Introduction: Evaluations of Community Health Worker programs consistently document improvements in health, yet few articles clearly describe the roles of Community Health Workers (CHWs) from the CHWs' perspective. This article presents the CHWs' points of view regarding the various roles they played in a community-based participatory research (CBPR) project, Poder es Salud/Power for Health in Portland, Oregon, including their roles as community organizers and co-researchers. Methods: Authors draw from an analysis of transcript data from in-depth interviews conducted with CHWs to present a description of the strategies employed by the CHWs to build leadership skills and knowledge among community members. CHWs also discuss their own personal and professional development. Results: The analysis of the interviews suggests that CHWs valued their multiple roles with Poder es Salud/Power for Health and their participation on the project's Steering Committee. Based on CHWs' descriptions of their work, this type of involvement appears to build the CHWs' leadership skills and sense of efficacy to create change in their communities. Conclusion: By serving as community organizers and participating as producers of research, rather than acting merely as a deliverer of the intervention activities, the CHWs were able to build skills that make them more successful as CHWs.

Introduction: To date, traditional biomedical hospital-centered models of medical education have not produced physicians in quantities or with the competencies and commitment needed to meet health needs in poor communities worldwide. The Global Health Education Consortium conducted an initial assessment of selected medical education programs/schools established specifically to meet these needs. The goals of this assessment are to determine whether there is a need for and interest in collaborating and developing a common framework of core principles and evaluation standards to measure the impact of the programs on access to care and on health status in the communities they serve. Methods: A literature review of 290 articles was conducted focusing on standards, tools and multi-institutional evaluation efforts of socially accountable medical education programs designed to increase the number of doctors in underserved communities. Site visits, which included semi-structured interviews with deans, faculty and students, were carried out at eight schools on five continents, whose core mission is self-described as training to meet the needs of the underserved. Preliminary findings form the framework around which a rigorous outcome and impact evaluation tool will be developed by participating schools. Findings: No systematic international evaluation of socially accountable medical schools was found and current tools to measure the social responsiveness of programs need more rigor. All target schools identified a need to develop common evaluation and collaborative frameworks. Preliminary findings suggest that these schools, although operating in different contexts and employing somewhat different strategies, share common principles and a core mission to serve marginalized communities. Conclusion: There is a clear need for a common rigorous evaluation tool for socially accountable medical education, particularly for schools created to address the shortage of doctors in neglected areas. While it will be difficult to determine the impact of socially accountable medical education on health outcomes, target schools agreed to collaborate and develop a common evaluation framework to strengthen the evidence base on how to train doctors to meet health needs in underserved area.

Objective: This study explored and compared medical students' attitudes toward communication skills and empathic tendency before and after communication skills training. Methods: Fifty-nine first-year students voluntarily completed a questionnaire consisting of the Communication Skills Attitudes Scale and the Empathic Tendency Scale before and after training. K-means cluster analysis and Student's t-test were used for statistical analysis. Results: In the pre-test, 49% of the students had positive attitudes toward communication skills learning and 59% had higher empathic tendencies. In post-test, the mean score in the positive attitude group decreased significantly, whereas there was no change in the negative attitude group. In the high empathy group, empathy scores did not change significantly after training; however, in the low empathy group, empathic tendency significantly increased. Discussion: As students' low empathic tendency level became higher and positive attitudes toward communication skills learning significantly changed in a negative direction after training, we observed that our training programme seems to have an effect that makes students similar to each other in terms of their empathic tendency and attitudes toward communication skills learning. Women had more positive attitudes toward communication skills and their empathic tendencies were higher than men's. Conclusions: Our findings suggest that our curriculum is in need of further examination and modification. Future studies with larger samples are needed to investigate the effects of communication skills training on students' attitudes.

Context: A key element of medical education is patients' willingness to and cooperation in involving a medical student in their care. Objective: To assess patients' attitudes and their associated factors toward involving medical students in their care. Methods: This study was conducted over a period of two months in two hospitals in Riyadh, Saudi Arabia. Six hundred patients were approached to participate in outpatient and inpatient settings of four medical specialty services. A pre-tested questionnaire was used to collect the data. Results: There were 492 respondents (82%), of whom 50% were males, 74% were married, and 51% were outpatients. Sixty percent identified medical students on the team of doctors that had treated them. Eighty-one percent of respondents felt that students' general appearance and manner were important to their willingness to have them participate in their care, and 64% would not object to the presence of medical students during physical examinations. Most (63%) preferred to be informed about students' involvement beforehand. Fifty-five percent believed that they had the right to refuse medical students, with women, married and less educated individuals and those seen in particular departments more likely to believe so. The preferred role for students also varied with gender, marital status and department. Conclusion: This study finds that most Saudi patients view medical students' involvement in their care positively. They prefer to be told in advance about students' presence, asked for their permission, and have students' involvement restricted to certain times.

