Canada, like other countries around the world, has health inequities. The literature on social accountability and responsibility urges medical schools to be grounded in the needs of communities to address health inequities. The Canadian professional and regulatory bodies promote the CanMEDS Competencies of which one, the Health Advocate Competency, speaks of addressing community issues. Yet medical schools face challenges actualizing social responsibility and teaching the Health Advocate Competency. Therefore it is important to understand how the teaching of health advocacy and social responsibility is incorporated into the undergraduate curricula of self-defined socially responsible medical schools in Canada. In this study, mixed methods were used beginning with a semi-structured questionnaire administered to undergraduate Course Directors at two medical schools in Canada with a response rate of 74% (n=60). This was followed by a series of open-ended interviews with eleven equity leaders to bring their perspective into the data collection and establish knowledge about frontline intersectional equity work. The major theoretical lens encircling this work was intersectionality which examines historical oppression and how the intersection of gender, race, and class compound health inequities. Questionnaire results made it clear that biomedical ideology and the CanMEDS Medical Expert Competency were privileged in the undergraduate curriculum at the expense of other knowledge such as health advocacy and social responsibility. The objective biomedical discourse ignores or marginalizes important social influences on health which are highlighted by using an intersectional lens. The semi-structured interviews provided rich data about working in an intersectional equity framework highlighting the impact of the intersections of race, gender, class and other identities on health inequities. These interviews also demonstrate the importance of health advocacy in improving health care outcomes and addressing social responsibility. Incorporating intersectionality into previously accepted assessment tools for physicians adds an important dimension to the health care encounter. Explicitly embedding social responsibility and health advocacy in the medical school mission and curriculum is essential to their acceptance. A series of supporting recommendations are offered.

Canada, like other countries around the world, has health inequities. The literature on social accountability and responsibility urges medical schools to be grounded in the needs of communities to address health inequities. The Canadian professional and regulatory bodies promote the CanMEDS Competencies of which one, the Health Advocate Competency, speaks of addressing community issues. Yet medical schools face challenges actualizing social responsibility and teaching the Health Advocate Competency. Therefore it is important to understand how the teaching of health advocacy and social responsibility is incorporated into the undergraduate curricula of self-defined socially responsible medical schools in Canada. In this study, mixed methods were used beginning with a semi-structured questionnaire administered to undergraduate Course Directors at two medical schools in Canada with a response rate of 74% (n=60). This was followed by a series of open-ended interviews with eleven equity leaders to bring their perspective into the data collection and establish knowledge about frontline intersectional equity work. The major theoretical lens encircling this work was intersectionality which examines historical oppression and how the intersection of gender, race, and class compound health inequities. Questionnaire results made it clear that biomedical ideology and the CanMEDS Medical Expert Competency were privileged in the undergraduate curriculum at the expense of other knowledge such as health advocacy and social responsibility. The objective biomedical discourse ignores or marginalizes important social influences on health which are highlighted by using an intersectional lens. The semi-structured interviews provided rich data about working in an intersectional equity framework highlighting the impact of the intersections of race, gender, class and other identities on health inequities. These interviews also demonstrate the importance of health advocacy in improving health care outcomes and addressing social responsibility. Incorporating intersectionality into previously accepted assessment tools for physicians adds an important dimension to the health care encounter. Explicitly embedding social responsibility and health advocacy in the medical school mission and curriculum is essential to their acceptance. A series of supporting recommendations are offered.

From 1950 to 2000 the former Faculty of Medicine, University of Natal, Durban, pursued the traditional, didactic curriculum. The implementation of problem-based learning, Curriculum 2001, introduced many changes in the curriculum where facilitators guide instead of teach students. Based on this it is important to understand the principles of problem-based learning (PBL) more extensively and the demands that may be made on the Library and the Librarians. It is assumed that a partnership exits between the librarians and the School of Undergraduate Medical Education (SUME). The object of this study is to determine whether the introduction of Curriculum 2001 impacted on the role and functions of the library and the librarians. The 5th year students from the Traditional Curriculum and 2nd year students from Curriculum 2001 were selected to participate in this study. The methods used in this study were the analysis of the minutes of the meetings that were held to discuss and plan Curriculum 2001 of the Curriculum Development Task Force, questionnaires for the undergraduate students and semi-structured interviews with the facilitators in Curriculum 2001 and medical librarians. The minutes of the CDTF were examined to ascertain if the librarians had any input in Curriculum 2001. The interviews would determine whether PBL had an impact on the role and functions of the library and the librarians. Four librarians and 15 facilitators were interviewed. Quantitative and qualitative methods were used in this study with the assistance of the EPI Info and NVivo software to analyze the results. The results of this study indicated that there is room for greater and enhanced collaboration and faculty partnerships between SUME and the library to assist the students to improve and develop their information literacy skills that are integral part in problem solving in the PBL curriculum. / Thesis (M.Ed.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.

