The economic burden of chronic pain extends beyond financial terms, and also includes both direct and indirect societal and workplace costs. Due to the diverse and complex nature of many pain problems, however, multidisciplinary team approaches to treatment and management are required, which necessitate innovative educational strategies to enable culturally appropriate and high-quality health care. This article discusses the global issue of pain and describes a Master’s program developed by the Pain Management Research Institute at the University of Sydney (Sydney, Australia) and three other universities aimed at facilitating the delivery of an online, graduate-level pain education program. The opportunities and advantages of such alliances and the incorporation of recent advances in information and communications technology are discussed from institutional, academic and student perspectives.
The effective management of pain is a complex and costly global issue, requiring a range of innovative educational strategies to enable culturally appropriate and high-quality health care provision. In response to this issue, the Pain Management Research Institute at the University of Sydney (Sydney, Australia) has established several strategic alliances with other overseas universities to deliver online postgraduate education in pain management. The present article discusses the rationale for joining forces, and the approach adopted in creating and maintaining these alliances. It also provides insights into the benefits, challenges and opportunities associated with collaborative educational initiatives of this nature, from institutional, academic and student perspectives.
Educational collaboration; Internationalization; Online education; Pain management; Partnership; Postgraduate
An overview of medical education at both the undergraduate and postgraduate levels in Canadian faculties of medicine is provided. Particular attention is focused on changes that have occurred in the 1990s and their effect on medical students and on educational programs. Also considered are the effects of reductions in the number of entry-level positions for residency training and the changes in educational requirements for licensure on senior medical students.
Today universities have to compete for the best brains more than ever before. The issues of reconciliation of work/study and family and the work-life balance have become increasingly important recently in higher education policy development as higher education institutions in the competition for the best minds are already forced to tackle these issues, some of which are still novel to them, as they are faced with demographic change. High dropout rates among students with children, increasing shortages of physicians and high sector emigration and high levels of childlessness among graduates serve as indicators for urgent action towards more family-oriented university and faculty strategies.
But how can medical schools, hospitals and (teaching) hospitals achieve a family-oriented profile? Which key players, which areas of higher education management are relevant to management and decision-making structures? What exemplary measures for designing family-friendly medical studies and work places offer success?
The underrepresentation of women in the next generation of scientists also poses an additional challenge to the development of an innovative higher education policy if it is to be sustainable. Thus strategies promoting the next generation and family orientation are key factors for a future-oriented higher education policy. These factors should therefore be seen as leadership strategies which will introduce measures that will make (re)design the university’s profile. To this end, a holistic approach which will lead to fundamental reforms of higher education structures which are outlined below and illustrated with examples are a prerequisite for successful implementation.
Work-Life-Balance; family-friendliness; medical studies; study design; equality
The rapid growth of individual undergraduate courses, minors, and baccalaureate degrees in public health presents a new issue for graduate public health education: how does a graduate or professional program address previously completed undergraduate public health coursework? A review of college directories found listings for 154 North American baccalaureate degrees in public health, public health education, and public health nursing. This article addresses the purposes of public health undergraduate education as (1) general liberal arts education, (2) education complementary to other non-public health graduate degrees, (3) preprofessional education, and (4) professional education preparing undergraduates for entry-level careers. Following a discussion of reasons to consider articulation of undergraduate and graduate degrees, as well as barriers to articulation, the article presents potential strategies for articulation and future issues to consider in addressing admission of undergraduate public health students to master of public health programs.
Critical appraisal of scientific literature is an integral part of Evidence Based Medicine (EBM). Many medical practitioners have either limited or no formal education in research and are inadequately prepared to critically analyze the quality of research they are reading. This study presents the instructional strategy, students’ evaluation and the feedback of the undergraduate and postgraduate students on teaching critical appraisal of published medical literature to undergraduate and postgraduate students in the Ziauddin Medical University, Karachi, Pakistan.
Two batches of undergraduate medical students of Year-3 (n = 85) and a group of (n = 18) postgraduate students in basic sciences, community health sciences and family medicine.
After 170 hours of teaching of biostatistics, epidemiology and survey methodology in Year-1 & 2, in Year-3 of undergraduate curriculum, six 2-hour structured sessions for critical appraisal of research articles published in peer reviewed journals were held.
All (N=103) students who took the course appeared in the objective structured practical examination (OSPE), where out of 100 they scored 74.3 ± 9.1. The studentds’ feedback on a 5-point Likert’s scale questionnaire showed the mean of overall satisfaction of the students is 3.93, and appreciation of relevance of quantitative subjects to understand medical literature is 4.89. All respondents agreed and strongly agreed the course helped them appreciate the relevance of quantitative subjects to understanding of medical literature
This course should be considered as the first step in the journey of becoming a competent self learner and should be followed by courses on EBM.
