Introduction: Communications skills curricula and pedagogy for medical students are often exported to non-English speaking settings. It is assumed that after learning communication skills in English, doctors will be able to communicate effectively with patients in their own language. Methods: We distributed a questionnaire to third year Emirati students at a medical school within the United Arab Emirates. We assessed their confidence in interviewing patients in Arabic after communication skills training in English. Of the 49 students in the sample, 36 subjects (73.5%) completed and returned the questionnaire. Results: Nearly three-quarters (72.2%) of students said they felt confident in taking a history in English, while 27.8% of students expressed confidence in taking a history in Arabic. Half of students anticipated that after their training they would be communicating with their patients primarily in Arabic, and only 8.3% anticipated they would be communicating in English. Conclusions: Communication skills training purely in English can leave Arab medical students ill equipped to communicate with patients in their own communities and tongue.

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Context: The ability to effectively communicate through posters and podium presentations using appropriate visual content and style is essential for health care educators. Objectives: To offer suggestions for more effective visual elements of posters and podium presentations. Methods: We present the experiences of our multidisciplinary publishing group, whose combined experiences and collaboration have provided us with an understanding of what works and how to achieve success when working on presentations and posters. Many others would offer similar advice, as these guidelines are consistent with effective presentation. Findings/Suggestions: Certain visual elements should be attended to in any visual presentation: consistency, alignment, contrast and repetition. Presentations should be consistent in font size and type, line spacing, alignment of graphics and text, and size of graphics. All elements should be aligned with at least one other element. Contrasting light background with dark text (and vice versa) helps an audience read the text more easily. Standardized formatting lets viewers know when they are looking at similar things (tables, headings, etc.). Using a minimal number of colors (four at most) helps the audience more easily read text. For podium presentations, have one slide for each minute allotted for speaking. The speaker is also a visual element; one should not allow the audience's view of either the presentation or presenter to be blocked. Making eye contact with the audience also keeps them visually engaged. Conclusions: Health care educators often share information through posters and podium presentations. These tips should help the visual elements of presentations be more effective.

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Context: Graduating clinically competent medical students is probably the principal objective of all medical curricula. Training for clinical competence is rather a complex process and to be effective requires involving all stakeholders, including students, in the processes of planning and implanting the curriculum. This study explores the perceptions of students of the College of Medicine at King Abdul-Aziz Bin Saud University for Health Sciences (KASU-HS), Riyadh, Saudi Arabia of the features of effective clinical rotations by inviting them to answer the question: "Which experiences or activities in your opinion have contributed to the development of your clinical competence? This college was established in 2004 and adopted a problem-based learning curriculum. Methods: This question was posed to 24 medical students divided into three focus groups. A fourth focus group interview was conducted with five teachers. Transcriptions of the tape-recorded focus group interviews were qualitatively analyzed using a framework analysis approach. Findings: Students identified five main themes of factors perceived to affect their clinical learning: (1) the provision of authentic clinical learning experiences, (2) good organization of the clinical sessions, (3) issues related to clinical cases, (4) good supervision and (5) students' own learning skills. These themes were further subdivided into 18 sub-themes. Teachers identified three principal themes: (1) organizational issues, (2) appropriate supervision and (3) providing authentic experiences. Conclusion: Consideration of these themes in the process of planning and development of medical curricula could contribute to medical students' effective clinical learning and skills competency.

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Introduction: The Western Pacific region has a dearth of appropriately educated eye care providers, training programs and large and increasing eye health needs. Method: To ensure regional eye health needs would be met, an iterative process sought triangulations between the literature and consultations with local stakeholders from various fields. This information was used to develop competencies to meet quality standards for educational outcomes. A framework for social accountability was used to evaluate the proposed educational initiative, and the subsequent eye care service the graduates could provide. Results: Current human resource development and deployment is inadequate to protect and restore ocular and visual health in the region. Some of these service needs could be met by task-shifting from conventional health professionals to appropriately trained mid-level personnel. A competency-based curriculum was developed to meet eye care needs and define this new cadre of mid-level professionals in relation to other professionals. This initiative met the relevance, equity, cost effectiveness and quality criteria for social accountability. Discussion: The consultative process resulted in broad acceptance of the need for an appropriately educated mid-level cadre that could be recruited, educated, deployed, supported and retained in the Western Pacific region to supplement and substitute for established eye care professionals. This process also provided validation of the initiative prior to implementation, as being appropriate to the region, meeting educational standards and social accountability criteria for outcomes. It could be replicated in other regions that wish to develop such an education for new cadres of health care professionals.