Context: Community-based education (CBE) was developed thirty years ago in response to the maldistribution of physicians and subsequent inequity of health care services across geographical areas in developed and developing countries. Several medical schools in Nigeria report adopting CBE. This study seeks to identify and describe the CBE programs in accredited Nigerian medical schools and to report students' assessments of the knowledge and skills gained during their community-based educational experience. Methods: Researchers developed a questionnaire that was distributed to student representatives at 19 of the 20 accredited medical schools. Student representatives distributed the questionnaire to 20 final year medical students and returned the completed questionnaires to the researchers. Quantitative data were entered into SPSS 14. Results: Most students from CBE schools participated in CBE experiences of 4 to 8 weeks duration during their fifth or sixth year and paid for their food and transportation costs. Medical school personnel supervised the students who were also often assisted by community personnel. Students' rated highest their learning about environmental-related health risks and how to identify community health problems. They rated lowest what they learned about how to train health workers and how to implement and analyze results of community health interventions. Discussion and Conclusion: CBE teaches future physicians how to function as health care providers in underserved communities. CBE curricula in Nigeria are addressing most, but not all, of the validated CBE generic objectives. Most notably, the curricula are not providing adequate education in the implementation and analysis of results of a community health intervention.

Objective:In this study, the overall job satisfaction of medical laboratory scientist graduates of one Kuwaiti University was examined in relation to the environment and organizational features of their places of employment. Materials and Methods:A questionnaire was distributed to 105 graduates of the Medical Laboratory Sciences (MLS) Department, Faculty of Allied Health Sciences, Kuwait University from the years 1982 to 2001 who are currently working in Ministry of Health hospitals. Of those, 85 questionnaires were returned and this was a response rate of 80 percent. Results:Fifty-six percent of respondents were satisfied overall with their jobs, but 44% were not satisfied. Overall job satisfaction was found to be associated with having the opportunity of applying their academic knowledge and laboratory skills to their work when job conditions were conducive to the work and there was collegiality in the laboratory. Reporting to only one supervisor also showed a positive relationship with overall job satisfaction. In contrast, perceptions of unhealthy working conditions, where employees tended to be a hindrance to another employee, were associated with lower overall job satisfaction. Forty-nine percent of all respondents reported that they were not satisfied with organizational practice, 44% were not satisfied with the work environment, and 39% were not satisfied with their autonomy and freedom to work. Conclusion:A high percentage of laboratory technologists were not satisfied overall with their jobs or with specific aspects of their jobs. Particularly important in this respect were whether technologists felt that their work appropriately used their knowledge, feelings of technical competency, work related rules/procedures, and presence of unhealthy competition. These issues of health worker dissatisfaction need to be addressed by the health authority managers responsible for these services and by academics who train MLS workers.

Introduction: A key aspect of the success of a PBL curriculum is the effective implementation of its small group tutorials. Diversity among students participating in tutorials may affect the effectiveness of the tutorials and may require different implementation strategies. Aims: To determine how students from diverse backgrounds perceive the effectiveness of the processes and content of the PBL tutorials. This study also aims to explore the relationship between students' perceptions of their PBL tutorials and their gender, age, language, prior educational training, and secondary schooling. Materials/Methods: Data were survey results from 244 first-year student-respondents at the Nelson Mandela School of Medicine at the University of KwaZulu-Natal in South Africa. Exploratory factor analysis was conducted to verify scale constructs in the questionnaire. Relationships between independent and dependent variables were investigated in an analysis of variance. Results: The average scores for the items measured varied between 3.3 and 3.8 (scale value 1 indicated negative regard and 5 indicated positive regard). Among process measures, approximately two-thirds of students felt that learning in a group was neither frustrating nor stressful and that they enjoyed learning how to work with students from different social and cultural backgrounds. Among content measures, 80% of the students felt that they learned to work successfully with students from different social and cultural groups and 77% felt that they benefited from the input of other group members. Mean ratings on these measures did not vary with students' gender, age, first language, prior educational training, and the types of schools they had previously attended. Discussion and Conclusion: Medical students of the University of KwaZulu-Natal, regardless of their backgrounds, generally have positive perceptions of small group learning. These findings support previous studies in highlighting the role that small group tutorials can play in overcoming cultural barriers and promoting unity and collaborative learning within diverse student groups.