Evidence based medicine; critical appraisal skills
The development of a seamless general practice 'spiral' curriculum, in which topics may be revisited at different levels of intensity and complexity during the learning process, has been discussed in the context of undergraduate-postgraduate co-operation. Although the lifelong curriculum for all doctors contains a number of core competencies that aim to produce a 'stem' doctor, concerns remain about the effects of excessive reductionism. It is therefore essential that the content and delivery of the spiral curriculum ensure that intellectual interest is nurtured, by containing both taught theory and training in a hospital context. The opportunity for generalists to teach core competencies such that general practice is at the centre of the undergraduate curriculum--emphasising working within primary health care teams in teaching and training practices--is an ideal area for undergraduate-postgraduate co-operation. The use of the directly observed measures of performance would bring the undergraduate approach to assessment closer to that used in postgraduate general practice. However, supporting the tutors' network is crucial in undergraduate departments where much can be gained by joint working with postgraduate colleagues.
India has approximately 335 medical colleges, which produce around 40,000 medical graduates annually. Even though medical professional have a critical role in prevention and control of noncommunicable diseases (NCDs) including injuries, it has been observed that the present medical and nursing curriculum in India does not adequately cover prevention and control of NCDs. The topics for specific approach to prevent NCDs and various strategies can be incorporated into public health and clinical courses in undergraduate medical education, with brief optional courses in residency and continuing medical education for established practitioners. High-level expert group instituted by Planning Commission of India on Universal Health Coverage recommended that medical education requires greater orientation of providers to the social determinants of health as well as to gender and equity issues. Curricula in medical schools should keep pace with the changing dynamics of public health, health policy, and health demographics. Medical education and training should be reoriented by introducing competency-based, health system connected curricula, and continuous education. There is a need to review of medical curriculum, introducing innovative integrated teaching methods, and capacity building of teachers for meeting the challenge of rising burden of NCDs in India.
Curriculum; medical education; noncommunicable diseases; prevention; training
Changes in modern healthcare's provision, complexity, and workforce demands provide a compelling rationale for an increasing emphasis on leadership development at all levels of training within the medical profession. Undergraduate medical education has traditionally focused on the development of clinical acumen with little emphasis on the development of leadership skills or on the operational and systemic issues surrounding healthcare delivery. Incorporating leadership education and competencies presents a number of challenges to medical schools, including defining the subject area, determining the specific skills and knowledge bases that should constitute the basis of the program, and optimizing training to be integrated into the existing clinical curriculum. We present a case study of the Medical Leadership Program at The University of Queensland School of Medicine that runs concurrent to the undergraduate medical degree. We outline the inception of the program, its aims, participant selection, and program components and reflect on the program to date.
Curriculum; leadership; medical education; medical student
The purpose of this study was to determine resident satisfaction with an acute care psychiatric clinic designed in collaboration with a nearby community mental health center. We also sought to demonstrate that this rotation helps meet program requirements for emergency psychiatry training, provides direct assessments of resident interviewing skills and clinical knowledge in the postgraduate year-1, and provides exposure to public sector systems of care.
We developed a resident satisfaction questionnaire and fielded it to each of the residents who participated in the clinic over the first 3 years. Data were collected, organized, and analyzed.
Of the 15 residents in the acute care psychiatric clinic, 12 completed and returned the satisfaction questionnaires. Educational aspects of the clinic experience were rated favorably.
This postgraduate year-1 acute care psychiatric clinic provides a mechanism for the fulfillment of emergency psychiatry training as well as direct supervision of clinical encounters, which is a satisfactory and useful educational experience for trainees.
Graduate and postgraduate health-care professional training and postdoctoral fellowship programs that deny trainees opportunities to practice both oral and written communication skills produce an incompletely trained health-care provider unable to compete for faculty positions at university hospitals and affiliated staffs. Therefore, it is imperative that program directors make medical writing a prerequisite to successful completion of postgraduate training programs. To make trainees as well as administrators and faculty aware of the importance of oral and written communication skills, a variety of oral abilities needed for presenting medical findings prior to publication are detailed. The use of 2 x 2 slides to support a presentation as well as transparencies, movies, and videotapes are considered. The poster session/scientific exhibit, now becoming more visible because of increasing attendance at professional meetings, is also explained. Written communication abilities are discussed. Consideration is given to the writing of professional manuscripts for publication in a refereed journal. Other types of written communication include case reports, clinicopathological conferences, letters to the editor, book reviews, books, and book contributions. The opportunity to learn needed skills must be offered in the postgraduate health-care curriculum. Mandatory medical writing will maximize the marketability of black health-care professionals for faculty staff placement. Moreover, the establishment of a "track record" early in a professional career will increase the likelihood that black health providers are awarded grants for research.
