Context: In New Zealand, the government's key strategy to improve the health of the indigenous population is advanced through a policy where families are supported to achieve their maximum health and well-being: "whānau ora" (for a glossary of Māori words and phrases, see appendix). Objectives: This paper outlines the role Māori community health workers (CHWs) play in the delivery of whānau ora services and explores the tensions and challenges faced by these workers in carrying out their role. Methods: Recent literature, existing qualitative research data and local level verification from a practising community health worker with 12 years experience. Findings: Roles were complex, varied and generally executed in high need communities. Differing expectations between the contractual requirements, the community and the CHW's own expectations meant CHWs continually managed competing demands. CHWs describe training opportunities as being short-term and ad hoc, specific to a particular health provider's needs and offering only limited options for career advancement. Conclusion: CHWs form an integral part of the New Zealand health workforce acting as the interface between the health sector and Māori communities. By working in a culturally distinctive manner, they help give effect to Māori health development aspirations. Increasingly this work is carried out in complex and demanding environments. Key challenges that need to be resolved to further advance the position of CHWs in New Zealand include greater recognition of the unique role they play in the delivery of public health and primary healthcare services, linking this recognition to appropriate remuneration and ensuring ongoing role development is met within a Māori worldview.

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Introduction: The educational environment is widely considered to be a major factor affecting students' motivation and learning outcomes. Although students' perceptions of their educational environment are often reported, we are unaware of any published reports that relate this information to students' clinical competence, either self-perceived or objectively measured. Objectives: We aimed to correlate students' perceptions of their learning environment and their self-perceived competence in clinical, practical and personal skills, using validated scales. Methods: Subjects included a cohort of 71 final-year medical students who were posted to a peripheral campus affiliated with a district hospital. Two questionnaires were administered concurrently: a modified DREEM (50 items) to assess the learning environment and an abbreviated IMU Student Competency Survey (29 items) to examine self-perceived competence across a wide range of skills and work-readiness. We correlated the major domains in both surveys using Spearman's Correlation. Findings: Fifty-nine students (83%) completed the questionnaires. Comparing correlations of the five major domains of the modified DREEM questionnaire ("Perception of learning", "Perception of teachers", "Academic self-perception", "Perception of atmosphere" and "Social self-perception") with all subscales in the abbreviated IMU Student Competency Survey (clinical, practical, personal skills and overall work-readiness), we found that academic self-perception domain had the strongest correlations (r:0.405 to 0.579, p:0.002 to < 0.001) and perception of teachers bears the weakest correlations (r:0.171 to 0.284, p:0.254 to 0.031). Self-perceived competence in practical skills in the IMU Student Competency Survey correlated the weakest with all domains of the modified DREEM (r:0.206 to 0.405, p:0.124 to 0.002). Discussion and conclusion: The overall weak-to-moderate correlations between perceptions of learning environment and selfperceived clinical competence suggest that other factors might interact with the learning environment to determine students' confidence and achievements.

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Context: First Nation communities in Canada rely on a mix of non-Indigenous professionals and large numbers of Indigenous paraprofessionals to deliver healthcare. Formerly allowed to perform controlled acts in emergencies, the direct care role of paraprofessionals is now restricted because of concerns about liability and accountability. As such, they are limited to health promotion and prevention activities. Objectives: Focusing on the largest group of Indigenous health workers, viz. Community Health Representatives (CHRs), for illustration purposes, this paper (1) examines the evolving role of First Nation health workers, and (2) discusses the proposed introduction of competency-based standards for their education, certification and regulation. Methods: The paper is informed by findings from open ended, semi-structured and focus group interviews, as well as qualitative survey data, derived from seven studies done in Ontario, Canada. Outcomes: Paraprofessionals face conflicting and sometimes unrealistic expectations. Past practices have accustomed community members to hands-on care, however, professionals will no longer delegate tasks requiring clinical skills to them. Moreover, First Nation leaders are concerned about liability for their paraprofessional employees' actions. The paper discusses issues related to paraprofessional competence, preparation for practice, and continuing health education. It then presents the National Indian and Inuit Community Health Representatives Organization's proposal to establish a scope of practice and set of competencies that can form the basis for national practice and training standards, accreditation and regulation. Conclusions: In Canada or elsewhere, changing practice environments may require adjustments in the roles played by Indigenous health workers. The case of First Nation Community Health Representatives illustrates a strategy for role transformation.

