Background: Community-based medical education (CBME) is the delivery of medical education in a specific social context. Learners become a part of social and medical communities where their learning occurs. Longitudinal integrated clerkships (LICs) are year-long community-based placements where the curriculum and clinical experience is typically delivered by primary care physicians. These programs have proven to be robust learning environments, where learners develop strong communication skills and excellent clinical reasoning. To date, no learning model has been offered to describe CBME. Methods: The characteristics of CBME are explored by the authors who suggest that the social and professional context provided in small communities enhances medical education. The authors postulate that meaningfulness is engendered by the authentic context, which develops over time. These relationships with preceptors, patients and the community provide meaningfulness, which in turn enhances learning. Results and Discussion: The authors develop a novel learning model. They propose that the context-rich environment of CBME allows for meaningful relationships and experiences for students and that such meaningfulness enhances learning.

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Introduction: Students' learning approaches have a significant impact on the success of the educational experience, and a mismatch between instructional methods and the learning approach is very likely to create an obstacle to learning. Educational institutes' understanding of students' learning approaches allows those institutes to introduce changes in their curriculum content, instructional format, and assessment methods that will allow students to adopt deep learning techniques and critical thinking. The objective of this study was to determine and compare learning approaches among medical students following an interdisciplinary integrated curriculum. Methods: This was a cross-sectional study in which an electronic questionnaire using the Biggs two-factor Study Process Questionnaire (SPQ) with 20 questions was administered. Results: Of a total of 402 students at the medical school, 214 (53.2%) completed the questionnaire. There was a significant difference in the mean score of superficial approach, motive and strategy between students in the six medical school years. However, no significant difference was observed in the mean score of deep approach, motive and strategy. The mean score for years 1 and 2 showed a significantly higher surface approach, surface motive and surface strategy when compared with students in years 4-6 in medical school. Discussion: The superficial approach to learning was mostly preferred among first and second year medical students, and the least preferred among students in the final clinical years. These results may be useful in creating future teaching, learning and assessment strategies aiming to enhance a deep learning approach among medical students. Future studies are needed to investigate the reason for the preferred superficial approach among medical students in their early years of study.

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Background: REACH (Realising Education and Access in Collaborative Health) is an initiative of  students of the University of Melbourne to improve access to primary health care services. It is driven by the voluntary commitment of over 120 students and is built upon the principles of collaboration, interprofessionalism and client-centered care. Summary of work: The feasibility of student-led clinics has been demonstrated with the operation of over 100 such clinics in North America. Senior students from Medicine, Physiotherapy, Nursing and Social Work attended a student-run clinics conference in Jacksonville, Florida, USA in 2010. On return, research was conducted to identify a local underserviced community appropriate for a clinic. On review of the literature, it was determined an interprofessional model of care would best serve this community. The student body engaged a local community health service as a project partner. The model of care at the REACH Clinic was developed by senior students from the schools of Medicine, Physiotherapy, Nursing and Social Work and managed by an interconnected student committee structure. The final consultation model involves a triage process and simultaneous consultation by two disciplines. This model of care was successfully implemented during a 4-week pilot period in October 2011. Results: Several issues were identified during the REACH pilot, with dissonance between the at-times competing principles in health care of interprofessionalism, client-centered care and efficient care. Conclusions: An interprofessional model of care was developed and successfully implemented in a 4-week pilot student-run clinic within an established community health service. While providing a free health service, this model facilitated interprofessional learning at both a clinical and management level and highlighted logistical and ideological challenges that served as the basis for further refinement of this model of community service .