Public health educational pathways in Australia have traditionally been the province of Universities, with the Master of Public Health (MPH) recognised as the flagship professional entry program. Public health education also occurs within the fellowship training of the Faculty of Public Health Medicine, but within Australia this remains confined to medical graduates. In recent years, however, we have seen a proliferation of undergraduate degrees as well as an increasing public health presence in the Vocational Education and Training (VET) sector.
Following the 2007 Australian Federal election, the new Labour government brought with it a refreshing commitment to a more inclusive and strategic style of government. An important example of this was the 2020 visioning process that identified key issues of public health concern, including an acknowledgment that it was unacceptable to allocate less than 2% of the health budget towards disease prevention. This led to the recommendation for the establishment of a national preventive health agency (Australia: the healthiest country by 2020 National Preventative Health Strategy, Prepared by the Preventative Health Taskforce 2009).
The focus on disease prevention places a spotlight on the workforce that will be required to deliver the new investment in health prevention, and also on the role of public health education in developing and upskilling the workforce. It is therefore timely to reflect on trends, challenges and opportunities from a tertiary sector perspective. Is it more desirable to focus education efforts on selected lead issues such as the "obesity epidemic", climate change, Indigenous health and so on, or on the underlying theory and skills that build a flexible workforce capable of responding to a range of health challenges? Or should we aspire to both?
This paper presents some of the key discussion points from 2008 - 2009 of the Public Health Educational Pathways workshops and working group of the Australian Network of Public Health Institutions. We highlight some of the competing tensions in public health tertiary education, their impact on public health training programs, and the educational pathways that are needed to grow, shape and prepare the public health workforce for future challenges.
Several forces have resulted in the creation in Tayside of the first formally integrated unit of undergraduate and postgraduate education in general practice in the United Kingdom. Forces that helped this integration included the desire for change, national developments in education, financial support through funds set aside to cover the additional cost of teaching, and a management structure which concentrates on shared leadership. Forces that hindered the integration included uneasiness about ideas for reforming traditional structures, institutional inertia, the complexity of financial arrangements, and tensions over priorities. The experience of managing institutional changes in Tayside has been invaluable and will lead to a more cohesive approach to undergraduate teaching, postgraduate training, and the provision of services relevant to the development of general practice.
Over the last two decades, concern has been expressed about the readiness of the public health workforce to adequately address the scientific, technological, social, political and economic challenges facing the field. A 1988 report from the Institute of Medicine (IOM) served as a catalyst for the re-examination of the public health workforce. The IOM's call to increase the relevance of public health education and training prompted a renewed effort to identify competences needed by public health personnel and the organizations that employ them.
A recent evaluation sought to address the role of the 10 essential public health services in job services among the Texas public health workforce. Additionally, the evaluation examined the Texas public health workforce's need for training in the 10 essential public health services.
Results and conclusion
Overall, the level of perceived training needs varied dramatically by job category and health department type. When comparing aggregate training needs, public health workers with greater day-to-day contact (nurses, health educators) indicated a greater need for training than their peers who did not, such as those working in administrative positions. When prioritizing and designing future training modules regarding the 10 essential public health services, trainers should consider the effects of job function, location and contact with the public.
In July 1987, a workshop was held to evaluate the environmental health workforce. The workshop was sponsored by the Bureau of Health Professions. Health Resources and Services Administration of the Public Health Service. Participants were drawn from State and local agencies, Federal agencies, industry, and academia. Estimates of workforce needs were based on background information and informed consensus judgments of workshop participants. The final report of the workshop was published in January 1988. The authors synthesize some of the consensus judgements and review data from a position paper developed for the workshop. The supply, demand, and projected need for new academicians in environmental health on both graduate and undergraduate levels through 1992 are estimated. These estimates are based on the need for persons trained in the various environmental health subspecialties identified during the workshop. Outlined are the number and educational backgrounds of new faculty required. The types of new training programs that are required to meet the needs for environmental health specialists through 1992 are discussed.