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Introduction: Aboriginal Health Workers (AHWs) play a crucial role in the delivery of primary health care services in underserved rural and remote communities throughout Australia. The Mount Isa Centre for Rural and Remote Health (MICRRH), in Northwest Queensland, Australia, has been involved in training AHWs since 2001. During this time, it has been observed that while there has been interest in pursuing further education in other health careers, the uptake for advanced study by AHWs has been minimal. This exploratory study was designed to assess the career aspirations of local AHWs (both qualified and students) as well as community stakeholder views to identify barriers experienced when undertaking advanced education. Methods: The study used a descriptive and exploratory design. AHWs and key stakeholders were invited to participate. Openended interviews were undertaken with nine participants in two communities in the Mount Isa Health Service District in Northwest Queensland, Australia. Findings: While there was some interest expressed in careers like medicine and nursing, the majority of participants indicated a preference for advancement to management or specialist areas as AHWs. In relation to the barriers faced by AHWs and students in continuing study or career advancement, three main themes emerged: support; infrastructure; and promotion.

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Introduction: In addition to understanding core public health fundamentals, health professionals must also be equipped with the skills necessary to implement strategies to promote population health. In response, the University of New Hampshire (UNH) has developed a unique Public Health Certificate (PHC) Program designed to strengthen knowledge and skills in basic public health competencies of working health professionals. A distinctive feature of this program is its culminating course "Applied Topics in the Essentials of Public Health," which entails a practical, applied learning experience where students explore a variety of essential public health services (EPHS) relevant to their career goals. Objectives: 1) Explain the rationale for educating working health professionals about public health; 2) Describe the UNH graduate PHC Program, its framework and innovative process for implementing a skills-based course to improve the competency of practitioners to perform the EPHS; 3) Review the benefits and challenges of implementing a skills-based course for working health professionals; and 4) Evaluate the PHC Program. Discussion: The UNH PHC Program and its capstone course serve as a model for providing a unique, skills-based learning opportunity for working health professionals pursuing advanced public health education in U.S.-based or international public health education programs. This novel course design allows for students to develop the skills necessary to perform the EPHS.

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Context: The goal of the Professional Skills Program at Arabian Gulf University, Bahrain, is to prepare medical students for the clerkship phase. In the six-year integrated problem-based learning (PBL) medical program, the Professional Skills Program is introduced in years two to four. The aim of this study was to evaluate program effectiveness as perceived by the students in the clerkship phase. Method: Students' perceptions were obtained using a mailed questionnaire. Close-ended questions were assessed using a 5-point Likert scale. Students were also asked to comment on areas of strengths or suggestions for improvement. The questionnaire was piloted with a group of students in the clerkship years. Results were analyzed in relation to the different domains of the program. Results: Students were positive about their clinical skills training in preparing them for their clerkship in relation to three levels of Kirkpatrick outcome measures. This was particularly true for the domains of physical examination and procedural skills. However, they indicated some areas in need of program development, particularly in the history-taking domain. Conclusion: The students' opinions generally support the effectiveness of the Professional Skills Program training in preparing them for the clerkship phase. Program evaluation has helped us to plan for further development of the program.

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Background: Scientific publication is a vital mission of medical schools and it is important to periodically document how well schools fulfil this mission. Aims: This study aimed to analyse the publication record of Libyan medical schools in international journals indexed in PubMed between 1988 and 2007. Methods: Medline was searched using PubMed for publications affiliated to Libya during 1988-2007. Results: Out of 417 papers related to Libya, 348 (84%) are affiliated to the medical schools and related hospitals. More than 60% of the 348 papers are affiliated to Al-Arab Medical University, Benghazi, while Al-Fateh Medical University, Tripoli, contributed 103 papers (30%). The rest of the papers (n=25, 7%) were published by medical schools in other parts of the country. The publication rate declined by 3% annually between 1988 and 2007. The decline was mainly due to a decrease in the publication rate by Al-Arab Medical University, Benghazi. Overall, nine departments produced 10 or more papers each. Out of about 1675 staff members, there are only 148 first authors and 207 last authors. The estimated annual publication rate is 0.7 papers per 100 academic staff members. Conclusion: This study reveals that published scholarship of the Libyan medical schools is extremely low, that the publication rate has declined, and that most academic staff have no publications listed in PubMed. This issue needs urgent attention.