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Background: University of New Mexico Health Sciences Center (UNMHSC), located in Albuquerque, New Mexico, USA, has an international reputation for developing and implementing curricular initiatives addressing health inequities. The Street Outreach and Shelter Care elective is designed to provide interprofessional service learning opportunities for senior pharmacy and medical students addressing the needs of our nation's most marginalized population-those experiencing homelessness. Methods: Our institution collaborated with multiple community partners serving the homeless to develop, implement and teach a 4-week senior elective for health professions students. During this elective, senior pharmacy and medical student teams provide individualized health care to men in local homeless shelter facilities. Students also participate in street outreach programs across a continuum of homeless populations. Weekly interprofessional education (IPE) faculty-facilitated sessions allow students to reflect on their experiences and learn from other discipline perspectives. Results: Student evaluations uniformly reflect the transformative nature of the rotation since its inception, April 2009. Our outcomes corroborated the findings of similar service learning models developed to sensitize health professions students to the complex challenges of homeless populations. Discussion: Academic centers can play a central role in health education reform by instituting curricula focusing on the primacy of population welfare and just distribution of resources. Senior year is an opportune time to reinforce social accountability among health professions before graduation. This elective is based on adult principles of learning and can serve as an international educational model for developing interprofessional curricular innovations addressing the healthcare needs of vulnerable populations.

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Background: The aging of the population demands a development of the skills of different health professionals working in teams due to the complexity of the problems arising from this population. This article discusses the integration of two residency programs: medical and multiprofessional. The challenge was to construct a curriculum with practical and theoretical activities that develop competencies within the scope of interprofessional education, ensuring the necessary depth and detail of study in all the professional areas involved in the development of specific skills. Methods: The curricular integration was accomplished by conducting workshops with the participation of coordinators from both programs and service areas, preceptors of medicine, nursing, nutrition, psychology, physiotherapy, and social services. In these workshops, we agreed upon the goals, general and specific competencies, the standard weekly schedule, practice scenarios, evaluation, and selection. Results: The interprofessional program has 26 residents, of which 6 are physicians 4 each from the other areas, with 25 preceptors from the 6 areas that comprise the program. The residents develop their training in six practical scenarios distributed between the first and second years with increasing complexity. Discussion: The program is based on guidelines, physical conditions and human resources that allow for the overcoming of barriers to the development of interprofessional education and collaborative practice.

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Background: There is considerable heterogeneity in the extent to which global health education is emphasized in undergraduate medical curricula. Here, we performed an exploratory analysis to test the hypothesis that exposure to global health education may influence the attitudes of medical students toward the treatment of local vulnerable patient populations. Methods: All pre-clerkship students at an urban Canadian university were invited to attend a voluntary global health education session on challenges in treating human immunodeficiency virus (HIV) in the developing world. Those who attended as well as those who did not completed pre- and post-session surveys measuring willingness to treat patients with HIV and related attitudes. A repeated measure analysis of variance (ANOVA) was performed to assess the effect of the intervention on attitudes toward locally affected populations. Results: A total of 201 (81.4%) and 143 (58.3%) students completed the pre- and post-session surveys, respectively. Students who scored their willingness to treat patients with HIV within highest 10% of the scale on the pre-session survey were excluded from the analysis to account for a ceiling effect. On repeated measure ANOVA, willingness to treat local patients with HIV increased significantly following the session (P < 0.01). Students intending to attend the session also reported a greater propensity to treat patients with HIV than those who did not (P = 0.03). Discussion: In this exploratory study, we find that following exposure to a global health lecture on the challenges of HIV in the developing world, students possessed more favorable attitudes toward the treatment of marginalized local patient populations, a finding that may be exploited in undergraduate and continuing medical education.

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Background: Many studies have reported an association between periodontitis and adverse pregnancy outcomes, but there has been little research on the knowledge of obstetricians regarding oral care. The aim of the study was to assess the knowledge and attitudes of practicing obstetricians in India about the relationship between oral health and pregnancy outcomes, as well as their practice behaviors regarding oral healthcare in pregnant women in Indian settings. Methods: A structured online questionnaire was sent to 130 obstetricians in the city of Chandigarh and adjoining areas of the union territory. The questionnaire was prepared by dentists and obstetricians and was validated in a prior pilot study. Obstetricians' knowledge of the effects of pregnancy on oral health, and vice versa, were correlated with their experience and practices. Results: A total of 79.2% responded to the questionnaire. More than 70% of respondent obstetricians correctly knew of the effects of periodontitis on preterm birth and low birth weight babies. Only 40% recommended dental examination during pregnancy and 47% advised patients about oral care during pregnancy. There were significant correlations between knowledge of dental health effects on pregnancy and referrals of patients to dentists. Conclusions: This study found that although obstetricians generally were knowledgeable about appropriate dental care practices during pregnancy as well as the relationship between oral health and pregnancy outcomes, this knowledge often did not translate into appropriate practice behavior.