Introduction: No protocol for assessing ultrasound imaging skill has been validated. We sought to develop and validate an assessment protocol for ultrasound imaging for the Focused Assessment with Sonography for Trauma. Methods: Our assessment tool consisted of task checklists, a global rating scale, and hand-motion analysis and was developed by a modified Delphi technique. Novice and expert cohorts were recruited to perform a FAST exam on a volunteer for assessment under the protocol. Results: Experts scored higher on static image acquisition (11.58 of 16 versus 6.63, p<0.0001), dynamic image acquisition (17.21 of 24 versus 11.08, p=0.0005), and our global rating scale (29.79 of 40 versus 18.42, p<0.0001); experts used fewer movements (263.0 movements versus 452.4, p=0.0216) and a shorter path length than novices (60.097 m versus 32.777 m, p=0.0041). Conclusion: Our protocol for assessing ultrasound imaging skill has criterion validity in assessing expertise and may lead to improvements to training and credentialing programs.

In the context of a country and a continent that is largely rural, education for rural medical practice in Africa is relatively undocumented and poorly conceptualized. The arena of medical education in South Africa has been largely unchanged by the transition to democracy, despite intentions of reform. The literature reveals a lack of empirical evidence as well as theory in education for rural health, particularly in developing countries. This report presents twelve original papers on a range of key issues that represent the author’s contribution to filling this gap in South Africa. It aims to contribute to the development of a discourse in education for rural medical practice in an African context, and culminates in a theoretical paper regarding pedagogy for rural health. A conceptual framework is utilized that is based on the standard chronological steps in the initial career path of medical doctors in South Africa. Beginning with the literature that is focused around the need to recruit and retain health professionals in rural and underserved areas around the world, the report then addresses the policy context for medical education in South Africa, examining the obstacles to true reform of a transformatory nature. The selection of students of rural origin, and the curricular elements necessary to prepare graduates for rural practice are then investigated, including the actual career choices that medical graduates make in South Africa. Out in the workplace, the educational components of the year of compulsory community service are described, including organizational learning and apprenticeship as novice practitioners, placed under severe pressure in rural hospitals in the South African public health service. A community-oriented type of medical practice is described amongst exemplary individuals, indicating the aspiration towards a different kind of educational outcome. Finally the thesis as such is presented in the final paper regarding a theoretical basis for education for rural health, consisting of the combined notions of placed-based and critical pedagogy. It is argued that while the geographic elements of rural practice require a pedagogy that is situated in a particular rural context, the developmental imperatives of South Africa demand a critical analysis of health and the health care system, and the conceptual basis of this position is explained. / Thesis (Ph.D.) - University of KwaZulu-Natal, Durban, 2010.

Bibliographische Beschreibung Petra Hönigschmid Motivierung von Medizinstudenten zur allgemeinärztlichen Tätigkeit durch Hausärztliche Praktika – eine Prä-Post-Studie Universität Leipzig, Dissertation 62 Seiten, 20 Tabellen, 1 Abbildung, 36 Literaturverweise Referat: In der vorliegenden Arbeit wurde untersucht, inwieweit frühzeitige hausärztliche Praktika am Beispiel des Leipziger Wahlfachs Allgemeinmedizin Vorklinik die Einstellung und den Berufswunsch zur Hausarztmedizin beeinflussen. In einer Prä-Post-Studie wurden alle für dieses Wahlfach eingeschriebenen Medizinstudenten der Universität Leipzig von Februar 2008 bis Februar 2010 befragt. Es konnte gezeigt werden, dass bei einem geeigneten Lehrkonzept die Ausbildung bei niedergelassenen Hausärzten einen positiven Effekt auf die Karrierewahl Allgemeinmedizin hat. Die große Bandbreite an Erkrankungen, die Behandlung komplexer Krankheitsbilder und der Aufbau langfristiger Patientenbeziehungen wurden dabei sehr geschätzt. Nach dem Praktikum stieg der Berufswunsch Allgemeinmedizin signifikant an. Etwa die Hälfte der Studierenden konnte sich eine niedergelassene Tätigkeit vorstellen. Bezüglich der Kontrollierbarkeit der wöchentlichen Arbeitszeit und der Organisation eines vernünftigen Verhältnisses zwischen Arbeit und Freizeit gab es nach dem Praktikum keine wesentlichen Abweichungen. Die Studierenden schätzten dies als realisierbar ein. Auch eine höhere Arbeitsbelastung des Hausarztes im Vergleich zu anderen Fachärzten konnte nach dem Praktikum nicht bestätigt werden. Die vermutete Arbeitszeit eines Hausarztes wurde nach dem Praktikum nach oben korrigiert. Das Interesse an einer Famulatur, einem PJ-Tertial oder einer Promotion in der Allgemeinmedizin war nach dem Praktikum unverändert hoch. Die Evaluierung der Lehrveranstaltung zeigte, dass die Arbeitsweise des Lehrarztes und die damit verbundene Vorbildwirkung für die Studierenden einen wesentlichen Aspekt für die spätere Karrierewahl darstellen.