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Introduction: The intern year is a critical time for making career decisions and gaining confidence in clinical skills, communication and teamwork practices; this justifies an interest in junior doctors' perceptions of their level of preparedness for hospital work. This study explored Australian junior doctors' perspectives regarding the transition from student to doctor roles, their preparation as medical undergraduates within either traditional metropolitan schools or smaller, outer metropolitan-based (rural) programs such as Rural Clinical Schools (RCS), and the educational environment they experienced in their internship. Methods: A qualitative cross-sectional design used semi-structured interviews with postgraduate year one and two junior doctors (9 females and 11 males) within teaching hospitals in Queensland Australia. Interview questions focussed on four major content areas: preparedness for hospital work, undergraduate training, building confidence and career advice. Data were analyzed using a framework method to identify and explore major themes. Results: Junior doctors who spent undergraduate years training at smaller, non-traditional medical schools felt more confident and better prepared at internship. More hands-on experience as students, more patient contact and a better grounding in basic sciences were felt by interns to be ideal for building confidence. Junior doctors perceived a general lack of career guidance in both undergraduate and postgraduate teaching environments to help them with the transition from the student to junior doctor roles. Discussion: Findings are congruent with studies that have confirmed student opinion on the higher quality of undergraduate medical training outside a traditional metropolitan-based program, such as a RCS. The serious shortage of doctors in rural and remote Australia makes these findings particularly relevant. It will be important to gain a better understanding of how smaller nontraditional medical programs build confidence and feelings of work readiness in graduates. Career advice should become a more regular part of the medical education continuum.

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Project goal: To adapt a successful Canadian health-promoting school initiative to a Ugandan context through international partnership. Rationale: Rural children face many health challenges worldwide; health professionals in training understand these better through community-based learning. Aboriginal leaders in a Canadian First-Nations community identified poor oral health as a child health issue with major long-term societal impact and intervened successfully with university partners through a school-based program called "Brighter Smiles". Makerere University, Kampala, Uganda (MUK) sought to implement this delivery model for both the benefit of communities and the dental students. Key steps/hurdles addressed: MUK identified rural communities where hospitals could provide dental students with community based learning and recruited four local schools. A joint Ugandan and Canadian team of both trainees and faculty planned the program, obtained ethics consent and baseline data, initiated the Brighter Smiles intervention model (daily at-school tooth-brushing; in-class education), and recruited a cohort to receive additional bi-annual topical fluoride. Hurdles included: challenging international communication and planning due to inconsistent internet connections; discrepancies between Canadian and developing world concepts of research ethics and informed consent; complex dynamics for community engagement and steep learning curve for accurate data collection; an itinerant population at one school; and difficulties coordinating Canadian and Ugandan university schedules. Accomplishments: Four health-promoting schools were established; teachers, children, and families were engaged in the initiative; community-based learning was adopted for the university students; quarterly team education/evaluation/service delivery visits to schools were initiated; oral health improved, and new knowledge and practices were evident; an effective international partnership was formed providing global health education, research and health care delivery.