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Background: The healthcare system is complex and the education of medical and nursing students is not always a priority within it. However, education offered at the point of care provides students with opportunities to apply knowledge, and to develop the necessary skills and attitudes needed to practice their future profession. The major objective of this study was to identify students' views of generic aspects of the healthcare environment that influences their progress towards professional competence. Methods: We collected free text answers of 75 medical students and 23 nursing students who had completed an extensive questionnaire concerning their learning in clinical wards. In order to obtain richer data and a deeper understanding, we also interviewed a purposive sample of students. Qualitative content analysis was conducted. Results: We identified three themes: (1) How management, planning and organising for learning enabled content and learning activities to relate to the syllabus and workplace, and how this management influenced space and resources for supervision and learning; (2) Workplace culture elucidated how hierarchies and communication affected student learning and influenced their professional development and (3) Learning a profession illustrated the importance of supervisors' approaches to students, their enthusiasm and ability to build relationships, and their feedback to students on performance. Discussion: From a student perspective, a valuable learning environment is characterised as one where management, planning and organising are aligned and support learning. Students experience a professional growth when the community of practice accepts them, and competent and enthusiastic supervisors give them opportunities to interact with patients and to develop their own responsibilities.

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Background: At Shifa College of Medicine, evaluation is an integral part of the curriculum. We used focus groups as a tool to obtain in-depth information regarding students' experience with the new integrated, system- based curriculum. The purpose of this study was to explore the usefulness of focus groups in identifying important issues for curriculum improvement and to explore the trustworthiness and representativeness of data obtained through this strategy. Methods: In 2012, we used focus groups to seek feedback from students regarding their experience with the integrated curriculum. One course of each of the three preclinical years was selected for this purpose. Three parallel focus groups were conducted for each selected course. Each focus group was audio recorded, and the moderator and a volunteer student took additional notes during the session. The audio recordings were transcribed and data obtained from the three sources were analyzed, coded, and categorized independently by three investigators. Both manifest and latent themes were identified, using an inductive approach. Final agreement on themes was reached by comparison of the independently done thematic analysis by the three researchers. Reliability of data was established by comparing responses from the three parallel focus groups of each course. Trustworthiness of inferences was ensured by multiple coding, audit trail and member checking with focus group participants who reviewed the themes for validity. Results: Most of the data on students' perceptions of their courses from each of the parallel groups were in agreement: Similar themes were seen within groups of the same class as well as across the three preclinical years. Conclusion: Focus groups can be a useful tool for collecting trustworthy and reliable information through a process that promotes interaction among student participants. They can support quantitative data from students and be used to support curriculum reform.

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Background: In the remote northern region of Mozambique the ratio of doctors to patients is 1:50,000. In 2007, Lúrio University initiated an innovative, "One Student/One Family" program of teaching and learning for health professions students, to complement their traditional core curriculum. All students of each of the school's six health degree programs complete a curriculum in "Family and Community Health" in each year of their training. Methods: Groups of six students from six different health professions training programs make weekly visits to communities, where each student is allocated to a family. Students learn from their families about community life and health issues, within a community where 80% of the population still lacks access to modern health care and rely on indigenous doctors and traditional remedies. In turn, students transmit information to families about modern health care and report to the faculty any major health problems they find. The educational/experiential approach is interprofessional and community-oriented. Results: The main perceived advantages of the program are that it is applied and problem-based learning for students, while simultaneously providing needed healthcare services to the community. The major disadvantages include the complexity of coordinating multidisciplinary groups, the time and distance required of students in traveling to communities, and interpretation of multiple reports with variable data. Discussion: This community-oriented education program involving students from six disciplines uses nontraditional teaching/learning methods is the basis of the ex libris of Lúrio University.