The postgraduate hospitals of London grew up in the nineteenth century and offered a unique national specialist service. Since then specialist services have developed in undergraduate hospitals throughout Britain as well as in London, but the postgraduate hospitals have nevertheless preserved their high levels of staffing. Although numbers of medical posts in the provinces have grown, this has not been by redistribution of London posts but merely differential growth. The fact identified by Tomlinson--that Londoners are not receiving the most appropriate clinical care--is in fact the strongest argument for changing postgraduate medical education. Such education needs to be rooted first in clinical care, though Tomlinson underestimates the importance to education of such care being sited in a shared environment with strong scientific activity.
To assess undergraduate and postgraduate pharmacy students' perceptions of plagiarism and academic honesty.
A questionnaire was administered to undergraduate and postgraduate pharmacy students to determine their levels of awareness of university policy concerning academic honesty; attitudes to plagiarism by rating the acceptability of a range of plagiarizing and cheating practices; and choice of appropriate penalties for a first and second occurrence. The choice of behaviors in response to a scenario about the preparation of a reading-based written assignment and the strategies that students would be prepared to use in order to submit the assignment on time were also assessed.
Findings indicated widespread deficiencies in student knowledge of, and attitudes towards, plagiarism. Students did not perceive plagiarism as a serious issue and the use of inappropriate strategies for sourcing and acknowledging material was common.
The study highlights the importance of achieving a balance among the 3 dimensions of plagiarism management: prevention, detection and penalty.
academic honesty; plagiarism; cheating; Australia
In 2002, the University of Minnesota School of Public Health (UMNSPH) adopted an approach that supports basic, advanced, and continuing education curricula to train current and future public health workers. This model for lifelong learning for public health practice education allows for the integration of competency domains from the Council on Linkages Between Academia and Public Health Practice's core public health workforce competency levels and the Centers for Disease Control and Prevention's Bioterrorism and Emergency Readiness Competencies.
This article describes how UMNSPH has implemented the model through coordination with state planning efforts and needs assessments in the tristate region of Minnesota, North Dakota, and Wisconsin. In addition, we discuss methods used for credentialing practitioners who have achieved competency at various levels of performance to enhance the capacity of the public health preparedness systems.
Because of the need for a well-trained public health workforce, professional competencies have been recently revised by the Institute of Medicine and the National Health Educator Competencies Update Project. This study compared the self-identified training needs of public health educators with the updated competencies and assessed employer support for continuing education.
A convenience sample of public health educators was recruited from an e-mail list of San Jose State University master of public health alumni. Respondents completed a Web-based survey that elicited information on emerging trends in public health education, training needs, and employer support for continuing education.
Concerns about funding cuts and privatization of resources emerged as a theme. Key trends reported were an increase in information technology, the need for policy advocacy skills, and the importance of a lifespan approach to health issues. Primary areas for training were organization development, evaluation, and management. Although most employers were reported to support continuing education, less than two-thirds of respondents were reimbursed for expenses.
These findings have implications for both research and practice. Innovative technologies should be developed to address health education professionals' training needs, and emerging themes should be incorporated into curricula for students.
This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base. Although the public health workforce is central to the performance of health systems, very little is known about its composition, training or performance. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems? Other questions concern: the nature of the public health workforce, including its size, composition, skills, training needs, current functions and performance; the appropriate roles of the workforce; and how the workforce can be strengthened to support new approaches to priority health problems.
The available evidence to shed light on these policy issues is limited. The World Health Organization is supporting the development of evidence to inform discussion on the best approaches to strengthening public health capacity in developing countries. WHO's priorities are to build an evidence base on the size and structure of the public health workforce, beginning with ongoing data collection activities, and to map the current public health training programmes in developing countries and in Central and Eastern Europe. Other steps will include developing a consensus on the desired functions and activities of the public health workforce and developing a framework and methods for assisting countries to assess and enhance the performance of public health training institutions and of the public health workforce.
Where is the present flurry of activity in medical education leading and what sort of future is envisaged? This paper looks at trends in postgraduate medical education. Four themes and two trends for each theme have been identified. The themes are: the postgraduate medical curriculum, the application of learning technologies, assessment of competence, and professionalism in medical education. The trends are: outcome based education and a unitary approach to medical education; the use of simulators and e‐learning; competency and performance based assessment, and portfolios and self assessment; and training the trainer and best evidence medical education. Any limitations in implementing change will likely result from a lack of imagination in those planning postgraduate medical education and their ability to bring about the necessary changes. To avoid a growing gap developing between what is possible educationally and what is delivered, it is clear that we need a new paradigm for postgraduate medical education.
e‐learning; medical education; postgraduate; simulators
To design and assess an educational program for preparing pharmacy students for success during the American Society of Health-System Pharmacists Midyear Clinical Meeting (ASHP-MCM) and postgraduate training search.
