Building Health Workforce Capacity Through Community-Based Health Professional Education Workshop Summary (2015) / Chapter Skim
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2 Skill Sets and Pedagogy
2 Skill Sets and Pedagogy
Pages 25-52
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• Community health and public health principles need to be threaded throughout the educational process. (Morton, Siega-Sur)
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Velde said that community members taught the students these competencies even before the health professionals began educating students on their professional competencies, because community comes first in a community-built health practice. Velde's work drew heavily from the interprofessional educational methodology.
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For many years, training of health workers in the Philippines has used a Western-based, hospital-oriented model, which resulted in their graduates leaving the country. This particularly affected the University of the Philippines College of Medicine, who found that 63 percent of their medical graduates leave the country versus the national medical school average of 50 percent (Bonifacio, 1978; Estrada, 1978)
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SERVICE LEAVE & LICENSURE Certificate in Community Health Work (Midwifery) Scholar nominated by an underserved community FIGURE 2-1 The stepladder curriculum.
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As noted in Figure 2-2, the star displays the skill sets taught to students, and the small circles at the edge of the star represent the five competency areas described earlier, which are health care provider, community organizer and mobilizer, health service and program manager, researcher, and trainer/ educator. Threaded into all of these competency areas are four main skill sets -- communication, advocacy, cultural competence, and decision making.
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• Management of the BHS/BHC • Data collection on vital statistics, survey • Health education to individuals and families NOTE: BHS/BHC = Barangay Health Station/Barangay Health Center; CHDP = community health development program; MCH = maternal and child health; MHDP = Municipal Health Development Plan; M/S = medical-surgical. SOURCE: Siega-Sur, 2014.
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in the Philippines, the UP-SHS curriculum has a very strong service orienta Figure 2-2 tion in their students' training. There is much dialogue about compassion, equity, social accountability, and commitment to serve the communities that nominated them to train as health workers.
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In essence, Siega-Sur said, the goal is to train students to think creatively and to network and collaborate with health or nonhealth stakeholders in the community who are in a position to improve health outcomes. For several of their cohorts, Siega-Sur reported successfully bringing down maternal mortality rates as well as infant mortality rates (Zuellig Family Foundation, 2013a,b)
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Adapted from Asian Institute of Management, n.d.
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One level assesses student learning, and the second evaluates the effect students have on community health indicators, as established by the Department of Health. Such indicators might include studying whether student placement in the community increased facility-based childbirth or increased the number of deliveries handled by skilled birth attendants.
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CHANNELS Project Jennifer Morton, University of New England Jennifer Morton is Program Director for the Department of Nursing at the University of New England. She is also a core faculty member for the Interprofessional Education Collaborative at the university, which is located in Maine.
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The program, called CHANNELS (Community, Health, Access, Network, Navigate, Education, Leadership, Service) , is based on a model of education for students, training of health professionals, and service to the community (see Figure 2-4 for the program model)
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SKILL SETS AND PEDAGOGY 37 CHANNELS To improve the health of immigrants and refugees through innovations in community-based interprofessional care Education Training Service-IPCP Integrated Expanded Curriculum Community Health Riverton Health Health Professions Outreach Worker Center Students (CHOW) Model Interprofessional SmilePartners Oral Team Training Health Program IPCP Population Focused Public Health Nurse Leader Activities Institute-Statewide FIGURE 2-4 CHANNELS program model.
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She believes that community health and public health principles need to be threaded throughout the educational process and not presented as a stand-alone course. Therefore, in designing their program, Morton and her colleagues elected to integrate population health throughout the students' education and to teach the more advanced skills for community and population health during the final semester.
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So, Morton and her colleagues developed a public health nursing institute that provides public health nurses in the field with advanced public health nursing skills, as well as leadership development. Service to the Community The interprofessional clinical practice environments of Morton's program included the rollout of a new health center that was part of an FQHC, an oral health program, and roughly 50 public health activities that have been critical to the work of their program.
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Therefore, Morton and her colleagues built a community-based clinic that is a satellite of the local community health center. In building the community-based clinic, Morton's group conducted a formal needs assessment and asked the community members what services they wanted, and even how the clinic should be decorated.
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for their education and training model for communication, quality, and safety and to measure progress toward and attainment of important interprofessional skills among her students and community health professionals. For the service side of Morton's program, she relies heavily upon usage reports, electronic medical records, and satisfaction measured through Consumer Assessment of Healthcare Providers and Systems (CAHPS)
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What he looked forward to was see BOX 2-2 Debate Topics and Forum Member Debaters Admission Versus Training: Rick Kellerman, American Academy of Family Physicians Sarita Verma, University of Toronto Longitudinal Versus Block: Lucinda Maine, American Association of Colleges of Pharmacy Holly Wise, American Council of Academic Physical Therapy Virtual Versus Real: Pam Jeffries, Johns Hopkins University School of Nursing Eric Holmboe, Accreditation Council for Graduate Medical Education
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Debate Number 1: Admission Versus Training In framing the first debate, Newton expressed the opinion that social accountability of health professional education involves placing health professionals in rural and underserved communities. However, this has been a challenge throughout the world.
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BOX 2-4 Longitudinal Rotations Versus Block Rotations Proposition Should health professions education of the future promote the use of lon gitudinal clinical educational experiences to the advantage of patients, learners, sites, and academic programs? Vote 1: Those in favor of longitudinal education Vote 2: Those in favor of block rotations
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Jeffries then reiterated her view that first should be mastery of the competency using virtual or simulated experiences, and next should be the BOX 2-5 Virtual Versus Real Proposition Should a priority of health professions education be the development of ro bust simulations that can be used to train and assess the variety and complexity of behaviors necessary to implement the Triple Aim? Vote 1: Those in favor of virtual education Vote 2: Those in favor of educating with real patients
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However, if the goal is to produce health workers with experience in working with people, educators may want to rethink the structure. His final remark involved the cost of high-fidelity simulation.
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Bjorg Palsdottir Belgium I would not want to choose between the two. Around the world, the pool of health professional students in higher education tends to be drawn from similar economic and social backgrounds.
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Doing block rotations in the community could result in making the community fit into the university's academic objectives rather than fitting students into the dynamics of the community. Maria Tassone Canada We in Canada are experimenting with what has been traditionally longitudinal and moving more toward a rotational design, but within the same system, within the same site.
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That experience takes place in many different forms and shapes within the context of human conversation. Bjorg Palsdottir Belgium I want to emphasize the need for partnering with communities throughout the entire educational process so communities co-own the education of their health professionals.
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Low technology simulation skills labs provide hands-on training opportunities in order to scale up the number of health workers produced. Maria Tassone Canada I would agree with the important role for simulation, but I think there is an opportunity to be more thoughtful about the role that simulation plays.
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Presented at the IOM workshop: Scaling up best practices in community-based health professional education. Washington, DC, May 1.
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