The engaged university is a descriptive term for linking the different perspectives of university/community partnerships in higher education in the United States. While interest in this idea comes from recent events and processes, there is an historical background for university/community relations that offers important suggestions on the issue related to institutionalizing this concept. The history includes the original religious founding of US institutions, the establishment of the land-grant system of colleges, and the expansion of the mass education system in US universities. The development of community-based research disciplines, dating from the time of the settlement house movement in America, provides support for university/community collaboration. While some faculty and administrators support this idea, others are more critical and do not see it supporting the strategic interests of their institutions or disciplines. Comprehensively supporting the engaged university at an institutional level means changing the way the academy operates and including community concerns in research, teaching and administrative decisions. This article explores some of these issues and some possible solutions.

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There is growing interest and investment in health-related collaboration in the United States. In an environment characterized by increasingly complex health problems, substantial resource constraints, and a fragmented health system, public and private organizations as well as communities are recognizing that most objectives related to health and health care cannot be achieved by any single person or organization working alone. Partnerships that bring together diverse people and organizations have the potential for developing new and creative ways of dealing with today's turbulent environment. Despite its potential advantages, collaboration also presents daunting challenges. Further, documenting the effectiveness of partnerships in improving health and well-being has been difficult. Given the significant difficulties of collaboration and the lack of evidence of its effectiveness, questioning whether the investment in health partnerships is justified seems reasonable. In this paper we address this question by illustrating the connective power of collaboration. We describe how collaboration, by connecting individual-level services, broadening community involvement in population based health strategies, and linking individual-level services and population-based strategies, can improve the health of communities. We then discuss activities that could assist partnerships in reaching their collaborative potential and conclude by presenting the most compelling reasons for pursuing collaboration.

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Community-based participatory research in public health focuses on social, structural, and physical environmental inequities through active involvement of community members, organiz ational representatives, and researchers in all aspects of the research process. Partners contribute their expertise to enhance understanding of a given phenomenon and integrate the knowledge gained with action to bene® t the community involved. This article presents key principles of community-based participatory research ( CBPR ), discusses the rationale for its use, and provides a number of policy recommendations at the organiz ational, community and national levels aimed at advancing the application of CBPR. While the issues addressed here draw primarily upon experiences in the United States, the emphasis throughout this article on the establishment of policies to enhance equity that would serve both to increase the engagement of communities as partners in health research, and to reduce health disparities, has relevant applications in a global context.

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Health professions education is directly effected by changes in health care service delivery and Financing systems. In the United States, as the health care industry increasingly shifts to a mark et economy, service delivery venues are moving away from acute care facilities and into community-based settings. Additionally, there is increased emphasis on primary prevention programs, often provided in public health settings. For health professions programs that traditionally provide clinical training in hospitals and long-term care facilities, there are unique challenges associated with identifying new venues in order to insure that students are exposed to a wide variety of patients with a range of chronic to acute disease conditions. One set of tools that has demonstrated usefulness during these kinds of transitions is service learning. This teaching methodology emphasizes increased partnership with clinical training sites, extensive orientation to patient populations and community resources, structured reflection and instilling the ethic of service in future health care providers. Although this article describes utilization of service learning in the context of current conditions in the United States, we hope that the principles presented here can be readily adapted in any setting.

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Context: Health care and health professions education has been shifting into community settings. Hawai'i participated in the Community Partnerships for Health Professions Education program, an initiative funded by the W.K. Kellogg Foundation that aimed to develop educational collaboration between community health centers, their respective communities and health professions schools. Objective: In 1998, after completing 5 academic years in this program, former students from one community health center site were polled to begin exploring those components of their experience that were most valuable to their subsequent health care practice. Method: A survey was mailed to 65 former students, ask ing three questions: ( 1 ) what three components of your Ke Ola O Hawai'i experience (Wai'anae site ) had the most impact on your practice; ( 2 ) is there anything else you would lik e us to know; and ( 3 ) where do you see yourself in 5 years? Findings: Thirty responses were received for a 46% response rate. Students identi® ed three components as having the greatest im pact: ( 1 ) the multiprofessional approach to health care and learning, ( 2 ) the community setting/contact, and ( 3 ) understanding the culture of the community. A fourth component that was also revealed was the im pact this experience had on their personal and professional growth. Most students reported employment or plans to practice in a community-based, rural, or underserved area. Conclusion: These responses introduce ideas for sustaining a community-based multiprofessional curriculum that is relevant to current health care practice.

