen after the training interventions: some knowledge improvement, greater compliance with vaccine management practices and improved vaccine coverage. Deficiencies in information transfer to the periphery were identified. Conclusions: The program involves shared responsibility for planning, implementation and financing with national stakeholders while emphasizing the training of leaders and managers to ensure sustainability. Although short-term gains were measured, our initial assessments indicate that sustained impact will require improvements in staffing, financing and guidelines to ensure delivery of information and skills to the periphery.

Context: Two unmatched blood units were transfused to a patient undergoing surgery. In order to learn from this kind of error, the department had to report the adverse event, the staff had to discuss the situation of what went wrong and why and how to improve their routines to prevent such errors in the future. In health care, learning to improve quality and safety needs to occur at the individual, team and organisational levels. However, most formal learning occurs at the individual level at the start of a professional career. Errors are too often seen as personal carelessness or incompetence to be corrected by "naming, blaming and shaming." However, errors occur within the context of teams in organisations and learning needs to move from the individual to the context. Thus, understanding and improving how health professionals work together in organisations is a crucial part of the efforts to improve patient care and safety. Objective: The purpose of this paper is to show how health personnel can improve and avoid harmful errors in patient care by delivering care within the setting of a clinical team and addressing and analyzing errors through a systematic learning process. This paper describes this learning process in detail and shows how it can be applied to various clinical situations to improve patient safety. Findings: Learning takes place on several levels: from single-loop learning (adaptive learning) through double-loop learning (reflection in and on action) to triple-loop learning (meta-learning), and extending ones understanding and competencies of how to learn individually and in groups. Linking professional knowledge (e.g. medical sciences) and improvement knowledge (knowledge of system improvement), and paying attention to multidisciplinary team learning, are crucial to understanding how patient care and safety can be improved in clinical microsystems.