An informational handout packet was prepared and a 1-hour educational forum was conducted prior to the 2007 and 2008 ASHP-MCMs. Following the ASHP-MCM, participating students were invited to complete an anonymous online survey instrument.
Among the 66 participating students, 73% agreed they were adequately prepared for the ASHP-MCM, with 89%, 80%, and 79% agreeing the educational forum equipped them for their activities preceding, during, and following the ASHP-MCM, and 90%, 83%, and 69% agreeing the informational handout packet equipped them for their activities preceding, during, and following the ASHP-MCM. Among 14 students seeking a residency during the 2008 ASHP-MCM, 86% were successfully placed with a program.
An educational program was useful in preparing students for success during the ASHP-MCM and postgraduate training search.
pharmacy student; residency; postgraduate training; Midyear Clinical Meeting
Postgraduate education for medical librarians is approachable from several perspectives, including internships, certificate programs, and continuing education programs. The diverse population of medical library personnel calls for a varied yet coordinated system of postgraduate education involving the Medical Library Association, regional medical libraries, library schools, and the National Library of Medical, in addition to active participation by all librarians in the health sciences field. Basic philosophies for each of the major types of programs are discussed and recommendations for future training of health sciences librarians are provided.
BACKGROUND. Diabetes can be effectively treated and monitored in general practice. Postgraduate medical education at a local level is required to support this strategic shift of medical care from hospital to general practice. AIM. This study set out to determine whether a structured educational programme initiated by and led by general practitioners, but involving all health professionals, leads to improved care for diabetic patients. METHOD. The primary health care teams from 12 of the general practices in Tynedale, Northumberland who attend the local postgraduate centre and refer patients to the local general hospital were involved in the educational initiative which led to a locally agreed protocol for diabetic care. A comparison was made of data for all diabetic patients, registered with the general practitioners in 1991, in the years 1986 and 1991 (before and after the educational initiative) in order to determine the prevalence of diabetes, place of care and treatment received, and to collect clinical information. RESULTS. More patients received general practice care only or shared care in 1991 than in 1986. There was a reduction in the use of oral hypoglycaemic agents among non-insulin dependent diabetic patients and more patients were maintained on diet alone. A greater proportion of patients were referred to dietitians, ophthalmologists and chiropodists in 1991 than 1986, and there was increased recording of, examination of, and identification of, diabetic complications. Little change was found in the mean values for clinical parameters between the two years. CONCLUSION. Structured educational programmes involving all professionals are an effective way of producing protocols that are adhered to by all concerned, and lead to improved clinical care for diabetic patients.
Distance learning is an effective strategy to address the many barriers to continuing education faced by the public health workforce. With the proliferation of online learning programs focused on public health, there is a need to develop and adopt a common set of principles and practices for distance learning. In this article, we discuss the 10 principles that guide the development, design, and delivery of the various training modules and courses offered by the North Carolina Center for Public Health Preparedness (NCCPHP). These principles are the result of 10 years of experience in Internet-based public health preparedness educational programming. In this article, we focus on three representative components of NCCPHP's overall training and education program to illustrate how the principles are implemented and help others in the field plan and develop similar programs.
Many countries have recently reformed their postgraduate medical education (PGME). New pedagogic initiatives and blueprints have been introduced to improve quality and effectiveness of the education. Yet it is unknown whether these changes improved the daily clinical training. The purpose was to examine the impact of a national PGME reform on the daily clinical training practice.
The Danish reform included change of content and format of specialist education in line with outcome-based education using the CanMEDS framework. We performed a questionnaire survey among all hospital doctors in the North Denmark Region. The questionnaire included items on educational appraisal meetings, individual learning plans, incorporating training issues into work routines, supervision and feedback, and interpersonal acquaintance. Data were collected before start and 31/2 years later. Mean score values were compared, and response variables were analysed by multiple regression to explore the relation between the ratings and seniority, type of hospital, type of specialty, and effect of attendance to courses in learning and teaching among respondents.
Response rates were 2105/2817 (75%) and 1888/3284 (58%), respectively. We found limited impact on clinical training practice and learning environment. Variances in ratings were hardly affected by type of hospital, whereas belonging to the laboratory specialities compared to other specialties was related to higher ratings concerning all aspects.
The impact on daily clinical training practice of a national PGME reform was limited after 31/2 years. Future initiatives must focus on changing the pedagogical competences of the doctors participating in daily clinical training and on implementation strategies for changing educational culture.