A Summary of the latest Health Professionals Global Network discussion on Community Based Education and Interprofessional Education
Here's a taste of the latest digest of the Health Professionals Global Network discussion on Community Based Education and Interprofessional Education. The fourth digest of the Community Based Education Virtual Global Discussion Forum covers the contributions from both Day 4 and Day 5.
The valuable discussions during the two days covered several perspectives related to CBE and Interprofessional Education where participants shared their experiences and views. During the two days participants covered several perspectives related to CBE and Interprofessional Education, sharing their experiences and views. These discussions were enriched by twelve contributions from Egypt, USA, Canada, South Africa, Ukraine, Netherlands and Philippines.
Lamia Fiala (from FOM/SCU - Egypt) highlighted a new aspect of CBE which is project-based learning activity that is conducted in community. From the first academic year, students start working on high priority health problems in their field projects. These projects help students to learn and apply the principles and steps of scientific research. Students come in contact with people (sick and healthy) in different settings within the community, such as: homes (household survey), primary care units, geriatric nursery home, schools and universities. Along the six years of the medical school the projects range from descriptive and analytic studies conducted by the whole batch in the first three years, to intervention studies in small groups and finally individual mini-projects in the sixth year. Another indirect educational outcome from working in field projects and more widely in all CBE activities is building students’ interpersonal skills through working in teams and practicing leadership in the different community settings.
Another similar inspiring experience was posted on day (2) of discussions by Diane R. Bridges (from USA) who attached a paper about community based service learning project in which all first-year students are grouped into interprofessional teams representing the allied health profession taught at the university. Each team is expected to perform a service-learning project (SLP) with required elements. Community partnerships were formed and continue to be strengthened each year through the service-learning projects.
Shimaa El-Araby (from Egypt) described a different CBE activity which is conducting family visits to pregnant women and chronic patients, which provide an opportunity to students to learn more – outside campus - about urban and rural communities, cultures, believes and the concept of follow-up as well as preventive aspects. She also values
early patient contact by students which enables them to encounter a wide spectrum of health problems, improve their communication and clinical skills.
In her contribution, Noha Salah (a recent FOM/SCU graduate from Egypt) stressed on an important outcome of CBE which helped her to be able to communicate with Bedwin Patients who have a different accent and terms. She becomes capable of understanding not just the words or the terms but the medical habits that might have been the cause of their medical problems.
A wider view by Tess Panizales (From USA) adopts the idea that education should integrate awareness to the socio-cultural, political, economic condition of the community. Most new 'transplanted' community health care workers or volunteers coming from developed nations gets 'culture shock' once they are on their assigned areas. Providing a
pre-exposure briefing and post exposure de-briefing covering specifics about the area helps both the community and the care worker/trainee. In Tess’s opinion, interprofessional education and collaboration does exist only if the trainee welcomes such experience.
On the other hand, Ronald Paguirigan from the Philippines said that; sadly, in the Philippines, only a few doctors eventually end up practicing community medicine and wondering about how other countries encourage their graduates to go into community practice.
Nomtuse Mbere displays an inspiring experience from South Africa to deal with such problems; he stated that South Africa started a program in which newly qualified medical doctors were allocated to rural areas with very little resources. While some resented the '' waste of their time'' others were grateful for the exposure. With telemedicine and other means of electronic communication, such doctors, who have no experience can be supported. It is important to have some form of a coordinating committee for all extension workers in a village/district so that holistic health care can be provided to the community.
Luc Besancon (from Netherlands) has many examples of national pharmacists associations been involved in educating the public through health promotion campaign relayed by community pharmacies throughout the world. Moreover, national associations of pharmacists have also been involved in educating the local population through conferences, or lectures given in several countries. He posted only a few examples
out of hundreds: - in Spain: on lice, on health food habit for children- in Japan: on rational use of medicines for children- in Czech Republic: on rational medicines for elderly patients.
Amruta D. Parekh from USA has an impressive experience at the Health Science Center in San Antonio where students from 5 schools participate in an elective which comprises of a didactic part, clinic visit where students interact with the interprofessional team at the clinic, and a community based learning service project where they work as a team in doing a needs based assessment, and develop educational media for educating the patients at the clinic and so at the end the self reflective exercises, the students had a better understanding of not only their own role responsibilities, but also that of others in
the team. Amruta concluded that it is a winwin situation for optimal patient care.