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Background: Populations are ageing and therefore non-communicable diseases are becoming leading causes of global morbidity, which need to be the focus of primary care services and training. Some older patients are uncomfortable with general practitioner (GP) trainees managing their chronic conditions, reducing clinical experience opportunities for trainees. This Australian cross-sectional study explored the factors underlying patients' attitudes to trainees in an agency theory framework. Methods: Fifty patients aged 60 and over from each of 38 training practices were offered a questionnaire after their consultation. Principal component analysis of the results was undertaken. Factor scores were calculated. Binary logistic modelling was used to identify relationships between participant characteristics, behaviours, attitude items and factor scores. Results: The response rate was 47.9% (n = 911). Three factors were identified: 'Interpersonal Trust' (IPT); 'Institution/system Trust' (ST); and 'Interpersonal Continuity' (IPC). Lower self-rated health (SRH) was associated with higher IPT factor scores (P = 0.023); higher SRH with higher ST scores (P = 0.001); and chronic illness with higher IPC scores (P = 0.005). Higher ST scores were associated with greater comfort with trainees' involvement in chronic care (P < 0.001) and frequency of trainee visits (P < 0.001), while higher IPC scores were negatively associated (P < 0.001 and P = 0.003, respectively). High IPT scores were associated with lower satisfaction with trainee visits (P = 0.001). Discussion: These results indicate that better SRH, via higher institution/ST, is associated with favourable attitudes and attendance with trainees. In addition, chronic illness, via a higher need for IPC, is associated with lower comfort and attendance. These findings are consistent with agency theory, which shows potential as a framework for future interventions and research into older patient-trainee interactions.

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Context and objectives: Peer tutoring is a well-researched and established method of learning defined as 'a medical student facilitating the learning of another medical student'. While it has been adopted in many medical schools, other schools may be reluctant to embrace this approach. The attitude of the teaching staff, responsible for organizing and or teaching students in an undergraduate medical course to formal peer teaching will affect how it is introduced and operationalized. This study elicits faculty opinions on how best to introduce peer tutoring for medical students. Methods: Structured telephone interviews were recorded, transcribed and analyzed using thematic analysis. The interviews were with medically qualified staff responsible for organizing or teaching undergraduate medical students at a New Zealand medical school. Six questions were posed regarding perceived advantages and disadvantages of peer tutoring and how the school and staff could support a peer-tutoring scheme if one was introduced. Findings: Staff generally supported the peer tutoring concept, offering a safe environment for learning with its teachers being so close in career stage to the learners. They also say disadvantages when the student-teachers imparted wrong information and when schools used peer tutoring to justify a reduction in teaching staff. Subjects felt that faculty would be more accepting of peer tutoring if efforts were made to build staff 'buy in' and empowerment, train peer tutors and introduce a solid evaluation process. Conclusions: Staff of our school expressed some concerns about peer tutoring that are not supported in the literature, signaling a need for better communication about the benefits and disadvantages of peer tutoring.

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Background: In the health professions, competency in communication skills is necessary for the development of a satisfactory physician-patient interaction. Body expression is an important domain of the communication process, often not adequately addressed. The aim of this study was to describe the methodology and content of a pilot introductory training session in body expression for dental students before the beginning of their clinical training. Methods: The educational methods were based on experiential learning and embodied training, where the session's content focused on five themes representing different phases of the dental treatment session. A questionnaire was distributed before and after the session to assess any changes in students' self-perceptions in communication skills. Results: There were statistically significant improvements in the total values of the students self-perceptions of their communication skills obtained before and after the training and in specific elements such as small group situations, performing an interview, understanding the feelings of others and expressing one's own feelings. Discussion: The dental students in the present study felt that this preclinical experiential learning session improved their communication skills. The feedback from this training experience will enable further development of an effective communication course for clinical dentistry.