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A large number of children suffer from behavioral problems during their development. Many of these problems are transient and may not even be noticed. A t times, however, the extent of these problems and their overall effects on a child's development can be serious (Morita et al., 1993 ). Further, children may exhibit these behaviors in one setting and not in others ( e.g. at home or in school, but not both ). In developed countries, parents tend to seek advice for even minor problems, such as persistent thumb sucking, while in developing countries, major problems, even childhood schizophrenia, may go unattended. A n awareness of the prevalence of these problems is im portant so that appropriate mental health services can be planned and provided for affected children, to improve their prospects for leading healthy, productive lives. Such awareness can help enhance the teaching of graduate doctors, equipping them to deal with these problems effectively

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Context: A t the College of Medicine and Medical Sciences, A rabian Gulf University, Bahrain, a system has been introduced in which clerk ship students evaluate clinical faculty using Visual Indicators of Teaching and L earning Success ( V ITA L S ). Objective: To describe the use of VITA L S in reporting student feedback on teaching and learning effectiveness of clinical faculty in the clerkship. Design: Descriptive study. Subjects: A total of 210 clerk ship students evaluated 76 clinical tutors over a period of 3 years. Feedback was also obtained from seven programme managers and one supportive staff member. Method: Nine indicators of effective clinical teaching were identi; ed through a literature search. Students individually reported on clinical faculty teaching capabilities using a 5-point, L ik ert-type scale. Cumulative reports of students' feedback on clinical faculty teaching were prepared using opposing bar graphs, reͿ ecting perceived areas of strength or weakness in each teacher's performance. Results: A total of 1450 evaluation forms were completed by 180 of 210 students ( 85.7% ). VITA L S graph representations of students' perceptions of clinical tutors were communicated to each clinical tutor at the end of each clerk ship and academic year. Twenty-one students out of 53 who gave written comments were related to V ITA L S. They reͿ ected a positive view of VITA L S as a process or tool of faculty evaluation. Clinical faculty ( 18 ), programme managers ( 7 ) and supporting staff ( 1 ) gave comments indicating acceptance of the system. Conclusion: This preliminary study suggests that V ITA L S could be an effective tool for improving clinical teaching. It is acceptable to students, faculty and managers of educational programmes. The database reͿ ecting their teaching and educational pro; les were used to provide clinical faculty with constructive feedback.

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Context: In too many schools in the health professions, students are given little or no opportunities to reflect systematically on their simulated or real experiences practicing the sk ills they need as clinicians ( e.g. eliciting information and solving problems ). In addition, they are given little or no help in learning the skills that are central to being reflective practitioners. Rationale : Reflecting alone or with the help of educators or others, students and residents can learn to identify and build on their existing knowledge, identify their biases and assumptions, integrate new understandings, and formulate generaliz ations that will enable them to mak e positive changes in what they do in future situations. Put another way, they can derive lessons from their experiences that will enhance their skills and enable them to provide better patient care. When learners reflect aloud on their insights and their strengths and de® ciencies before their teachers give them advice or feedback , learners can mak e their own discoveries and have the dignity of identifying what they need to work on. The learners' self-disclosures provide educators with "diagnostic" information that can enable them to tailor their teaching to the learners' interests and needs. Suggestions: Educators can help learners become reflective practitioners by taking such steps as ensuring learners have worthy experiences on which to reflect; observing learners in action; scheduling times and places for reflection; building trust; determining the learners' prior experiences, comfort with, and attitudes toward reflection; ensuring learners understand the rationale and strategies for reflection; modeling reflection; clarifying the learning goals; encouraging learners to have questions to ask themselves; helping learners reflect on their thoughts, feelings, biases, and assumptions; helping learners consider other approaches; inviting learners to identify the lessons they've learned; and ask ing them to discuss how they intend to use these new understandings.