Victor Biryukov from Ukraine wrote that there is a difference between our traditional thinking due to the peculiarities of national mentality, so he suggested to structure the discussion’ CBE topic and break it up into four sectors. First, efforts to preserve life;
second, interventions to preserve health (vaccination, hygiene, etc.); third, improving the quality of life; fourth, the struggle for an active longevity. He added that according to WHO, CBE should be a harmonic component in primary health care and that at the secondary and tertiary levels CBE is less in demand. About his experience, the
practical CBE skills are performed during the summer internship, where students are in rural areas far from the center, they visit farms, groups of rural residents, rural hospitals, where there is a talk with people on certain planning topics. He also said that practice shows that a live chat with a health worker gives a greater effect than the distribution of booklets, posters, Internet communications, radio and television broadcasts.
Hani Salem from Egypt said that Field training in Community-Based Medical Education (CBME) is a great medium for applying the principles of interprofessional education and collaboration, it is an opportunity to learn in a safe environment and it is a way of exchanging knowledge and experiences.
Kathleen Harris from Canada agrees to Hani’s point of view as she mentioned that stronger CBE experiences facilitate inter-professional collaboration opportunities for students. In her University; student members of many health care disciplines work together in a rural community in education or a health promotion activity giving a very
positive feedback. She stresses that for success of IPE and IPC we need to improve the ability to walk in with an open mind, without an inflexible pre-determined agenda and to truly appreciate the perspective of the community. Building the trust of the community is
needed to be privileged to true collaborative communications in a CBE experience.
She thinks that the gap between the knowledge on the value of inter-professional education and the long-standing need for improvement. Quality, holistic care of communities and individuals of those communities, takes strong inter-professional team work and respect. This will only come with stronger CBE experiences that make this a priority and facilitate inter-professional collaboration opportunities.
Gissele Damiani-Taraba from Canada presents another experience where the government has supported the development of Family Health Teams (FHTs) who work together in the community. They focus on chronic disease management, disease prevention and health promotion. FHTs offer placements for student of various health professions to interact with other students and learn, with, from and about each other. Gissele demands for more training for staff, students and community stakeholders and providing more placements for students in the community that focus on interprofessional education. Gissele also
suggests that there is a need for more resources/tools/strategies to offer to organizations so that in turn, they can offer more IPE opportunities for students and staff.
Hani Salem (from Egypt) suggestions for improvement were: to accurately stating the mission and objectives of field training and communicating such mission and objectives to the academic and administrative staff members as well as students in the schools, to
make the necessary reform in the curriculum, to raise the awareness of the students and field training tutors about the importance of CBME, to coordinate with the officials of the Ministry of Health and finally to allocate more scores on the field training activities with
follow-up of its activities.
Educational psychologists claimed that learning is a collaborative and interactive process. Learning in homogenousheterogeneous groups will result in deeper learning. Egypt team agrees to what many of the contributors mentioned, IPE fits best in the primary care setting where students have the opportunity to tailor their projects and activities to the specific needs of a certain community. More important is to adopt the positive attitude about the value of learning with different professionals, the role of each professional
and the benefits for the patients and health care system from good interprofessional collaboration.
Barriers to IPE will not disappear by simply being ignored, but they can be managed and overcome. IPE strategies may well contribute to the development of the knowledge and skill required by learners and practitioners, but only if (a) the goals of IPE are agreed among stakeholders; (b) the desired outcomes are clearly specified; (c) the most effective methods of delivery at different stages of professional training are determined; (d) robust evaluation is incorporated using both qualitative and quantitative approaches.
IPE must not only foster good communication skills and awareness of the roles of team members, but it must enable students to recognize, value, and engage with the difference arising from the range of health professional knowledge and practice. In your discussions you suggested innovative and important ideas for improvement of CBE and IPE.
Suggestions for future improvements might include:
(1) Identify curriculum gaps and work with stakeholders to modify it in-favor of IPE
(2) locate champions: someone with authority and influence in each participating profession to support the initiative;
(3) Future cooperation with other schools within the same university to conduct several joined sessions at training sites
(4) Start a future project where the mixed model can be used in sites and topics such as: geriatric care institutions, diabetic foot care societies
(5) Train faculties and clinicians first: teachers must be able to incorporate team principles and skills into their work and model them for learners;
(6) Another idea is to add the dimension of quality improvement of health services to CBE with help of interprofessional teams.
* Interprofessional Education for Collaborative, Patient-Centred
Practice - 146.2 KB, application/pdf
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