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Background: Working and learning go hand in hand during interprofessional collaborative practice. Patients' nursing records are designed to record patient care and health status. It is not known whether these records are also used to keep track of interprofessional contacts or interprofessional learning between team members. This study explored the usefulness of patients' nursing records in optimising interprofessional workplace learning for general practitioners. Methods: We utilized a descriptive retrospective chart review. All palliative home care teams of the Dutch speaking part of Belgium were involved. Throughout the year 2010, a representative sample of patient charts was selected. Characteristics of encounters between general practitioners and palliative care nurses were extracted from the charts. Results: Detailed accounts of interprofessional contacts were found in the charts. Palliative care nurses recorded number and type of contacts, topics discussed during contacts and general practitioner's learning activities. Discussion: Palliative care nurses are sensitive and open towards the general practitioners' learning needs. Patients' nursing records provide useful information for interprofessional team discussions on workplace learning. Healthcare professionals should be trained to respond to each other's learning needs.

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For about a half century the World Health Organization (WHO), supported by the literature in the field of health personnel education, has argued for the benefits of a learner-centered and community-oriented approach to professional education. Nevertheless, change has not happened in the vast majority of schools and countries. This paper describes the obstacles and constraints to change in health professional education: Obsolete administrative rules, the low profile of public health, the lack of real decision power of faculty, a dearth of faculty trained in the field of education, the arbitrary separation between so-called basic sciences and clinical practice, the disciplinary orientation of learning objectives, a lack of explicit definition of desirable professional competencies, and, above all, too little value placed on the evaluation of educational programs. The recent literature continues to argue for change but action does not follow. Only very few training institutions currently put newer approaches into practice. The university culture remains an environment that stifles change.

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Background: This article presents an innovative model for interprofessional community-oriented learning. The Engagement Studios model involves a partnership between community organizations and students as equal partners in conversations and activities aimed at addressing issues of common concern as they relate to the social determinants of health. Methods: Interprofessional teams of students from health and non-health disciplines work with community partners to identify priority community issues and explore potential solutions. Results: The student teams work with a particular community organization, combining their unique disciplinary perspectives to develop a project proposal, which addresses the community issues that have been jointly identified. Approved proposals receive a small budget to implement the project. Discussion: In this paper we present the Engagement Studios model and share lessons learned from a pilot of this educational initiative.

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Background: Recent data question whether medical education adequately prepares physicians to care for the growing number of children with chronic medical conditions. We describe a 10-week course designed to provide undergraduate students with the knowledge and skills required to understand and care for children with chronic or catastrophic illnesses. The course presented the illness experience from the child's perspective and thus presented information in a manner that was efficient, conducive, and memorable. The curriculum was designed like a graduate-level seminar that included workshops, lectures, readings, writing, and lively discussions. Methods: This is an educational intervention study that used survey data to assess changes in attitudes among and between participants completing this course versus students not exposed to this course. We used Somers' D test and Fisher's z-transformation to perform both pre- and post-nonparametric comparisons. Results: Course participants were more likely to change their attitudes and agree that chronically ill children "feel comfortable talking with their peers about their condition" (P=0.003) and less likely to agree that these children "want to be treated differently," "want more sympathy," or "care less about romantic relationships" (P = 0.003, 0.002 and 0.02, respectively). Controls were more likely to continue to agree that chronically ill children "want to be treated differently" (P = 0.009) and "care less about romantic relationships" (P = 0.02), and less likely to agree that these children "talk openly" or "feel comfortable talking with their peers about their condition" (P = 0.04). Conclusions: This classroom-based course serves as a feasible and cost-effective model for universities and medical schools to aid in improving student attitudes toward treating chronically ill children. The course provides the unique opportunity to learn directly from those who care for and those who have lived with chronic illness.

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