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Context: In the United Kingdom (UK), learning about teaching is an integral part of the General Medical Council's recommendations for the undergraduate medical curriculum. Yet often, implementing this aspect of learning presents a challenge to curriculum organisers in terms of content, timing and student interest. Programme Objectives and Structure: The Doctors as Teachers and Educators (DATE) programme was set up at Barts and the London School of Medicine and Dentistry specifically to meet the requirements for development in teaching. Although largely practical, the two-day programme offers an introduction to educational theory and the teaching requirements for junior doctors in training. The methods used are lectures and group work within plenary sessions, followed by small group micro-teaching sessions. The DATE programme has now been undertaken by over 900 graduates. Evaluation Methods: We evaluated the Date programme by means of end-of-course questionnaires completed by two cohorts of students during the 2007/8 academic year and through the use of Nominal Group Technique in 2008/9. In line with the goals of the evaluation, the data on students' views were analysed to elicit self-reported learning and develop the programme. Results: Response rates of the two cohorts to the surveys were high (80% and 98%). Nearly 100% of the students reported through the survey that they had gained confidence in teaching. In the nominal groups, students indicated that they had gained insight into educational principles like student-centredness and gained an appreciation for the nature of educational evidence and scholarship. They challenged the curriculum organisers to achieve an appropriate balance between theory and practice. Conclusions: A programme about teaching at the undergraduate medical level can be well-received by students; the DATE model could be transferred to other international contexts.

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Context: A web-based evaluation system for residents to provide feedback on faculty was piloted in four training programs at the Aga Khan University prior to institution-wide implementation. Of the four programs, less than 50% of forms were submitted by residents of three programs while more than 70% of forms were submitted by the residents of one program. This study was conducted to identify reasons for the varying participation rates of the four programs with a view to improving the system. Methods: A qualitative approach was employed using focus group discussions (FGDs). Volunteers were invited and three groups of eight to ten residents each were formed. Participants for FGDs were selected from all residency years. FGDs were used to identify residents' perceptions regarding the web-based faculty evaluation system and to identify residents' problems and concerns with completing the web-based faculty evaluating forms. Results: Technical issues in completing and submitting the forms online were identified to be the main deterrents to completing the evaluation forms. Non-accessibility of a resource person for resolving technical problems with the software and the burden of taking time out to complete the forms were considered as limiting factors by many residents. Residents recommended a focused orientation session to the new system within the departments. Conclusion: Residents' confidence and support are key to promoting adequate participation in web-based evaluations. Focused orientation sessions, reinforcement, reminders, assurances of confidentiality, and removal of technical glitches should help to improve resident participation.

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Context: Clinical clerkships in medical colleges are increasingly relying on teaching by community physicians in ambulatory clinics. Objectives: The aim of the study was to determine the attitudes and perceptions of community physicians towards teaching medical students at their clinics. Methods: A focus group discussion with 14 and a survey questionnaire of 23 community-based physicians were conducted. Findings: The focus group discussion session yielded insight into the expectations of community physicians about student attachments, including: the need for learning objectives; continuity; feedback; ongoing communication; and planned placement of students. The answers to the survey questions showed willingness to teach medical students (mean score = 4.7 on a scale of 1 to 5) and the view that medical students added value to the clinics (mean = 4.4). However, the respondents gave lower ratings to the questions about students being able to independently evaluate patients in the beginning of their clerkship (mean = 3.3). Conclusions: Community physicians request clear learning objectives, assessment criteria and advance planning for teaching medical students. Clerkship coordinators should ensure ongoing communication with community preceptors in these areas as well as offer recognition of teaching contribution and opportunities for professional development.

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Context: Community agency employees' interest and involvement in academic-community research partnerships are keys to successful collaborations. One main barrier to success can be employees' lack of knowledge about research. We present data on an "orientation to research" program for community agency employees in a large U.S. city designed to improve knowledge about research in general and that specific to the agency. Methods: We developed an agency intranet website, a scavenger hunt to facilitate learning through the intranet research website, and a ten-item quantitative knowledge assessment tool. Academic and agency partners were actively involved in the design of the program and its evaluation. Findings: More educated and long-term employees had higher pre-test scores but not post-test scores. Significant improvement in post-test scores was observed for employees after completion of the program. Informal feedback about course content and the academic-community partnership was positive. Conclusions: This report examines the feasibility of a structured knowledge program targeted at community agency employees at all levels within an agency. We believe that this approach is generalizable to other settings to the extent that there are shared interests, resources, and investment of the academic partner and agency.

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