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Introduction: E-learning is a teaching tool used successfully in many medical subspecialties. Experience with its use in urology, however, is scarce. We present our teaching experience with the INMEDEA simulator to teach urological care to medical students. Methods: The INMEDEA simulator is an interactive e-learning system built around a virtual hospital which includes a department of urology. It allows students to solve virtual patient cases online. In this study, students were asked to prepare two urological cases prior to discussion of the cases in small groups. This blended teaching approach was evaluated by students through anonymous questionnaires. Results: Of 70 4th year medical students 76% judged this teaching method as good or very good. Eighty-seven percent felt that it offered a good way to understand urological diseases better and 72% felt that learning with this method was fun. Nevertheless, 30 out of 70 free text statements revealed that further improvements of the program, including an easier and more comfortable navigation and a faster supply of information are necessary. Conclusions: Virtual patient cases offer a practicable solution for teaching based on problem solving in urology with a high acceptance rate by students.

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Context: Women's health is an often neglected component of health professions education despite the well-documented need to improve the health status of women, especially in low income countries. This paper was written on behalf of all members of The Network: Towards Unity for Health Women and Health Taskforce (WHTF) which unites leaders in women's health and higher education from different countries around the world. The WHTF objectives include teaching health providers the skills and knowledge necessary to improve care to women; encouraging universities to partner with community women's groups; promoting the inclusion of women's rights and gender issues in curricula; and cultivating leadership among female health professions students. Objective/Content: The main goal of the paper is to provide an overview of the collaborative processes, the accomplishments and the lessons learned in this project since the early 1990s. It includes the history and evolution of the Taskforce; the importance of human rights and gender issues in approaching women's health; teaching tools - the Women and Health Learning Package (WHLP); implementation of WHLP in health professions education and community settings; and main outcomes and future challenges. The WHLP was implemented in fourteen universities and seven university community programs. A new edition of WHLP will be available in 2009. Conclusion: The WHTF is a model of south-south collaboration in health professions education and community programs to improve women's health. It has been successful in reaching universities and communities all over the globe and provides a model for other education, health and community issues.

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Background: Increasing enrollment in pharmacy schools has led to a shortage of adequate advanced pharmacy practice experience (APPE) sites. Objective: We sought to assess our preceptors' support for a standardized rotation schedule for the multiple schools that compete for APPE sites in our area. A secondary objective was to ascertain preceptors' beliefs about the impact a regional standardized rotation schedule might have on the number of students their sites would be able to accept on rotation. Methods: A short questionnaire was developed. All APPE preceptors at our institution were invited to participate by e-mail, telephone and/or U.S. mail. Results: A total of 232 preceptors were contacted; questionnaires were returned by 133 preceptors (57%). A proposed region-wide rotation schedule was supported by 75.2% of respondents. Most (79%) believed that the standardization of schedules will not affect the number of students they will be able to accommodate on rotations, while 18.1% believed the new schedule will allow them to accept more students. Conclusion: APPE preceptors in our area generally support standardization of pharmacy students' community rotation schedules, and this may increase the APPE availability but perhaps for only a minority of sites.

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Introduction: A little over fifty years ago, Edward McGavran, Dean of the University of North Carolina School of Public Health, articulated the concept of treating the community as if it were a patient. Although McGavran was addressing public health practitioners, the concept has applicability in academic medicine and reflects contemporary thought in patient care, research, and education. The goals of this paper are (1) to present a framework through which clinicians can conceptualize the community as an appropriate level of intervention to improve health, to conduct research and to educate students, and (2) to illustrate the framework by presenting information on how programs at Morehouse School of Medicine have used it to organize community-focused initiatives. The concept may be called Clinical Community Health. Clinical Community Health and Its Applications at Morehouse School of Medicine: Health problems of communities are more readily understood by clinicians when analyzed in the same way that clinicians analyze the health problems of individual patients: by gathering subjective and objective data, formulating an assessment that is expressed as a problem list, and developing a plan ("SOAP"). The plan is created in consultation with the community, much as a modern physician engages in shared decision making with a patient rather than issuing "doctor's orders." Similarly, community-based participatory research creates a relationship between the researcher and the community that parallels the relationship between the researcher and the individual research participant in traditional clinical research. When viewed through this lens, the education of students in the community resembles the education of students in the hospital or clinic - both are a type of service-learning. Hence, the community work of faculty is best evaluated and rewarded in a fashion that parallels evaluation of faculty work in the clinic or hospital. This paper reports on our experiences at Morehouse School of Medicine (MSM), a historically black institution in the United States whose mission focuses on primary care and the health of the underserved. We report on our efforts to apply the model in service, research, and education. Conclusion: Viewing the community as a patient provides a useful conceptual framework for primary care physicians and other clinicians, since it allows them to recognize that it is not necessary to learn a different conceptual framework to diagnose and treat the community; rather, one can think of the community as a patient and apply a similar approach to that used in the care of individuals.

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