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Background: In a problem-based learning ( PBL ) program, students are encouraged to develop self-motivation, self-con® dence, communication sk ills and problem-solving sk ills. Measuring these attributes when selecting students into medical schools is a formidable task . A dmission to medical school typically depends upon students' academic achievement in their prior education. In the past 3 years the College of Medicine and Medical Science ( CMMS ) at the A rabian Gulf University, which has a PBL curriculum, adopted an admission policy that utiliz es ® nal high school scores, a written admission examination in English and science, as well as a structured interview. Objective: To determine the extent to which the admissions measures predict academic achievement in the ® rst year of studies at CMMS. Design: Prediction study of prospectively collected data. Final cumulative score for all subjects at the end of the ® rst year was the main dependent variable analyzed. Subjects: A ll students admitted to the college during the academic year 1998± 1999. Results: The written admission science examination scores had the highest correlation ( r=0.663, p50.05 ) with the Y ear 1 ® nal cumulative score. A lthough the admission interview focused on non-cognitive student attributes, which may or may not affect the students' academic performance, its score had a statistically signi® cant, if low, correlation with the Y ear 1 ® nal cumulative score ( r=0.275, p50.012 ). A pproxim ately 59% of the total variability of the Y ear 1 ® nal cumulative scores could be explained by the admission examination scores in science and English and the high school scores. Conclusion: Procedures for selecting students who are most lik ely to succeed academically in the initial year at an innovative medical school deserve further study and probably should include both academic performance and non-academic attributes.

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Context: This study was undertaken with all 299 graduates of 12 consecutive classes ( in 6 years ) of a Brazilian medical school. Purpose: To appraise the relationships of gender, early preference for a career, the experience of selective training ( a form of elective clerk ship ) and student preceptor ship ( cross-year clinical tutoring by peers ), with the career choices of graduates. Method: Data were obtained at three points: at the beginning of medical studies, on career preference; at the end of medical studies, on selective traineeship and student preceptor ship; and after graduation, on medical residency selected. Chi-square tests and logistic regression analysis were done on the data of the graduates, grouped in terms of choice, or not, of frontline care specialties ( internal edicine, pediatrics or obstetrics-gynecology ). Results: Findings are presented on 299 graduates, of whom 48.5% were female, and 53.8% preferred frontline care ( FC ) specialties at the beginning of the program. After graduation, 50.2% of the subjects chose FC specialties, among which two-thirds had kept their early preference for a specific specialty. Logistic regression analysis predicted 86.7% of the graduates' choices of FC specialties. Female gender, early preference, student preceptor ship and, mostly, selective traineeship in the same broad area were significant factors. Conclusion: In this study a strong association was found between selective traineeship and career choice of FC specialties in relation to three additional predictive factors. It also revealed student preceptor ship as a factor of potential educational significance in the career decision process and as a matter of institutional concern.

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Context: In India, biostatistics in the medical curriculum is usually taught as a separate course, using either ``imaginary'' data or data from the literature. Knowledge of statistics is particularly important in the context of ``evidence-based medicine''. Objective: To evaluate the efficacy of a biostatistics course integrated into the practical haematology first-year medical course with the following special characteristics: ( 1 ) students learn statistics on data generated by and on themselves, ( 2 ) the course avoids mathematical computation, ( 3 ) the statistical exercises are link ed to the learning objectives of the physiology curriculum, and ( 4 ) the course is without the threat of university examinations. Methods: Statistical exercises were incorporated into specific haematology practicals with the aim of covering simple descriptive and inferential statistics. Statistics tests were administered, without prior information, to 60 first-year medical students before the biostatistics course, immediately following the course, and nine months later. Fifty-four students completed all three evaluations. Results: Students had a poor knowledge of statistics at baseline. They substantially increased their scores in the statistics test immediately following the biostatistics course. These scores remained higher than baseline nine months after completion of the course, although there was a small decline in the absolute scores when compared with scores soon after the biostatistics course. Implications: Integrating biostatistics into other subjects in the medical curriculum may be an important addition to ``stand alone'' courses in biostatistics.