Objectives: The Ege University Faculty of Medicine (EUMF) introduced a community-oriented undergraduate curriculum in 2001. In developing the epidemiology portion of the new curriculum, learning objectives were written for their relevance to different learner stages within the general curriculum and to Turkey's public health problems. Key learning objectives were that students should be able to comprehend the moral values of scientific research, principles of study design and evidence appraisal, and the role of epidemiology in clinical practice. The curriculum included didactic lectures and group activities. The aim of the present study was to explore third-year students' perceptions of the epidemiology curriculum. Methods: The program was evaluated at the end of our students' third year through written evaluations using quantitative and qualitative methods. Two hundred fifty-five students (92.7%) of all third-year medical students participated in the evaluation. Quantitative methods were based on student ratings, whereas qualitative method assessments involved content analysis of the students' open-ended statements. Findings: Based on responses to fixed response items, more than seven out of every 10 students appreciated the value of epidemiology to the work of physicians. More than six out of 10 students evaluated the curriculum favorably, but only a third indicated that they became more interested in epidemiology with time, and one-quarter found epidemiology challenging. In students' open-ended responses, the most frequent positive statements referred to students' heightened interest in research and appreciation of the curriculum's interactive teaching. Some students criticized the content as difficult and felt that there were too many didactic lectures. Conclusion: Based on their evaluations, students found our new epidemiology curriculum acceptable, and regarded it as relevant and valuable to their future practice.

Background: In South Africa, first-contact primary care is delivered by nurses in small clinics and larger community health centres (CHC). CHCs also employ doctors, who often work in isolation from the nurses, with poor differentiation of roles and little effective teamwork or communication. Worcester CHC, a typical public sector CHC in rural South Africa, decided to explore how to create more successful practice teams of doctors and nurses. This paper is based on their experience of both unsuccessful and successful attempts to introduce practice teams and reports on their learning regarding organisational change. Methods: An emergent action research study design utilised a co-operative inquiry group. The first nine months of inquiry focused on understanding the initial unsuccessful attempt to create practice teams. This paper reports primarily on the subsequent nine months (four cycles of planning, action, observation and reflection) during which practice teams were re-introduced. The central question was how more effective practice teams of doctors and nurses could be created. The group utilised outcome mapping to assist with planning, monitoring and evaluation. Outcome mapping defined a vision, mission, boundary partners, outcome challenges, progress markers and strategies for the desired changes and supported quantitative monitoring of the process. Qualitative data were derived from the co-operative inquiry group (CIG) meetings and interviews with doctors, nurses, practice teams and patients. Findings: The CIG engaged effectively with 68% of the planned strategies, and more than 60% of the progress markers were achieved for clinical nurse practitioners, doctors, support staff and managers, but not for patients. Key themes that emerged from the inquiry group's reflection on their experience of the change process dealt with the amount of interaction, type of communication, team resilience, staff satisfaction, leadership style, reflective capacity, experimentation and evolution of new structures. Conclusion: The group's learning supported a view of change that sees the organisation as a living system in which information flow, participation and the development of resilience are key aspects. These themes fit well into an understanding of change based on complexity theory. If managers of the health system wish to enhance organisational change, then their goal may need to shift from optimising health care delivery in a mechanistic model to optimising health care workers in a living system.

Context and Objectives: Conveying empathy is a multi-phase process involving an inner resonation phase, communication phase, and reception phase. Previous investigations on physician empathy have focused on a physician's inner resonation phase or communication phase and not on the patient's reception phase. The purpose of this study was to investigate the differences in the perception of physicians' empathy between emergency physicians (EPs) and their patients. The answer to this question will allow us to more fully understand all phases of empathy and will help guide the teaching of how to effectively communicate empathy in the clinical setting. Methods: From 2004 to 2005, we conducted in-depth, semi-structured interviews with 7 each of EPs, patients, patients' family members and nurses. A phenomenological approach was used to analyze the data. Results: Four themes emerged from the analysis: (1) When patients expressed their feelings, EPs usually did not resonate with their concerns; (2) Patients needed EPs to provide psychological comfort, but EPs focused only on patients' physical discomfort; (3) Patients needed appropriate feedback from EPs, but EPs did not reflect on whether their patients had received empathy from them; (4) EPs' ability to empathize was affected by environmental factors, which EPs found difficult to overcome. Conclusion: EPs and their patients perceive the physicians' empathy differently. These findings provide insights into patients' perceptions of their physicians' empathic expressions and provide a framework for teaching physicians how to convey empathy in the emergency department setting.