It is well documented in the literature that Aboriginal peoples have a lower health status compared to the non-Aboriginal population in Canada. The underlining causes for this health disparity are found in the historical and contemporary practices of colonization and social, economic, and political deprivation. This thesis focuses on another of the complex factors which affect Aboriginal health status: the education and training provided to undergraduate medical students on Aboriginal health issues and the social determinants of health in British Columbia. I conducted a critical discourse analysis of the readings materials of three selected courses. I conclude from the analysis that although some of the themes covered by the courses critically present the historical, social and economic contexts for this health disparity, Aboriginal peoples are still characterized as a needy and sick population. Indigenous issues are far from being centrally positioned in the medical curriculum in British Columbia. / Graduate / 0326 / gabipere@hotmail.com

Patient centred collaborative practice between nurses and physicians is currently being promoted worldwide. There is increasing evidence that post licensure interprofessional educational interventions improve patient outcomes but similar evidence for pre-licensure interprofessional learning is lacking. The impact of contemporary nursing and medical education on graduates’ ability to collaborate in the workplace is also unclear. To address this gap, an interview based qualitative study underpinned by hermeneutic phenomenology and informed by the theoretical lens of social identity was designed. Eleven junior registered nurses and eleven junior residents from a single healthcare jurisdiction each, in Canada and the United Kingdom (UK) were interviewed to explore how the processes that lead to socialization, professional identification and identity formation in professional schools are perceived to influence collaborative teamwork upon graduation. Data were as analyzed through iterative naive and thematic interpretations aligned with the hermeneutic process, to arrive at a comprehensive understanding. The impact of contemporary undergraduate nursing and medical education on the ability to practice collaboratively was found to be obfuscated by internal contradictions and overshadowed by the contingencies and demands of the workplace, during residency and early nursing practice in both locations. In medical schools, the intense socialization described in literature was replaced by individual reflection and a struggle to maintain work-life balance. Values internalized were of a sense of responsibility and hard work. Students espoused an attitude of collaboration but lacked training in enabling competencies and practical application. Exposure to interprofessional learning and its impact was variable and inconsistent and formal assertions of collaboration were not consistently modeled by faculty. In nursing schools, the value of caring, self-awareness and assertiveness was promoted. Training for collaboration with physicians was largely transactional and teaching about the status of the nurse vis-à-vis the physician was mired in contradictions. Residents and the nurses could not rely on their experience of professional school as they transited to the workplace. Initiation was frequently precipitous and contingencies of the workplace determined how they acted. For residents the community of clinical practice was fluid and repeatedly new. Both residents and nurses were overwhelmed by unpreparedness, workload, and responsibility and acted to get by and get the job done. Residents learned to preface doing the best for the patient and not compromising patient care, while nurses became proficient at routine tasks and found fulfilment as the patient’s advocate. There was a propensity for conflict when uniprofessional roles and values collided. In busy wards each group had interdependent but competing priorities which lead to adversarial expressions of uniprofessional identity and consequent derogatory out-group stereotyping. In contrast situations demanding urgent focused attention, such as a cardiac arrest, lead to the spontaneous formation of a collaborative team which briefly expressed an interprofessional identity. Complex cross-generational and gender based interactions were sometimes adversarial and provoked resentment. Consequently junior nurses retreated to derive fulfilment as the patient`s advocate while residents looked forward to collaborating with other health professionals on their own terms, in the future. Neither contemporary professional education nor the hospital environment sustained consistent collaborative practice. / Graduate

It is well documented in the literature that Aboriginal peoples have a lower health status compared to the non-Aboriginal population in Canada. The underlining causes for this health disparity are found in the historical and contemporary practices of colonization and social, economic, and political deprivation. This thesis focuses on another of the complex factors which affect Aboriginal health status: the education and training provided to undergraduate medical students on Aboriginal health issues and the social determinants of health in British Columbia. I conducted a critical discourse analysis of the readings materials of three selected courses. I conclude from the analysis that although some of the themes covered by the courses critically present the historical, social and economic contexts for this health disparity, Aboriginal peoples are still characterized as a needy and sick population. Indigenous issues are far from being centrally positioned in the medical curriculum in British Columbia. / Graduate / 0326 / gabipere@hotmail.com

The Resident-Medical Student Shadowing Program is a novel program in which first-year medical students shadowed a first-year resident during their clinical duties. It was developed to enhance the preparedness of medical students for clinical training. To examine the program’s effectiveness, a randomized control trial was conducted within a concurrent triangulation mixed methods study. Student participants were compared to controls using validated questionnaires. Participants’ experiences were further explored using semi-structured interviews. Results indicate that participation gave students an understanding of the clinical environment and their role within it, and taught them the skills and knowledge needed to perform that role. Students’ learning was enhanced by the relationship developed with their resident, facilitated by the residents’ approachability and relatability and their dedication to teaching. Residents, in turn, gained expertise in teaching and learned about professionalism. Suggestions for implementing this program in the future as well as future directions for research are discussed. / Measurement, Evaluation and Cognition