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As the US health-care system continues on a path toward greater patient and provider dissatisfaction and decreasing access to primary health services, there is a growing need for leadership among tomorrow's health professionals. Students of today must acquire the skills to lead the United States toward solutions that will offer universal access and eliminate disparities. A s examined in the US, there are two main modes for students to learn these meaningful skills; curriculum- and institution-based leadership development and organization-based leadership development. In this paper we review these two methods from an American perspective and discuss ways that educational institutions can support student leadership development. In addition, we address ways in which non-governmental organizations can provide opportunities to foster student leadership. Lastly, we offer recommendations for US policy change at institutional, local, state, and national levels to help achieve the goals stated above.

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Because much of health professions education in the US is publicly financed, the actions of politicians have profound effects on the organiz ation of health professions education. The success of health professions education programs, therefore, depends in part on the ability of educators to advocate for change in the legislature. Successful legislative advocacy requires a general understanding of the legislative process and the needs of politicians combined with effective communications strategy. The tools of individual legislative advocacy include position papers, letter writing, politician meetings and visits, and using the media. Professional associations advocate on behalf of their members through coalitions, key contact programs, grassroots campaigns, and lobbyists. Successful legislative advocacy depends on credibility and the development of long-term relationships with members of the legislature. The process of legislative advocacy is straightforward and should be viewed as an integral part of health professions education.

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Context: A s faculty at health professionals schools have become increasingly engaged with their communities in partnerships to improve health, new questions have arisen about faculty rewards for such activities. To sustain the community work of their faculty, institutions need to reconceptualize faculty rewards, promotion, and tenure that are relevant to community activities. Historical perspective: Scholarship has evolved since the 17th century from a focus on character-building to the practical needs of the nation to an emphasis on research. In 1990, Boyer proposed four interrelated dimensions of scholarship: ( 1 ) discovery; ( 2 ) integration; ( 3 ) application; and ( 4 ) teaching. The challenge became the development of criteria and innovative and creative ways to assess community scholarship. Current models for community scholarship: This paper reviews four evidence-based models to document and evaluate scholarly activities that are applicable to community scholarship. Proposed model for community scholarship: We propose a new model for community scholarship that focuses on both processes and outcomes, crosses the boundaries of teaching, research, and service, and reshapes and integrates them through community partnership. We hope this model will generate national discussion about community scholarship and provide thought-provoking information that will move the idea of community scholarship to its next stage of development.

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Context: Many rural and inner-city communities in the United States have persistent shortages of health professionals. In addition, health services are increasingly delivered in community-based settings by interdisciplinary teams. Y et, health professions students in the US continue to receive most of their training in urban hospitals. Objective: To assess the extent to which national and state government programs in the US that fund health professions education provide financial resources for community based and interdisciplinary education in the health professions. Methods: Literature review. Findings: Most national and state government funding provided to health professions schools and clinical training sites in the US is not targeted to community-based and interdisciplinary education. Nationally, the Bureau of Health Professions, however, does administer some targeted grant programs. In addition, a number of states are addressing these needs through targeted appropriations to health professions schools and Medicaid payments to clinical training sites. Recommendations: The US experience with government funding of health professions education suggests several questions that policy makers in other nations should consider and several principles for developing effective policies to promote community-based and interdisciplinary education.

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Purpose: To evaluate student response to a community health course taught using a small-group, interdisciplinary, service-learning approach. Method: Student evaluations for the course were reviewed for a 3-year period ( 1994 ± 1997 ). Results: Student evaluations of the course im proved over the 3-year period. A total of 60 ± 76% of the students indicated that they preferred the small-group experiential approach to lectures. Examination of evaluation scores for individual small groups showed that some small groups gave the course very high ratings, while others found the experience inadequate. Conclusion: A course in community health is best taught in the community rather than the classroom. A small-group approach may result in a course with considerable variation among groups as a result of variations in community receptivity, faculty skills, and perhaps other factors.

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